As life expectancy increases, degenerative lumbar spinal stenosis (DLSS) becomes a common health problem among the elderly. DLSS is usually caused by degenerative changes in bony and/or soft tissue elements. The poor correlation between radiological manifestations and the clinical picture emphasizes the fact that more studies are required to determine the natural course of this syndrome. Our aim was to reveal the association between lower lumbar spine configuration and DLSS. Two groups were studied: the first included 67 individuals with DLSS (mean age 66 ± 10) and the second 100 individuals (mean age 63.4 ± 13) without DLSS-related symptoms. Both groups underwent CT images (Philips Brilliance 64) and the following measurements were performed: a cross-section area of the dural sac, vertebral body dimensions (height, length and width), AP diameter of the bony spinal canal, lumbar lordosis and sacral slope angles. All measurements were taken at L3 to S1. Vertebral body lengths were significantly greater in the DLSS group at all levels compared to the control, whereas anterior vertebral body heights (L3, L4, L5) and middle vertebral heights (L3, L5) were significantly smaller in the LSS group. Lumbar lordosis, sacral slope and bony spinal canal were significantly smaller in the DLSS compared to the control. We conclude that the size and shape of vertebral bodies and canals significantly differed between the study groups. A tentative model is suggested to explain the association between these characteristics and the development of degenerative spinal stenosis.
Hamoud, K.; May, H.; Hay, O.; Medlej, B.; Masharawi, Y.; Peled, N.; Hershkovitz, I.
ABSTRACT: Study Design. A descriptive study of the association between demographic factors, and physical characteristics, and degenerative lumbar spinal stenosis (DLSS).Objective. To shed light on the association of socioeconomic parameters and physical characteristics with DLSS.Summary of Background Data. Lumbar spinal stenosis is a prevalent and disabling condition in the aging population. DLSS is considered to be the most common type and is essentially associated with disc disease, facet joint arthrosis, ligamentum flavum thickening and osteophyte formation. While there is ample information regarding the association between BMI, cardiovascular disorders, smoking habits and disc disease, very little is known about their association with DLSS. Data on the association of body physique (e.g., height and weight) and DLSS are limited.Methods. Two sample populations were studied. The first included 165 individuals with DLSS (mean age 64 ± 9.9 years) and the second 180 individuals without spinal stenosis related symptoms (mean age 62.5 ± 12.6 years). An evaluation of the cross-sectional area of the dural sac and degenerative listhesis for all participants was performed on CT lumbar spine images, utilizing Philips EBW station (Brilliance 64, Philips Medical System, Cleveland Ohio). All participants were interviewed in order to obtain demographic, physical and health data. Independent T- test, Mann-Whitney and Chi-square tests were used to determine the association between parametric and non-parametric variables and DLSS. Logistic regression analysis was carried out in order to reveal predicting variables for DLSS.Results. Stenosis females were significantly heavier and shorter compared to their counterparts in the control group. We also noticed that they delivered babies more often than those in the control group. Prevalence of individuals suffering from diabetes mellitus was significantly higher in the stenosis males compared to control group. In the stenosis group, the frequencies of individuals engaged in heavy manual labor (males) and housekeeping (females) were significantly higher compared to their counterparts in the control group.Conclusions. Heavy manual labor and diabetes mellitus in males and housekeeping (females) play major roles in the genesis of DLSS. PMID:23380820
Abbas, J; Hamoud, K; May, H; Peled, N; Sarig, R; Stein, D; Alperovitch-Najenson, D; Hershkovitz, I
Expansive laminoplasty, a procedure used more and more often for cervical myelopathy, was carried out in patients with lumbar\\u000a spinal stenosis in the Department of Orthopaedics, Paraplegia, Physical Medicine and Rehabilitation of our institute. Twenty-five\\u000a such clinico-radiologically proven cases were operated upon. For radiological evaluation, computed tomography (CT) was used.\\u000a Expansive laminoplasty decompresses the nerve roots by osteoplastic enlargement of
S. S. Sangwan; Zile Singh Kundu; Pankaj Walecha; R. C. Siwach; Pradeep Kamboj; Raj Singh
The X-Stop interspinous distraction device has shown to be an attractive alternative to conventional surgical procedures in\\u000a the treatment of symptomatic degenerative lumbar spinal stenosis. However, the effectiveness of the X-Stop in symptomatic\\u000a degenerative lumbar spinal stenosis caused by degenerative spondylolisthesis is not known. A cohort of 12 consecutive patients\\u000a with symptomatic lumbar spinal stenosis caused by degenerative spondylolisthesis were
Olaf J. Verhoof; Johannes L. Bron; Frits H. Wapstra; Barend J. van Royen
Objective The objectives of this study were to clarify the short-term effects of transforaminal epidural steroid injection (TFESI) for degenerative lumbar scoliosis combined with spinal stenosis (DLSS), and to extrapolate factors relating to the prognosis of treatment. Method Thirty-six patients with lumbar radicular pain from DLSS were enrolled. Subjects were randomly assigned to one of two groups (steroid or lidocaine group). We compared the effect of pain suppression at 2, 4 and 12 weeks after the procedure between the two groups. Radiographic analysis included measurement of the Cobb's angle, the upper endplate obliquities of L3 and L4, and maximal lateral olisthy between two adjacent lumbar vertebrae. Sagittal plane measurement included lumbar lordosis, and thoracolumbar kyphosis. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two. Results There were no significant differences in the demographic data, initial visual analogue scale (VAS) or Oswestry disability index (ODI) between the steroid group (n=17) and the lidocaine group (n=19). Two, 4, and 12 weeks after injection VAS, ODI showed a significantly greater improvement in the steroid group compared to the lidocaine group (p<0.05). The radiographic and clinical parameters were not significantly correlated with treatment outcome. Conclusion Our findings suggest that fluoroscopic transforaminal epidural steroid injections appear to be an effective non-surgical treatment option for patients with degenerative lumbar scoliosis combined with spinal stenosis (DLSS) and radicular pain.
Lumbar spinal stenosis, the results of congenital and degenerative constriction of the neural canal and foramina leading to lumbosacral nerve root or cauda equina compression, is a common cause of disability in middle-aged and elderly patients. Advanced neuroradiologic imaging techniques have improved our ability to localize the site of nerve root entrapment in patients presenting with neurogenic claudication or painful radiculopathy. Although conservative medical management may be successful initially, surgical decompression by wide laminectomy or an intralaminar approach should be done in patients with serious or progressive pain or neurologic dysfunction. Because the early diagnosis and treatment of lumbar spinal stenosis may prevent intractable pain and the permanent neurologic sequelae of chronic nerve root entrapment, all physicians should be aware of the different neurologic presentations and the treatment options for patients with spinal stenosis. Images
Ciricillo, S F; Weinstein, P R
The X-Stop interspinous distraction device has shown to be an attractive alternative to conventional surgical procedures in the treatment of symptomatic degenerative lumbar spinal stenosis. However, the effectiveness of the X-Stop in symptomatic degenerative lumbar spinal stenosis caused by degenerative spondylolisthesis is not known. A cohort of 12 consecutive patients with symptomatic lumbar spinal stenosis caused by degenerative spondylolisthesis were treated with the X-Stop interspinous distraction device. All patients had low back pain, neurogenic claudication and radiculopathy. Pre-operative radiographs revealed an average slip of 19.6%. MRI of the lumbosacral spine showed a severe stenosis. In ten patients, the X-Stop was placed at the L4–5 level, whereas two patients were treated at both, L3–4 and L4–5 level. The mean follow-up was 30.3 months. In eight patients a complete relief of symptoms was observed post-operatively, whereas the remaining 4 patients experienced no relief of symptoms. Recurrence of pain, neurogenic claudication, and worsening of neurological symptoms was observed in three patients within 24 months. Post-operative radiographs and MRI did not show any changes in the percentage of slip or spinal dimensions. Finally, secondary surgical treatment by decompression with posterolateral fusion was performed in seven patients (58%) within 24 months. In conclusion, the X-Stop interspinous distraction device showed an extremely high failure rate, defined as surgical re-intervention, after short term follow-up in patients with spinal stenosis caused by degenerative spondylolisthesis. We do not recommend the X-Stop for the treatment of spinal stenosis complicating degenerative spondylolisthesis.
Verhoof, Olaf J.; Bron, Johannes L.; Wapstra, Frits H.
Degenerative lumbar spinal stenosis (DLSS) has become increasingly common and is characterized by multilevel disc herniation and lumbar spondylolisthesis, which are difficult to treat. The current study aimed to evaluate the short-term clinical outcomes and value of the combined use of microendoscopic discectomy (MED) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the treatment of multilevel DLSS with spondylolisthesis, and to compare the combination with traditional posterior lumbar interbody fusion (PLIF). A total of 26 patients with multilevel DLSS and spondylolisthesis underwent combined MED and MI-TLIF surgery using a single cage and pedicle rod-screw system. These cases were compared with 27 patients who underwent traditional PLIF surgery during the same period. Data concerning incision length, surgery time, blood loss, time of bed rest and Oswestry Disability Index (ODI) score prior to and following surgery were analyzed statistically. Statistical significance was reached in terms of incision length, blood loss and the time of bed rest following surgery (P<0.05), but there was no significant difference between the surgery time and ODI scores of the two groups. The combined use of MED and MI-TLIF has the advantages of reduced blood loss, less damage to the paraspinal soft tissue, shorter length of incision, shorter bed rest time, improved outcomes and shorter recovery times and has similar short-term clinical outcomes to traditional PLIF.
WU, HAN; YU, WEI-DONG; JIANG, RUI; GAO, ZHONG-LI
Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. LSS is being more commonly diagnosed and may relate to better access to advanced imaging and to an aging population. This review focuses on radicular symptoms related to degenerative central and lateral stenosis and updates knowledge of LSS pathophysiology, diagnosis and management. Since patients with anatomic LSS can range from asymptomatic to severely disabled, the clinical diagnosis focuses on symptoms and examination findings associated with LSS. Imaging findings are helpful for patients with persistent, bothersome symptoms in whom invasive treatments are being considered. There is limited information from high quality studies about the relative benefits and harms of commonly used treatments. Interpreting and comparing results of available research is limited by a lack of consensus about the definition of LSS. Nevertheless, evidence supports decompressive laminectomy for patients with persistent and bothersome symptoms. Recommendations favor a shared decision making approach due to important trade-offs between alternative therapies and differences among patients in their preferences and values.
The purpose of this study was to develop and validate a classification of indications for fusion in lumbar degenerative disease. Nineteen spine surgeons reviewed a series of 32 case histories and selected the indication for fusion based on an outlined classification system. To determine the degree of interrater variability, K coefficients were calculated (K for all 32 cases, 0.63). Results from this study show the significant difficulty in classifying the indication for fusion in lumbar degenerative disease. The level of the 19 surgeons' agreement regarding surgical indication was only moderate, despite a study design that eliminated controversial issues of patient and procedure selection. To a significant extent, the difficulty in classifying indication for fusion underlines the importance of the process. If we cannot agree on why a specific patient is selected for fusion, it is then impossible to accurately compare outcomes for a given disease process or surgical technique. For this reason, an ongoing effort to refine nomenclature and classification is necessary. PMID:16689515
Glassman, Steven D; Carreon, Leah Y; Dimar, John R; Campbell, Mitchell J; Johnson, John R; Puno, Rolando M
Objective To evaluate the short-term and long-term effects of fluoroscopically guided caudal epidural steroid injection (ESI) for the\\u000a management of degenerative lumbar spinal stenosis (DLSS) and to analyze outcome predictors.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods All patients who underwent caudal ESI in 2006 for DLSS were included in the study. Response was based on chart documentation\\u000a (aggravated, no change, slightly improved, much improved, no
Joon Woo Lee; Jae Sung Myung; Kun Woo Park; Jin S. Yeom; Ki-Jeong Kim; Hyun-Jib Kim; Heung Sik Kang
This video describes a minimally invasive approach for treatment of symptomatic grade I spondylolisthesis and high-grade spinal stenosis. In this procedure, a unilateral approach for bilateral decompression is utilized in conjunction with a modified transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation. The key steps in the procedure are outlined, and include positioning, fluoroscopic positioning/guidance, exposure with tubular retractor system, technique for ipsilateral and contra-lateral decompression, disc space preparation and interbody grafting, percutaneous pedicle screw and rod placement, and closure. The video can be found here: http://youtu.be/QTymO4Cu4B0. PMID:23829853
Chen, Kevin S; Than, Khoi D; Lamarca, Frank; Park, Paul
Background: Utilization of the transforaminal lumbar interbody fusion (TLIF) approach for scoliosis offers the patients deformity correction and interbody fusion without the additional morbidity associated with more invasive reconstructive techniques. Published reports on complications associated with these surgical procedures are limited. The purpose of this study was to quantify the intra- and postoperative complications associated with the TLIF surgical approach in patients undergoing surgery for spinal stenosis and degenerative scoliosis correction. Methods: This study included patients undergoing TLIF for degenerative scoliosis with neurogenic claudication and painful lumbar degenerative disc disease. The TLIF technique was performed along with posterior pedicle screw instrumentation. The average follow-up time was 30 months (range, 15–47). Results: A total of 29 patients with an average age of 65.9 years (range, 49–83) were evaluated. TLIFs were performed at 2.2 levels on average (range, 1–4) in addition to 6.0 (range, 4–9) levels of posterolateral instrumented fusion. The preoperative mean lumbar lordosis was 37.6° (range, 16°–55°) compared to 40.5° (range, 26°–59.2°) postoperatively. The preoperative mean coronal Cobb angle was 32.3° (range, 15°–55°) compared to 15.4° (range, 1°–49°) postoperatively. The mean operative time was 528 min (range, 276–906), estimated blood loss was 1091.7 mL (range, 150–2500), and hospitalization time was 8.0 days (range, 3–28). A baseline mean Visual Analog Scale (VAS) score of 7.6 (range, 4–10) decreased to 3.6 (range, 0–8) postoperatively. There were a total of 14 (49%) hardware and/or surgical technique related complications, and 8 (28%) patients required additional surgeries. Five (17%) patients developed pseudoarthrosis. The systemic complications (31%) included death (1), cardiopulmonary arrest with resuscitation (1), myocardial infarction (1), pneumonia (5), and pulmonary embolism (1). Conclusion: This study suggests that although the TLIF approach is a feasible and effective method to treat degenerative adult scoliosis, it is associated with a high rate of intra- and postoperative complications and a long recovery process.
Burneikiene, Sigita; Nelson, E. Lee; Mason, Alexander; Rajpal, Sharad; Serxner, Benjamin; Villavicencio, Alan T.
Degenerative spondylolisthesis (DS) is a disorder that causes the slip of one vertebral body over the one below due to degenerative\\u000a changes in the spine. Lumbar DS is a major cause of spinal canal stenosis and is often related to low back and leg pain. We\\u000a reviewed the symptoms, prognosis and conservative treatments for symptoms associated with DS. PubMed and
Leonid Kalichman; David J. Hunter
Lumbar Spinal Stenosis is a typical disease of the elderly patient that mainly originates in degenerative multisegmental changes of the lumbar vertebral column. The classical symptom of pain irradiation into the legs whilst walking and relief with standing is similar to peripheral arterial disease presentation but differs in the sense that symptoms can be triggered through lumbar extension and relieved with lumbar flexion whereas arterial disease is correlated with pathological arteriovascular findings. Diagnosis is usually confirmed through magnetic resonance imaging (MRI) and response to conservative treatment (analgetics, physiotherapy, epidural injections) is usually good in the majority of cases. Only a minority of about 20% of all cases show progressive disease and may necessitate surgical interventions. PMID:23531906
Nydegger, Alexander; Brühlmann, Pius; Steurer, Johann
Study Design Retrospective subgroup analysis of prospectively collected data according to treatment received. Objective The purpose of this study is to determine if obesity affects treatment outcomes for lumbar stenosis (SpS) and degenerative spondylolisthesis (DS). Summary of Background Data Obesity is thought to be associated with increased complications and potentially less favorable outcomes following the treatment of degenerative conditions of the lumbar spine. This, however, remains a matter of debate in the existing literature. Methods An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of SpS or DS. A comparison was made between patients with a body mass index (BMI) <30 (“non-obese”, n=373 SpS, 376 DS) and those with a BMI ? 30 (“obese”, n=261 SpS, 225 DS). Baseline patient characteristics, intraoperative data, and complications were documented. Primary and secondary outcomes were measured at baseline and regular follow-up time intervals up to 4 years. The difference in improvement over baseline between surgical and nonsurgical treatment (i.e. treatment effect) was determined at each follow-up interval for the obese and nonobese groups. Results At 4-years follow-up, operative and nonoperative treatment provided improvement in all primary outcome measures over baseline in patients with BMI of < 30 and ? 30. For SpS patients, there were no differences in the surgical complication or reoperation rates between groups. DS patients with BMI ? 30 had a higher postoperative infection rate (5% vs. 1%, p=0.05) and twice the reoperation rate at 4-years follow-up (20% vs. 11%, p=0.01) than those with BMI < 30. At 4-years, surgical treatment of SpS and DS was equally effective in both BMI groups in terms of the primary outcome measures, with the exception that obese DS patients had less improvement from baseline in the SF36 physical function score compared to nonobese patients (22.6 vs. 27.9, p=0.022). With nonoperative treatment, SpS patients with BMI ? 30 did worse in regards to all three primary outcome measures, and DS patients with BMI ? 30 had similar SF-36 bodily pain scores but less improvement over baseline in the SF-36 physical function and ODI scores. Treatment effects for SpS and DS were significant within each BMI group for all primary outcome measures, in favor of surgery. Obese patients had a significantly greater treatment effect compared to nonobese patients with SpS (ODI, p=0.037) and DS (SF36 PF, p=0.004), largely due to the relatively poor outcome of nonoperative treatment in obese patients. Conclusion Obesity does not affect the clinical outcome of operative treatment for SpS. There are higher rates of infection and reoperation and less improvement from baseline in the SF-36 physical function score in obese patients following surgery for DS. Nonoperative treatment may not be as effective in obese patients with SpS or DS.
Rihn, Jeffrey A.; Radcliff, Kristen; Hilibrand, Alan S.; Anderson, David T.; Zhao, Wenyan; Lurie, Jon; Vaccaro, Alexander R.; Freedman, Mitch K.; Albert, Todd J.; Weinstein, James N.
Spinal stenosis and degenerative spondylolisthesis share many symptoms and the same treatment, but their causes remain unclear. Bone mineral density has been suggested to play a role. The aim of this study was to investigate differences in spinal bone density between spinal stenosis and degenerative spondylolisthesis patients. 81 patients older than 60 years, who underwent DXA-scanning of their lumbar spine one year after a lumbar spinal fusion procedure, were included. Radiographs were assessed for disc height, vertebral wedging, and osteophytosis. Pain was assessed using the Low Back Pain Rating Scale pain index. T-score of the lumbar spine was significantly lower among degenerative spondylolisthesis patients compared with spinal stenosis patients (-1.52 versus -0.52, P = 0.04). Thirty-nine percent of degenerative spondylolisthesis patients were classified as osteoporotic and further 30% osteopenic compared to only 9% of spinal stenosis patients being osteoporotic and 30% osteopenic (P = 0.01). Pain levels tended to increase with poorer bone status (P = 0.06). Patients treated surgically for symptomatic degenerative spondylolisthesis have much lower bone mass than patients of similar age treated surgically for spinal stenosis. Low BMD might play a role in the development of the degenerative spondylolisthesis, further studies are needed to clarify this. PMID:24024179
Andersen, Thomas; Christensen, Finn B; Langdahl, Bente L; Ernst, Carsten; Fruensgaard, Søren; Østergaard, Jørgen; Andersen, Jens Langer; Rasmussen, Sten; Niedermann, Bent; Høy, Kristian; Helmig, Peter; Holm, Randi; Egund, Niels; Bünger, Cody
Spinal stenosis and degenerative spondylolisthesis share many symptoms and the same treatment, but their causes remain unclear. Bone mineral density has been suggested to play a role. The aim of this study was to investigate differences in spinal bone density between spinal stenosis and degenerative spondylolisthesis patients. 81 patients older than 60 years, who underwent DXA-scanning of their lumbar spine one year after a lumbar spinal fusion procedure, were included. Radiographs were assessed for disc height, vertebral wedging, and osteophytosis. Pain was assessed using the Low Back Pain Rating Scale pain index. T-score of the lumbar spine was significantly lower among degenerative spondylolisthesis patients compared with spinal stenosis patients (?1.52 versus ?0.52, P = 0.04). Thirty-nine percent of degenerative spondylolisthesis patients were classified as osteoporotic and further 30% osteopenic compared to only 9% of spinal stenosis patients being osteoporotic and 30% osteopenic (P = 0.01). Pain levels tended to increase with poorer bone status (P = 0.06). Patients treated surgically for symptomatic degenerative spondylolisthesis have much lower bone mass than patients of similar age treated surgically for spinal stenosis. Low BMD might play a role in the development of the degenerative spondylolisthesis, further studies are needed to clarify this.
Christensen, Finn B.; Langdahl, Bente L.; Ernst, Carsten; Fruensgaard, S?ren; ?stergaard, J?rgen; Andersen, Jens Langer; Niedermann, Bent; H?y, Kristian; Helmig, Peter; Holm, Randi; Egund, Niels; Bunger, Cody
Clinical Outcomes and Radiologic Changes Following Microsurgical Bilateral Decompression via a Unilateral Approach in Patients With Lumbar Canal Stenosis and Grade I Degenerative Spondylolisthesis With a Minimum 3-year Follow-up.
STUDY DESIGN:: A retrospective study. OBJECTIVE:: To analyze the clinical outcomes and radiologic changes following microsurgical bilateral decompression via a unilateral approach in patients with lumbar canal stenosis and degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA:: Satisfactory short-term results have been observed following minimally invasive decompressive procedures, but intermediate and long-term outcomes have not been assessed. It is not yet clear whether decompressive laminectomy with concomitant fusion is the optimal surgical treatment for spinal stenosis combined with mild degenerative spondylolisthesis. We therefore evaluated minimum 3-year clinical outcomes and radiologic changes in patients with lumbar canal stenosis and grade 1 degenerative spondylolisthesis who underwent microsurgical bilateral decompression via a unilateral approach, without fusion. METHODS:: We assessed 21 consecutive patients who underwent surgery conducted by a single surgeon of our hospital, between 2005 and 2007. The Oswestry Disability Index (ODI) was determined preoperatively, just before discharge, and at last follow-up. Plain dynamic x-rays were used to determine slip percentages. RESULTS:: Average patient age and clinical and radiologic follow-up periods were 67 years, 49.3 months, and 18 months, respectively. Preoperative, immediate postoperative, and last follow-up average ODIs were 59.52±9.00, 50.19±7.23, and 26.19±12.42, respectively. But one patient experienced aggravated symptoms and later underwent a fusion procedure. Of the 22 levels with spondylolisthesis, 15 had no sagittal motion as the difference in slip percentage on dynamic x-rays but 7 showed sagittal motion. Average slip percentages increased from 13.90±5.41% to 14.60±5.78% for levels without sagittal motion on dynamic x-ray and from 13.12±3.48% to 18.58±4.55% for levels with sagittal motion. CONCLUSIONS:: Despite small case series with retrospective design and the absence of a control group, our study suggest that bilateral decompression via a unilateral approach in patients with lumbar spinal stenosis and grade 1 degenerative spondylolisthesis showed good mid-term clinical outcomes, despite an increase in slip percentage.However, more marked increases in slippage were observed in patients with sagittal motion in spondylolisthesis levels on preoperative dynamic x-ray than in patients without sagittal motion. Therefore bilateral decompression via a unilateral approach can aggravate symptom related to instability in patients with preoperative sagittal motion on dynamic x-ray and needs longer term follow-up than in our study. PMID:23073148
Jang, Jun-Won; Park, Jin-Hun; Hyun, Seung-Jae; Rhim, Seung-Chul
The paper provides critical analysis of the article "Correlated analysis of radiologic criteria's referred to central degenerative spinal canal stenosis and intensity of clinical implications". Critical analysis was carried out by the 5-step evidence cycle. First step is supposed to formulate primary goal of the research and identify its type. This investigation belongs to prognostic studying of certain patient's characteristics and their impact on the state of disease and the treatment outcome. According to Oxford evidence based center of medicine gradation, this study is attributed to level IV (clinical series). Analysis performed allowed to state that investigation sampling might be considered as representative, but nonhomogeneous. Absence of blind evaluation of the treatment results could alter treatment outcomes when compared by two different scales. Multifactor analysis was not held in the present study. Analyzed investigation has low methodological level, however, it has no major disadvantages. Statistical significance between various factors and clinical effect can be achieved when study is based upon database analysis of many patients, which however cannot be managed by efforts of a single medical institution. Organizing investigations by registration treatment outcomes with follow up evaluation nationwide could be a problem solution. In particular, vertebrological register might be a very useful tool for development prognostic risk scales and predictive models in degenerative spine disease surgery. PMID:23033596
Shevelev, I N; Kornienko, V N; Konovalov, N A; Cherkashov, A M; Iashina, L P; Asiutin, D S; Timonin, S Iu
Symptomatic lumbar degenerative disk disease, or discogenic back pain, is difficult to treat. Patients often report transverse low back pain that radiates into the sacroiliac joints. Radicular or claudicatory symptoms are generally absent unless there is concomitant nerve compression. Physical examination findings are often unremarkable. Radiographic examination may reveal disk space narrowing, end-plate sclerosis, or vacuum phenomenon in the disk; magnetic resonance imaging is useful for revealing hydration of the disk, annular bulging, or lumbar spine end-plate (Modic) changes in the adjacent vertebral bodies. The use of diskography as a confirmatory study remains controversial. Recent prospective, randomized trials and meta-analyses of the literature have helped expand what is known about degenerative disk disease. In most patients with low back pain, symptoms resolve without surgical intervention; physical therapy and nonsteroidal anti-inflammatory drugs are the cornerstones of nonsurgical treatment. Intradiskal electrothermal treatment has not been shown to be effective, and arthrodesis remains controversial for the treatment of discogenic back pain. Nucleus replacement and motion-sparing technology are too new to have demonstrated long-term data regarding their efficacy. PMID:19202123
Madigan, Luke; Vaccaro, Alexander R; Spector, Leo R; Milam, R Alden
Lumbar spinal stenosis is a common condition in elderly patients and may lead to progressive back and leg pain, muscular weakness, sensory disturbance, and/or problems with ambulation. Multiple studies suggest that surgical decompression is an effective therapy for patients with symptomatic lumbar stenosis. Although traditional lumbar decompression is a time-honored procedure, minimally invasive procedures are now available which can achieve the goals of decompression with less bleeding, smaller incisions, and quicker patient recovery. This paper will review the technique of performing ipsilateral and bilateral decompressions using a tubular retractor system and microscope.
Popov, Victor; Anderson, David G.
Purpose To evaluate the clinical outcomes of cantilever transforaminal lumbar interbody fusion (c-TLIF) for upper lumbar diseases. Materials and Methods Seventeen patients (11 males, 6 females; mean ± SD age: 62 ± 14 years) who underwent c-TLIF using kidney type spacers between 2002 and 2008 were retrospectively evaluated, at a mean follow-up of 44.1 ± 12.3 months (2 year minimum). The primary diseases studied were disc herniation, ossification of posterior longitudinal ligament (OPLL), degenerative scoliosis, lumbar spinal canal stenosis, spondylolisthesis, and degeneration of adjacent disc after operation. Fusion areas were L1-L2 (5 patients), L2-L3 (9 patients), L1-L3 (1 patient), and L2-L4 (2 patients). Operation time, blood loss, complications, Japanese Orthopaedic Association (JOA) score for back pain, bone union, sagittal alignment change of fusion level, and degeneration of adjacent disc were evaluated. Results JOA score improved significantly after surgery, from 12 ± 2 to 23 ± 3 points (p < 0.01). We also observed significant improvement in sagittal alignment of the fusion levels, from - 1.0 ± 7.4 to 5.2 ± 6.1 degrees (p < 0.01). Bony fusion was obtained in all cases. One patient experienced a subcutaneous infection, which was cured by irrigation. At the final follow-up, three patients showed degenerative changes in adjacent discs, and one showed corrective loss of fusion level. Conclusion c-TLIF is a safe procedure, providing satisfactory results for patients with upper lumbar degenerative diseases.
Hioki, Akira; Hosoe, Hideo; Sugiyama, Seiichi; Suzuki, Naoki; Shimizu, Katsuji
The extent of fusion for degenerative lumbar scoliosis has not yet been determined. The purpose of this study was to compare\\u000a the results of short fusion versus long fusion for degenerative lumbar scoliosis. Fifty patients (mean age 65.5 ± 5.1 years)\\u000a undergoing decompression and fusion with pedicle screw instrumentation were evaluated. Short fusion was defined as fusion\\u000a within the deformity, not exceeding the
Kyu-Jung Cho; Se-Il Suk; Seung-Rim Park; Jin-Hyok Kim; Sung-Soo Kim; Tong-Joo Lee; Jeong-Joon Lee; Jong-Min Lee
1. Edith Cavell Clinic and 2. Hôpital Molière Longchamp Lumbar spinal stenosis in the elderly is mostly an acquired condition and is a result of a combination of factors. Disc space narrowing with annular bulging and buckling of the ligamenta flava, combined with a degenerative hypertrophy of the facet joints, compresses the neural structures to such a degree that their
Robert Gunzburg; Marek Szpalski
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. PMID:23407682
Zhou, Dong; Nong, Lu-Ming; DU, Rui; Gao, Gong-Ming; Jiang, Yu-Qing; Xu, Nan-Wei
This prospective longitudinal randomized clinical and radiological study compared the evolution of instrumented posterolateral lumbar and lumbosacral fusion using either coralline hydroxyapatite (CH), or iliac bone graft (IBG) or both in three comparable groups, A, B and C, which included 19, 18 and 20 patients, respectively, who suffered from symptomatic degenerative lumbar spinal stenosis and underwent decompression and fusion. The
Panagiotis Korovessis; Georgios Koureas; Spyridon Zacharatos; Zisis Papazisis; Elias Lambiris
Dynamic stabilization technology has increasingly become the hot spot in basic and clinical research for treating lumbar degenerative diseases. As one kind of dynamic stabilization technology,dynamic neutralization system (Dynesys) keeps the spinal motion ability and improve clinical symptoms of patients, moreover, it shows a certain advantage in delaying the degeneration of adjacent segments. From the available documents,the preliminary biomechanical and clinical results of Dynesys were optimistically, it has become another choice in treating the lumbar degenerative diseases besides the lumbar fusion, and it primarily applies to the treatment of mild to moderate lumbar degenerative disease. However, it lacks a mechanism to maintain and restore the lumbar lordosis and patients need active stretching to achieve lordosis. What's more, how to extend the service life and prevent complications remain to be solved, the long-term effect and the mechanism of delaying the adjacent segment degeneration need further investigation. In this article, the design principle, biomechanical research, clinical outcome and clinical application of Dynesys was reviewed. PMID:24015664
Chen, Xi-Jun; Fan, Shun-Wu
Purpose Although instrumented posterior lumbar interbody fusion (PLIF) has been becoming a popular and effective method for treating\\u000a degenerative lumbar scoliosis, the clinical outcome is rarely reported. We retrospectively evaluated the clinical and radiographic\\u000a outcomes in patients with degenerative lumbar scoliosis after instrumented PLIF.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods A total of 58 patient’s clinical characteristics had been reviewed retrospectively including clinical presentations, preoperative
Tai-Hsin Tsai; Tzuu-Yuan Huang; Ann-Shung Lieu; Kung-Shing Lee; Sui-Sum Kung; Cheng-Wei Chu; Shiuh-Lin Hwang
Background: For carefully selected patients with lumbar stenosis, decompression surgery is more efficacious than nonoperative treatment. However, some patients undergo repeat surgery, often because of complications, the failure to achieve solid fusion following arthrodesis procedures, or persistent symptoms. We assessed the probability of repeat surgery following operations for the treatment of lumbar stenosis and examined its association with patient age, comorbidity, previous surgery, and the type of surgical procedure. Methods: We performed a retrospective cohort analysis of Medicare claims. The index operation was performed in 2004 (n = 31,543), with follow-up obtained through 2008. Operations were grouped by complexity as decompression alone, simple arthrodesis (one or two disc levels and a single surgical approach), or complex arthrodesis (more than two disc levels or combined anterior and posterior approach). Reoperation rates were calculated for each follow-up year, and the time to reoperation was analyzed with proportional hazards models. Results: The probability of repeat surgery fell with increasing patient age or comorbidity. Aside from age, the strongest predictor was previous lumbar surgery: at four years the reoperation rate was 17.2% among patients who had had lumbar surgery prior to the index operation, compared with 10.6% among those with no prior surgery (p < 0.001). At one year, the reoperation rate for patients who had been managed with decompression alone was slightly higher than that for patients who had been managed with simple arthrodesis, but by four years the rates for these two groups were identical (10.7%) and were lower than the rate for patients who had been managed with complex arthrodesis (13.5%) (p < 0.001). This difference persisted after adjusting for demographic and clinical features (hazard ratio for complex arthrodesis versus decompression 1.56, 95% confidence interval, 1.26 to 1.92). A device-related complication was reported at the time of 29.2% of reoperations following an initial arthrodesis procedure. Conclusions: The likelihood of repeat surgery for spinal stenosis declined with increasing age and comorbidity, perhaps because of concern for greater risks. The strongest clinical predictor of repeat surgery was a lumbar spine operation prior to the index operation. Arthrodeses were not significantly associated with lower rates of repeat surgery after the first postoperative year, and patients who had had complex arthrodeses had the highest rate of reoperations. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Deyo, Richard A.; Martin, Brook I.; Kreuter, William; Jarvik, Jeffrey G.; Angier, Heather; Mirza, Sohail K.
Lumbar channel stenosis is frequently manifested by a Cauda Equina intermittent claudication. Only exceptionally erections during walking have been described. We have observed two patients with severe lumbar channel stenosis and a Cauda Equina syndrome with intermittent erections during walking. One patient was laminectomized presenting a clinical improvement. There does not exist a satisfactory explanation for this strange affectation. PMID:2244059
García-Albea, E; Palomo, F; Tejeiro, J
BACKGROUND CONTEXT: Posterolateral fusion with pedicle screw instrumentation is currently the most widely accepted technique for degenerative lumbar scoliosis in elderly patients. However, a high incidence of complications has been reported in most series. Dynamic stabilization without fusion in patients older than 60 years has not previously been compared with the use of posterior fusion in degenerative lumbar scoliosis. PURPOSE: To compare dynamic stabilization without fusion and posterior instrumented fusion in the treatment of degenerative lumbar scoliosis in elderly patients, in terms of perioperative findings, clinical outcomes, and adverse events. STUDY DESIGN: A retrospective study. PATIENT SAMPLE: Fifty-seven elderly patients were included. There were 45 women (78%) and 12 men (22%) with a mean age of 68.1 years (range, 61-78 years). All patients had degenerative de novo lumbar scoliosis, associated with vertebral canal stenosis in 51 cases (89.4%) and degenerative spondylolisthesis in 24 patients (42.1%). OUTCOME MEASURES: Clinical (Oswestry Disability Index, visual analog scale, Roland-Morris Disability Questionnaire) and radiological (scoliosis and lordosis corrections) outcomes as well as incidence of complications. METHODS: Patients were divided into two groups: 32 patients (dynamic group) had dynamic stabilization without fusion and 25 patients (fusion group) underwent posterior instrumented fusion. All the patients' medical records and X-rays were reviewed. Preoperative, postoperative, and follow-up questionnaires were obtained to evaluate clinical outcomes. RESULTS: At an average follow-up of 64 months (range, 42-90 months), clinical results improved similarly in both groups of patients. Statistically superior scoliosis and final lordosis corrections were achieved with posterior fusion (56.9% vs. 37.3% and -46.8° vs. -35.8°, respectively). However, in the dynamic group, incidence of overall complications was lower (25% vs. 44%), and fewer patients required revision surgery (6.2% vs. 16%). Furthermore, lower average values of operative duration (190 vs. 240 minutes) and blood loss (950 vs. 1,400 cc) were observed in the dynamic group than in the fusion group. CONCLUSIONS: In elderly patients with degenerative lumbar scoliosis, pedicle screw-based dynamic stabilization was less invasive with shorter operative duration, less blood loss, and lower adverse event rates than instrumented posterior fusion. Scoliosis curve reduction and lumbar lordosis were superior after fusion; however, dynamic stabilization achieved satisfying values of both these parameters, and these results were stable after an average follow-up of more than 5 years. Furthermore, there was no difference between the two techniques in terms of functional clinical outcomes at the last follow-up. PMID:23257571
Di Silvestre, Mario; Lolli, Francesco; Bakaloudis, Georgios
BACKGROUND: The relationship between severity of preoperative radiographic findings and surgical outcomes following decompression for lumbar degenerative spinal canal stenosis is unclear. Our aim in this paper was to gain insight into this relationship. We determined pre-operative radiographic severity on MRI scans using strict methodological controls and correlated such severity with post-operative outcomes using prospectively collected data. METHODS: Twenty-seven consecutive
Bradley K Weiner; Nilesh M Patel; Matthew A Walker
\\u000a \\u000a \\u000a This study was carried out from 1986 to 1996 to evaluate the technique of translaminal epidural endoscopic discectomy in lumbar\\u000a hernias occupying over 50% of the radicular canal, foraminal hernias, and hernias invading it entirely. This minimally invasive\\u000a arthroscopic technique was applied in patients suffering from degenerative lumbar stenosis between L3 and S1. The first part\\u000a of the study
D. J. De Antoni; M. L. Claro
Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. In typical cases, the first symptoms of GBS are pain, numbness, paresthesia, weakness in the limbs. Autonomic involvement is common and causes urinary retention and ileus. Much of these symptoms overlap with those of lumbar spinal stenosis. Therefore, correct diagnosis of GBS in a patient with symptomatic lumbar spinal stenosis or in a patient with atypical manifestations of GBS can be difficult, especially early in the course of GBS. Here, we report on a case of atypical GBS in a 74-year-old previously healthy patient with lumbar spinal stenosis and discuss the differential diagnosis of the GBS and lumbar spinal stenosis.
Jung, Dae Young; Lee, Seung Chul
Copeptin is a new biomarker of cardiovascular diseases. Its diagnostic value in degenerative aortic valve stenosis (AS) with preserved left ventricle systolic function is unknown. We aimed to assess the association of serum copeptin levels with AS severity and coexistence of coronary artery disease (CAD). Sixty-four patients with AS and preserved left ventricle systolic function including 40 with severe degenerative AS (group sAS, effective orifice area EOA = 0.67 cm(2)) and 24 with moderate degenerative AS (group mAS, EOA = 1.40 cm(2)) were enrolled into the study. Twenty-three patients without AS and heart failure, matched for age, sex, and CAD occurrence served as the control group (group C). Serum levels of copeptin and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using enzyme-linked immunosorbent assay. The mean serum copeptin concentrations were significantly higher in patients with AS: sAS (405 pg/ml) and mAS (351 pg/ml; sAS vs mAS P < 0.05), compared with group C (302 pg/ml, P < 0.05). Serum copeptin levels correlated inversely with EOA (r = -0.55; P < 0.001) in AS patients. There was no correlation between copeptin and NT-proBNP or association with the coexisting CAD. Receiver-operating characteristics analysis showed that copeptin was a good marker of severe/moderate AS (sensitivity 71 %; specificity 87 %), with the optimized cut-off value of 354 pg/ml. Serum copeptin concentration constitutes a novel biomarker of degenerative AS. Coexisting CAD does not interfere with copeptin level. PMID:23142954
Mizia-Stec, Katarzyna; Lasota, Bartosz; Mizia, Magdalena; Chmiel, Artur; Adamczyk, Tomasz; Chudek, Jerzy; Gasior, Zbigniew
Summary: We present an unusual case of a primary lumbar disk-space mass that presumably developed secondary to a chronic hyperextension spinal fracture associated with spinal stenosis. This injury resulted in the appearance of a lumbar intervertebral disk-space mass or pseudotumor. The pseudo- tumor most likely resulted from a prior spinal fracture, lead- ing to a fused hyperextension deformity in a
Robert A. Koenigsberg; Perry Black; Scott H. Faro; Jeffrey Rykken
Executive Summary Objective To assess the safety and efficacy of artificial disc replacement (ADR) technology for degenerative disc disease (DDD). Clinical Need Degenerative disc disease is the term used to describe the deterioration of 1 or more intervertebral discs of the spine. The prevalence of DDD is roughly described in proportion to age such that 40% of people aged 40 years have DDD, increasing to 80% among those aged 80 years or older. Low back pain is a common symptom of lumbar DDD; neck and arm pain are common symptoms of cervical DDD. Nonsurgical treatments can be used to relieve pain and minimize disability associated with DDD. However, it is estimated that about 10% to 20% of people with lumbar DDD and up to 30% with cervical DDD will be unresponsive to nonsurgical treatments. In these cases, surgical treatment is considered. Spinal fusion (arthrodesis) is the process of fusing or joining 2 bones and is considered the surgical gold standard for DDD. Artificial disc replacement is the replacement of the degenerated intervertebral disc with an artificial disc in people with DDD of the lumbar or cervical spine that has been unresponsive to nonsurgical treatments for at least 6 months. Unlike spinal fusion, ADR preserves movement of the spine, which is thought to reduce or prevent the development of adjacent segment degeneration. Additionally, a bone graft is not required for ADR, and this alleviates complications, including bone graft donor site pain and pseudoarthrosis. It is estimated that about 5% of patients who require surgery for DDD will be candidates for ADR. Review Strategy The Medical Advisory Secretariat conducted a computerized search of the literature published between 2003 and September 2005 to answer the following questions: What is the effectiveness of ADR in people with DDD of the lumbar or cervical regions of the spine compared with spinal fusion surgery? Does an artificial disc reduce the incidence of adjacent segment degeneration (ASD) compared with spinal fusion? What is the rate of major complications (device failure, reoperation) with artificial discs compared with surgical spinal fusion? One reviewer evaluated the internal validity of the primary studies using the criteria outlined in the Cochrane Musculoskeletal Injuries Group Quality Assessment Tool. The quality of concealment allocation was rated as: A, clearly yes; B, unclear; or C, clearly no. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the overall quality of the body of evidence (defined as 1 or more studies) supporting the research questions explored in this systematic review. A random effects model meta-analysis was conducted when data were available from 2 or more randomized controlled trials (RCTs) and when there was no statistical and or clinical heterogeneity among studies. Bayesian analyses were undertaken to do the following: Examine the influence of missing data on clinical success rates; Compute the probability that artificial discs were superior to spinal fusion (on the basis of clinical success rates); Examine whether the results were sensitive to the choice of noninferiority margin. Summary of Findings The literature search yielded 140 citations. Of these, 1 Cochrane systematic review, 1 RCT, and 10 case series were included in this review. Unpublished data from an RCT reported in the grey literature were obtained from the manufacturer of the device. The search also yielded 8 health technology assessments evaluating ADR that are also included in this review. Six of the 8 health technology assessments concluded that there is insufficient evidence to support the use of either lumbar or cervical ADR. The results of the remaining 2 assessments (one each for lumbar and cervical ADR) led to a National Institute for Clinical Excellence guidance document supporting the safety and effectiveness of lumbar and cervical ADR with the proviso that an ongoing audit of all clinical outcomes be undertaken owing to a lack of long-term outcome data from clinical trials. Regard
Introduction In an attempt to fill a gap between simple decompression alone and fusion in the spectrum of surgical treatment for degenerative\\u000a lumbar spinal stenosis (DLSS), the authors sought to demonstrate the efficacy and reproducibility of soft stabilization with\\u000a interspinous artificial ligament after microsurgical fenestration to prevent post-decompression segmental instability for\\u000a mildly unstable DLSS.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods Clinical outcomes from 556 patients
Sang-Ho Lee; Manuel Enes; Thomas Hoogland
A case of postfusion lumbar stenosis caused by the presence of sublaminar hooks is described. The patient was a 52-year-old man who 11 years previously had undergone lumbar fusion with Harrington rod instrumentation for a traumatic L-2 vertebral body fracture. Postoperatively, he developed progressive low-back pain, neurogenic claudication, and significant lower-extremity weakness and atrophy. Upon radiological examination, he was found to have high-grade lumbar stenosis at the level of the caudal sublaminar hooks. The instrumentation was removed and the area of radiological stenosis decompressed. Clinically, both the patient's pain and motor deficits resolved and, on postoperative imaging, the stenosis was relieved. Thus, despite other areas of persisting pathology, it is concluded that the stenosis occurring at the level of the caudal sublaminar hooks contributed to the patient's symptoms. Although not a common cause of postfusion stenosis, the presence of instrumentation in the proximity of neural elements must be considered as an etiology for neurological dysfunction. PMID:8169632
Myseros, J S; Broaddus, W C; Trumble, E R; Adelaar, R S
BACKGROUND Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials. METHODS Surgical candidates from 13 centers in 11 U.S. states who had at least 12 weeks of symptoms and image-confirmed degenerative spondylolisthesis were offered enrollment in a randomized cohort or an observational cohort. Treatment was standard decompressive laminectomy (with or without fusion) or usual nonsurgical care. The primary outcome measures were the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) bodily pain and physical function scores (100-point scales, with higher scores indicating less severe symptoms) and the modified Oswestry Disability Index (100-point scale, with lower scores indicating less severe symptoms) at 6 weeks, 3 months, 6 months, 1 year, and 2 years. RESULTS We enrolled 304 patients in the randomized cohort and 303 in the observational cohort. The baseline characteristics of the two cohorts were similar. The one-year crossover rates were high in the randomized cohort (approximately 40% in each direction) but moderate in the observational cohort (17% crossover to surgery and 3% crossover to nonsurgical care). The intention-to-treat analysis for the randomized cohort showed no statistically significant effects for the primary outcomes. The as-treated analysis for both cohorts combined showed a significant advantage for surgery at 3 months that increased at 1 year and diminished only slightly at 2 years. The treatment effects at 2 years were 18.1 for bodily pain (95% confidence interval [CI], 14.5 to 21.7), 18.3 for physical function (95% CI, 14.6 to 21.9), and ?16.7 for the Oswestry Disability Index (95% CI, ?19.5 to ?13.9). There was little evidence of harm from either treatment. CONCLUSIONS In nonrandomized as-treated comparisons with careful control for potentially confounding baseline factors, patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically. (ClinicalTrials.gov number, NCT00000409.)
Weinstein, James N.; Lurie, Jon D.; Tosteson, Tor D.; Hanscom, Brett; Tosteson, Anna N.A.; Blood, Emily A.; Birkmeyer, Nancy J.O.; Hilibrand, Alan S.; Herkowitz, Harry; Cammisa, Frank P.; Albert, Todd J.; Emery, Sanford E.; Lenke, Lawrence G.; Abdu, William A.; Longley, Michael; Errico, Thomas J.; Hu, Serena S.
We describe a rare case of lumbar spinal stenosis due to a large calcified mass in the ligamentum flavum. This patient presented with a 12-month history of severe right leg pain and intermittent claudication. A computed tomography scan was performed, revealing a large calcified mass on the ligamentum flavum at the right-hand side of the lumbar spinal canal. We performed a laminotomy at the L4/5 level with resection of the calcified mass from the ligamentum flavum. The findings of various analyses suggested that the calcified mass consisted mostly of Ca3(PO4)2 and calcium phosphate intermixed with protein and water. The calcified mass in the ligamentum flavum was causing lumbar spinal stenosis. Surgical decompression by resection of the mass was effective in this patient. The calcified material was composed mainly of elements derived from calcium phosphate. Degenerative changes in the ligamentum flavum of the lumbar spine may have been involved in the production of this calcified mass. PMID:24066222
Seki, Shoji; Kawaguchi, Yoshiharu; Ishihara, Hirokazu; Oya, Takeshi; Kimura, Tomoatsu
We describe a rare case of lumbar spinal stenosis due to a large calcified mass in the ligamentum flavum. This patient presented with a 12-month history of severe right leg pain and intermittent claudication. A computed tomography scan was performed, revealing a large calcified mass on the ligamentum flavum at the right-hand side of the lumbar spinal canal. We performed a laminotomy at the L4/5 level with resection of the calcified mass from the ligamentum flavum. The findings of various analyses suggested that the calcified mass consisted mostly of Ca3(PO4)2 and calcium phosphate intermixed with protein and water. The calcified mass in the ligamentum flavum was causing lumbar spinal stenosis. Surgical decompression by resection of the mass was effective in this patient. The calcified material was composed mainly of elements derived from calcium phosphate. Degenerative changes in the ligamentum flavum of the lumbar spine may have been involved in the production of this calcified mass.
Kawaguchi, Yoshiharu; Ishihara, Hirokazu; Oya, Takeshi; Kimura, Tomoatsu
Background To evaluate by MRI intervertebral disc degeneration in patients with lumbar degenerative disease using the Pfirrmann grading system and to determine whether Modic changes correlated with the Pfirrmann grades and modified Pfirrmann grades of disc degeneration. Methods The clinical data of 108 surgical patients with lumbar degenerative disease were reviewed and their preoperative MR images were analyzed. Disc degeneration was evaluated using the Pfirrmann grading system. Patients were followed up and low back pain was evaluated using the visual analog scale (VAS) and the effect of back pain on the daily quality of life was assessed using Oswestry disability index (ODI). Results Forty-four cases had normal anatomical appearance (Modic type 0) and their Pfirrmann grades were 3.77±0.480 and their modified Pfirrmann grades were of 5.81±1.006. Twenty-seven cases had Modic type I changes and their Pfirrmann grades were 4.79±0.557 and their modified Pfirrmann grades were 7.00±0.832. Thirty-six cases exhibited Modic type II changes and their Pfirrmann grades and modified Pfirrmann grades were 4.11±0.398 and 6.64±0.867, respectively. One case had Modic type III changes. Kruskal-Wallis test revealed significant difference in modified Pfirrmann grade among Modic type 0, I and II changes (P<0.01) but no significant difference between Modic type I and II changes (P>0.05). Binary regression analysis showed that Modic changes correlated most strongly with disc degeneration. Follow up studies indicated that the VAS and ODI scores were markedly improved postoperatively. However, no difference was noted in VAS and ODI scores among patients with different Modic types. Conclusion Modic changes correlate with the Pfirrmann and modified Pfirrmann grades of disc degeneration in lumbar degenerative disease. There is no significant correlation between Modic types and surgical outcomes.
Yin, Guo-Yong; Ren, Yong-Xin; Hu, Zhi-Yi
Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated with subjective clinical results and the radiographic degree of stenosis. Forty-seven patients with central LSS and typical spinal claudication scheduled for surgery were included. The level of activity (number of gait cycles) was quantified for 7 consecutive days using the StepWatch Activity Monitor (SAM). Visual analogue scales (VAS) for back and leg pain, Oswestry disability index and Roland–Morris score were used to assess the patients’ clinical status. The patients were investigated before surgery and 3 and 12 months after surgery. In addition, the radiographic extent of central LSS was measured digitally on preoperative magnetic resonance imaging or computed tomography. The following results were found preoperatively: 3,578 gait cycles/day, VAS for back pain 5.7 and for leg pain 6.5. Three months after surgery, the patients showed improvement: 4,145 gait cycles/day, VAS for back pain 4.0 and for leg pain 3.0. Twelve months after surgery, the improvement continued: 4,335 gait cycles/day, VAS for back pain 4.1 and for leg pain 3.3. The clinical results and SAM results showed significant improvement when preoperative data were compared with data 3 and 12 months after surgery. The results 12 months after surgery did not differ significantly from those 3 months after surgery. The level of activity correlated significantly with the degree of leg pain. The mean cross-sectional area of the spinal canal at the central LSS was 94 mm2. The radiographic results did not correlate either with objective SAM results or with clinical outcome parameters. In conclusion, this study is the first to present objective data on continuous activity monitoring/measurements in patients with central LSS. The SAM could be an adequate tool for performing these measurements in spine patients. Except for leg pain, the objective SAM results did not correlate with the clinical results or with the radiographic extent of central LSS.
Schubert, Tim; Winter, Corinna; Brandes, Mirko; Hackenberg, Lars; Wassmann, Hansdetlef; Liem, Dennis; Rosenbaum, Dieter; Bullmann, Viola
In animal models of degenerative lumbar disease, inducible nitric oxide synthase (iNOS) is expressed in macrophages and Schwann\\u000a cells following compression of the cauda equina. We previously reported that NO metabolites (nitrite plus nitrate: [NOx])\\u000a in the cerebrospinal fluid (CSF) correlate with postoperative pain relief in patients with degenerative lumbar disease and\\u000a with neurologic recovery rate postoperatively or after conservative
Hiroshi Denda; Shinji Kimura; Akiyoshi Yamazaki; Noboru Hosaka; Yuichi Takano; Kenji Imura; Yoichi Yajiri; Naoto Endo
Background Lumbar spinal stenosis is the most frequent reason for spinal surgery in elderly people. For patients with moderate or severe symptoms different conservative and surgical treatment modalities are recommended, but knowledge about the effectiveness, in particular of the conservative treatments, is scarce. There is some evidence that surgery improves outcome in about two thirds of the patients. The aims of this study are to derive and validate a prognostic prediction aid to estimate the probability of clinically relevant improvement after surgery and to gain more knowledge about the future course of patients treated by conservative treatment modalities. Methods/Design This is a prospective, multi-centre cohort study within four hospitals of Zurich, Switzerland. We will enroll patients with neurogenic claudication and lumbar spinal stenosis verified by Computer Tomography or Magnetic Resonance Imaging. Participating in the study will have no influence on treatment modality. Clinical data, including relevant prognostic data, will be collected at baseline and the Swiss Spinal Stenosis Questionnaire will be used to quantify severity of symptoms, physical function characteristics, and patient's satisfaction after treatment (primary outcome). Data on outcome will be collected 6 weeks, and 6, 12, 24 and 36 months after inclusion in the study. Applying multivariable statistical methods, a prediction rule to estimate the course after surgery will be derived. Discussion The ultimate goal of the study is to facilitate optimal, knowledge based and individualized treatment recommendations for patients with symptomatic lumbar spinal stenosis.
In 2000, Nachemson and coll. published a book about modern treatment of spine related pathologies. They concluded that evidence regarding efficiency of surgical and non surgical treatments of lumbar spinal stenosis was poor. Despite this and the fact that the precise mechanism of pain is still unknown, surgical treatment of spinal stenosis, mainly consisting in a laminectomy, has made it through the years. More recently, higher quality scientific publications have brought significant evidence that surgery yields better short and long term functional results, than non surgical conservative treatment. This advantage might also compensate for possible internistic complications in a usually older and fragile population. PMID:19405274
Faundez, Antonio Arturo
The purpose of this study was to evaluate the surgical indication and clinical outcomes of endoscopic decompression for lumbar spinal canal stenosis. From September 1998 to March 2002, 250 consecutive patients underwent posterior endoscopic surgery for lumbar radiculopathy. Among these patients, 27 were treated by posterior endoscopic decompression for lumbar canal stenosis. There were 19 men and 8 women, and
Munehito Yoshida; Akitaka Ueyoshi; Kazuhiro Maio; Masaki Kawai; Yukihiro Nakagawa
Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar degenerative spinal deformities, which include symptomatic spondylolisthesis and degenerative scoliosis. Through a description of each procedure, we hope to illustrate the potential benefits of TLIF over PLIF. In a retrospective study of 53 ALIF/PLIF patients and 111 TLIF patients we found reduced risk of vessel and nerve injury in TLIF patients due to less exposure of these structures, shortened operative time and reduced intra-operative bleeding. These advantages could be translated to shortened hospital stay, faster recovery period and earlier return to work. The disadvantages of TLIF such as incomplete intervertebral disc and vertebral end-plate removal and potential occult injury to exiting nerve root when under experienced hands are rare. Hence TLIF remains the mainstay of treatment in degenerative deformities of the lumbar spine. However, TLIF being a unilateral transforaminal approach, is unable to decompress the opposite nerve root. This may require contralateral laminotomy, which is a fairly simple procedure. The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to treat degenerative lumbar spinal deformity is still in its early stages. Although the initial results appear promising, it remains a difficult operative procedure to master with a steep learning curve. In a recent study comparing 29 MI-TLIF patients and 29 open TLIF, MI-TLIF was associated with longer operative time, less blood loss, shorter hospital stay, with no difference in SF-36 scores at six months and two years. Whether it can replace traditional TLIF as the surgery of choice for degenerative lumbar deformity remains unknown and more studies are required to validate the safety and efficiency.
Hey, Hwee Weng Dennis; Hee, Hwan Tak
Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar degenerative spinal deformities, which include symptomatic spondylolisthesis and degenerative scoliosis. Through a description of each procedure, we hope to illustrate the potential benefits of TLIF over PLIF. In a retrospective study of 53 ALIF/PLIF patients and 111 TLIF patients we found reduced risk of vessel and nerve injury in TLIF patients due to less exposure of these structures, shortened operative time and reduced intra-operative bleeding. These advantages could be translated to shortened hospital stay, faster recovery period and earlier return to work. The disadvantages of TLIF such as incomplete intervertebral disc and vertebral end-plate removal and potential occult injury to exiting nerve root when under experienced hands are rare. Hence TLIF remains the mainstay of treatment in degenerative deformities of the lumbar spine. However, TLIF being a unilateral transforaminal approach, is unable to decompress the opposite nerve root. This may require contralateral laminotomy, which is a fairly simple procedure. The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to treat degenerative lumbar spinal deformity is still in its early stages. Although the initial results appear promising, it remains a difficult operative procedure to master with a steep learning curve. In a recent study comparing 29 MI-TLIF patients and 29 open TLIF, MI-TLIF was associated with longer operative time, less blood loss, shorter hospital stay, with no difference in SF-36 scores at six months and two years. Whether it can replace traditional TLIF as the surgery of choice for degenerative lumbar deformity remains unknown and more studies are required to validate the safety and efficiency. PMID:20419002
Hey, Hwee Weng Dennis; Hee, Hwan Tak
Lumbar spinal stenosis is a narrowing of spinal canal or neural foramina producing root ischaemia and neurogenic claudication[1–3].\\u000a Both the neural canal and foramen are narrowed with the spine in extension and opened in flexion. Patients are usually sixty\\u000a years or over and present with unilateral or bilateral leg pain with or without back pain. The pain is worse on
A. K. Bhadra; A. S. Raman; S. Tucker; H. H. Noordeen
Study Design A retrospective study. Purpose To comparatively investigated the rate of the adjacent segment degeneration and the clinical outcomes in patients with spondylolytic spondylolisthesis, spinal stenosis or degenerative spondylolisthesis. Overview of Literature There have been few studies reported on the adjacent segment degeneration following posterior lumbar interbody fusion(PLIF). Many risk factors for the adjacent segment degeneration following PLIF have been proposed. The range of decompression has been presented as one of the risk factors, yet controversial. Methods This study enrolled sixty-three patients who had been treated with single-level PLIF and who were followed up for more than two years. The patients were divided into 3 groups based on the preoperative diagnosis. We analyzed the difference between the preoperative and postoperative intervertebral disc heights of the superior adjacent segments. The incidence rates of instability and the clinical outcomes were comparatively analyzed between each group. Results The average age of the patients was 55.8 years in the spondylolytic spondylolisthesis group, 65.9 years in the degenerative spondylolisthesis group and 60.4 years in the spinal stenosis group. The average follow-up period was 44 months, 43 months and 42 months, respectively. At the last follow-up, compared to the preoperative period, the intervertebral disc height decreased in all three groups. A statistically significant decrease (p < 0.01) was observed only in the spondylolytic spondylolisthesis group and no significant difference was observed between each group (p = 0.41). The incidence rate of instability and the clinical outcome were not significantly different between each group. Conclusions Spondylolytic spondylolisthesis with total laminectomy and single-level PLIF showed no significant difference in the superior adjacent segment degeneration and instability, and the clinical outcome as compared to that of partial laminectomy with single-level PLIF for treating degenerative spondylolisthesis or spinal stenosis.
Yu, Chang Hun; Lee, Jung Eun; Yang, Jae Jun; Lee, Choon-Ki
Objective The purpose of this study was to investigate the possible association of estrogen receptor alpha (ER?) gene polymorphisms in a cohort of degenerative spondylolisthesis (DS) patients. Methods Accordingly, the authors examined the association between DS and ER? gene polymorphisms in 174 patients diagnosed with DS. The Pvu II and Xba I polymorphisms, bone mineral density at the lumbar spine and femoral neck, and biochemical markers were analyzed and compared in the 174 patients with DS and 214 patients with spinal stenosis (SS). Results A comparison of genotype frequencies in DS and SS patients revealed a significant difference for the Pvu II polymorphism only (p=0.0452). No significant difference was found between these two groups with respect to the Xba I polymorphism, BMD or biochemical markers. No significant association was found between the Pvu II polymorphism of ER? and BMD, vertebral slip or biochemical markers in patients with DS. Conclusion These results suggest that the ER? gene polymorphism using Pvu II restriction enzyme influences the prevalence of DS.
Suh, Kuen Tak; Kim, Jeung Il; Lim, Jong Min; Goh, Tae Sik
We retrospectively examined the prevalence and natural history of asymptomatic lumbar canal stenosis in patients treated surgically for cervical compressive myelopathy in order to assess the influence of latent lumbar canal stenosis on the recovery after surgery. Of 214 patients who had undergone cervical laminoplasty for cervical myelopathy, we identified 69 (32%) with myelographically documented lumbar canal stenosis. Of these, 28 (13%) patients with symptomatic lumbar canal stenosis underwent simultaneous cervical and lumbar decompression. Of the remaining 41 (19%) patients with asymptomatic lumbar canal stenosis who underwent only cervical surgery, 39 were followed up for ? 1 year (mean 4.9 years (1 to 12)) and were included in the analysis (study group). Patients without myelographic evidence of lumbar canal stenosis, who had been followed up for ? 1 year after the cervical surgery, served as controls (135 patients; mean follow-up period 6.5 years (1 to 17)). Among the 39 patients with asymptomatic lumbar canal stenosis, seven had lumbar-related leg symptoms after the cervical surgery. Kaplan-Meier analysis showed that 89.6% (95% confidence interval (CI) 75.3 to 96.0) and 76.7% (95% CI 53.7 to 90.3) of the patients with asymptomatic lumbar canal stenosis were free from leg symptoms for three and five years, respectively. There were no significant differences between the study and control groups in the recovery rate measured by the Japanese Orthopaedic Association score or improvement in the Nurick score at one year after surgery or at the final follow-up. These results suggest that latent lumbar canal stenosis does not influence recovery following surgery for cervical myelopathy; moreover, prophylactic lumbar decompression does not appear to be warranted as a routine procedure for coexistent asymptomatic lumbar canal stenosis in patients with cervical myelopathy, when planning cervical surgery. PMID:22371547
Tsutsumimoto, T; Shimogata, M; Yui, M; Ohta, H; Misawa, H
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.
Wong, Albert P.; Smith, Zachary A.; Lall, Rohan R.; Bresnahan, Lacey E.; Fessler, Richard G.
Background: With the rise of health care costs, there is increased emphasis on evaluating the cost of a particular surgical procedure for quality adjusted life year (QALY) gained. Recent data have shown that surgical intervention for the treatment of degenerative spondylolisthesis (DS) is as cost-effective as total joint arthroplasty. Despite these excellent outcomes, some argue that the addition of interbody fusion supplemented with bone morphogenetic protein (BMP) enhances the value of this procedure. Methods: This review examines the current research regarding the cost-effectiveness of the surgical management of lumbar DS utilizing interbody fusion along with BMP. Results: Posterolateral spinal fusion with instrumentation for focal lumbar spinal stenosis with DS can provide and maintain improvement in self-reported quality of life. Based on the available literature, including nonrandomized comparative studies and case series, the addition of interbody fusion along with BMP does not lead to significantly better clinical outcomes and increases costs when compared with more routine posterolateral fusion techniques. Conclusions: To enhance the value of the surgical management for DS, costs must decrease or there should be substantial improvement in effectiveness as measured by clinical outcomes. To date, there is insufficient evidence to support the use of interbody fusion devices along with BMP to treat routine cases of focal stenosis accompanied by DS, which are routinely adequately treated utilizing posterolateral fusion techniques.
Moatz, Bradley; Tortolani, P. Justin
Background: Posterior decompression, instrumentation, and posterolateral fusion are sur- gical procedures for the treatment of degenerative lumbar diseases. Solid fusion usually causes adjacent problems. This study investigated the clinical outcome and radiographic fate of the L5-S1 segment in patients who under- went posterior instrumented surgery for degenerative lumbar diseases. Methods: From January 1999 to December 2000, 181 patients (average age
Jen-Chung Liao; Wen-Jer Chen; Lih-Huei Chen; Chi-Chien Niu
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
Jian Zhao; Feng Zhang; Xiaoqing Chen; Yu Yao
A first-generation implant for non-rigid stabilization of lumbar segments was developed in 1986. It included a titanium interspinous blocker and an artificial ligament made of dacron. Following an initial observational study in 1988 and a prospective controlled study from 1988 to 1993, more than 300 patients have been treated for degenerative lesions with this type of implant with clinical and
Study Design: Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program (VASQIP) database.Objective: Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis; and examine risk factors for these complications.Summary of Background Data: Surgery for spinal stenosis is concentrated among older adults, for whom complications are more frequent than among middle-aged patients. Many studies have focused on infections or device complications, but fewer have focused on major cardiopulmonary complications, using prospectively collected data.Methods: We identified patients who underwent surgery for a primary diagnosis of lumbar stenosis between 1998 and 2009 from the VASQIP database. We created a composite of major medical complications, including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest.Results: Among 12,154 eligible patients, major medical complications occurred in 2.1%; wound complications in 3.2%; and 90-day mortality in 0.6%. Major medical complications, but not wound complications, were strongly associated with age. American Society of Anesthesiologists (ASA) class was a strong predictor of complications. Insulin use, chronic corticosteroid use, and preoperative functional status were also significant predictors. Fusion procedures were associated with higher complication rates than decompression alone. In logistic regressions, ASA class and age were the strongest predictors of major medical complications (OR for ASA class 4 vs. classes 1or 2: 2.97, 95% CI 1.68, 5.25, p = 0.0002). After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than decompression alone (OR 2.85, 95% CI 2.14, 3.78, p<0.0001).Conclusion: ASA class, age, type of surgery, insulin or corticosteroid use, and functional status were independent risk factors for major medical complications. These factors may help in selecting patients and planning procedures, improving patient safety. PMID:23778366
Deyo, Richard A; Hickam, David; Duckart, Jonathan P; Piedra, Mark
Minimally invasive unilateral pedicle screw fixation for the treatment of degenerative lumbar diseases has won the support of many surgeons. However, few data are available regarding clinical research on unilateral pedicle screw fixation associated with minimally invasive techniques for the treatment of lumbar spinal diseases. The purpose of this study was to evaluate clinical outcomes in a selected series of patients with lumbar degenerative diseases treated with minimally invasive unilateral vs classic bilateral pedicle screw fixation and lumbar interbody fusion. Patients in the unilateral group (n=43) underwent minimally invasive unilateral pedicle screw fixation with the Quadrant system (Medtronic, Memphis, Tennessee). The bilateral group (n=42) underwent bilateral instrumentation via the classic approach. Visual analog scale pain scores, Oswestry Disability Index scores, fusion rate, operative time, blood loss, and complications were analyzed. Mean operative time was 75 minutes in the unilateral group and 95 minutes in the bilateral group. Mean blood loss was 220 mL in the unilateral group and 450 mL in the bilateral group. Mean postoperative visual analog scale pain score was 3.10±0.16 in the unilateral group and 3.30±1.10 in the bilateral group. Mean postoperative Oswestry Disability Index score was 15.67±2.3 in the unilateral group and 14.93±2.6 in the bilateral group. Successful fusion was achieved in 92.34% of patients in the unilateral group and 93.56% of patients in the bilateral group. Minimally invasive unilateral pedicle screw fixation is an effective and reliable option for the surgical treatment of lumbar degenerative disease. It causes less blood loss, requires less operative time, and has a fusion rate comparable with that of conventional bilateral fixation. PMID:23937756
Lin, Bin; Xu, Yang; He, Yong; Zhang, Bi; Lin, Qiuyan; He, Mingchang
Local injection therapy is of great value in the border area between non-operative or operative treatment of discogenic and spinal stenotic radicular syndromes. With a series of deep periradicular infiltrations of local anesthetics and antiphlogistics it is possible to reduce the pain peaks in the spontaneous course of degenerative spinal diseases, so that planned surgery is no longer necessary. For the rare serious palsies immediate surgery is still necessary. On-going improvement is reached by physiotherapy and psychotherapy and with the back school. PMID:22349366
Objective: This study was designed to evaluate the feasibility of the implantation of a new interspinous device (Falena) in patients with lumbar spinal stenosis. The clinical outcomes and imaging results were assessed by orthostatic MR during an up to 6-month follow-up period. Methods: Between October 2008 and February 2010, the Falena was implanted at a single level in 26 patients (17 men; mean age, 69 (range, 54-82) years) who were affected by degenerative lumbar spinal stenosis. All of the patients were clinically evaluated before the procedure and at 1 and 3 months. Furthermore, 20 patients have completed a 6-month follow-up. Pain was assessed before and after the intervention using the Visual Analogue Scale score and the Oswestry Disability Index questionnaire. Orthostatic MR imaging was performed before the implantation and at 3 months to assess the correlation with the clinical outcome. Results: The mean ODI score decreased from 48.9 before the device implantation to 31.2 at 1 month (p < 0.0001). The mean VAS score decreased from 7.6 before to 3.9 (p < 0.0001) at 1 month and 3.6 at 3 months after the procedure (p = 0.0115). These values were stable at 6 months evaluation. No postimplantation major complications were recorded. MRI evaluation documented in most cases an increased size of the spinal canal area. Similarly a bilateral foraminal area improvement was found. The variation of the intervertebral space height measured on the posterior wall was not significant. Conclusions: In our preliminary experience with the Falena in a small cohort of patients, we obtained clinical and imaging results aligned to those reported with similar interspinous devices.
Masala, Salvatore; Fiori, Roberto; Bartolucci, Dario Alberto, E-mail: firstname.lastname@example.org; Volpi, Tommaso; Calabria, Eros [University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging, Interventional Radiology, Nuclear Medicine and Radiation Therapy (Italy); Novegno, Federica [University of Rome 'Tor Vergata', Department of Neurosurgery (Italy); Simonetti, Giovanni [University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging, Interventional Radiology, Nuclear Medicine and Radiation Therapy (Italy)
The paper focuses on algorithms of outcomes assessment of surgical treatment of the patients with degenerative lumbar disk disease. From 1997 to 2006 389 patients with discogenic lumbar pain were operated in the Medical Center of Central Bank of Russia. 185 patients underwent radiofrequency destruction of facet nerves, laser percutaneous lumbar discectomy was performed in 39 patients, microdiscectomy -- in 131, and decompression combined with lumbar spine stabilization -- in 31 cases. Clinical and radiological data of each patient were recorded in the database using 3-point scale according to intensity of the feature. Assessment of patients' condition was performed pre- and postoperatively (after discharge and after 6, 12 and 24 months interval). Postoperative outcome was recorded for the current period in compliance with modified criteria of Kawabata et al. Obtained data were mathematically and statistically processed. Developed algorithms allowed assessment of postoperative outcome in the patients with degenerative lumbar disk disease. Outcome data can be used for evaluation of feasibility of surgical treatment as well as for selection of surgical technique. PMID:19505029
Zhuravlev, Iu I; Nazarenko, G I; Cherkashov, A M; Riazanov, V V; Nazarenko, A G
Low back pain as a result of degenerative disc disease imparts a large socioeconomic impact on the health care system. Traditional concepts for treatment of lumbar disc degeneration have aimed at symptomatic relief by limiting motion in the lumbar spine, but novel treatment strategies involving stem cells, growth factors, and gene therapy have the theoretical potential to prevent, slow, or even reverse disc degeneration. Understanding the pathophysiological basis of disc degeneration is essential for the development of treatment strategies that target the underlying mechanisms of disc degeneration rather than the downstream symptom of pain. Such strategies ideally aim to induce disc regeneration or to replace the degenerated disc. However, at present, treatment options for degenerative disc disease remain suboptimal, and development and outcomes of novel treatment options currently have to be considered unpredictable.
Taher, Fadi; Essig, David; Lebl, Darren R.; Hughes, Alexander P.; Sama, Andrew A.; Cammisa, Frank P.; Girardi, Federico P.
Study Design Retrospective review of a prospectively collected multi-institutional database. Objective In the present analysis we investigate the impact of incidental durotomy on outcome in patients undergoing surgery for lumbar degenerative spondylolisthesis. Summary of Background Data Surgery for lumbar degenerative spondylolisthesis has several potential complications, one of the most common of which is incidental durotomy. The effect of incidental durotomy on outcome, however, remains uncertain. Methods Spine Patient Outcomes Research Trial cohort participants with a confirmed diagnosis of lumbar degenerative spondylolisthesis (DS) undergoing standard first-time open decompressive laminectomy, with or without fusion, were followed from baseline at 6 weeks, and 3, 6, 12 months and yearly thereafter, at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database was reviewed. As of May 2009, the mean (Standard Deviation) follow-up among all analyzed DS patients was 46.6 (13.1) months (No durotomy: 46.7 vs. Had durotomy: 45.2, p-value=0.49). The median (range) follow-up time among all analyzed DS patients was 47.6 (2.5, 84) months. Results A 10.5% incidence of durotomy was detected among the 389 patients undergoing surgery. No significant differences were observed with or without durotomy in age, race, the prevalence of smoking, diabetes and hypertension, decompression level, number of levels, or whether a fusion was performed. There were no differences in incidence of nerve root injury, post-op mortality, additional surgeries, SF-36 scores of body pain or physical function, or Oswestry disability index at 1, 2, 3 and 4 years. Conclusions Incidental durotomy during first time surgery for lumbar degenerative spondylolisthesis does not appear to impact outcome in affected patients.
Desai, Atman; Ball, Perry A.; Bekelis, Kimon; Lurie, Jon; Mirza, Sohail K.; Tosteson, Tor D.; Zhao, Wenyan; Weinstein, James N.
The objective of this study is to evaluate the effectiveness and safety of total disc replacement surgery compared with spinal\\u000a fusion in patients with symptomatic lumbar disc degeneration. Low back pain (LBP), a major health problem in Western countries,\\u000a can be caused by a variety of pathologies, one of which is degenerative disc disease (DDD). When conservative treatment fails,\\u000a surgery
Karin D. van den Eerenbeemt; Raymond W. Ostelo; Barend J. van Royen; Wilco C. Peul; Maurits W. van Tulder
BACKGROUND: Parameters of MR imaging play a pivotal role in diagnosing lumbar spinal stenosis (LSS), and serve as an important tool in clinical decision-making. Despite the importance of MR imaging, little is known about the correlation between MRI parameters, objective gait analysis, and clinical presentation of patients with lumbar spinal stenosis. METHODS: Sixty-three patients from our clinic with symptomatic lumbar
Felix Zeifang; Marcus Schiltenwolf; Rainer Abel; Babak Moradi
There have been a few reports of patients with a combination of lumbar and thoracic spinal stenosis. We describe six patients who suffered unexpected acute neurological deterioration at a mean of 7.8 days (6 to 10) after lumbar decompressive surgery. Five had progressive weakness and one had recurrent pain in the lower limbs. There was incomplete recovery following subsequent thoracic decompressive surgery. The neurological presentation can be confusing. Patients with compressive myelopathy due to lower thoracic lesions, especially epiconus lesions (T10 to T12/L1 disc level), present with similar symptoms to those with lumbar radiculopathy or cauda equina lesions. Despite the rarity of this condition we advise that patients who undergo lumbar decompressive surgery for stenosis should have sagittal whole spine MRI studies pre-operatively to exclude proximal neurological compression. Cite this article: Bone Joint J 2013;95-B:1388-91. PMID:24078537
Fushimi, K; Miyamoto, K; Hioki, A; Hosoe, H; Takeuchi, A; Shimizu, K
The authors developed an original procedure, modified fenestration with restorative spinoplasty (MFRS) for the treatment of lumbar spinal stenosis. The first step is to cut the spinous process in an L-shape, which is caudally reflected. This procedure allows easy access to the spinal canal, including lateral recesses, and makes it easy to perform a trumpet-style decompression of the nerve roots without violating the facet joints. After the decompression of neural tissues, the spinous process is anatomically restored (spinoplasty). The clinical outcomes at 2 years were evaluated using the Japanese Orthopaedic Association (JOA) scale and patients' satisfaction. Radiological follow-up included radiographs and CT. Between January 2000 and December 2002, 109 patients with neurogenic intermittent claudication with or without mild spondylolisthesis underwent MFRS. Of these, 101 were followed up for at least 2 years (follow-up rate 93%). The average score on the self-administered JOA scale in 89 patients without comorbidity causing gait disturbance improved from 13.3 preoperatively to 22.9 at 2 years' follow-up. Neurogenic intermittent claudication disappeared in all cases. The patients' assessment of treatment satisfaction was "satisfied" in 74 cases, "slightly satisfied" in 12, "slightly dissatisfied" in 2, and "dissatisfied" in 1 case. In 16 cases (18%), a minimum progression of slippage occurred, but no symptomatic instability or recurrent stenosis was observed. Computed tomography showed that the lateral part of the facet joints was well preserved, and the mean residual ratio was 80%. The MFRS technique produces an adequate and safe decompression of the spinal canal, even in patients with narrow and steep facet joints in whom conventional fenestration is technically demanding. PMID:19558293
Matsudaira, Ko; Yamazaki, Takashi; Seichi, Atsushi; Hoshi, Kazuto; Hara, Nobuhiro; Ogiwara, Satoshi; Terayama, Sei; Chikuda, Hirotaka; Takeshita, Katsushi; Nakamura, Kozo
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.
Ha, Kee-yong; Son, Jong-Min; Im, Jin-Hyung; Oh, In-Soo
Objective: Minimally invasive surgery has seen increasing application in the treatment of spinal disorders. Treatment of degenerative spinal stenosis, with or without spondylolisthesis, with minimally invasive technique preserves stabilizing ligaments, bone, and muscle. Satisfactory results can be achieved without the need for fusion in most cases. Methods: Fifty-four consecutive patients underwent bilateral decompressions from a unilateral approach for spinal stenosis using METRx instrumentation. Visual Analog Scale (VAS) pain scores were recorded preoperatively and patients were interviewed, in person or by phone, by our office nurse practitioner (LD) to assess postoperative VAS scores, and patient satisfaction with the clinical results 21-39 months postoperatively (median 27 months). Results: Fifty-four patients underwent decompression at 77 levels (L4/5 = 43, L3/4 = 22, L5/S1 = 8, L1/2 = 4, L2/3 = 4), (single = 35, double = 16, triple = 2, quadruple = 1). There were 39 females and 15 males. The average age was 67 years. The average operative time was 78 minutes and the average blood loss was 37 ml per level. Twenty-seven patients had preoperative degenerative spondylolisthesis (Grade 1 = 26, Grade 2 = 1). Eight patients had discectomies and four had synovial cysts. Patient satisfaction was high. Use of pain medication for leg and back pain was low, and VAS scores improved by more than half. There were three dural tears. There were no deaths or infections. One patient with an unrecognized dural tear required re-exploration for repair of a pseudomeningocele and one patient required a lumbar fusion for pain associated with progression of her spondylolisthesis. Conclusions: Minimally invasive bilateral decompression of acquired spinal stenosis from a unilateral approach can be successfully accomplished with reasonable operative times, minimal blood loss, and acceptable morbidity. Two-year outcomes in this series revealed high patient satisfaction and only one patient progressed to lumbar fusion.
Palmer, Sylvain; Davison, Lisa
There is increasing interest in the use of pelvic indices to evaluate sagittal balance and predict outcomes in patients with spinal disease. Conventional posterior lumbar fusion techniques may adversely affect lumbar lordosis and spinal balance. Minimally invasive fusion of the lumbar spine is rapidly becoming a mainstay of treatment of lumbar degenerative disc disease. To our knowledge there are no studies evaluating the effect of extreme lateral interbody fusion (XLIF) on pelvic indices. Hence, our aim was to study the effect of XLIF on pelvic indices related to sagittal balance, and report the results of a prospective longitudinal clinical study and retrospective radiographic analyses of patients undergoing XLIF in a single centre between January 2009 and July 2011. Clinical outcomes are reported for 30 patients and the retrospective analyses of radiographic data is reported for 22 of these patients to assess global and segmental lumbar lordosis and pelvic indices. Effect of XLIF on the correction of scoliotic deformity was assessed in 15 patients in this series. A significant improvement was seen in the visual analogue scale score, the Oswestry Disability Index and the Short Form-36 at 2months and 6months (p<0.0001). The mean pelvic index was 48.6°±11.9° (± standard deviation, SD) with corresponding mean sacral slopes and pelvic tilt of 32.0°±10.6° (SD) and 18.0°±9.5 (SD), respectively. XLIF did not significantly affect sacral slope or pelvic tilt (p>0.2). Global lumbar lordosis was not affected by XLIF (p>0.4). XLIF significantly increased segmental lumbar lordosis by 3.3° (p<0.0001) and significantly decreased the scoliotic Cobb angle by 5.9° (p=0.01). We found that XLIF improved scoliosis and segmental lordosis and was associated with significant clinical improvement in patients with lumbar degenerative disc disease. However, XLIF did not change overall lumbar lordosis or significantly alter pelvic indices associated with sagittal balance. Long-term follow-up with a larger cohort will be required to further evaluate the effects of XLIF on sagittal balance. PMID:23375396
Johnson, R D; Valore, A; Villaminar, A; Comisso, M; Balsano, M
There is a debate regarding the distal fusion level for degenerative lumbar scoliosis. Whether a healthy L5-S1 motion segment should be included or not in the fusion remains controversial. The purpose of this study was to determine the optimal indication for the fusion to the sacrum, and to compare the results of distal fusion to L5 versus the sacrum in the long instrumented fusion for degenerative lumbar scoliosis. A total of 45 patients who had undergone long instrumentation and fusion for degenerative lumbar scoliosis were evaluated with a minimum 2 year follow-up. Twenty-four patients (mean age 63.6) underwent fusion to L5 and 21 patients (mean age 65.6) underwent fusion to the sacrum. Supplemental interbody fusion was performed in 12 patients in the L5 group and eleven patients in the sacrum group. The number of levels fused was 6.08 segments (range 4–8) in the L5 group and 6.09 (range 4–9) in the sacrum group. Intraoperative blood loss (2,754 ml versus 2,938 ml) and operative time (220 min versus 229 min) were similar in both groups. The Cobb angle changed from 24.7° before surgery to 6.8° after surgery in the L5 group, and from 22.8° to 7.7° in the sacrum group without statistical difference. Correction of lumbar lordosis was statistically better in the sacrum group (P = 0.03). Less correction of lumbar lordosis in the L5 group seemed to be associated with subsequent advanced L5-S1 disc degeneration. The change of coronal and sagittal imbalance was not different in both groups. Subsequent advanced L5-S1 disc degeneration occurred in 58% of the patients in the L5 group. Symptomatic adjacent segment disease at L5-S1 developed in five patients. Interestingly, the development of adjacent segment disease was not related to the preoperative grade of disc degeneration, which proved minimal degeneration in the five patients. In the L5 group, there were nine patients of complications at L5-S1 segment, including adjacent segment disease at L5-S1 and loosening of L5 screws. Seven of the nine patients showed preoperative sagittal imbalance and/or lumbar hypolordosis, which might be risk factors of complications at L5-S1. For the patients with sagittal imbalance and lumbar hypolordosis, L5-S1 should be included in the fusion even if L5-S1 disc was minimal degeneration.
Cho, Kyu-Jung; Suk, Se-Il; Kim, Jin-Hyok; Choi, Sung-Wook; Yoon, Young-Hyun; Won, Man-Hee
PURPOSE: Lumbar disc degeneration may be associated with intensity of neovascularization in disc herniations. Our study was designed to evaluate how much the severity of histodegeneration is related to the development of neovascularization and to the level of pleiotrophin in the herniated lumbar discs. METHODS: Surgically excised lumbar disc specimens were obtained from 29 patients with noncontained (i.e., extruding through the posterior longitudinal ligament) and 21 patients with contained disc herniations. The histodegeneration scores and levels of neovascularization were estimated according to semiquantitative analysis in lumbar disc and endplate samples. Immunohistochemical staining were performed to identify the newly formed blood vessels and to detect the presence of pleiotrophin in the specimens. RESULTS: Higher levels of disc and endplate neovascularity were registered in noncontained herniations. The level of neovascularization was significantly related to the score of histodegeneration in the herniated disc tissues but not in the endplate specimens. Both contained and noncontained herniations had the highest values of histodegeneration in conjunction with the highest level of neovascularization but the relations between neovascularity and degenerative changes remained to be significant only in the group of noncontained herniations. Registration or frequency of pleiotrophin positive cells did not correlate significantly with histodegeneration or level of neovascularization in the disc samples. CONCLUSION: Severe histodegeneration of the lumbar disc herniations is associated with enhanced neovascularization and potentially also spontaneous regression of the herniated tissue. PMID:23736847
Rätsep, Tõnu; Minajeva, Ave; Asser, Toomas
Background Beside symptoms and clinical signs radiological findings are crucial in the diagnosis of lumbar spinal stenosis (LSS). We investigate which quantitative radiological signs are described in the literature and which radilogical criteria are used to establish inclusion criteria in clincical studies evaluating different treatments in patients with lumbar spinal stenosis. Methods A literature search was performed in Medline, Embase and the Cochrane library to identify papers reporting on radiological criteria to describe LSS and systematic reviews investigating the effects of different treatment modalities. Results 25 studies reporting on radiological signs of LSS and four systematic reviews related to the evaluation of different treatments were found. Ten different parameters were identified to quantify lumbar spinal stenosis. Most often reported measures for central stenosis were antero-posterior diameter (< 10 mm) and cross-sectional area (< 70 mm2) of spinal canal. For lateral stenosis height and depth of the lateral recess, and for foraminal stenosis the foraminal diameter were typically used. Only four of 63 primary studies included in the systematic reviews reported on quantitative measures for defining inclusion criteria of patients in prognostic studies. Conclusions There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies.
Degenerative aortic stenosis is the most common worldwide cause of valve replacement. While it shares certain risk factors with coronary artery disease, it is not delayed or reversed by reducing exposure to risk factors (e.g., therapies that lower lipids). Therefore, it is necessary to better understand its pathophysiology for preventive measures to be taken. In this work, aortic valve samples were collected from 20 patients that underwent aortic valve replacement (55% males, mean age of 74 years) and 20 normal control valves were obtained from necropsies (40% males, mean age of 69 years). The proteome of the samples was analyzed by quantitative differential electrophoresis (2D-DIGE) and mass spectrometry, and 35 protein species were clearly increased in aortic valves, including apolipoprotein AI, alpha-1-antitrypsin, serum albumin, lumican, alfa-1-glycoprotein, vimentin, superoxide dismutase Cu-Zn, serum amyloid P-component, glutathione S-transferase-P, fatty acid-binding protein, transthyretin, and fibrinogen gamma. By contrast, 8 protein species were decreased (transgelin, haptoglobin, glutathione peroxidase 3, HSP27, and calreticulin). All of the proteins identified play a significant role in cardiovascular processes, such as fibrosis, homeostasis, and coagulation. The significant changes observed in the abundance of key cardiovascular proteins strongly suggest that they can be involved in the pathogenesis of degenerative aortic stenosis. Further studies are warranted to better understand this process before we can attempt to modulate it. PMID:22276806
Martín-Rojas, Tatiana; Gil-Dones, Felix; Lopez-Almodovar, Luis F; Padial, Luis R; Vivanco, Fernando; Barderas, Maria G
Lumbar spinal stenosis is a progressive degenerative condition that manifests as low back pain with neurogenic claudication as a cardinal clinical feature. Although mild radicular symptoms can often be successfully treated with conservative care, management of lumbar spinal stenosis grows increasingly difficult as symptoms worsen. No satisfactory nonsurgical treatments exist to manage moderate radicular symptoms and, therefore, these patients are faced with the decision of continuing ineffective conservative options or opting to undergo invasive decompressive spine surgery. The Superion(®) Interspinous Spacer (Vertiflex, Inc., CA, USA) was developed specifically to fill the therapeutic void between conservative care and surgical decompression. The Superion device is a titanium implant that is delivered percutaneously and deployed between the spinous processes at the symptomatic vertebral levels. The Superion device improves radicular symptoms by limiting spinal extension and, consequently, minimizing impingement of neural and vascular elements. This article describes the rationale for and the design of the Superion device and summarizes initial clinical results with this novel, minimally invasive interspinous spacer. PMID:21728727
Loguidice, Vito; Bini, Walter; Shabat, Shay; Miller, Larry E; Block, Jon E
An imaging test has an important role in the diagnosis of lumbar abnormalities since it allows to examine the internal structure of soft tissues and bony elements without the need of an unnecessary surgery and recovery time. For the past decade, among various imaging modalities, magnetic resonance imaging (MRI) has taken the significant part of the clinical evaluation of the lumbar spine. This is mainly due to technological advancements that lead to the improvement of imaging devices in spatial resolution, contrast resolution, and multi-planar capabilities. In addition, noninvasive nature of MRI makes it easy to diagnose many common causes of low back pain such as disc herniation, spinal stenosis, and degenerative disc diseases. In this paper, we propose a method to diagnose lumbar spinal stenosis (LSS), a narrowing of the spinal canal, from magnetic resonance myelography (MRM) images. Our method segments the thecal sac in the preprocessing stage, generates the features based on inter- and intra-context information, and diagnoses lumbar disc stenosis. Experiments with 55 subjects show that our method achieves 91.3% diagnostic accuracy. In the future, we plan to test our method on more subjects.
Koh, Jaehan; Alomari, Raja S.; Chaudhary, Vipin; Dhillon, Gurmeet
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.
Kaner, Tuncay; Ozer, Ali Fahir
The complexity of the clinical, biochemical, hystochemical and immunologic aspects of the intervertebral disk, along with its molecular biology, justifies the object of our study on the extracellular matrix modifications in lumbar disk hernias and their impact on patient quality of life. Material and method: the research lot was composed of 50 patients, aged between 18 and 73, who have undergone lumbar disk hernia surgery. MMP–9 (metalloproteinase–9) and TIMP–1 (tissue inhibitor of matrix metalloprotease 1) have been dosed in order to study the modifications on extracellular disk matrix, and quality of life assessment was carried out both in pre–operatory and post–operatory periods. Conclusions: patients may prevent the appearance of degenerative processes of the intervertebral disk with care and responsibility by controlling their weight, avoiding intense physical activities and ceasing to smoke.
Ciurea, AV; Mitrica, M; Mohan, A
PURPOSE. To compare early outcome of transforaminal lumbar interbody fusion (TLIF) for lytic versus degenerative spondylolisthesis. METHODS. 14 women and 8 men aged 20 to 60 (mean, 36) years underwent TLIF for lytic (n=15) or degenerative (n=7) spondylolisthesis. Of the 15 patients with lytic spondylolisthesis, 9 involved L4/ L5 and 6 L5/S1. Of the 7 patients with degenerative spondylolisthesis, 3 involved L4/L5, 2 L5/S1, one L2/L3, and one L3/L4. The spondylolistheses were classified as grade II (n=15), grade III (n=4), and retrolisthesis (n=3). 11 patients with lytic and 2 with degenerative spondylolisthesis had sensory deficits (n=12), motor deficits (n=9), and diminished reflexes (n=7). Visual analogue score (VAS) for pain and the Oswestry Disability Index (ODI) of each patient were assessed at months 3, 6, and 12, and 6 monthly thereafter. Fusion status was assessed by radiologists. Comprehensive outcome of each patient was graded as excellent, good, fair, or poor. RESULTS. The mean VAS score for low back pain improved significantly from 7.4 preoperatively to 2.1 at year 1 (p<0.001), as did the mean VAS score for leg pain from 6.7 to 1.4 (p<0.001) and the mean ODI from 67.8% to 11.8% (p<0.001). No patient had any residual neurological deficit, and all achieved radiological fusion. The comprehensive outcome was excellent in 16 patients, good in 5, and fair in one. 16 patients returned to their previous level of activity. CONCLUSION. TLIF is a safe and effective surgical procedure for the treatment of lytic and degenerative spondylolisthesis. PMID:23255650
Ali, Y; Najmus-Sakeb, N; Rahman, M; Mhamud, S
Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw.
Kim, Hong-Sik; Baek, Seung-Wook; Lee, Sang-Hyun
Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw. PMID:24009909
Park, Ye-Soo; Kim, Hong-Sik; Baek, Seung-Wook; Lee, Sang-Hyun
Background Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal stenosis. We describe our prospective, double-blind, randomized controlled trial that tests the hypothesis that epidural injections with steroids plus local anesthetic are more effective than epidural injections of local anesthetic alone in improving pain and function among older adults with lumbar spinal stenosis. Methods We will recruit up to 400 patients with lumbar central canal spinal stenosis from at least 9 clinical sites over 2 years. Patients with spinal instability who require surgical fusion, a history of prior lumbar surgery, or prior epidural steroid injection within the past 6 months are excluded. Participants are randomly assigned to receive either ESI with local anesthetic or the control intervention (epidural injections with local anesthetic alone). Subjects receive up to 2 injections prior to the primary endpoint at 6 weeks, at which time they may choose to crossover to the other intervention. Participants complete validated, standardized measures of pain, functional disability, and health-related quality of life at baseline and at 3 weeks, 6 weeks, and 3, 6, and 12 months after randomization. The primary outcomes are Roland-Morris Disability Questionnaire and a numerical rating scale measure of pain intensity at 6 weeks. In order to better understand their safety, we also measure cortisol, HbA1c, fasting blood glucose, weight, and blood pressure at baseline, and at 3 and 6 weeks post-injection. We also obtain data on resource utilization and costs to assess cost-effectiveness of epidural steroid injection. Discussion This study is the first multi-center, double-blind RCT to evaluate the effectiveness of epidural steroid injections in improving pain and function among older adults with lumbar spinal stenosis. The study will also yield data on the safety and cost-effectiveness of this procedure for older adults. Trial Registration Clinicaltrials.gov NCT01238536
Low back pain and lumbar spinal stenosis (LSS) is an extensive problem in the elderly presenting with pain, disability, fall risk and depression. The incidence of LSS is projected to continue to grow as the population ages. In light of the risks, costs and lack of long-term results associated with surgery, and the positive outcomes in studies utilizing physical therapy
Karen Maloney Backstrom; Julie M. Whitman; Timothy W. Flynn
Background context: Lumbar radiculopathy is commonly caused by degenerative conditions such as a herniated disc or lumbar spinal stenosis. Less common etiologies include intraspinal extradural masses such as synovial cysts and gas-containing ganglion cysts. Intraspinal extradural cysts that communicate with the intervertebral disc are a rare entity and thus, an uncommon cause of lumbar radiculopathy. There are only ten cases
Gerard K Jeong; John A Bendo
This is a retrospective case series to evaluate clinical variables, complications and outcome of 50 patients who underwent anterior lumbar interbody fusion (ALIF) supplemented with posterior percutaneous pedicle screw fixation for degenerative conditions of the lumbar spine. Twenty-four patients underwent single-level fusion and 26 patients had a two-level fusion for a total of 76 levels fused. The mean lengths of the anterior and posterior (including repositioning) portions of the procedure were 131 and 102 min, respectively. The mean estimated blood loss for the entire procedure was 288 ml. The overall adverse event rate was 12%. The mean VAS score for leg pain, VAS score for back pain and mean ODI all improved postoperatively. This study found that ALIF using allograft bone and rhBMP-2 combined with percutaneous pedicle screw fixation had a high fusion rate and a low incidence of perioperative complications. Patient outcomes showed significant improvements in back and leg pain and physical functioning. PMID:21484538
Anderson, D Greg; Sayadipour, Amirali; Shelby, Kevin; Albert, Todd J; Vaccaro, Alexander R; Weinstein, Michael S
Study Design Case-control study. Objective . To evaluate the effect of lumbar degenerative disc disease (DDD) on the disc deformation at the adjacent level and at the level one above the adjacent level during end ranges of lumbar motion. Summary of Background Data It has been reported that in patients with DDD, the intervertebral discs adjacent to the diseased levels have a greater tendency to degenerate. Although altered biomechanics have been suggested to be the causative factors, few data have been reported on the deformation characteristics of the adjacent discs in patients with DDD. Methods Ten symptomatic patients with discogenic low back pain between L4 and S1 and with healthy discs at the cephalic segments were involved. Eight healthy subjects recruited in our previous studies were used as a reference comparison. The in vivo kinematics of L3–L4 (the cephalic adjacent level to the degenerated discs) and L2–L3 (the level one above the adjacent level) lumbar discs of both groups were obtained using a combined magnetic resonance imaging and dual fluoroscopic imaging technique at functional postures. Deformation characteristics, in terms of areas of minimal deformation (defined as less than 5%), deformations at the center of the discs, and maximum tensile and shear deformations, were compared between the two groups at the two disc levels. Results In the patients with DDD, there were significantly smaller areas of minimal disc deformation at L3–L4 and L2–L3 than the healthy subjects (18% compared with 45% of the total disc area, on average). Both L2–L3 and L3–L4 discs underwent larger tensile and shear deformations in all postures than the healthy subjects. The maximum tensile deformations were higher by up to 23% (of the local disc height in standing) and the maximum shear deformations were higher by approximately 25% to 40% (of the local disc height in standing) compared with those of the healthy subjects. Conclusion Both the discs of the adjacent level and the level one above experienced higher tensile and shear deformations during end ranges of lumbar motion in the patients with DDD before surgical treatments when compared with the healthy subjects. The larger disc deformations at the cephalic segments were otherwise not detectable using conventional magnetic resonance imaging techniques. Future studies should investigate the effect of surgical treatments, such as fusion or disc replacement, on the biomechanics of the adjacent segments during end ranges of lumbar motion.
Wang, Shaobai; Xia, Qun; Passias, Peter; Li, Weishi; Wood, Kirkham; Li, Guoan
Summary\\u000a Objectives To eliminate radicular symptoms by decompression of a lumbar nerve root (usually L5) from its dural exit to the intervertebral\\u000a foramen up to the lateral compartment without damaging the facet joint.\\u000a \\u000a \\u000a \\u000a \\u000a Indications Bony compression of a lumbar nerve root at the lateral recess. in the intervertebral foramen. and in the intervertebral compartment.\\u000a The mediolateral and lateral decompression is indicated in
To describe two cases of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery for lumbar canal stenosis and a complaint of claudication. The follow-up period ranged from 1 year and 6 months to 1 year and 8 months. The neurological deficit due to thoracic meningioma after surgery for lumbar canal stensois was decreased after mass excision. So, careful physical examination and magnetic resonance imaging can reveal another thoracic spine compressive lesion such as meningioma. Additional thoracic decompressive surgery can provide partial amelioration of each patient's neurological condition. Surgeons should know that a silent meningioma can aggrevate neurological symptoms after lower lumbar spine surgery and should inform their patient before surgery.
Lee, Sang-Wook; Shim, Jung-Hyun
Summary \\u000a Low back ache and pain in the legs are not always due to disc displacement and lumbar spinal degenerative changes. Some infrequent,\\u000a but really not very rare diseases are presented in order to avoid mistakes which can have serious consequences for the patients.\\u000a Degenerative changes of the lumbar spine are very common, not only in aged people. A superficial
Whether to combine spinal decompression with fusion in patients with symptomatic lumbar spinal stenosis remains controversial. We performed a cohort study to determine the effect of the addition of fusion in terms of patient satisfaction after decompressive spinal surgery in patients with and without a degenerative spondylolisthesis. The National Swedish Register for Spine Surgery (Swespine) was used for the study. Data were obtained for all patients in the register who underwent surgery for stenosis on one or two adjacent lumbar levels. A total of 5390 patients fulfilled the inclusion criteria and completed a two-year follow-up. Using multivariable models the results of 4259 patients who underwent decompression alone were compared with those of 1131 who underwent decompression and fusion. The consequence of having an associated spondylolisthesis in the operated segments pre-operatively was also considered. At two years there was no significant difference in patient satisfaction between the two treatment groups for any of the outcome measures, regardless of the presence of a pre-operative spondylolisthesis. Moreover, the proportion of patients who required subsequent further lumbar surgery was also similar in the two groups. In this large cohort the addition of fusion to decompression was not associated with an improved outcome. PMID:23814250
Försth, P; Michaëlsson, K; Sandén, B
The lateral recess is one of the main compression sites in lumbar spinal canal stenosis. Lumbar nerve root is mainly entrapped\\u000a by bony tissue in compression syndrome. The patient has a long history of back pain in conjunction with claudication symptoms.\\u000a Besides laminotomy and facetectomy techniques, several specific surgical approaches to treat the lateral recess stenosis have\\u000a been described. The
Ahmet Çolak; K?vanç Topuz; Murat Kutlay; Serdar Kaya; Hakan ?im?ek; Ahmet Çetinkal; Mehmet N. Demircan
Leg pain\\/numbness and gait disturbance, two major symptoms in the lower extremities of lumbar spinal stenosis (LSS), are generally\\u000a expected to be alleviated by decompression surgery. However, the paucity of information available to patients before surgery\\u000a about specific predictors has resulted in some of them being dissatisfied with the surgical outcome when the major symptoms\\u000a remain after the procedure. This
Nobuhiro HaraHiroyuki; Hiroyuki Oka; Takashi Yamazaki; Katsushi Takeshita; Motoaki Murakami; Kazuto Hoshi; Sei Terayama; Atsushi Seichi; Kozo Nakamura; Hiroshi Kawaguchi; Ko Matsudaira
Percutaneous disc decompression was used to treat three patients with severe spinal stenosis using Nucleoplasty. Access to the disc was obtained bilaterally using a paramedian approach. Channels were created bilaterally using Coblation and stabilized using coagulation. The patients were reassessed at 1 week, 2 weeks, 4 weeks, 6 weeks, 6 months, and 1 year. MRI was obtained on the first two patients at 6 weeks. All three patients demonstrated significant reduction in pain scores as well as increased functionality for various periods of time. The use of analgesics was also reduced in each of the three patients during the period of diminished pain. PMID:16871306
Pace, Charles; Reyna, Jose; Schlicht, Christian
Degenerative disc disease (DDD) causes gradual intervertebral space collapse, concurrent discogenic or facet-induced pain,\\u000a and possible compression radiculopathy. A new minimal invasion procedure of percutaneous posterior-lateral lumbar interbody\\u000a fusion (PPLIF) using a B-Twin stand-alone expandable spinal spacer (ESS) was designed to treat this disease and evaluated\\u000a by follow-up more than 1 year. 12 cases with chronic low back pain and compressive
Lizu Xiao; Donglin Xiong; Qiang Zhang; Jin Jian; Husan Zheng; Yuhui Luo; Juanli Dai; Deren Zhang
Vertebral compression fractures (VCFs) can cause symptomatic spinal canal stenosis secondary to posterior wall retropulsion. This report describes four patients with VCF and lumbar stenosis secondary to posterior wall retropulsion who were treated with combined kyphoplasty and percutaneous interspinous spacer (IS) placement. Clinical and imaging follow-up ranged from 12-36 months. Outcomes were favorable. Combined kyphoplasty and percutaneous IS implant represents a minimally invasive, safe, and efficient option to treat VCF with symptomatic spinal stenosis. PMID:23101915
Bonaldi, Giuseppe; Cianfoni, Alessandro
INTRODUCTION Symtomatic lumbar ligamantum flavum calcification is quite rare in the young age group. PRESENTATION OF CASE The authors report a case of young adult with diagnosis of lumbar spinal stenosis, presenting with leg pain and neurological deficits. Computerized tomography (CT) scan and magnetic resonance (MR) imaging studies revealed ossification of the ligamantum flavum as the causative factor of the disease and the patient recovered completely after the decompressive operation. DISCUSSION It is emphasized that attention should be given to this rare etiological factor of lumbar spinal stenosis. CONCLUSION Complete relief can be achieved with early and adequate surgery.
Yilmaz, Murat; Kalemci, Orhan; Yilmaz, Hakan; Palaz, Necdet M.
Background Degenerative changes of lumbar spine anatomy resulting in the encroachment of neural structures are often regarded progressive, ultimately necessitating decompressive surgery. However the natural course is not necessarily progressive and the efficacy of a variety of nonsurgical interventions has also been described. At present there is insufficient data to compare surgical and nonsurgical interventions in terms of their relative benefit and safety. Previous attempts failed to provide clear clinical recommendations or to distinguish subgroups that substantially benefit from a certain treatment strategy. We present the design of a randomized controlled trial on (cost-) effectiveness of surgical decompression versus prolonged conservative treatment in patients with neurogenic intermittent claudication caused by lumbar stenosis. Methods/Design The aim of the Verbiest trial is to evaluate the effectiveness of prolonged conservative treatment compared to decompressive surgery. The study is a multi-center randomized controlled trial with two parallel groups design. Patients (age over 50) presenting to the neurologist or neurosurgeon with at least 3 months complaints of neurogenic intermittent claudication and considering surgical treatment are eligible for inclusion. Participants are randomly allocated to either prolonged conservative treatment, receiving further treatment from their general practitioner and physical therapist, or allocated to surgery and operated within 4 weeks. Primary outcome measure is the functional assessment of the patient as measured by the Zurich Claudication Questionnaire at 24 months of follow-up. Data is analyzed according to the intention to treat principle. Discussion With a cost-effectiveness analysis the trade off between the costs of prolonged conservative treatment and delayed surgery in a smaller number of patients are compared with the current policy of surgical management. As surgery is expected to be inevitable in certain subgroups of patients, the distinction of and classification by predictive patient characteristics is most relevant to clinical practice. Trial registration Netherlands Trial Register (NTR): NTR2216
Endometriosis is a chronic gynaecological disorder characterized by the presence of endometrial tissue outside the uterus. The disease most often affects the ovaries, uterine ligaments, fallopian tubes, and cervical-vaginal region. Urinary tract involvement is rare, accounting for around 1%-2% of all cases, of which 84% are in the bladder. We report a case of isolated lumbar ureteral stenosis due to endometriosis in a 37-year-old patient. The patient came to our observation complaining from lumbar back pain and presented with severe fever. The urological examination found monolateral left positive sign of Giordano. Blood tests evidenced marked lymphocytosis and increased valued of C-reactive protein. Urologic ultrasound showed hydronephrosis of first degree in the left kidney and absence of images related to stones bilaterally. Uro-CT scan evidenced ureteral stenosis at the transition between the iliac and pelvic tracts. We addressed the patient to surgery, and performed laparoscopic excision of the paraureteral bulk, endoscopic mechanical ureteral dilation, and stenting. The histological examination evidenced glandular structures lined by simple epithelium and surrounded by stroma. Immunohistochemical test of the glandular epithelium showed positivity for estrogen and progesterone receptors and moreover stromal cells were positive for CD10. The finding suggested a very rare diagnosis of isolated lumbar ureteral endometriosis.
Buttice, Salvatore; Barresi, Valeria; Inferrera, Antonino; Mucciardi, Giuseppe; Di Benedetto, Antonina; D'Amico, Carmela Emanuela; Magno, Carlo
Study Design. A prospective clinical study of modified unilateral laminotomy for bilateral decompression (M-ULBD) of lumbar spinal stenosis (LSS).Objective. In this paper, the authors describe the technique of modified unilateral laminotomy for bilateral decompression for lumbar spinal stenosis, and reported 2 years follow-up results.Summary of Background Data. Recent researches showed that atrophy of multifidus muscles and chronic low back pain after conventional laminectomy may relate to disturbance of the arterial supply caused by long duration of muscle retraction, extensive muscle stripping, and damage to the dorsal rami of the posterior branches.Methods. A total of 56 patients with LSS were randomly divided into group A and B. The 27 patients in Group A (15 males and 12 females) underwent M-ULBD. The other 29 patients in group B (18 males and 11 females) received conventional laminectomy. JOA score of low back pain, 10cm-VAS, CPK three days after operation, pre- and post-operative cross-sectional areas of multifidus were used to evaluate the clinical results.Results. There was no significant difference in preoperative data between both groups. A total of 54 patients (27 in each group A and B) completed 2 years of follow-up. The postoperative JOA and VAS scores in both groups were improved significantly compared with the corresponding preoperative ones (P<0.05). The postoperative CPK, VAS of low back pain, and atrophy rate of multifidus CSA in group A are lower than those in group B (P<0.05). Dural tear at the contralateral side occurred in 3 cases (11.1%) in group A and 1 case in group B (3.4%).Conclusions. Our two years follow-up shows that this method is efficient for lumbar spinal stenosis treatment, however, it still need long term follow-up and to compare with other modified methods. PMID:23466507
Liu, Xinyu; Yuan, Suomao; Tian, Yonghao
OBJECTIVE. The objective of our study was to perform a systematic review of the semiquantitative and qualitative radiologic criteria that are used for the diagnosis of lumbar spinal stenosis (LSS). MATERIALS AND METHODS. A four-step systematic literature search including the MEDLINE database was performed by an experienced librarian to reveal all semiquantitative or qualitative radiologic criteria used for the diagnosis of LSS. The precise definitions of all criteria, normal or abnormal values (if applicable), and intra- and interrater reliability were noted by two independent readers. Descriptive statistics were used. RESULTS. A total of 14 semiquantitative or qualitative radiologic parameters were identified and distinguished according to relevant anatomic spaces into criteria for central canal stenosis, lateral (recess) stenosis, and foraminal stenosis. Great variability in terms of the exact definitions of the criteria was found. For 10 of the 14 criteria, the intra- and interrater reliability data were found with kappa values ranging from 0.01 to 1.0. CONCLUSION. Our systematic literature review identified 14 different semiquantitative or qualitative radiologic criteria that are used for the diagnosis of LSS; however, these criteria show remarkable variability in terms of their exact individual definitions and intra- and interrater reliability. PMID:24147503
Andreisek, Gustav; Imhof, Mario; Wertli, Maria; Winklhofer, Sebastian; Pfirrmann, Christian W A; Hodler, Juerg; Steurer, Johann
Objective Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. Methods From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. Results The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16±2.1 and 8.03±2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3±2.9 and 1.2±3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029). Conclusion Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.
Kim, Ho Jung; Chun, Hyoung Joon; Oh, Suck Jun; Kang, Tae Hoon; Yang, Moon Sool
Background The increase in the number of anterior lumbar interbody fusions being performed carries with it the potential for the long-term\\u000a complication of adjacent segmental degeneration. While its exact mechanism remains uncertain, adjacent segment degeneration\\u000a has become much more widespread. Using a nonlinear, three-dimensional finite element model to analyze and compare the biomechanical\\u000a influence of anterior lumbar interbody fusion and lumbar
Shujie Tang; Brandon J. Rebholz
Object. This study was conducted to compare the quality of life (QOL) in patients with neurogenic intermittent clau- dication (NIC) secondary to lumbar spinal stenosis (LSS). Using the 36-Item Short Form (SF-36) questionnaire, the authors compared the results obtained in patients treated with the X STOP Interspinous Process Decompression (IPD) System with those obtained in patients who underwent nonoperative therapies.
Ken Y. Hsu; James F. Zucherman; Charles A. Hartjen; Thomas F. Mehalic; Dante A. Implicito; Michael J. Martin; DONALD R. JOHNSON II; Grant A. Skidmore; Paul P. Vessa; James W. Dwyer; Joseph C. Cauthen; Richard M. Ozuna
Context In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over non-operative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in elderly patients, so benefits and risks must be carefully weighed in the choice of surgical procedure. Objective Examine trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity. Design, Setting, and Patients Retrospective cohort analysis of Medicare claims for 2002–2007, focusing on 2007 to assess complications and resource use in U.S. hospitals. Operations for Medicare recipients undergoing surgery for lumbar stenosis (n=32,152 in the first 11 months of 2007) were grouped into 3 gradations of invasiveness: decompression alone, simple fusion (one or two disc levels, single surgical approach) or complex fusion (more than 2 disc levels or combined anterior and posterior approach). Main Outcome Measures Rates of the 3 types of surgery, major complications, postoperative mortality, and resource use. Results Overall, surgical rates declined slightly from 2002–2007, but the rate of complex fusion procedures increased 15-fold, from 1.3 to 19.9 per 100,000 beneficiaries. Life-threatening complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex fusion compared to decompression alone was 2.95 (95% CI 2.50–3.49). A similar pattern was observed for rehospitalization within 30 days, which occurred for 7.8% of patients undergoing decompression and 13.0% having a complex fusion (adjusted OR 1.94; 95% CI 1.74–2.17). Adjusted mean hospital charges for complex fusion procedures were $80,888 compared to $23,724 for decompression alone. Conclusions Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased, while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use.
Deyo, Richard A.; Mirza, Sohail K.; Martin, Brook I.; Kreuter, William; Goodman, David C.; Jarvik, Jeffrey G.
Study Design. A case report by Kara Krajewski and Jan Regelsberger.Objective. To demonstrate a case of intradural lumbar disc herniation including imaging studies, intraoperative imaging and an intraoperative video.Summary of Background Data. The first case of lumbar intradural disc herniation was reported as early as 1942; since then over 150 cases have been reported, mostly in the lumbar spine. Gadolinium-enhanced MRI is considered the gold standard for diagnosing this entity, though it is rarely peformed routinely in lumbar disc disease and diagnosis is often made intraoperatively.Methods. A 70-year-old man presented to the emergency department as a referral complaining of lower back pain, loss of sensation in the right thigh and difficulty walking. On examination, he showed uneven gait, right-sided foot drop (1/5), hypesthesias in the right inguinal area and ventral thigh and a positive straight leg raise test on the right. Anal sphincter tone was within normal limits. An MRI of the lumbar spine showed a large mediolateral herniated disc at L3/4, with caudal displacement and unclear signal changes intradurally.Results. Intraoperatively, the herniated disc was found upon opening the dural sac.Conclusion. Intradural disc herniations are a rare entity. The opening and inspection of the dural sack should be considered when the correct spinal level can be confirmed and insufficient herniated disc material can be visualized extradurally. PMID:23462573
Krajewski, K; Regelsberger, J
Paradigm change has recently taken place in spine surgery with the application of minimally invasive techniques. Minimally invasive techniques have several advantages over the open traditional techniques: less blood loss, preservation of spine muscle integrity, shorter hospitalization, early mobilization, reduced pain levels, lower risk of infection. The presented cases cover following lumbar pathologies: segmental spinal instability, LV-SI grade II. spondylolisthesis, degenerative spondylolisthesis, spine trauma. Unilateral or bilateral mini-open technique was employed in the degenerative cases, depending on symptoms and signes. If unilateral symptoms--pathology was identified, screws and rod were implanted percutaneously on the side contralateral to the pathology. The segmental fusion between vertebral bodies was always assured by a cage and autologous bone. The presented trauma case involved combined AO type A2 and B fractures. The anterior column was strengthened with vertebral body stents filled with bone cement, the posterior column was fixed with a percutaneously implanted screw rod system. Insertion of stents in the collapsed vertebra significantly increased the vertebral body height and also improved the stability of the spine. Minimally invasive spine surgery techniques appear more advantageous over the traditional open spine surgery that necessitates for large midline approaches. PMID:23750428
Schwarcz, Attila; Kasó, Gábor; Büki, András; Dóczi, Tamás
Summary ¶?The discussion regarding factors that reliably predict the long-term surgical results in patients with lumbar spinal stenosis\\u000a is still going on. This retrospective study analyses the relation between the dimensions of the dural sac and patients' clinical\\u000a status before and after decompressive operations performed with or without additional discectomy.\\u000a \\u000a ?The type of surgery performed in 134 patients and the dural
A. F. Aliashkevich; R. A. Kristof; J. Schramm; D. Brechtelsbauer
Objective: to present the experience of the authors with the treatment of the lumbar spine stenosis in 37 patients undergone a radicular decompression throught the technic of laminotomy and\\/or foraminotomy without laminectomia (fenestration), preserving the posterior structural elements11. Methods: a retrospective study performed on 37 patients seen during a period of jan\\/1996 to dec\\/2003, operated at the Hospital of the
Samuel Caputo de Castro; Antônio Geraldo; Diniz Roquette; Marcelo Batista Chioato; Samantha Martins Comácio; Diego Carvalho; Gomes de Moraes
BACKGROUND: While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe
Donald R Murphy; Eric L Hurwitz; Amy A Gregory; Ronald Clary
Study Design This is a prospective study. Purpose We compared the outcomes of segmental decompression and wide decompression in patients who had multilevel lumbar foraminal stenosis with back pain. Overview of Literature Wide decompression and fusion in patients with multilevel lumbar foraminal stenosis may increase the risk of perioperative complications. Methods From March 2005 to December 2007, this study prospectively examined 87 patients with multilevel lumbar foraminal stenosis and who were treated by segmental or wide decompression along with posterior fusion using pedicle screw fixation, and these patients could be followed-up for a minimum of 2 years. Of the 87 patients, 45 and 42 patients were assigned to the segmental decompression group (group 1) and the wide decompression group (group 2), respectively. We compared the clinical and radiological outcomes of the patients in these two groups. Results There were no significant differences between groups 1 and 2 in terms of the levels of postoperative pain based on the visual analogue scale, the Oswestry Disability Score, the clinical results based on the Kirkaldy-Willis Criteria, the complication rate or the posterior fusion rate. On the other hand, the mean operating times in groups 1 and 2 were 153 ± 32 minutes and 187 ± 36 minutes, respectively (p < 0.05). The amount of blood loss during surgery and on the first postoperative day was 840 ± 236 ml and 1,040 ± 301 ml in groups 1 and 2, respectively (p < 0.05). Conclusions These results suggest that segmental decompression offers promising and reproducible clinical and radiological results for patients suffering from multilevel lumbar foraminal stenosis.
Seong, Yoon Jae; Suh, Kuen Tak; Kim, Jeung Il; Lim, Jong Min; Goh, Tae Sik
The purpose of this study was to assess the outcome of peri-radicular infiltration for radicular pain in patients with spinal stenosis and lumbar disc herniation (LDH). Patients with spinal stenosis ( n=62) or LDH ( n=55) who met our criteria received fluoroscopically guided peri-radicular infiltration of local anaesthetic and steroid at the site of documented pathology. All the patients were
Leslie Chong Lich Ng; Philip Sell
Neurogenic claudication due to lumbar spinal stenosis is the commonest cause of back and leg pain in the elderly. It consumes large amounts of healthcare resource and is a common reason for GP consultations. Surgical management by decompressive laminectomy is the traditional method used for those patients in whom conservative management has failed. However, the advent of minimally invasive interspinous distraction devices, which are designed to alleviate symptoms of neurogenic intermittent claudication without subjecting the patient to a major operation, has potentially revolutionised the management of lumbar spinal stenosis. This review describes the principles of interspinous distraction devices, the rationale for their use in the management of lumbar spinal stenosis, indications and predictors of outcome. Published data on the safety and efficacy of the various devices available is encouraging but long term results are awaited. The superiority of interspinous distraction devices over conservative treatment has already been established, however, the precise indication for this new technology and whether the implants can replace conventional decompressive surgery in some situations has not been clearly defined. PMID:22582741
Borg, Anouk; Nurboja, Besnik; Timothy, Jake; Choi, David
Purpose Although posterior lumbar interbody fusion (PLIF) using stand-alone cages was a popular arthrodesis method, the effectiveness\\u000a of using such cages has been questioned. We assessed retrospectively the long-term clinical and radiological outcomes of PLIF\\u000a surgery using stand-alone cages for the treatment of degenerative lumbar spine disease, the incidences of pseudoarthrosis,\\u000a and its risk factors.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Between May 2000 and May 2005,
Jin Hoon Park; Sung Woo Roh
Prior attempts to classify degenerative disc disease (DDD) of the lumbar spine have been based on magnetic resonance imaging (MRI) signal intensity. Internal disruption of the disc is not reliably diagnosed by MRI alone. No attempt has been made to include provocative discography and plain radiographs. The intervertebral joint is a three-joint complex consisting not only of the end plate–disc–end
John S. Thalgott; Todd J. Albert; Alexander R. Vaccaro; Charles N. Aprill; James M. Giuffre; John S. Drake; Jonathan P. Henke
Background Degenerative disease of the lumbar spine is characterized by symptoms related to the affected nerve root. A recently described method allows the classification of the roots in relation to the occurrence of compression on its course. This method can serve as a clinical selection tool and decision support for semi-invasive pain therapy in back pain patients. Material/Methods We examined 40 lumbar spine MRIs in 3 sessions of transcription each, according to the method being evaluated. Every MRI evaluation was performed by each of 3 different observers. Intra- and interobserver reproducibility was calculated using chance-corrected agreement using a weighted kappa (?) value with quadratic weights to assess reliability for each nerve root separately. Results We found high intraobserver agreement in indication of the root with most pronounced interference due to potential compression by degenerative changes, at the level mean ?=0.81 (with 95% CI, range 0.04). Less agreement was observed in the interobserver evaluation test with the mean ?=0.75 (95% CI within the range not exceeding 0.03), although it still reached the substantial agreement. Conclusions This zstudy provides evidence for substantial inter- and intraobserver agreement for the decision support method allowing selection of the most serious nerve structure compression in degenerative disease of the lumbar spine based on of the MRI description.
Kubaszewski, Lukasz; Nowakowski, Andrzej; Gasik, Robert; LabedY, Wojciech
Using a continuum approach for modeling the constitutive mechanical behavior of the intervertebral disk's annulus fibrosus holds the potential for facilitating the correlation of morphology and biomechanics of this clinically important tissue. Implementation of a continuum representation of the disk's tissues into computational models would yield a particularly valuable tool for investigating the effects of degenerative disease. However, to date, relevant efforts in the literature towards this goal have been limited due to the lack of a computationally tractable and implementable constitutive function. In order to address this, annular specimens harvested from a total of 15 healthy and degenerated intervertebral disks were tested under planar biaxial tension. Predictions of a strain energy function, which was previously shown to be unconditionally convex, were fit to the experimental data, and the optimized coefficients were used to modify a previously validated finite element model of the L4/L5 functional spinal unit. Optimization of material coefficients based on experimental results indicated increases in the micro-level orientation dispersion of the collagen fibers and the mechanical nonlinearity of these fibers due to degeneration. On the other hand, the finite element model predicted a progressive increase in the stress generation in annulus fibrosus due to stepwise degeneration of initially the nucleus and then the entire disk. Range of motion was predicted to initially increase with the degeneration of the nucleus and then decrease with the degeneration of the annulus in all rotational loading directions, except for axial rotation. Overall, degeneration was observed to specifically impact the functional effectiveness of the collagen fiber network of the annulus, leading to changes in the biomechanical behavior at both the tissue level and the motion-segment level. PMID:23083194
Ayturk, Ugur M; Gadomski, Benjamin; Schuldt, Dieter; Patel, Vikas; Puttlitz, Christian M
Non-fusion stabilization of the lumbar spine in the case of degenerative diseases with a dynamic pedicle screw rod Estabilização dinâmica da coluna lombar no tratamento das doenças degenerativas ARTIGO ORIGINAL \\/ ORIGINAL ARTICLE
Objective: To compare the results of the posterior non-fusion stabilizations and fusion in the treatment of painful degenerative diseases of the lumbar spine. Methods: Cosmic is a dynamic non-fusion pedicle screw rod system for the stabilization of the lumbar vertebral column. The hinged pedicle screw provides for the load being shared between the implant and the vertebral column and allows
Archibald von Strempel; Christoph Stoss; Dieter Moosmann; Arno Martin
Purpose To assess the safety and effectiveness of a novel, minimally invasive interspinous spacer in patients with moderate lumbar spinal stenosis (LSS). Methods A total of 53 patients (mean age, 70 ± 11 years; 45% female) with intermittent neurogenic claudication secondary to moderate LSS, confirmed on imaging studies, were treated with the Superion® Interspinous Spacer (VertiFlex, Inc, San Clemente, CA) and returned for follow-up visits at 6 weeks, 1 year, and 2 years. Study endpoints included axial and extremity pain severity with an 11-point numeric scale, Zurich Claudication Questionnaire (ZCQ), back function with the Oswestry Disability Index (ODI), health-related quality of life with the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-12, and adverse events. Results Axial and extremity pain each decreased 54% (both P < 0.001) over the 2-year follow-up period. ZCQ symptom severity scores improved 43% (P < 0.001) and ZCQ physical function improved 44% (P < 0.001) from pre-treatment to 2 years post-treatment. A statistically significant 50% improvement (P < 0.001) also was noted in back function. PCS and MCS each improved 40% (both P < 0.001) from pre-treatment to 2 years. Clinical success rates at 2 years were 83%–89% for ZCQ subscores, 75% for ODI, 78% for PCS, and 80% for MCS. No device infection, implant breakage, migration, or pull-out was observed, although two (3.8%) patients underwent explant with subsequent laminectomy. Conclusion Moderate LSS can be effectively treated with a minimally invasive interspinous spacer. This device is appropriate for select patients who have failed nonoperative treatment measures for LSS and meet strict anatomical criteria.
Shabat, Shay; Miller, Larry E; Block, Jon E; Gepstein, Reuven
Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody fusion in low-grade spondylolisthesis performed with an independent blade retractor system or a traditional open approach. A prospective clinical study of 85 consecutive cases of degenerative and isthmic lower grade spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion (MiTLIF) or open transforaminal lumbar interbody fusion (OTLIF) was done. A total of 85 patients suffering from degenerative spondylolisthesis (n = 46) and isthmic spondylolisthesis (n = 39) underwent one-level MiTLIF (n = 42) and OTLIF (n = 43) by two experienced surgeons at one hospital, from June 2006 to March 2008 (minimum 13-month follow-up). The following data were compared between the two groups: the clinical and radiographic results, operative time, blood loss, transfusion needs, X-ray exposure time, postoperative back pain, length of hospital stay, and complications. Clinical outcome was assessed using the visual analog scale (VAS) and the Oswestry disability index. The operative time, clinical and radiographic results were basically identical in both groups. Comparing with the OTLIF group, the MiTLIF group had significantly lesser blood loss, lesser need for transfusion, lesser postoperative back pain, and shorter length of hospital stay. The radiation time was significantly longer in MiTLIF group. One case of nonunion was observed from each group. Minimally invasive TLIF has similar surgical efficacy with the traditional open TLIF in treating one-level lower grade degenerative or isthmic spondylolisthesis. The minimally invasive technique offers several potential advantages including smaller incisions, less tissue trauma and quicker recovery. However, this technique needs longer X-ray exposure time. PMID:20411281
Wang, Jian; Zhou, Yue; Zhang, Zheng Feng; Li, Chang Qing; Zheng, Wen Jie; Liu, Jie
We report an 85-year-old woman with an L3 vertebral body fracture who presented with back pain, bilateral leg pain, and weakness after four months of conservative treatment. Because of unstable pseudoarthrosis, the L3 vertebral body collapsed in the standing position and the L3 nerve root was compressed. The indicated surgery decompressed the L3-L4 foramen and fused the unstable segment. The back pain and neurologic symptoms improved significantly following surgery. We propose that delayed neurologic deficit following an osteoporotic fracture of the lumbar body may be caused not only by retropulsion of vertebral body fragments with significant canal compromise, but also by foraminal stenosis with the late collapse of the vertebral fracture. This new pathomechanism for delayed neurologic deficit has not been previously described. If a collapse takes place in the caudal part of the vertebral body below the base of the pedicle, spine surgeons should be aware of the possibility of foraminal stenosis.
Sasaki, Yu; Aoki, Yasuchika; Shibata, Yoshifumi; Sonobe, Masato; Takahashi, Kazuhisa; Ohtori, Seiji; Nakagawa, Koichi
Introduction Retrospective clinical study has done concerning the outcomes of lumbar spinal stenosis (LSS) patients treated with trans-interspinous\\u000a ligament approach method. The object is to determine the efficacy of this procedure and to confirm that the interspinous ligament\\u000a could be removed for the decompression surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Method Seventy patients were treated with this method and 63 patients were followed up for more than
Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied. Study Design: A prospective evaluation. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis. Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter. Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12, 18 and 24 months post treatment. The primary outcome measure was 50% or more improvement in pain scores and ODI scores. Results: Overall, a primary outcome or significant pain relief and functional status improvement of 50% or more was seen in 71% of patients at the end of 2 years. The overall number of procedures over a period of 2 years were 5.7 ± 2.73. Limitations: The lack of a control group and a prospective design. Conclusions: Significant relief and functional status improvement as seen in 71% of the 70 patients with percutaneous adhesiolysis utilizing local anesthetic steroids and hypertonic sodium chloride solution may be an effective management strategy in patients with chronic function limiting low back and lower extremity pain with central spinal stenosis after failure of conservatie management and fluoroscopically directed epidural injections.
Manchikanti, Laxmaiah; Cash, Kimberly A.; McManus, Carla D.; Pampati, Vidyasagar
Study Design Controlled experimental study. Objective To evaluate the kinematical effects of X-Stop device on the spinal process at the operated and the adjacent segments before and after X-Stop surgeries during various weight-bearing postures in elderly patients with lumbar spine stenosis. Summary of Background Data The mechanism of interspinous process (ISP) devices is to directly distract the ISP of the implanted level to indirectly decompress the intervertebra foramen and spinal canal. Few studies have investigated the changes of ISP gap caused by X-Stop implantation using magnetic resonance imaging or radiography, but the effect of X-Stop surgery on the kinematics of spinous processes during functional activities is still unclear. Methods Eight patients were tested before and, on average, 7 months after surgical implantation of the X-Stop devices using a combined computed tomography/magnetic resonance imaging and dual fluoroscopic imaging system during weight-bearing standing, flexion-extension, left-right bending, and left-right twisting positions of the torso. The shortest distances of the ISPs at the operated and the adjacent levels were measured using iterative closest point method and was dissected into vertical (gap) and horizontal (lateral translation) components. Results At the operated levels, the shortest vertical ISP distances (gap) significantly (P <0.05) increased by 1.5mm during standing, 1.2mm during left twist, 1.3mm during extension, and 1.1mm during flexion, whereas they also increased yet not significantly (P>0.05) in right twist, left bend, and right bend after the X-Stop implantation. The lateral translations were not significantly affected. At both cephalad and caudad adjacent levels, the ISP distances (vertical and horizontal) were not significantly affected during all postures after X-Stop implantation. Conclusion The findings of this study indicate that implantation of the X-Stop devices can effectively distract the ISP space at the diseased level without causing apparent kinematic changes at the adjacent segments during the studied postures.
Wan, Zongmiao; Wang, Shaobai; Kozanek, Michal; Passias, Peter G.; Mansfield, Frederick L.; Wood, Kirkham B.; Li, Guoan
Context The clinical syndrome of lumbar spinal stenosis (LSS) is a common diagnosis in older adults presenting with lower extremity pain. Objective To systematically review the accuracy of the clinical examination for the diagnosis of the clinical syndrome of LSS. Data Sources MEDLINE, EMBASE, and CINAHL searches of articles published from January 1966 to September 2010. Study Selection Studies were included if they contained adequate data on the accuracy of the history and physical examination for diagnosing the clinical syndrome of LSS, using a reference standard of expert opinion with radiographic or anatomic confirmation. Data Extraction Two authors independently reviewed each study to determine eligibility, extract data, and appraise levels of evidence. Data Synthesis Four studies evaluating 741 patients were identified. Among patients with lower extremity pain, the likelihood of the clinical syndrome of LSS was increased for individuals older than 70 years (likelihood ratio [LR], 2.0; 95% confidence interval [CI], 1.6–2.5), and was decreased for those younger than 60 years (LR, 0.40; 95% CI, 0.29–0.57). The most useful symptoms for increasing the likelihood of the clinical syndrome of LSS were having no pain when seated (LR, 7.4; 95% CI, 1.9–30), improvement of symptoms when bending forward (LR, 6.4; 95% CI, 4.1–9.9), the presence of bilateral buttock or leg pain (LR, 6.3; 95% CI, 3.1–13), and neurogenic claudication (LR, 3.7; 95% CI, 2.9–4.8). Absence of neurogenic claudication (LR, 0.23; 95% CI, 0.17–0.31) decreased the likelihood of the diagnosis. A wide-based gait (LR, 13; 95% CI, 1.9–95) and abnormal Romberg test result (LR, 4.2; 95% CI, 1.4–13) increased the likelihood of the clinical syndrome of LSS. A score of 7 or higher on a diagnostic support tool including history and examination findings increased the likelihood of the clinical syndrome of LSS (LR, 3.3; 95% CI, 2.7–4.0), while a score lower than 7 made the diagnosis much less likely (LR, 0.10; 95% CI, 0.06–0.16). Conclusions The diagnosis of the clinical syndrome of LSS requires the appropriate clinical picture and radiographic findings. Absence of pain when seated and improvement of symptoms when bending forward are the most useful individual findings. Combinations of findings are most useful for identifying patients who are unlikely to have the diagnosis.
Suri, Pradeep; Rainville, James; Kalichman, Leonid; Katz, Jeffrey N.
BACKGROUND: Neurogenic claudication (NC) is the clinical syndrome commonly associated with lumbar spinal stenosis (LSS). Non-surgical management is recommended as initial treatment, but little is known about current practice in relation to the assessment and management of these patients in the non-surgical setting. METHODS: We conducted a questionnaire survey of physiotherapists in a large UK primary care musculoskeletal service which
Christine M Comer; Anthony C Redmond; Howard A Bird; Philip G Conaghan
Study Design Retrospective subgroup analysis of prospectively collected data according to treatment received. Objective The purpose of this study is to determine if the duration of symptoms affects outcomes following the treatment of spinal stenosis (SS) or degenerative spondylolisthesis (DS). Summary of Background Data The Spine Outcomes Research Trial (SPORT) study was designed to provide scientific evidence on the effectiveness of spinal surgery versus a variety of non-operative treatments. Methods An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of SS or DS. A comparison was made between patients with SS with ?12 months (n=405) and those with >12 months (n=227) duration of symptoms. A comparison was also made between patients with DS with ?12 months (n=397) and those with >12 months (n=204) duration of symptoms. Baseline patient characteristics were documented. Primary and secondary outcomes were measured at baseline and at regular follow-up time intervals up to 4 years. The difference in improvement among patients whose surgical or nonsurgical treatment began less than or greater than 12 months after the onset of symptoms was measured. In addition, the difference in improvement with surgical versus nonsurgical treatment (treatment effect) was determined at each follow-period for each group. Results At final followup, there was significantly less improvement in primary outcome measures in SS patients with >12 months symptom duration. Primary and secondary outcome measures within the DS group did not differ according to symptom duration. There were no statistically significant differences in treatment effect of surgery in SS or DS patients. Conclusions Patients with spinal stenosis with fewer than twelve months of symptoms experienced significantly better outcomes with surgical and nonsurgical treatment relative to those with symptom duration greater than twelve months. There was no difference in outcome of patients with degenerative spondylolisthesis according to symptom duration.
Radcliff, Kristen; Rihn, Jeff; Hilibrand, Alan; DiIorio, Timothy; Tosteson, Tor; Lurie, Jon; Zhao, Wenyan; Vaccaro, Alex; Albert, Todd; Weinstein, James N.
Objective We compared the results of two surgical techniques by retrospective study of 60 elderly patients (65 years or older) who underwent either decompression alone or fusion for the treatment of two-level or more lumbar spinal stenosis. Methods During the period of 2003 and 2008, two-level or more decompression alone or fusion was performed for lumbar spinal stenosis by three surgeons at our institution. Patients were allocated to two groups by surgical modality, namely, to a decompression group (31 patients) or a fusion group (29 patients). Overall mean age was 71.1 years (range, 65-84) and mean follow-up was 5.5 years (range, 3-9). A retrospective review of clinical, radiological, and surgical data was conducted. Results No significant difference between the two groups was found with respect to age, follow-up period, surgical levels, or preoperative condition. At the last follow-up, correction of lumbar lordotic angle (determined radiologically) was better in the fusion group. However, clinical outcomes including visual analogue scale, Oswestry Disability Index, and the Odom's criteria were not significantly different in the two groups. On the other hand, surgical outcomes, such as, operation time, estimated blood loss, and surgical complications were significantly better in the decompression alone group. Conclusion Our findings suggest that decompressive laminectomy alone achieves good outcomes in patients with two-level or more lumbar spinal stenosis, associated with an advanced age, poor general condition, or osteoporosis.
Son, Seong; Lee, Sang Gu; Park, Chan Woo; Lee, Keun
Object. Interspinous process decompression (IPD) theoretically relieves narrowing of the spinal canal and neur- al foramen in extension and thus reduces the symptoms of neurogenic intermittent claudication (NIC). The purpose of this study was to compare the efficacy of IPD with nonoperative treatment in patients with NIC secondary to degenerative spondylolisthesis. Methods. The authors conducted a randomized controlled study in
Paul A. Anderson; Cliff B. Tribus; Scott H. Kitchel
Study Design Retrospective study. Purpose The aims of the current study are to evaluate the minimum 10-year follow-up clinical results of anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. Overview of Literature ALIF has been widely used as a treatment regimen in the management of lumbar spondylolisthesis. Still much controversy exists regarding the factors that affect the postoperative clinical outcomes. Methods The author performed a retrospective review of 20 patients with degenerative spondylolisthesis treated with ALIF (follow-up, 16.4 years). The clinical results were assessed by the Japanese Orthopaedic Association (JOA) score for low back pain, vertebral slip and disc height index on the radiographs. Results The mean preoperative JOA score was 7.1 ± 1.8 points (15-point-method). At 1 year, 5 years, and 10 years or more after surgery, the JOA scores were assessed as 12.4 ± 2.2 points, 12.7 ± 2.6 points, 12.0 ± 2.5 points, respectively (excluding the data of reoperated cases). The adjacent disc degeneration developed in all cases during the long-term follow-up. The progressive pattern of disc degeneration was divided into three types. Initially, disc degeneration occurred due to disc space narrowing. After that, the intervertebral discs showed segmental instability with translation at the upper level. But the lower discs showed osteophyte formation, and occasionally lead to the collapse or spontaneous union. Conclusions The clinical results of the long-term follow-up data after ALIF became worse due to the adjacent disc degeneration. The progressive pattern of disc degeneration was different according to the adjacent levels.
Yasuda, Taketoshi; Hori, Takeshi; Suzuki, Kayo; Kawaguchi, Yoshiharu
Study Design. Prospective clinical study. Objective. This study compares the clinical results of anterior lumbar total disc replacement and posterior transpedicular dynamic stabilization in the treatment of degenerative disc disease. Summary and Background Data. Over the last two decades, both techniques have emerged as alternative treatment options to fusion surgery. Methods. This study was conducted between 2004 and 2010 with a total of 50 patients (25 in each group). The mean age of the patients in total disc prosthesis group was 37,32 years. The mean age of the patients in posterior dynamic transpedicular stabilization was 43,08. Clinical (VAS and Oswestry) and radiological evaluations (lumbar lordosis and segmental lordosis angles) of the patients were carried out prior to the operation and 3, 12, and 24 months after the operation. We compared the average duration of surgery, blood loss during the surgery and the length of hospital stay of both groups. Results. Both techniques offered significant improvements in clinical parameters. There was no significant change in radiologic evaluations after the surgery for both techniques. Conclusion. Both dynamic systems provided spine stability. However, the posterior dynamic system had a slight advantage over anterior disc prosthesis because of its convenient application and fewer possible complications.
Oktenoglu, Tunc; Ozer, Ali Fahir; Sasani, Mehdi; Ataker, Yaprak; Gomleksiz, Cengiz; Celebi, Irfan
The clinical outcome of patients with symptomatic lumbar spinal stenosis (LSS) was assessed during a follow-up period of 2 years\\u000a after X-Stop implantation. The X-Stop is the most commonly used interspinous distraction device in patients with neurogenic\\u000a intermittent claudication due to LSS. Between 2003 and 2007, more than 1,000 patients were examined in our centre with symptoms\\u000a of intermittent claudication due
Johannes Kuchta; Rolf Sobottke; Peer Eysel; Patrick Simons
This study aimed to investigate the expression of brain-derived neurotrophic factor (BDNF) in dorsal root ganglia (DRG) of a rat model of lumbar spinal stenosis (LSS). Adult male rats were divided into the operation and sham operation groups. The operation group was comprised of the rat models of LSS. Walking distance and BDNF expression levels in DRG were measured in the two groups at different time points. The total BDNF protein levels and positive cell mean optical density (MOD) values in the operation group were significantly higher at each time point compared with that of the sham operation and preoperative control groups (P<0.05). The total BDNF protein levels and MOD values following sport in the operation group were significantly higher compared with those prior to sport (P<0.05). In the sham operation group, BDNF protein levels and MOD values before and after sport at each time point showed no significant differences than those of the operation group (P>0.05). Moreover, BDNF protein levels and MOD values in the operation group indicated a negative correlation with walking distance. The present study demonstrated that the expression of BDNF in rat models of LSS increased with time and was associated with a decrease in walking distance. BDNF was therefore important for the process of intermittent claudication caused by LSS. PMID:24127005
Li, Qinliang; Liu, Yi; Chu, Zhaoming; Chen, Jinchuan; Dai, Fenglei; Zhu, Xiaorong; Hu, Ankang; Yun, Cai
Background Degenerative disease of the lumbar spine (DLS) is a common condition for which surgery can be beneficial in selected patients. With recent surgical trends toward more focused subspecialty training, it is unclear how characteristics of the surgical consultant may impact on treatment and reoperations. Our objective was to understand the relations between surgeon factors (who), surgical procedures (what) and recent trends (when) and their influence on reoperations for DLS surgery. Methods We performed a longitudinal population-based study using administrative databases including all patients aged 50 years and older who underwent surgery for DLS. We collected data on surgeon characteristics (specialty, volume), index procedures (decompressions, fusions) and reoperations. Results We identified 6128 patients who underwent surgery for DLS (4200 who had decompressions, 1928 who had fusions). We observed an increasing proportion of fusions over decompressions while the per capita surgeon supply declined. Orthopedic specialty and higher surgical volume were associated with a higher proportion of fusions (p < 0.001). The overall reoperation rate was 10.6%. Reoperations were more frequent in patients who had decompressions than those who had fusions at 2 years (5.4% v. 3.8%, odds ratio 1.4, p < 0.013), but not over the long-term. Long-term survival analysis demonstrated that a lower surgical volume was related to a higher reoperation rate (hazard ratio 1.28, p = 0.038). Conclusion Lumbar spinal fusion rates for DLS have been increasing in Ontario. There is wide variation in surgical procedures between specialty and volume: namely high-volume and orthopedic surgeons have higer fusion rates than other surgeons. We observed better long-term survival among patients of high-volume surgeons. Referring physicians should be aware that the choice of surgical consultant may influence patients’ treatments and outcomes. With increasing rates of spinal surgery, the efficacy and cost benefit of current surgical options require ongoing study.
Bederman, S. Samuel; Kreder, Hans J.; Weller, Iris; Finkelstein, Joel A.; Ford, Michael H.; Yee, Albert J.M.
The use of technology in the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. It has been extensively studied in combination with various techniques for spinal stabilization from both the anterior and posterior approach. Minimally invasive and instrumental approach via posterior fixation is increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar vertebrae. Posterior access to the lumbar disc spaces for posterolateral fusion scan has been technically challenging, frequently requiring the use of an approach surgery for adequate exposure. For successful surgery and suitable instrumental design, adequate anatomical knowledge of the lumbar vertebra is also needed. Anatomic features of lumbar vertebrae are of importance for posterior screw fixation technique. The morphometry of L1-L5 has been studied to facilitate the safe application of pedicle screws. Thus, we aimed to evaluate the morphometric landmarks of lumbar vertebrae such as pedicle, vertebral body, vertebral foramen, intervertebral space height and volume for safe surgical intervention using a posterior fixation approach to offer anatomical supports for lumbar discectomy, stenosis and cases of deformity. The features of the L1-L5 vertebral body, the detailed morphometric parameters of lumbar vertebrae and the intervertebral space were analyzed using computerized tomography scan, magnetic resonance imaging and also dry lumbar vertebrae. Additionally, intervertebral space volumes were measured using stereological methods to ensure safe surgical intervention. PMID:21550221
Karabekir, Hamit S; Gocmen-Mas, Nuket; Edizer, Mete; Ertekin, Tolga; Yazici, Canan; Atamturk, Derya
Stand-alone cage for posterior lumbar interbody fusion in the treatment of high-degree degenerative disc disease: design of a new device for an “old” technique. A prospective study on a series of 116 patients
Chronic lumbar pain due to degenerative disc disease affects a large number of people, including those of fully active age.\\u000a The usual self-repair system observed in nature is a spontaneous attempt at arthrodesis, which in most cases leads to pseudoarthrosis.\\u000a In recent years, many possible surgical fusion techniques have been introduced; PLIF is one of these. Because of the growing
Francesco Costa; Marco Sassi; Alessandro Ortolina; Andrea Cardia; Roberto Assietti; Alberto Zerbi; Martin Lorenzetti; Fabio Galbusera; Maurizio Fornari
A prospective, randomized, controlled trial was conducted to compare clinical outcomes in patients treated with an investigational interspinous spacer (Superion) versus those treated with an FDA-approved spacer (X-STOP). One hundred sixty-six patients with moderate lumbar spinal stenosis (LSS) unresponsive to conservative care were treated randomly with the Superion (n = 80) or X-STOP (n = 86) interspinous spacer. Study subjects were followed through 6 months posttreatment. Zurich Claudication Questionnaire (ZCQ) symptom severity scores improved 30% with Superion and 25% with X-STOP (both P < 0.001). Similar changes were noted in ZCQ physical function with improvements of 32% with Superion and 27% with X-STOP (both P < 0.001). Mean ZCQ patient satisfaction score ranged from 1.7 to 2.0 in both groups at all follow-up visits. The proportion of subjects that achieved at least two of three ZCQ clinical success criteria at 6 months was 75% with Superion and 67% with X-STOP. Axial pain decreased from 55 ± 27?mm at pretreatment to 22 ± 26?mm at 6 months in the Superion group (P < 0.001) and from 54 ± 29?mm to 32 ± 31?mm with X-STOP (P < 0.001). Extremity pain decreased from 61 ± 26?mm at pretreatment to 18 ± 27?mm at 6 months in the Superion group (P < 0.001) and from 64 ± 26?mm to 22 ± 30?mm with X-STOP (P < 0.001). Back function improved from 38 ± 13% to 21 ± 19% with Superion (P < 0.001) and from 40 ± 13% to 25 ± 16% with X-STOP (P < 0.001). Preliminary results suggest that the Superion interspinous spacer and the X-STOP each effectively alleviate pain and improve back function in patients with moderate LSS who are unresponsive to conservative care. PMID:22448323
Miller, Larry E; Block, Jon E
Background: We describe a new posterior dynamic stabilizing system that can be used to augment the mechanics of the degenerating lumbar segment. The mechanism of this system differs from other previously described surgical techniques that have been designed to augment lumbar biomechanics. The implant and technique we describe is an extension-limiting one, and it is designed to support and cushion the facet complex. Furthermore, it is inserted through an entirely percutaneous technique. The purpose of this technical note is to demonstrate a novel posterior surgical approach for the treatment of lumbar degenerative. Methods: This report describes a novel, percutaneously placed, posterior dynamic stabilization system as an alternative option to treat lumbar degenerative disk disease with and without lumbar spinal stenosis. The system does not require a midline soft-tissue dissection, nor subperiosteal dissection, and is a truly minimally invasive means for posterior augmentation of the functional facet complex. This system can be implanted as a stand-alone procedure or in conjunction with decompression procedures. Results: One-year clinical results in nine individual patients, all treated for degenerative disease of the lower lumbar spine, are presented. Conclusions: This novel technique allows for percutaneous posterior dynamic stabilization of the lumbar facet complex. The use of this procedure may allow a less invasive alternative to traditional approaches to the lumbar spine as well as an alternative to other newly developed posterior dynamic stabilization systems.
Smith, Zachary A.; Armin, Sean; Raphael, Dan; Khoo, Larry T.
Background While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM) and neural mobilization (NM). Methods This is a prospective consecutive case series with long term follow up (FU) of fifty-seven consecutive patients who were diagnosed with LSS. Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM) and pain intensity was measured using the Three Level Numerical Rating Scale (NRS). Patients were also asked to rate their perceived percentage improvement. Results The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in "on average" pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in "at worst" pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in "on average" pain intensity from baseline to long term FU was 3.0 points. This was considered to be clinically meaningful. The mean improvement in "at worst" pain was 4.2 points. This was considered to be clinically meaningful. Only two patients went on to require surgery. No major complications to treatment were noted. Conclusion A treatment approach focusing on DM and NM may be useful in bringing about clinically meaningful improvement in disability in patients with LSS.
Murphy, Donald R; Hurwitz, Eric L; Gregory, Amy A; Clary, Ronald
Degenerative lumbar scoliosis (DLS) progresses with aging after 50–60 years. The genetic association of DLS remains largely unclear. In this study, the genetic association between glutamate receptor, ionotropic, N-methyl D-aspartate (NMDA, GRIN) receptor genes and DLS was investigated. A total of 9 coding single nucleotide polymorphisms (cSNPs) in NMDA receptor genes [GRIN2A (rs8049651, Leu425Leu; rs9806806, Tyr730Tyr); GRIN2B (rs7301328, Pro122Pro; rs35025065, Asp447Asp; rs1805522, Ile602Ile; rs1806201, Thr888Thr; rs1805247, His1399His); and GRIN2C (rs689730, Ala33Ala; rs3744215, Arg1209Ser)] were selected and genotyped using direct sequencing in 70 patients with DLS and 141 healthy controls. Multiple logistic models (codominant, dominant and recessive) were calculated for the odds ratio (OR), 95% confidence interval (CI) and corresponding P-values. The SNPStats, SNPAnalyzer and HelixTree programs were used for the evaluation of the genetic data. Among the SNPs examined, no significant associations were observed between the NMDA receptor genes and DLS. When the patients were divided into two groups according to clinical characteristics based on Cobb’s angle (<20° or ?20°) and lateral listhesis (<6 mm or ?6 mm), associations were observed between rs689730 of GRIN2C and Cobb’s angle (codominant, P=0.038; dominant, P=0.022) and between rs7301328 of GRIN2B and lateral listhesis (codominant, P=0.003; dominant, P=0.015; recessive, P=0.015). These results indicate that the GRIN2A, GRIN2B and GRIN2C genes do not affect the development of DLS. However, the GRIN2C gene may be associated with Cobb’s angle, while the GRIN2B gene may be associated with lateral listhesis.
KIM, KI-TACK; KIM, JINSUNG; HAN, YOO JIN; KIM, JUN HO; LEE, JONG SEOK; CHUNG, JOO-HO
Comparative Effectiveness Evidence from the Spine Patient Outcomes Research Trial: Surgical vs. Non-Operative Care for Spinal Stenosis, Degenerative Spondylolisthesis and Intervertebral Disc Herniation
Study Design Cost-effectiveness analysis of a randomized plus observational cohort trial Objective Analyze cost-effectiveness of Spine Patient Outcomes Research Trial (SPORT) data over 4 years comparing surgery with non-operative care for three common diagnoses: spinal stenosis (SpS), degenerative spondylolisthesis (DS) and intervertebral disc herniation (IDH). Summary of Background Data Spine surgery rates continue to rise in the US, but the safety and economic value of these procedures remains uncertain. Methods Patients with image-confirmed diagnoses were followed in randomized or observational cohorts with data on resource use, productivity and EQ-5D health state values measured at 6 weeks, 3, 6, 12, 24, 36, and 48 months. For each diagnosis, cost per quality-adjusted life year (QALY) gained in 2004 US Dollars was estimated for surgery relative to non-operative care using a societal perspective, with costs and QALYs discounted at 3% per year. Results Surgery was performed initially or during the 4-year follow-up among 414/634 (65.3%) SPS, 391/601 (65.1%) DS and 789/1192 (66.2%) IDH patients. Surgery improved health, with persistent QALY differences observed through 4 years (SpS QALY gain 0.22; 95%CI: 0.15, 0.34; DS QALY gain 0.34, 95%CI: 0.30, 0.47; IDH QALY gain 0.34, 95%CI: 0.31, 0.38). Costs per QALY gained decreased for SPS from $77,600 at 2 years to $59,400 (95%CI: $37,059, $125,162) at 4 years; for DS from $115,600 to $64,300/QALY (95%CI: $32,864, $83,117); and for IDH from $34,355 to $20,600/QALY (95%CI: $4,539, $33,088). Conclusions Comparative effectiveness evidence for clearly defined diagnostic groups from SPORT shows good value for surgery compared with non-operative care over 4-years.
Tosteson, Anna N. A.; Tosteson, Tor D.; Lurie, Jon D.; Abdu, William; Herkowitz, Harry; Andersson, Gunnar; Albert, Todd; Bridwell, Keith; Zhao, Wenyan; Grove, Margaret R.; Weinstein, Milton C.; Weinstein, James N.
Study Design Retrospective cohort study of Medicare claims. Objective Examine trends and patterns in the use of bone morphogenetic proteins (BMP) in surgery for lumbar stenosis; compare complications, reoperation rates, and charges for patients undergoing lumbar fusion with and without BMP. Summary of Background Data Small randomized trials have demonstrated higher rates of solid fusion with BMP than with allograft bone alone, with few complications, and in some studies, reduced rates of revision surgery. However, complication and reoperation rates from large population-based cohorts in routine care are unavailable. Methods We identified patients with a primary diagnosis of lumbar stenosis who had fusion surgery in 2003 or 2004 (n=16,822). We identified factors associated with BMP use; major medical complications during the index hospitalization, rates of rehospitalization within 30 days, and rates of reoperation within 4 years of follow-up (through 2008). Results Use of BMP increased rapidly, from 5.5% of fusion cases in 2003 to 28.1% of fusion cases in 2008. BMP use was greater among patients with previous surgery and among those having complex fusion procedures (combined anterior and posterior approach, or greater than 2 disc levels). Major medical complications, wound complications, and 30-day rehospitalization rates were nearly identical with or without BMP. Reoperation rates were also very similar, , even after stratifying by previous surgery or surgical complexity, and after adjusting for demographic and clinical features. On average, adjusted hospital charges for operations involving BMP were about $15,000 greater than hospital charges for fusions without BMP, though reimbursement under Medicare's Diagnosis-Related Group (DRG) system averaged only about $850 greater Significantly fewer patients receiving BMP were discharged to a skilled nursing facility (15.9% vs. 19.0%, p<0.001) Conclusion In this older population having fusion surgery for lumbar stenosis, uptake of BMP was rapid, and greatest among patients with prior surgery or having complex fusion procedures. BMP appeared safe in the perioperative period, with no increase in major medical complications. Use of BMP was associated with greater hospital charges but fewer nursing home discharges, and was not associated with reduced likelihood of reoperation.
Deyo, Richard A.; Ching, Alex; Matsen, Laura; Martin, Brook I.; Kreuter, William; Jarvik, Jeffrey G.; Angier, Heather; Mirza, Sohail K.
Evaluación post-quirúrgica de la cirugía de estenosis lumbar degenerativa por método descompresivo selectivo Avaliação dos resultados do tratamento da estenose do canal lombar pela técnica da descompressão seletiva
Objective: The Senegas Recalibration Technique consists in a lumbar channel selective decompression conserving the estabilizated elements.The aim of this study was to present our experience in the treatment of the degenerative lumbar stenosis whith the Senegas technique. Methods: Thirth eight patients operated whit this technique whit a follow up of 53.92%(84-24) months were evaluated. Results: In percentual, 52.63 % of
Study Design. A retrospective study. Purpose. Posterolateral fusion with pedicle screw instrumentation used for degenerative lumbar scoliosis can lead to several complications. In elderly patients without sagittal imbalance, dynamic stabilization could represent an option to avoid these adverse events. Methods. 57 patients treated by dynamic stabilization without fusion were included. All patients had degenerative lumbar de novo scoliosis (average Cobb angle 17.2°), without sagittal imbalance, associated in 52 cases (91%) with vertebral canal stenosis and in 24 (42%) with degenerative spondylolisthesis. Nineteen patients (33%) had previously undergone lumbar spinal surgery. Results. At an average followup of 77 months, clinical results improved with statistical significance. Scoliosis Cobb angle was 17.2° (range, 12° to 38°) before surgery and 11.3° (range, 4° to 26°) at last follow-up. In the patients with associated spondylolisthesis, anterior vertebral translation was 19.5% (range, 12% to 27%) before surgery, 16.7% (range, 0% to 25%) after surgery, and 17.5% (range, 0% to 27%) at followup. Complications incidence was low (14%), and few patients required revision surgery (4%). Conclusions. In elderly patients with mild degenerative lumbar scoliosis without sagittal imbalance, pedicle screw-based dynamic stabilization is an effective option, with low complications incidence, granting curve stabilization during time and satisfying clinical results. PMID:23781342
Di Silvestre, Mario; Lolli, Francesco; Greggi, Tiziana; Vommaro, Francesco; Baioni, Andrea
Study Design. A retrospective study. Purpose. Posterolateral fusion with pedicle screw instrumentation used for degenerative lumbar scoliosis can lead to several complications. In elderly patients without sagittal imbalance, dynamic stabilization could represent an option to avoid these adverse events. Methods. 57 patients treated by dynamic stabilization without fusion were included. All patients had degenerative lumbar de novo scoliosis (average Cobb angle 17.2°), without sagittal imbalance, associated in 52 cases (91%) with vertebral canal stenosis and in 24 (42%) with degenerative spondylolisthesis. Nineteen patients (33%) had previously undergone lumbar spinal surgery. Results. At an average followup of 77 months, clinical results improved with statistical significance. Scoliosis Cobb angle was 17.2° (range, 12° to 38°) before surgery and 11.3° (range, 4° to 26°) at last follow-up. In the patients with associated spondylolisthesis, anterior vertebral translation was 19.5% (range, 12% to 27%) before surgery, 16.7% (range, 0% to 25%) after surgery, and 17.5% (range, 0% to 27%) at followup. Complications incidence was low (14%), and few patients required revision surgery (4%). Conclusions. In elderly patients with mild degenerative lumbar scoliosis without sagittal imbalance, pedicle screw-based dynamic stabilization is an effective option, with low complications incidence, granting curve stabilization during time and satisfying clinical results.
Di Silvestre, Mario; Lolli, Francesco; Greggi, Tiziana; Vommaro, Francesco; Baioni, Andrea
Degenerative lumbar scoliosis is a coronal deviation of the spine that is prevalent in the elderly population. Although the\\u000a etiology is unclear, it is associated with progressive and asymmetric degeneration of the disc, facet joints, and other structural\\u000a spinal elements typically leading to neural element compression. Clinical presentation varies and is frequently associated\\u000a with axial back pain and neurogenic claudication.
Suhel Kotwal; Matthias Pumberger; Alex Hughes; Federico Girardi
The clinical outcome of patients with symptomatic lumbar spinal stenosis (LSS) was assessed during a follow-up period of 2 years after X-Stop implantation. The X-Stop is the most commonly used interspinous distraction device in patients with neurogenic intermittent claudication due to LSS. Between 2003 and 2007, more than 1,000 patients were examined in our centre with symptoms of intermittent claudication due to spinal stenosis. Between February 2003 and June 2007, in 175 of these patients an X-Stop device was implanted in one or two levels. Patients were clinically evaluated regularly during a follow-up period of up to 4 years using the VAS (leg pain) score and the Oswestry disability index. The mean VAS (leg pain) score in these 175 patients was reduced from 61.2% preoperatively to 39.0% at the first clincal follow-up examination at 6 weeks postoperatively. The mean VAS score at 24 months postoperatively was 39.0%. Oswestry score was 32.6% preoperatively, 22.7% at 6 weeks, and 20.3% at 24 months postoperatively on average. In eight out of the implanted 175 patients, the X-Stop had to be removed and a microsurgical decompression had to be performed because of unsatisfactory effect of the interspinous distraction device. Our single-centre results indicate not only a satisfactory short-term, but also a good long-term effect during a follow-up period of 2 years. Functional MRI examinations provide helpful, positional-dependent preoperative information. More than any radiological feature, the typical clinical picture of positional-dependent claudication with a relief of symptoms during flexion is the most important factor for appropriate patient selection. The interspinous device does not replace microsurgical decompression in patients with massive stenosis and continuous claudication, but offers a save, effective and less invasive alternative in selected patients with spinal stenosis. Concerning the operative technique, a minimally invasive implantation with preservation of the interspinous ligament is appropriate. Functional (upright-) MRI examinations were able to demonstrate the positional-dependent stenosis. If available, fMRI represents the most helpful radiologic examination in assessing the outcome of interspinous spacer implantation.
Sobottke, Rolf; Eysel, Peer; Simons, Patrick
Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce\\u000a approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective\\u000a manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody\\u000a fusion in low-grade spondylolisthesis performed with an
Jian Wang; Yue Zhou; Zheng Feng Zhang; Chang Qing Li; Wen Jie Zheng; Jie Liu
X-STOP is the first interspinous process decompres- sion device that was shown to be superior to nonoperative therapy in patients with neurogenic intermittent claudication secondary to spinal stenosis in the multicenter randomized study at 1 and 2 years. We present 4-year follow-up data on the X-STOP patients. Patient records were screened to identify potentially eligible subjects who underwent X-STOP implanta-
Dimitriy G. Kondrashov; Matthew Hannibal; Ken Y. Hsu; James F. Zucherman
Purpose Degenerative cervical spondylolisthesis has received insufficient attention, in contrast to degenerative lumbar spondylolisthesis.\\u000a In fact, degenerative cervical spondylolisthesis may be more common than previously thought.\\u000a \\u000a \\u000a \\u000a \\u000a Methods In order to provide appropriate guidelines for the treatment of degenerative cervical spondylolisthesis, a systematic review\\u000a of degenerative cervical spondylolisthesis was performed. An English literature search from January 1947 to November 2010\\u000a was completed with
Sheng-Dan Jiang; Lei-Sheng Jiang; Li-Yang Dai
Background Neurogenic claudication (NC) is the clinical syndrome commonly associated with lumbar spinal stenosis (LSS). Non-surgical management is recommended as initial treatment, but little is known about current practice in relation to the assessment and management of these patients in the non-surgical setting. Methods We conducted a questionnaire survey of physiotherapists in a large UK primary care musculoskeletal service which provides a city-wide multidisciplinary assessment and treatment facility for patients with spinal and other musculoskeletal problems. Data on therapists' recognition and management of patients with NC and LSS were collected. Results Fifty out of 54 therapists completed questionnaires, and all but one of these identified a clearly recognised posture-related clinical syndrome of NC. Almost all respondents (48: 96%) reported the routine use of physiotherapy treatments. In particular, advice and education (49: 98%) along with an exercise programme (47: 94%) incorporating flexion-based exercises (41: 82%) and trunk muscle stabilising exercises (35: 70%) were favoured. Conclusion Musculoskeletal physiotherapy clinicians in this survey recognised a clear clinical syndrome of NC, based on the findings of posture-dependent symptoms. Most therapists reported the routine use of flexion-based exercise, reflecting recommendations in the literature which are based on theoretical benefits, but for which trial evidence is lacking. There is a need for research evidence to guide the choice of physiotherapy treatments.
Comer, Christine M; Redmond, Anthony C; Bird, Howard A; Conaghan, Philip G
A cross-sectional epidemiological study via personal interviews was performed regarding low back pain and its related clinical aspects in a Hungarian sample of 10,000 people. Joining the international campaign of the “Bone and Joint Decade”, our aim was to give data on low back pain prevalence and to explore the underlying possible clinical conditions in a Central European adult and adolescent population. Ten thousand people aged 14–65, selected randomly by the Hungarian central office of statistics from three counties of the south-western Hungarian region, were surveyed using a special questionnaire focusing on low back pain and other degenerative spinal symptoms. People with low back pain complaints and written consent were asked to participate in a further clinical investigation, where radiological and clinical assessment was performed. A total of 4,389 persons (44.1%) reported low back pain in the last month at the time of the survey. Work absenteeism due to low back pain affected 2,140 persons (21.5%). A total of 292 people (2.9%) had already undergone spinal surgery. Upon request 682 people came for a clinical follow-up, where thorough physical examination and radiological analysis was performed and results were statistically interpreted. The Oswestry disability index (ODI) in the examined group of patients averaged 35.1%; radiological degenerative signs were observed in 392/682 (57.5%). Individuals with signs of radiological degeneration had a statistically significant higher ODI value, age, and a higher, yet not significantly increased BMI value than radiographically negative patients (p?0.05). Co-existence of hip and knee osteoarthritis was also investigated. Higher osteoarthritis prevalence was found in individuals with radiographic signs of spinal degeneration. Details of the survey and clinical investigations are discussed.
Koroknai, Gabriella; Acs, Barnabas; Than, Peter; Illes, Tamas
Stand-alone cage for posterior lumbar interbody fusion in the treatment of high-degree degenerative disc disease: design of a new device for an "old" technique. A prospective study on a series of 116 patients.
Chronic lumbar pain due to degenerative disc disease affects a large number of people, including those of fully active age. The usual self-repair system observed in nature is a spontaneous attempt at arthrodesis, which in most cases leads to pseudoarthrosis. In recent years, many possible surgical fusion techniques have been introduced; PLIF is one of these. Because of the growing interest in minimally invasive surgery and the unsatisfactory results reported in the literature (mainly due to the high incidence of morbidity and complications), a new titanium lumbar interbody cage (I-FLY) has been developed to achieve solid bone fusion by means of a stand-alone posterior device. The head of the cage is blunt and tapered so that it can be used as a blunt spreader, and the core is small, which facilitates self-positioning. From 2003 to 2007, 119 patients were treated for chronic lumbar discopathy (Modic grade III and Pfirrmann grade V) with I-FLY cages used as stand-alone devices. All patients were clinically evaluated preoperatively and after 1 and 2 years by means of a neurological examination, visual analogue score (VAS) and Prolo Economic and Functional Scale. Radiological results were evaluated by polyaxial computed tomography (CT) scan and flexion-extension radiography. Fusion was defined as the absence of segmental instability on flexion-extension radiography and Bridwell grade I or II on CT scan. Patients were considered clinical "responders" if VAS evaluation showed any improvement over baseline values and a Prolo value >7 was recorded. At the last follow-up examination, clinical success was deemed to have been achieved in 90.5% of patients; the rate of bone fusion was 99.1%, as evaluated by flexion-extension radiography, and 92.2%, as evaluated by CT scan. Morbidity (nerve root injury, dural lesions) and complications (subsidence and pseudoarthrosis) were minimal. PLIF by means of the stand-alone I-FLY cage can be regarded as a possible surgical treatment for chronic low-back pain due to high-degree DDD. This technique is not demanding and can be considered safe and effective, as shown by the excellent clinical and radiological success rates. PMID:21404031
Costa, Francesco; Sassi, Marco; Ortolina, Alessandro; Cardia, Andrea; Assietti, Roberto; Zerbi, Alberto; Lorenzetti, Martin; Galbusera, Fabio; Fornari, Maurizio
The intervertebral disc is characterized by a tension-resisting annulus fibrosus and a compression-resisting nucleus pulposus composed largely of proteoglycan. The most important function of the annulus and nucleus is to provide mechanical stability to the disc. Degenerative disc disease in the lumbar spine is a serious health problem. Although the three joint complex model of the degenerative process is widely accepted, the etiological basis of this degeneration is poorly understood. With the recent progress in molecular biology and modern biological techniques, there has been dramatic improvement in the understanding of aging and degenerative changes of the disc. Knowledge of the pathophysiology of the disc degeneration can help in the appropriate choice of treatment and to develop tissue engineering for biological restoration of degenerated discs.
Objective The aim of the present study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases. Methods The study population included 20 consecutive patients (13 females, 7 males) with a mean age of 61±6.98 years (range 46-70) who underwent decompression and dynamic stabilization with the Dynesys system between January 2005 and August 2006. The diagnoses included spinal stenosis with degenerative spondylolisthesis (9/20, 45%), degenerative spinal stenosis (5/20, 25%), adjacent segmental disease after fusion (3/20, 15%), spinal stenosis with degenerative scoliosis (2/20, 10%) and recurrent intervertebral lumbar disc herniation (1/20, 5%). All of the patients completed the visual analogue scale (VAS) and the Korean version of the Oswestry Disability Index (ODI). 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 (ROM) was then calculated. Results The mean follow-up period was 27.25±5.16 months (range 16-35 months), and 19 patients (95%) were available for follow-up. One patient had to have the implant removed. There were 30 stabilized segments in 19 patients. Monosegmental stabilization was performed in 9 patients (47.3%), 9 patients (47.3%) underwent two segmental stabilizations and one patient (5.3%) underwent three segmental stabilizations. The most frequently treated segment was L4-5 (15/30, 50%), followed by L3-4 (12/30, 40%) and L5-S1 (3/30, 10%). The VAS decreased from 8.55±1.21 to 2.20±1.70 (p<0.001), and the patients' mean score on the Korean version of the ODI improved from 79.58%±15.93% to 22.17%±17.24% (p<0.001). No statistically significant changes were seen on the ROM at the stabilized segments (p=0.502) and adjacent segments (above segments, p=0.453, below segments, p=0.062). There were no patients with implant failure. Conclusion The results of this study show that the Dynesys system could preserve the motion of stabilized segments and provide clinical improvement in patients with degenerative spinal stenosis with instability. Thus, dynamic stabilization systems with adequate decompression may be an alternative surgical option to conventional fusion in selected patients.
Lee, Soo-Eon; Park, Sung-Bae; Chung, Chun-Kee; Kim, Hyun-Jib
A vacuum facet phenomenon, seen on computed tomography as a lens-shaped lucency within a lumbar facet joint, was observed as a consequence of degenerative spondylolisthesis. The significance of this finding is discussed.
Lefkowitz, D.M.; Quencer, D.M.
Degenerative disc disease (DDD) is a chronic process that can become clinically manifest in multiple disorders such as idiopathic low back pain, disc herniation, radiculopathy, myelopathy, and spinal stenosis. The limited available technology for the treatment of these and other pathologic and disabling conditions arising from DDD is highly invasive (eg, surgical discectomy and fusion), manifesting a certain degree of
S Sobajima; JS Kim; LG Gilbertson; JD Kang
Total disc replacement and posterior dynamic stabilization represent alternatives to lumbar spinal fusion which should reduce the risk of adjacent segment degeneration. Disc replacement is indicated for pure discopathy without facet joint degeneration. Spinopelvic balance influences the implant's biomechanics. Therefore pelvic incidence, sacral slope, segmental lordosis and the mean axis of rotation need to be considered. Dynamic stabilization is indicated in moderate discopathy and facet joint degeneration, in degenerative spondylolisthesis grade I with a hypermobile segment and in dynamic lumbar stenosis. The combination of caudal fusion and cranial dynamic stabilization allows a better maintenance of lordosis with multiple level instrumentation and prevents adjacent segment degeneration. If pelvic incidence and sacral slope are high, L5-S1 should be fused because of elevated shear forces. PMID:21681502
Charles, Y P; Walter, A; Schuller, S; Steib, J-P
Calcific aortic stenosis is the most common cause of aortic valve replacement in developed countries, and this condition increases in prevalence with advancing age. The fibrotic thickening and calcification are common eventual endpoint in both non-rheumatic calcific and rheumatic aortic stenoses. New observations in human aortic valves support the hypothesis that degenerative valvular aortic stenosis is the result of active
Ertan Yetkin; Johannes Waltenberger
We describe the rare simultaneous occurrence of epidural lipomatosis and a perineural cyst at the same level, lumbar kyphosis, osteoporotic vertebral fractures, and neurological deficits. A 75-year-old corticosteroid-dependent female farmer presented with severe low back pain, progressive lumbar kyphosis, and inability to stand because of numbness and muscle weakness of both legs. Plain radiographs displayed markedly decreased bone density, significant lumbar kyphosis, and vertebral compression fractures of L2, L3, and L4. Magnetic resonance imaging of the lumbar spine revealed a perineural cyst at the L2-3 level, extensive epidural lipomatosis, and spinal canal stenosis. Laminectomy from L3 to L5 with resection of epidural fatty tissue restored her walking ability. We postulate that the osteoporotic fractures and epidural lipomatosis were induced by corticosteroid therapy. Preexisting degenerative lumbar kyphosis of the type commonly seen in elderly farmers could have promoted osteoporotic lumbar vertebral fractures at points where bending stress had been strongly exerted. The combination of a perineural cyst and epidural lipomatosis at the same level has not been reported previously. PMID:12486480
Miyakoshi, Naohisa; Shimada, Yoichi; Murai, Hajime; Suzuki, Tetsuya; Hongo, Michio; Itoi, Eiji
\\u000a Anterior lumbar interbody fusion (ALIF) is a method of achieving intersegmental arthrodesis that is indicated for the treatment\\u000a of symptomatic degenerative disease [1, 2]. While ALIF has use for indications involving multiple levels and complex combinations\\u000a of anterior and posterior instrumentation, fusions for degenerative and deformity cases, spondylolisthesis [3, 4], and failed\\u000a posterior surgery with pseudoarthroses, a common indication remains
Henry E. Aryan; Sigurd H. Berven; Christopher P. Ames
Retrospective analysis of 222 cases of degenerative disc disease treated by threaded cage fusion. The objective was to determine the safety and efficiency of lumbar interbody fusions using screwed titanium cages and autogenous bone. Two hundred twenty-two patients had lumbar fusion at 243 levels between L2 and S1, at one or two disc spaces. Main indication was discogenic back pain with radicular leg radiation in degenerative discopathy complicated by disc protusion, segmental canal stenosis with chronic instability or spondylolysthesis of the first degree. Previous failed surgery after discectomy, nonunion or biologically cured discitis were other indications in selected cases. Results were classified as good to excellent in 80%, 15% improved but remained disabled, 5% had minimal or no improvement. Fusion rate was 91% at one year and 96% at 2 years. Peroperative dural tears occurred in 10 patients and transient neurological deficits in 9. A superficial infection occurred in one patient. Reoperation in the first three months included a cage revision in one patient and a foraminotomy in another. Two osteoporotic women needed an additional posterior fixation for kyphotic deformity. In conclusion, lumbar interbody fusion with threaded titanium cages appears to be efficacious with an acceptable rate of complications. Experience up to 7 years confirms that impression. Long term observation is needed before recommending this new method. PMID:11283452
Leclercq, T A; Matgé, G
Since its inception in the year 2001 the minimally invasive trans-psoas Lateral Lumbar Interbody Fusion (LLIF) approach has gained significant favor among spine surgeons. It is now routinely utilized to treat an array of spinal pathologies including degenerative disc disease, low grade spondylolisthesis, and adult spinal deformity. The intent of this video is to provide a step by step account of the basic procedural details when performing the LLIF procedure for a single level broad based degenerated lumbar disc with herniation. The video can be found here: http://youtu.be/dZFMqmCz6Q8. PMID:23829851
Kanter, Adam S; Gandhoke, Gurpreet S
Summary Alkaptonuria is a rare, autosomal recessive metabolic disorder in which the homogentisic acid oxidase activity is absent.\\u000a Its incidence is as low as 0.001%. Ochronosis is the pigmentation of connective tissues and this pigmentation leads to degenerative\\u000a changes in alkaptonuric patients.\\u000a \\u000a Alkaptonuria most prominently involves the lumbar region, but lumbar disc herniation as the presenting feature of alkaptonuria\\u000a is not
D. Gürkanlar; M. Daneyemez; I. Solmaz; C. Temiz
Lumbar synovial cysts frequently present with back pain, chronic radiculopathy and/or progressive symptoms of spinal canal compromise. These cysts generally appear in the context of degenerative lumbar spinal disease. Few cases of spontaneous hemorrhage into synovial cysts have been reported in the literature.
Alen, Jose F.; Ramos, Ana; Lobato, Ramiro D.; Lagares, Alfonso
Study Design Randomized trial and concurrent observational cohort study Objective To compare 4 year outcomes of surgery to non-operative care for spinal stenosis. Summary of Background Data Surgery for spinal stenosis has been shown to be more effective compared to non-operative treatment over two years, but longer-term data have not been analyzed. Methods Surgical candidates from 13 centers in 11 U.S. states with at least 12 weeks of symptoms and confirmatory imaging were enrolled in a randomized cohort (RC) or observational cohort (OC). Treatment was standard decompressive laminectomy or standard non-operative care. Primary outcomes were SF-36 bodily pain (BP) and physical function (PF) scales and the modified Oswestry Disability index (ODI) assessed at 6 weeks, 3 months, 6 months and yearly up to 4 years. Results 289 patients enrolled in the RC and 365 patients enrolled in the OC. An as-treated analysis combining the RC and OC and adjusting for potential confounders found that the clinically significant advantages for surgery previously reported were maintained through 4 years, with treatment effects (defined as mean change in surgery group minus mean change in non-op group) for BP 12.6 (95% CI, 8.5 to 16.7); PF 8.6 (95% CI, 4.6 to 12.6); and ODI ?9.4 (95% CI, ?12.6, to ?6.2). Early advantages for surgical treatment for secondary measures such as bothersomeness, satisfaction with symptoms and self-rated progress also were maintained. Conclusions Patients with symptomatic spinal stenosis treated surgically compared to those treated non-operatively maintain substantially greater improvement in pain and function through four years.
Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna; Blood, Emily; Herkowitz, Harry; Cammisa, Frank; Albert, Todd; Boden, Scott D.; Hilibrand, Alan; Goldberg, Harley; Berven, Sigurd; An, Howard
In response to the rapid development and demand of outpatient endoscopic minimally invasive lumbar surgical technique, the SMART endoscopic spine system was developed for neurodecompression. This lumbar spine surgery is performed with a small skin incision, dilatation surgical technology, and an endoscopic-assisted spinal surgical system with progressive serial tubular retractors providing superior lighting and better visualization of the operative field for performing minimally invasive spinal surgery (MISS). The SMART system incorporates the advantages of posterior paramedian endoscopic assisted microdecompressive surgical spinal system and posterolateral endoscopic lumbar system. This versatile SMART endoscopic spine system with various sized working channels provides a generous and optimal access for endoscopic MISS of microdecompression of herniated lumbar disc, degenerative spinal disease, spinal stenosis, and removal of intraspinal lesions as well as creating an access for spinal arthroplasty and spinal fixation. With the unique features of the SMART system, the surgeon can take advantage of microscopic, endoscopic, or direct vision for microdecompressive spinal surgery, bridging endoscopic and conventional spinal surgery. It appears easy, safe, and efficacious. This less traumatic and easier outpatient MISS treatment leads to excellent result speedier recovery, and significant economic savings. The SMART endoscopic spine system, surgical indications, operative techniques, and the potential complications and their avoidance are described and discussed herein. PMID:17029182
Chiu, John C
Osteoplastic laminectomy has been used to treat lumbar canal stenosis and to prevent postoperative lumbar spinal instability by reconstructing the posterior element of the lumbar spine, which has been documented in many clinical studies. However, the biological sequence of repairing the posterior lumbar element, which is replaced at the time of surgery, has not yet been made clear. An in
Zhenglin Li; Toshihiko Taguchi; Toshikazu Gondo; Shinya Kawai; Kouichiro Toyoda
No consensus has been reached regarding surgical management of degenerative spondylolisthesis. The optimal type of surgical procedure and surgical indications have not been precisely defined. In order to screen for predictors of outcome, we retrospectively studied patient outcomes after posterior decompression and fusion for isolated lumbar degenerative spondylolisthesis. Twenty-four consecutive patients (age range 50–78 years) underwent primary surgery for isolated
Marc-Antoine Rousseau; Jean-Yves Lazennec; Elisa C. Bass; Gérard Saillant
"Degenerative" or calcific aortic stenosis is a complex, multifaceted, systemic disease that is not solely limited to the aortic valve but also includes reduced arterial compliance as well as alterations of left ventricular geometry and function. This particular nature of the disease underscores the need for a more comprehensive evaluation of disease severity going beyond the standard parameters routinely used to assess stenosis severity (i.e., peak jet velocity, pressure gradients, valve effective orifice area) or left ventricle function (i.e., left ventricular ejection fraction). The present paper thus proposes to review newer approaches to improve the quantification of disease severity taking into account the interrelation between the different valvular, arterial, and ventricular variables that may be responsible for the appearance of symptoms and/or poorer prognosis in patients with aortic stenosis. PMID:22789881
Pibarot, Philippe; Dumesnil, Jean G
This study is to compare the therapeutic effect of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody\\u000a fusion (TLIF) with pedicle screw fixation on treatment in adult degenerative spondylolisthesis. A retrospective analysis of\\u000a 187 patients to compare the complications and associated predictive factors of the two techniques of one level lumbar fusion.\\u000a Ninety-one had PLIF with two cages and
Deng-lu Yan; Fu-xing Pei; Jian Li; Cheng-long Soo
Objective. To date, there is still no consensus on the treatment of spinal degenerative disease. Current surgical techniques to manage painful spinal disorders are imperfect. In this paper, we aimed to evaluate the prospective results of posterior transpedicular dynamic stabilization, a novel surgical approach that skips the segments that do not produce pain. This technique has been proven biomechanically and radiologically in spinal degenerative diseases. Methods. A prospective study of 18 patients averaging 54.94 years of age with distant spinal segment degenerative disease. Indications consisted of degenerative disc disease (57%), herniated nucleus pulposus (50%), spinal stenosis (14.28%), degenerative spondylolisthesis (14.28%), and foraminal stenosis (7.1%). The Oswestry Low-Back Pain Disability Questionnaire and visual analog scale (VAS) for pain were recorded preoperatively and at the third and twelfth postoperative months. Results. Both the Oswestry and VAS scores showed significant improvement postoperatively (P < 0.05). We observed complications in one patient who had spinal epidural hematoma. Conclusion. We recommend skipping posterior transpedicular dynamic stabilization for surgical treatment of distant segment spinal degenerative disease.
Solmaz, Bilgehan; Aydin, Ahmet Levent; Gomleksiz, Cengiz; Ataker, Yaprak; Sasani, Mehdi; Oktenoglu, Tunc; Ozer, Ali Fahir
Objective. To date, there is still no consensus on the treatment of spinal degenerative disease. Current surgical techniques to manage painful spinal disorders are imperfect. In this paper, we aimed to evaluate the prospective results of posterior transpedicular dynamic stabilization, a novel surgical approach that skips the segments that do not produce pain. This technique has been proven biomechanically and radiologically in spinal degenerative diseases. Methods. A prospective study of 18 patients averaging 54.94 years of age with distant spinal segment degenerative disease. Indications consisted of degenerative disc disease (57%), herniated nucleus pulposus (50%), spinal stenosis (14.28%), degenerative spondylolisthesis (14.28%), and foraminal stenosis (7.1%). The Oswestry Low-Back Pain Disability Questionnaire and visual analog scale (VAS) for pain were recorded preoperatively and at the third and twelfth postoperative months. Results. Both the Oswestry and VAS scores showed significant improvement postoperatively (P < 0.05). We observed complications in one patient who had spinal epidural hematoma. Conclusion. We recommend skipping posterior transpedicular dynamic stabilization for surgical treatment of distant segment spinal degenerative disease. PMID:23091736
Solmaz, Bilgehan; Aydin, Ahmet Levent; Gomleksiz, Cengiz; Ataker, Yaprak; Sasani, Mehdi; Oktenoglu, Tunc; Ozer, Ali Fahir
The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD)
Fernando Luiz Rolemberg Dantas; Mirto Nelso Prandini; Mauro A. T. Ferreira
Decompression of the lumbar spine for spinal stenosis is a gratifying procedure, improving the quality of life for many otherwise fit elderly and middle-aged patients who are prematurely disabled. There is much debate as to whether or not fusion of the decompressed segments should be part of the surgical procedure. Failure to fuse may leave a patient with good legs
Background Comparatively little is known about the relation between the sagittal vertical axis and clinical outcome in cases of degenerative\\u000a lumbar spondylolisthesis. The objective of this study was to determine whether lumbar sagittal balance affects clinical outcomes\\u000a after posterior interbody fusion. This series suggests that consideration of sagittal balance during posterior interbody fusion\\u000a for degenerative spondylolisthesis can yield high levels of
Mi Kyung Kim; Sun-Ho Lee; Eun-Sang Kim; Whan Eoh; Sung-Soo Chung; Chong-Suh Lee
Clinical interpretation of health services research based on administrative databases is limited by the lack of patient-reported functional outcome measures. Reoperation, as a surrogate measure for poor outcome, may be biased by preferences of patients and surgeons and may even be planned a priori. Other available administrative data outcomes, such as postoperative cross sectional imaging (PCSI), may better reflect changes in functional outcome. The purpose was to determine if postoperative events captured from administrative databases, namely reoperation and PCSI, reflect outcomes as derived by validated functional outcome measures (short form 36 scores, Oswestry disability index) for patients who underwent discretionary surgery for specific degenerative conditions of the lumbar spine such as disc herniation, spinal stenosis, degenerative spondylolisthesis, and isthmic spondylolisthesis. After reviewing the records of all patients surgically treated for disc herniation, spinal stenosis, degenerative spondylolisthesis, and isthmic spondylolisthesis at our institution, we recorded the occurrence of PCSI (MRI or CT-myelograms) and reoperations, as well as demographic, surgical, and functional outcome data. We determined how early (within 6 months) and intermediate (within 18 months) term events (PCSI and reoperations) were associated with changes in intermediate (minimum 1 year) and late (minimum 2 years) term functional outcome, respectively. We further evaluated how early (6-12 months) and intermediate (12-24 months) term changes in functional outcome were associated with the subsequent occurrence of intermediate (12-24 months) and late (beyond 24 months) term adverse events, respectively. From 148 surgically treated patients, we found no significant relationship between the occurrence of PCSI or reoperation and subsequent changes in functional outcome at intermediate or late term. Similarly, earlier changes in functional outcome did not have any significant relationship with subsequent occurrences of adverse events at intermediate or late term. Although it may be tempting to consider administrative database outcome measures as proxies for poor functional outcome, we cannot conclude that a significant relationship exists between the occurrence of PCSI or reoperation and changes in functional outcome. PMID:19816717
Omoto, Daniel; Bederman, S Samuel; Yee, Albert J M; Kreder, Hans J; Finkelstein, Joel A
Background: There is considerable controversy about the long-term morbidity associated with the use of posterior autologous iliac crest bone graft for lumbar spine fusion procedures compared with the use of bone-graft substitutes. The hypothesis of this study was that there is no long-term difference in outcome for patients who had posterior lumbar fusion with or without iliac crest autograft. Methods: The study population includes patients enrolled in the degenerative spondylolisthesis cohort of the Spine Patient Outcomes Research Trial who underwent lumbar spinal fusion. Patients were divided according to whether they had or had not received posterior autologous iliac crest bone graft. Results: There were 108 patients who had fusion with iliac crest autograft and 246 who had fusion without iliac crest autograft. There were no baseline differences between groups in demographic characteristics, comorbidities, or baseline clinical scores. At baseline, the group that received iliac crest bone graft had an increased percentage of patients who had multilevel fusions (32% versus 21%; p = 0.033) and L5-S1 surgery (37% versus 26%; p = 0.031) compared with the group without iliac crest autograft. Operative time was higher in the iliac crest bone-graft group (233.4 versus 200.9 minutes; p < 0.001), and there was a trend toward increased blood loss (686.9 versus 582.3; p = 0.057). There were no significant differences in postoperative complications, including infection or reoperation rates, between the groups. On the basis of the numbers available, no significant differences were detected between the groups treated with or without iliac crest bone graft with regard to the scores on Short Form-36, Oswestry Disability Index, Stenosis Bothersomeness Index, and Low Back Pain Bothersomeness Scale or the percent of patient satisfaction with symptoms averaged over the study period. Conclusions: The outcome scores associated with the use of posterior iliac crest bone graft for lumbar spinal fusion were not significantly lower than those after fusion without iliac crest autograft. Conversely, iliac crest bone-grafting was not associated with an increase in the complication rates or rates of reoperation. On the basis of these results, surgeons may choose to use iliac crest bone graft on a case-by-case basis for lumbar spinal fusion. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Radcliff, Kristen; Hwang, Raymond; Hilibrand, Alan; Smith, Harvey E.; Gruskay, Jordan; Lurie, Jon D.; Zhao, Wenyan; Albert, Todd; Weinstein, James
\\u000a When dealing with degenerative disease at the cervical spine, the target of any procedure must be the complete removal of\\u000a the cause of the damage to the myeloradicu-lar structures. When the pathological process causes an anterior compression, the\\u000a anterior approach should be preferred. The release of the compressed neural structures via an anterior approach can be performed\\u000a by several techniques,
Vincenzo Denaro; Luca Denaro; Alberto Di Martino; Umile Giuseppe Longo; Nicola Maffulli
Decompression surgery for lumbar spinal stenosis is a common procedure. After surgery, segmental instability sometimes occurs, therefore, different methods for restabilization have been developed. Dynamic stabilization systems have been designed to improve segmental stability. In this study, clinical results of patients with lumbar spinal stenosis that underwent decompression and stabilization with the Accuflex dynamic system are presented; clinical, radiographic, and magnetic resonance imaging (MRI) findings are fully described. Improvements in all clinical measurements, including visual analog scale for back and leg pain, Oswestry disability index, and SF-36 health status survey were noticed. At a 2-year follow-up, 22.22% of patients required hardware removal due to fatigue while in 83% of them no progression of disk degeneration was observed after implantation of the Accuflex system. Additionally, as demonstrated by the MRI images at follow up, three patients (16%) showed disk rehydration with one grade higher on the Pfirmann classification. Although a relatively high hardware failure was observed (22.22%), the use of the dynamic stabilization system Accuflex posterior to decompression procedures, showed clinical benefits and stopped the degenerative process in 83% the patients.
Reyes-Sanchez, Alejandro; Ramirez-Mora, Isabel; Rosales-Olivarez, Luis Miguel; Alpizar-Aguirre, Armando; Sanchez-Bringas, Guadalupe
Background Currently, herniated nucleus pulposus (HNP) with radiculopathy and other preconditions are regarded as relative or absolute contraindications for lumbar total disc replacement (TDR). In Switzerland it is left to the surgeon's discretion when to operate. The present study is based on the dataset of SWISSspine, a governmentally mandated health technology assessment registry. We hypothesized that preoperative nucleus pulposus status and presence or absence of radiculopathy has an influence on clinical outcomes in patients treated with mono-segmental lumbar TDR. Methods Between March 2005 and April 2009, 416 patients underwent mono-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. The data collection consisted of perioperative and follow-up data (physician based) and clinical outcomes (NASS, EQ-5D). Patients were divided into four groups according to their preoperative status: 1) group degenerative disc disease ("DDD"): 160 patients without HNP and no radiculopathy, classic precondition for TDR; 2) group "HNP-No radiculopathy": 68 patients with HNP but without radiculopathy; 3) group "Stenosis": 73 patients without HNP but with radiculopathy, and 4) group "HNP-Radiculopathy": 132 patients with HNP and radiculopathy. The groups were compared regarding preoperative patient characteristics and pre- and postoperative VAS and EQ-5D scores using general linear modeling. Results Demographics in all four groups were comparable. Regarding the improvement of quality of life (EQ-5D) there were no differences across the four groups. For the two main groups DDD and HNP-Radiculopathy no differences were found in the adjusted postoperative back- and leg pain alleviation levels, in the stenosis group back- and leg pain relief were lower. Conclusions Despite higher preoperative leg pain levels, outcomes in lumbar TDR patients with HNP and radiculopathy were similar to outcomes in patients with the classic indication; this because patients with higher preoperative leg pain levels benefit from a relatively greater leg pain alleviation. The group with absence of HNP but presence of radiculopathy showed considerably less benefits from the operation, which is probably related to ongoing degenerative processes of the posterior segmental structures. This observational multicenter study suggests that the diagnoses HNP and radiculopathy, combined or alone, may not have to be considered as absolute or relative contraindications for mono-segmental lumbar TDR anymore, whereas patients without HNP but with radiculopathy seem to be suboptimal candidates for the procedure.
It is suggested that the former division of degenerative arthritis into idiopathic types and those secondary to some disease process is no longer valid. Recent studies have indicated that abnormal concentrations of force on cartilage lead to the development of this disease. A classification is presented that is based on the assumption that the process is initiated by abnormal concentrations of force on normal cartilage matrix, normal concentrations of force on abnormal cartilage matrix or normal concentrations of force on normal cartilage matrix that is supported by bone of abnormal consistency.
Mitchell, N. S.; Cruess, R. L.
BACKGROUND: To investigate how unilateral cage-instrumented posterior lumbar interbody fusion (PLIF) affects the three-dimensional flexibility in degenerative disc disease by comparing the biomechanical characteristics of unilateral and bilateral cage-instrumented PLIF. METHODS: Twelve motion segments in sheep lumbar spine specimens were tested for flexion, extension, axial rotation, and lateral bending by nondestructive flexibility test method using a nonconstrained testing apparatus. The
Ti-Sheng Chang; Jia-Hao Chang; Chien-Shiung Wang; Hung-Yi Chen; Ching-Wei Cheng
Anterior lumbar spine approaches may be indicated for fusion in degenerative lumbar spine disorders or to fill discal and bone gaps after fracture reduction. We present an anterior extraperitoneal approach applicable to any discal and vertebral levels from T12 to S1. The anatomic study, based on 25 cadavers, highlights retroperitoneal dissection principles for easy kidney and duodenopancreatic mobilisation and direct
J. Y. Lazennec; B. Pouzet; S. Ramare; N. Mora; S. Hansen; R. Trabelsi; H. Guérin-Surville; G. Saillant
Summary Anterior lumbar spine approaches may be indicated for fusion in degenerative lumbar spine disorders or to fill discal and bone gaps after fracture reduction. We present an anterior extraperitoneal approach applicable to any discal and vertebral levels from T12 to S1. The anatomic study, based on 25 cadavers, highlights retroperitoneal dissection principles for easy kidney and duodenopancreatic mobilisation and
J. Y. Lazennec; B. Pouzet; S. Ramare; N. Mora; S. Hansen; R. Trabelsi; H. Guérin-Surville; G. Saillant
The surgical management of idiopathic thoracolumbar and lumbar scoliosis is complex because of the surgeon's desire to achieve curve correction while maintaining normal lumbar lordosis with as many distal mobile lumbar segments as possible. By doing so, the surgeon is able to maintain normal sagittal alignment and decrease the chance of degenerative lumbar spine disease below the scoliosis fusion. This article discusses the surgical treatment of the thoracolumbar and lumbar curve, and, it is hoped, provides a better understanding of this complex problem. PMID:8159401
Puno, R M; Mehta, S; Byrd, J A
Total lumbar disc replacement (TDR) has been widely used as a treatment option for 2-level symptomatic degenerative disc disease.\\u000a However, recent studies have presented conflicting results and some authors concluded that outcome deteriorated when disc\\u000a replacement was performed bisegmentally, with an increase of complications for bisegmental replacements in comparison with\\u000a monosegmental disc arthroplasty. The goal of the present retrospective study
Mario Di Silvestre; Georgios Bakaloudis; Francesco Lolli; Francesco Vommaro; Patrizio Parisini
The dynamic fixation system Dynesys is utilized in the last 10 years for treatment of degenerative segmental disease of the\\u000a lumbar spine. Dynesys is a semi-rigid fixation system that allows minimal lengthening and shortening between two segmental\\u000a pedicle screws as opposed to a rigid metal bar. Thus, the system is regarded to maintain stability and near physiological\\u000a motion patterns of the
Matthias Bothmann; Erich Kast; Gerald Jens Boldt; Joachim Oberle
As the average life expectancy of the population increases, surgical decompression of the lumbar spine is being performed\\u000a with increasing frequency. It now constitutes the most common type of lumbar spinal surgery in older patients. The present\\u000a prospective study examined the 5-year outcome of lumbar decompression surgery without fusion. The group comprised 159 patients\\u000a undergoing decompression for degenerative spinal disorders
Anne F. MannionR; R. Denzler; J. Dvorak; D. Grob
Posterior lumbar interbody fusion (PLIF) is a popular procedure for treating lumbar canal stenosis with spinal instability,\\u000a and several reports concerning fusion assessment methods exist. However, there are currently no definitive criteria for diagnosing\\u000a a successful interbody fusion in the lumbar spine. We suggested evaluating fusion status using computed tomography (CT) in\\u000a extension position to detect pseudoarthrosis more precisely. The
Hiroaki NakashimaYasutsugu; Yasutsugu Yukawa; Keigo Ito; Yumiko Horie; Masaaki Machino; Shunsuke Kanbara; Daigo Morita; Shiro Imagama; Naoki Ishiguro; Fumihiko Kato
Purpose We investigated types and prevalence of coexisting lesions found on whole spine sagittal T2-weighted images (WSST2I) acquired from magnetic resonance imaging (MRI) and evaluated their clinical significance in surgical degenerative spinal diseases. Materials and Methods Coexisting spinal lesions were investigated using WSST2I from 306 consecutive patients with surgical degenerative spinal diseases. Severity of coexisting lesions was classified into four grades (0-3). Lesions of grade 2 and 3 were defined as "meaningful coexisting spine lesions" (MCSL). Degenerative spinal diseases were classified into three pathologies: simple disc herniation, degenerative spinal stenosis, and ligament ossification disease. The relationships between MCSL, gender, age, and primary spine lesions were analyzed. Results MCSL were found in 95 patients: a prevalence of 31.1%. Five out of 95 MCSL were surgically managed. The most common types of MCSL were disc herniation with 13.1% prevalence, followed by degenerative stenosis (9.5%) and ligament ossification diseases (6.8%). Older patients (age ? 40) showed a significantly higher prevalence of MCSL than younger patients. There was no significant difference between male and female patients. The prevalence of MCSL was significantly higher (52.4%) in ligament ossification diseases than in disc herniation or spinal stenosis. Conclusion Degenerative spinal diseases showed a high prevalence of MCSL, especially in old ages and ligament ossification diseases. WSST2I is useful for diagnosing coexisting spinal diseases and to avoid missing a significant cord-compressing lesion.
Han, In-Ho; Suh, Sang-Hyun; Kuh, Sung-Uk; Chin, Dong-Kyu
It is not clear whether spinal degeneration leads to hip arthritis, or hip arthritis leads to spinal degeneration. We conducted a study to determine which degenerative process precedes the other. We examined 340 cadaveric human specimens from the Hamann-Todd Osteological Collection (Cleveland, Ohio). Lumbar endplate degeneration was graded on a scale of 0 to 4, and hip degeneration on a scale of 0 to 3. Linear regression was used to analyze the relationship between hip osteoarthritis (OA) and lumbar degenerative disk disease (DDD). Exact tests were used to identify differences in each age group. Hip OA was significantly associated with endplate degeneration at the L1, L3, and L5 levels (P<.02). Of the specimens younger than 29 years, 35% had evidence of DDD in at least 1 lumbar level, and 17% of hip OA changes. At 70 years, 100% of the specimens had evidence of DDD and 50% of hip OA changes. There was a significant association between lumbar DDD and hip OA changes (P<.05). Early lumbar DDD was twice as common as hip OA changes in the early 20s age range. These findings suggest that lumbar degeneration precedes hip degeneration and may be a causative factor for hip OA. PMID:24078941
Bajwa, Navkirat S; Toy, Jason O; Young, Ernest Y; Cooperman, Daniel R; Ahn, Nicholas U
Heavy physical work and activity lead to degenerative changes, especially in the lumbar spine. We aimed to find out the occurence\\u000a of radiographic changes (vertebral osteophytes, heights of lumbar dicsc, concavity index) and abnormalities of the lumbar\\u000a spine in former professional football (association football or soccer) players according to their specialization (goalkeeper,\\u000a defender, midfielder, forward) in their past professional sport
Alpaslan Öztürk; Yüksel Özkan; Recai M. Özdemir; Nazan Yalç?n; Semra Akgöz; Vedat Saraç; Serkan Aykut
Objective Diagnosing degenerative disk disease (DDD) at the lumbosacral junction (LSJ) on plain films is often difficult, compared with\\u000a other disk levels. The purpose of this study was to determine whether criteria for diagnosis of DDD at the LSJ can be established\\u000a for plain films.\\u000a \\u000a \\u000a \\u000a Design and patients We retrospectively reviewed 100 lumbar MRI scans of patients who also had lumbar plain
Evan L. Cohn; Erik J. Maurer; Theodore E. Keats; Robert G. Dussault; Phoebe A. Kaplan
We investigated the spinopelvic morphology and global sagittal balance of patients with a degenerative retrolisthesis or anterolisthesis. A total of 269 consecutive patients with a degenerative spondylolisthesis were included in this study. There were 95 men and 174 women with a mean age of 64.3 years (sd 10.5; 40 to 88). A total of 106 patients had a pure retrolisthesis (R group), 130 had a pure anterolisthesis (A group), and 33 had both (R+A group). A backward slip was found in the upper lumbar levels (mostly L2 or L3) with an almost equal gender distribution in both the R and R+A groups. The pelvic incidence and sacral slope of the R group were significantly lower than those of the A (both p < 0.001) and R+A groups (both p < 0.001). The lumbar lordosis of the R+A group was significantly greater than that of the R (p = 0.025) and A groups (p = 0.014). The C7 plumb line of the R group was located more posteriorly than that of the A group (p = 0.023), but was no different from than that of the R+A group (p = 0.422). The location of C7 plumb line did not differ between the three groups (p = 0.068). The spinosacral angle of the R group was significantly smaller than that of the A group (p < 0.001) and R+A group (p < 0.001). Our findings imply that there are two types of degenerative retrolisthesis: one occurs primarily as a result of degeneration in patients with low pelvic incidence, and the other occurs secondarily as a compensatory mechanism in patients with an anterolisthesis and high pelvic incidence. Cite this article: Bone Joint J 2013;95-B:1244-9. PMID:23997140
Jeon, C-H; Park, J-U; Chung, N-S; Son, K-H; Lee, Y-S; Kim, J-J
Gossypiboma is a mass formed by a retained surgical sponge and reactive tissue. The cases with gossypiboma are usually asymptomatic or with nonspecific symptoms, which delay diagnosis for months or years after surgery. We describe imaging findings in a 43-year-old woman with a symptomatic retained surgical sponge in a lumbar laminectomy site. Ultrasonography, computed tomography, magnetic resonance imaging (MRI), and diffusion-weighted MRI were performed. Gossypiboma should be considered in the differential diagnosis of a mass in a patient with a history of prior surgery. Diffusion-weighted MRI may provide important data for differential diagnosis of gossypiboma. With diffusion-weighted MRI, gossypiboma may be distinguished from an abscess by its low signal intensity and increased apparent diffusion coefficient (ADC) as compared to high signal intensity with low ADC in cases of abscess. PMID:19813177
Erdem, Gülnur; Ate?, Ozkan; Koçak, Ayhan; Alkan, Alpay
Introduction There are several practical problems encountered in the TLIF procedure with implantation of two titanium cages, such as difficulty\\u000a in achieving symmetric positioning with two cages, loosening of the first cage following insertion of the second cage and\\u000a higher direct costs to the patient.\\u000a \\u000a \\u000a \\u000a \\u000a Method From January 2005 to December 2007, a total of 76 consecutive patients treated with instrumented TLIF
Jian Zhou; Bo Wang; Jian Dong; Xilei Li; Xiaogang Zhou; Taolin Fang; Hong Lin
We examined the impact of degenerative conditions in the spine (osteophytosis and endplate sclerosis) and aortic calcification in the lumbar region on bone mineral content\\/density (BMC\\/BMD) measured in the spine and forearm by absorptiometry and on fracture risk prediction. The radiographs of 387 healthy postmenopausal women, aged 68–72 years, were assessed in masked fashion for the presence of osteophytosis, endplate
P. von der Recke; M. A. Hansen; K. Overgaard; C. Christiansen
Degenerative instability affecting the functional spinal unit is discussed as a cause of symptoms. The value of imaging signs\\u000a for assessing the resulting functional impairment is still unclear. To determine the relationship between slight degrees of\\u000a degeneration and function, we performed a biomechanical study with 18 multisegmental (L2-S2) human lumbar cadaveric specimens.\\u000a The multidirectional spinal deformation was measured during the
Ulrich Quint; Hans-Joachim Wilke
Calcified aortic valve disease is a slowly progressive disorder that ranges from mild valve thickening with no obstruction of blood flow, known as aortic sclerosis, to severe calcification with impaired leaflet motion or aortic stenosis. In the present work we describe a rapid, reproducible and effective method to carry out proteomic analysis of stenotic human valves by conventional 2-DE and 2D-DIGE, minimizing the interference due to high calcium concentrations. Furthermore, the protocol permits the aortic stenosis proteome to be analysed, advancing our knowledge in this area. Summary: Until recently, aortic stenosis (AS) was considered a passive process secondary to calcium deposition in the aortic valves. However, it has recently been highlighted that the risk factors associated with the development of calcified AS in the elderly are similar to those of coronary artery disease. Furthermore, degenerative AS shares histological characteristics with atherosclerotic plaques, leading to the suggestion that calcified aortic valve disease is a chronic inflammatory process similar to atherosclerosis. Nevertheless, certain data does not fit with this theory making it necessary to further study this pathology. The aim of this study is to develop an effective protein extraction protocol for aortic stenosis valves such that proteomic analyses can be performed on these structures. In the present work we have defined a rapid, reproducible and effective method to extract proteins and that is compatible with 2-DE, 2D-DIGE and MS techniques. Defining the protein profile of this tissue is an important and challenging task that will help to understand the mechanisms of physiological/pathological processes in aortic stenosis valves.
Gil-Dones, Felix; Martin-Rojas, Tatiana; Lopez-Almodovar, Luis F.; de la Cuesta, Fernando; Darde, Veronica M.; Alvarez-Llamas, Gloria; Juarez-Tosina, Rocio; Barroso, Gemma; Vivanco, Fernando; Padial, Luis R.; Barderas, Maria G.
A study of 60 children with thoracic and lumbar spine injuries indicates that the child's response to trauma is unique. It is concluded that the potential for growth and development and the presence of healthy tissues separate these injuries from comparable injuries in adults. The epiphyseal growth partly or completely restores vertebral body height, leads to a mild spinal deformity in stable injuries, and can contribute to rapidly progressive spinal deformity in unstable injuries with or without paralysis. Healthy intervertebral discs account for the multiple compression fractures and lack of long term degenerative changes of the spine. On the basis of this review, a practical approach to patient care is presented. PMID:958686
Hubbard, D D
Background Laminectomy/laminotomy and foraminotomy are well established surgical techniques for treatment of symptomatic lumbar spinal stenosis. However, these procedures have significant limitations, including limited access to lateral and foraminal compression and postoperative instability. The purpose of this cadaver study was to compare bone, ligament, and soft tissue morphology following lumbar decompression using a minimally invasive MicroBlade Shaver® instrument versus hemilaminotomy with foraminotomy (HL). Methods The iO-Flex® system utilizes a flexible over-the-wire MicroBlade Shaver instrument designed for facet-sparing, minimally invasive “inside-out” decompression of the lumbar spine. Unilateral decompression was performed at 36 levels in nine human cadaver specimens, six with age-appropriate degenerative changes and three with radiographically confirmed multilevel stenosis. The iO-Flex system was utilized on alternating sides from L2/3 to L5/S1, and HL was performed on the opposite side at each level by the same investigator. Spinal canal, facet joint, lateral recess, and foraminal morphology were assessed using computed tomography. Results Similar increases in soft tissue canal area and decreases in ligamentum flavum area were noted in nondiseased specimens, although HL required removal of 83% more laminar area (P < 0.01) and 95% more bone resection, including the pars interarticularis and facet joints (P < 0.001), compared with the iO-Flex system. Similar increases in lateral recess diameter were noted in nondiseased specimens using each procedure. In stenotic specimens, the increase in lateral recess diameter was significantly (P = 0.02) greater following use of the iO-Flex system (43%) versus HL (7%). The iO-Flex system resulted in greater facet joint preservation in nondiseased and stenotic specimens. In stenotic specimens, the iO-Flex system resulted in a significantly greater increase in foraminal width compared with HL (24% versus 4%, P = 0.01), with facet joint preservation. Conclusion The iO-Flex system resulted in significantly better decompression of the lateral recess and foraminal areas compared with HL, while preserving posterior spinal elements, including the facet joint.
Lauryssen, Carl; Berven, Sigurd; Mimran, Ronnie; Summa, Christopher; Sheinberg, Michael; Miller, Larry E; Block, Jon E
Many studies have demonstrated that SIRT1, an NAD(+)-dependent deacetylase, reduces apoptosis in several different cells. However, the role of SIRT1 in apoptosis of disc nucleus pulposus (NP) cells remains unclear. The present study was performed to determine whether degenerative human NP would express SIRT1, and to investigate the role of SIRT1 in NP cells apoptosis. The expression of SIRT1 in disc NP of patients (>55 years) with lumbar disc degenerative disease (DDD) and the disc NP of patients (<25 years) with lumbar vertebra fracture (LVF) was assessed by immunohistochemistry, reverse transcription polymerase chain reaction, and Western blot analysis. The results showed that SIRT1 mRNA and protein levels were greater in LVF disc NP than those in DDD disc NP. Degenerative human NP cells were treated in culture with activator or inhibitor of SIRT1, resveratrol or nicotinamide, or SIRT1 small interfering RNA (siRNA), and cell apoptosis was quantified via flow cytometry. The rate of apoptosis was far fewer in resveratrol-treated NP cells than in SIRT1 siRNA-transfected or nicotinamide-treated NP cells. After SIRT1 siRNA was transfected, NP cells decreased phosphorylation of Akt, while resveratrol phosphorylated Akt. Treatment with LY294002 or Akt siRNA increased the rate of apoptosis. Our results suggested that SIRT1 plays a critical role in survival of degenerative human NP cells through the Akt anti-apoptotic signaling pathway. PMID:22990594
Wang, Dawu; Hu, Zhenming; Hao, Jie; He, Bin; Gan, Qiang; Zhong, Xiaoming; Zhang, Xiaojun; Shen, Jieliang; Fang, Ji; Jiang, Wei
Study Design: A prospective, non-comparative study of 27 patients to evaluate the safety and performance of the Memory Metal Spinal System used in a PLIF procedure in the treatment of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease (DDD). Objective: To evaluate the clinical performance, radiological outcome and safety of the Memory Metal Spinal System, used in a PLIF procedure, in the treatment of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease in human subjects. Summary of Background Data: Spinal systems that are currently available for correction of spinal deformities or degeneration such as lumbar spondylosis or degenerative disc disease, use components manufactured from stainless steel or titanium and typically comprise two spinal rods with associated connection devices. The Memory Metal Spinal System consists of a single square spinal rod made from a nickel titanium alloy (Nitinol) used in conjunction with connection devices. Nitinol is characterized by its shape memory effect and is a more flexible material than either stainless steel or titanium. With current systems there is loss of achieved reposition due to the elastic properties of the spine. By using a memory metal in this new system the expectation was that this loss of reposition would be overcome due to the metal’s inherent shape memory properties. Furthermore, we expect a higher fusion rate because of the elastic properties of the memory metal. Methods: Twenty-seven subjects with primary diagnosis of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease (DDD) were treated with the Memory Metal Spinal System in conjunction with the Brantigan IF® Cage in two consecutive years. Clinical performance of the device was evaluated over 2 years using the Oswestry Disability Index (ODI), Short Form 36 questionnaire (SF-36) and pain visual analogue scale (VAS) scores. Safety was studied by collection of adverse events intra-operative and during the followup. Interbody fusion status was assessed using radiographs and a CT scan. Results: The mean pre-operative ODI score of 40.9 (±14.52) significantly improved to 17.7 (±16.76) at 24 months postoperative. Significant improvement in the physical component from the SF36 questionnaire was observed with increases from the baseline result of 42.4 to 72.7 at 24 months (p<.0001); The emotional component in the SF36 questionnaires mean scores highlighted a borderline significant increase from 56.5 to 81.7 at 24 months (p=0.0441). The average level of leg pain was reduced by more than 50% postoperation (VAS values reduced from 5.7 (±2.45) to 2.2 (±2.76) at 24 month post-operation with similar results observed for back pain. CT indicated interbody fusion rate was not significantly faster compared to other devices in literature. No device related adverse events were recorded in this study. Conclusions: The Memory Metal Spinal System, different from other devices on the market with regard to material and the one rod configuration, is safe and performed very well by improving clinically important outcomes in the treatment of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease. In addition the data compares favorably to that previously reported for other devices in the literature.
Kok, D; Grevitt, M; Wapstra, FH; Veldhuizen, AG
Spinal stenosis in either the cervical or lumbar spinal segments is one of the most common indications for spine imaging and intervention, particularly among the elderly. This article examines the pathophysiology and imaging of the corresponding clinical syndromes, cervical spondylotic myelopathy or neurogenic intermittent claudication. The specificity fault of spine imaging is readily evident in evaluation of spinal stenosis, as many patients with anatomic cervical or lumbar central canal narrowing are asymptomatic. Imaging also may be insensitive to dynamic lesions. Those imaging features that identify symptomatic patients, or predict response to interventions, are emphasized. PMID:22643390
Maus, Timothy P
Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI). Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR) are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures. Results Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI. Conclusion Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.
Robinson, Yohan; Sanden, Bengt
Summary Background. Synovial cysts represent an uncommon and probably underestimated pathological entity of the degenerative lumbar spine. The\\u000a authors report a retrospective analysis of the clinical presentation, radiological studies and operative findings in 77 patients\\u000a surgically treated for symptomatic lumbar synovial cysts at their institution.\\u000a \\u000a Materials and method. Between January 1992 and June 1998, a total of 77 patients presenting with
P. Métellus; S. Fuentes; T. Adetchessi; O. Levrier; I. Flores-Parra; D. Talianu; H. Dufour; C. Bouvier; L. Manera; F. Grisoli
Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF) system is a minimally invasive fusion device that accesses the lumbar (L4–S1) intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.
Rapp, Steven M; Miller, Larry E; Block, Jon E
Interspinous devices (IDs) were introduced in the 90s. Since then, they have rapidly become very popular for the minimally\\u000a invasive treatment of lumbar pain disorders. They feature different shapes and biomechanical characteristics, and are used\\u000a in the spine degenerative pathologies or as motion segment stabilizers (dynamic stabilization) or to obtain the decompression\\u000a of neurological structures. The indications seem to be
Francesco Ciro Tamburrelli; Luca Proietti; Carlo Ambrogio Logroscino
Summary \\u000a Due to the decreased trauma in anterior as well as posterior surgical approaches to the spine, microsurgical techniques have\\u000a been used more frequently in recent years. This article describes two new microsurgical techniques to approach the anterior\\u000a lumbar spine for interbody fusion as part of a posterior-anterior stabilization concept in various diseases like spondylolisthesis,\\u000a degenerative instability; failed back surgery
H. M. Mayer; K. Wiechert
Decompression surgery for lumbar spinal stenosis is a common procedure. After surgery, segmental instability sometimes occurs,\\u000a therefore, different methods for restabilization have been developed. Dynamic stabilization systems have been designed to\\u000a improve segmental stability. In this study, clinical results of patients with lumbar spinal stenosis that underwent decompression\\u000a and stabilization with the Accuflex dynamic system are presented; clinical, radiographic, and
Alejandro Reyes-SanchezBaronZ; Barón Zárate-Kalfópulos; Isabel Ramírez-Mora; Luis Miguel Rosales-Olivarez; Armando Alpizar-Aguirre; Guadalupe Sánchez-Bringas
Laryngotracheal stenosis in infancy and childhood is challenging in many aspects. Diagnosis and therapy require specific expertise and must be tailored to the individual case. The most important presentations of airway pathology in children are presented in this paper. Conservative, endoscopic and surgical treatment options are discussed. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach.Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred.Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Subglottic stenosis in children requires expertise and experience in diagnosis and treatment. Considering the limited incidence these cases should be managed in a referral center. PMID:22700463
In a longitudinal study, the dose–response relationships between long term occupational exposure to whole-body vibration and degenerative processes in the lumbar spine caused by the lumbar disks were examined. From 1990 to 1992, 388 vibration-exposed workers from different driving jobs were examined medically and by lumbar X-ray. For each individual, a history of all exposure conditions was recorded, and a
S. Schwarze; G. Notbohm; H. Dupuis; E. Hartung
The application of MRI as a non-invasive, quantitative tool for diagnosing lumbar intervertebral disc degeneration is currently\\u000a an area of active research. The objective of this study was to examine, in vitro, the efficacy of a manganese chloride phantom-based\\u000a MRI technique for quantitatively assessing lumbar disc composition and degenerative condition. Sixteen human lumbar discs\\u000a were imaged ex vivo using T2-weighted
Lachlan J. Smith; Andrew P. Kurmis; John P. Slavotinek; Nicola L. Fazzalari
Background X-ray images of lumbar degenerative diseases often show not only claw osteophytes, but also pairs of osteophytes that form in a direction away from the adjacent disc. We have investigated the direction of the formation of anterior lumbar vertebral osteophytes across the lumbar vertebrae using a sufficient number of lumbar radiographs, because osteophytes images can provide essential information that will contribute to the understanding of the pathology and progress of lumbar spine degeneration. Methods The direction of the formation of 14,250 pairs of anterior lumbar vertebral osteophytes across the adjacent intervertebral discs in 2,850 patients who were all over 60 years old was investigated. Anterior lumbar vertebral osteophytes were distributed into six groups based on the direction of extension of each pair of osteophytes across the intervertebral disc space. Results In L1–L2 and L2–L3, the number of patients classified into groups B (the pair of osteophytes extended in the direction of the adjacent disc) and C (almost complete bone bridge formation by a pair of osteophytes across the intervertebral disc space) was larger than that classified into group D (the pair of osteophytes extended in a direction away from the adjacent disc). In L3–L4, L4–L5 and L5-S1, the number of patients in group D was greater than that of patients belonging to groups B and C. Conclusion Our study showed that pairs of osteophytes frequently formed in the direction of the adjacent disc in the upper lumbar vertebrae (L1–L2 and L2–L3) and in the direction away from the adjacent disc in middle or lower lumbar vertebrae (L3–L4, L4–L5, and L5-S1).
Kasai, Yuichi; Kawakita, Eiji; Sakakibara, Toshihiko; Akeda, Koji; Uchida, Atsumasa
Neurological complications of lumbar artificial disc replacement and comparison of clinical results with those related to lumbar arthrodesis in the literature: results of a multicenter, prospective, randomized investigational device exemption study of Charité intervertebral disc: Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004
Object. Arthrodesis is the gold standard for surgical treatment of lumbar degenerative disc disease (DDD). Solid fusion, however, can cause stress and increased motion in the segments adjacent to the fused level. This may initiate and\\/or accelerate the adjacent-segment disease process. Artificial discs are designed to restore and maintain normal motion of the lumbar intervertebral segment. Restoring and maintaining normal
Fred H. Geisler; Scott L. Blumenthal; Richard D. Guyer; Paul C. McAfee; John J. Regan; J. Patrick Johnson; Bradford Mullin
Objective. Posterior dynamic stabilization is an effective alternative to fusion in the treatment of chronic instability and degenerative disc disease (DDD) of the lumbar spine. This study was undertaken to investigate the efficacy of dynamic stabilization in chronic degenerative disc disease with Modic types 1 and 2. Modic types 1 and 2 degeneration can be painful. Classic approach in such cases is spine fusion. We operated 88 DDD patients with Modic types 1 and 2 via posterior dynamic stabilization. Good results were obtained after 2 years of followup. Methods. A total of 88 DDD patients with Modic types 1 and 2 were selected for this study. The patients were included in the study between 2004 and 2010. All of them were examined with lumbar anteroposterior (AP) and lateral X-rays. Lordosis of the lumbar spine, segmental lordosis, and ratio of the height of the intervertebral disc spaces (IVSs) were measured preoperatively and at 3, 12, and 24 months after surgery. Magnetic resonance imaging (MRI) analysis was carried out, and according to the data obtained, the grade of disc degeneration was classified. The quality of life and pain scores were evaluated by visual analog scale (VAS) score and Oswestry Disability Index (ODI) preoperatively and at 3, 12, and 24 months after surgery. Appropriate statistical method was chosen. Results. The mean 3- and 12-month postoperative IVS ratio was significantly greater than that of the preoperative group (P < 0.001). However, the mean 1 and 2 postoperative IVS ratio was not significantly different (P > 0.05). Furthermore, the mean preoperative and 1 and 2 postoperative angles of lumbar lordosis and segmental lordosis were not significantly different (P > 0.05). The mean VAS score and ODI, 3, 12, and 24 months after surgery, decreased significantly, when compared with the preoperative scores in the groups (P = 0.000). Conclusion. Dynamic stabilization in chronic degenerative disc disease with Modic types 1 and 2 was effective.
Eser, Olcay; Gomleksiz, Cengiz; Sasani, Mehdi; Oktenoglu, Tunc; Aydin, Ahmet Levent; Ataker, Yaprak; Suzer, Tuncer; Ozer, Ali Fahir
Interspinous devices have been introduced to provide a minimally invasive surgical alternative for patients with lumbar spinal\\u000a stenosis or foraminal stenosis. Little is known however, of the effect of interspinous devices on intersegmental range of\\u000a motion (ROM). The aim of this in vivo study was to investigate the effect of a novel minimally invasive interspinous implant,\\u000a InSwing®, on sagittal plane
Robert Gunzburg; Marek Szpalski; Stuart A. Callary; Christopher J. Colloca; Victor Kosmopoulos; Deed Harrison; Robert J. Moore
The procedure of anterior lumbar interbody fusion (ALIF) is commonly performed on patients suffering from pain and/or neurological symptoms associated with disorders of the lumbar spine caused by disc degeneration and trauma. Surgery is indicated when prolonged conservative management proves ineffective. Because an important objective of the ALIF procedure is solid arthrodesis of the degenerative spinal segment, bone graft selection is critical. Iliac crest bone grafts (ICBG) remain the "gold standard" for achieving lumbar fusion. However, patient dissatisfaction stemming from donor site morbidity, lengthier operating times and finite supply of ICBG has prompted a search for better alternatives. Here presented is a literature review evaluating available bone graft options assessed within the clinical setting. These options include autografts, allograft-based, synthetic and cell-based technologies. The emphasis is on the contentious use of recombinant human bone morphogenetic proteins, which is in widespread use and has demonstrated both significant osteogenic potential and risk of complications. PMID:23658041
Mobbs, Ralph J; Chung, Mina; Rao, Prashanth J
Yoga is a popular exercise with evidence of var - ious physical and psychological benefits. However, most of these studies are based on subjective scales. To our k nowledge, there are ver y few original studies on MRI analyses of yoga prac - ticing individuals at present. Here we conducted a MRI-based case-control study of yoga and lumbar degenerative disc
Tzu-Chieh Cheng; Fu-Jen Catholic Uiversity; Chin-Ming Jeng
Introduction. One common cause of low lumbar back pain is degenerative disc disease. A physiological intervertebral disc has several functions in the axial system. Each disc is attached to the vertebra above and below and serves as a connector and a spacer. Surgical treatment of back pain becomes more common in medical practice. There are two surgical methods in treating
At some point in their lives, about 80% of adults will suffer acute back pain as a result of normal degenerative processes.l As symptoms progress, lumbar surgery may become necessary. In fact, over 200,000 spinal fusion operations are performed each year in the United States to treat severe physical disability associated with lov back pain. Twothirds of these procedures are
Jens Peter Timm
BACKGROUND CONTEXT: Somatosensory evoked potentials (SSEP) are commonly used to monitor the spinal cord and nerve roots during operative procedures that put those structures at risk. The utility of SSEPs to evaluate cauda equina and nerve root function during posterior spinal arthrodesis with pedicular fixation for degenerative lumbar disease has been reported anecdotally and remains controversial.PURPOSE: An institution-wide review of
Mukund Gundanna; Mark Eskenazi; John Bendo; Jeffrey Spivak; Ronald Moskovich
Background. Anterior or posterior interbody fusion is performed to stabilise the mechanically inadequate segment of the lumbar spine. Posterior lumbar interbody fusion allows for simultaneous decompression of the spinal canal and restoration of the sagittal profile. Anterior interbody fusion allows for stabilisation of the segment without opening the spinal canal. The choice of technique has been the subject of much discussion. Material and methods. 111 patients with degenerative discopathy in the lumbar spine were treated surgically with either PLIF (Posterior Lumbar Intervertebral Fusion) or ALIF (Anterior Lumbar Intervertebral Fusion). The former group consisted of patients with nerve root symptoms; the latter, of patient with discogenic spinal pain. The outcomes were evaluated according to the Oswestry Index, the VAS, and patient satisfaction. Results. There were significant differences between groups in clinical presentation and radiological imaging. The main indication in the PLIF group was the need to decompress the nerve root. In the ALIF group, with no need to open the spinal canal, anterior fusion was performed from the extraperitoneal approach. In preliminary outcome analysis postoperative improvement was noted sooner in the ALIF group. Completion of the outcome analysis is in progress to assess the long-term effectiveness of these techniques. Conclusions. In my opinion the emphasis should be placed on early and proper diagnostic assessment allowing for the introduction of appropriate treatment including surgical intervention, at least in some groups of patients. PMID:17675984
Wójcik, Andrzej S
Previously, aortic valve stenosis (AS) etiology was usually congenital or due to rheumatic disease. However, the most frequent cause is now degenerative AS, which is often part of a continuum including increased rigidity of the aorta due to atherosclerosis and left ventricular dysfunction due to coronary artery disease. This article highlights newer approaches to quantify AS taking into account the inter-relation between the different components (valvular, vascular, and ventricular) affecting clinical outcome in these patients. Emphasis is given to a more comprehensive evaluation of AS severity going beyond classical measurements and including indices such as 1) the energy loss index to quantify the valvular obstruction net of pressure recovery; 2) systemic arterial compliance to quantify vascular load; and 3) valvular-arterial impedance to assess the global (valvular + vascular) increase in afterload. Routine use of these indices, easily measured by Doppler echocardiography, should improve clinical management of AS patients. PMID:18417008
Dumesnil, Jean G; Pibarot, Philippe; Akins, Cary
STUDY DESIGN:: A retrospective study. OBJECTIVE:: To determine the clinical and radiological outcomes of the long-term results of instrumented MIS-TLIF in unstable, single level, low-grade, isthmic spondylolisthesis (IS) or degenerative spondylosis (DS) including degenerative spondylolisthesis, foraminal stenosis with central stenosis, degenerative disc disease, and recurrent disc herniation. SUMMARY OF BACKGROUND DATA:: MIS-TLIF is a common surgical procedure to treat lumbar spondylolisthesis. However, there are no studies that have documented the long-term results of MIS-TLIF. METHODS:: Forty-four patients who had undergone instrumented MIS-TLIF between July 2003 and January 2005, were retrospectively reviewed. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), patient satisfaction rate (PSR), and the patient's return-to-work status were used to assess clinical and functional outcomes. Radiological follow-up were carried out in patients to check for adjacent segmental degeneration (ASD). The plain radiographs, CT and MRI were used in all patients in last follow-up period. RESULTS:: The mean VAS scores for back and leg pain decreased from 5.8 and 7 to 3.5 and 3.7 respectively in the DS group (n=19) and from 6.8 and 6.9 to 1.8 and 2.0 respectively in the IS group (n=25) (P<0.001). The mean ODI scores improved from 61.7% to 21.5% in the DS group and from 53.9% to 16% in the IS group (P<0.001). PSR was 80% and 81% in the DS and IS groups, respectively. Evidence of fusion was observed radiologically in 24 (96%) and 19 (100%) of the patients in the IS and the DS group respectively, giving an overall fusion rate of 97.7% (43/44). The final ASD rate, observed using radiography, was 68.4% (13/19) in the DS, and 40% (10/25) in the IS group. However, 15.8% (3/19) in the DS and 4% (1/25) in the IS group had symptoms associated with ASD. CONCLUSIONS:: The long-term clinical and radiologic outcomes after instrumented MIS-TLIF in patients with unstable single-level spine are favorable. PMID:23027364
Kim, Jin-Sung; Jung, Byungjoo; Lee, Sang-Ho
The benefits of anterior interbody arthrodesis in deformity surgery are well known and include load sharing and increased fusion rates. A minimally invasive lateral transpsoas approach to the anterior lumbar spine is a promising alternative to traditional interbody techniques for the treatment of adult degenerative scoliosis. The reported advantages of the minimally invasive lateral transpsoas approach include reduced blood loss and shorter length of stay. However, there are several approach-related complications associated with this technique including injury to the nerves within the abdominal wall leading to abdominal wall paresis, bowel injury, and injury to the lumbar plexus. In this video, we demonstrate the key steps of the minimally invasive lateral retroperitoneal transpsoas technique for interbody fusion in the treatment of adult degenerative scoliosis. The video demonstrates patient positioning, surgical opening, passage through the anatomical safe zone, use of multidirectional EMG to navigate away from the lumbar plexus, placement of the expandable retractor, discectomy, endplate preparation, graft insertion, and wound closure. Special emphasis is placed on the approach. We highlight the relevant nerves passing through the abdominal wall with the aid of a microscope. The video can be found here: http://youtu.be/XU1OujNF8F8. PMID:23829840
Amin, Beejal Y; Mummaneni, Praveen V; Ibrahim, Tarik; Zouzias, Alex; Uribe, Juan
The occurrence of degenerative spinal disease subsequent to dystonic movement disorders has been neglected and has received more attention only recently. Spinal surgery is challenging with regard to continuous mechanical stress when treatment of the underlying movement disorder is insufficient. To characterize better the particular features of degenerative spinal disease in patients with dystonia and to analyze operative strategies, we
Thomas J. Loher; Christian B. Bärlocher; Joachim K. Krauss
Degenerative spinal disorders, including intervertebral disc disease and spondylosis, seldom occur in domestic cats. In contrast, a retrospective study of 13 lions ( Panthera leo), 16 tigers (Panthera tigris), 4 leopards (Panthera pardis), 1 snow leopard (Panthera uncia), and 3 jaguars (Panthera onca) from the Knoxville Zoo that died or were euthanatized from 1976 to 1996 indicated that degenerative spinal
Christine Kolmstetter; Linda Munson; Edward C. Ramsay
Degenerative instability affecting the functional spinal unit is discussed as a cause of symptoms. The value of imaging signs for assessing the resulting functional impairment is still unclear. To determine the relationship between slight degrees of degeneration and function, we performed a biomechanical study with 18 multisegmental (L2-S2) human lumbar cadaveric specimens. The multidirectional spinal deformation was measured during the continuous application of pure moments of flexion/extension, bilateral bending and rotation in a spine tester. The three flexibility parameters neutral zone, range of motion and neutral zone ratio were evaluated. Different grading systems were used: (1) antero-posterior and lateral radiographs (degenerative disk disease) (2) oblique radiographs (facet joint degeneration) (3) macroscopic and (4) microscopic evaluation. The most reliable correlation was between the grading of microscopic findings and the flexibility parameters; the imaging evaluation was not as informative. PMID:18839226
Quint, Ulrich; Wilke, Hans-Joachim
Pain of the cervical spine is either directly or indirectly dependent on degenerative changes in the cervical dinks. Traumatic injury to the cervical spine may result in a cervical syndrome some years later as a result of degenerative changes. Cervical disk protrusuion or degenerative changes can be compared to a similar condition which occurs in the lumbar spine. Differential diagnosis in cases with only local cervical syndrome is difficult. In cases with brachialgia due to disk protrusion or exostosis of the uncinate processes (with segmental syndromes), careful clinical examination is very helpful in diagnosis. Despite the various causes for cervical disk syndromes, the conservative treatment is quite uniform. In cases where results of conservative treatment are non satisfactional, surgery should be disenssed. In cases with massive neurologic deficits, operation is necessary. Authors describe new spine graft "Tibone" for anterior interbody cervical fusion. PMID:18033211
Lukawski, S; Milecki, M
Background The operative treatment of adult degenerative scoliosis combined with osteoporosis increase following the epidemiological development. Studies have confirmed that screws in osteoporotic spines have significant lower-screw strength with more frequent screw movements within the vertebra than normal spines. Screws augmented with Polymethylmethacrylate (PMMA) or with autogenous bone can offer more powerful corrective force and significant advantages. Methods A retrospective analysis was conducted on 31 consecutive patients with degenerative lumbar scoliosis combined with osteoporosis who had surgery from December 2000. All had a minimum of 2-year follow-up. All patients had posterior approach surgery. 14 of them were fixed with pedicle screw by augmentation with Polymethylmethacrylate (PMMA) and the other 17 patients with autogenous bone. Age, sex and whether smoking were similar between the two groups. Surgical time, blood loss, blood transfusion, medical cost, post surgery ICU time, hospital day, length of oral pain medicines taken, Pre-and postoperative Oswestry disability index questionnaire and surgical revision were documented and compared. Preoperative, postoperative and final follow up Cobb angle, sagittal lumbar curve, correction rate, and Follow up Cobb loss were also compared. Results No significant differences were found between the autogenous bone group and Polymethylmethacrylate group with regards to all the targets above except for length of oral pain medicines taken and surgery cost. 2 patients were seen leakage during operation, but there is neither damage of nerve nor symptom after operation. No revision was needed. Conclusion Both augmentation pedicle screw with Polymethylmethacrylate (PMMA) and autogenous bone treating degenerative lumbar scoliosis combined with osteoporosis can achieve a good surgical result. Less oral pain medicines taken are the potential benefits of Polymethylmethacrylate augmentation, but that is at the cost of more medical spending.
Objectives: Congenital tracheal stenosis is a rare disease. Various methods for treatment exist but there is still much debate as to the appropriate surgical procedure. We present our surgical experiences of patch tracheoplasty and slide tracheoplasty as viable methods for the treatment of congenital tracheal stenosis. Methods: From 1994 to 2002, 13 patients were diagnosed with congenital tracheal stenosis. Eight
Hong Kwan Kim; Young Tae Kim; Sook Whan Sung; June Dong Park; Chang Hyun Kang; Joo Hyun Kim; Yong Jin Kim
Tracheal stenosis in burns is rare and usually results from prolonged intubation or tracheostomy. Inhalation injury itself has the potential risk of tracheal stenosis. We reviewed the records of 1878 burn patients during 1987 to 1995 and found seven with tracheal stenosis (0.37%) after an average of 4.4 years follow up. There were 4 males and 3 females with an
Jui-Yung Yang; Wen-Guei Yang; Li-Yen Chang; Shiow-Shuh Chuang
Stereotypies are simple or complex involuntary/unvoluntary behaviors, common in fronto-temporal dementia (FTD), but not studied in other types of degenerative dementias. The aim was to investigate stereotypy frequency and type in patients with FTD, Alzheimer's disease (AD), progressive supranuclear palsy (PSP) and Parkinson's disease with dementia (PDD) in a multicenter observational study; and to investigate the relation of stereotypies to cognitive, behavioral and motor impairment. One hundred fifty-five consecutive outpatients (45 AD, 40 FTD, 35 PSP and 35 PDD) were studied in four hospitals in northern Italy. Stereotypies were examined by the five-domain Stereotypy Rating Inventory. Cognition was examined by the Mini Mental State and Frontal Assessment Battery, neuropsychiatric symptoms by the Neuropsychiatric Inventory, and motor impairment and invalidity by the Unified Parkinson's Disease Rating Scale part III, and activities of daily living. Stereotypies were present in all groups. FTD and PDD had the greatest frequency of one-domain stereotypies; FTD also had the greatest frequency of two-or-more domain stereotypies; movement stereotypies were the most common stereotypies in all groups. AD patients had fewer stereotypies than the other groups. Stereotypies are not exclusive to FTD, but are also fairly common in PSP and PDD, though less so in AD. Stereotypies may be underpinned by dysfunctional striato-frontal circuits, known to be damaged in PSP and PDD, as well as FTD. PMID:22648476
Prioni, S; Fetoni, V; Barocco, F; Redaelli, V; Falcone, C; Soliveri, P; Tagliavini, F; Scaglioni, A; Caffarra, P; Concari, L; Gardini, S; Girotti, F
Infantile hypertrophic pyloric stenosis (IHPS) occurs in up to 1 in 4000 babies and results from thickening of the pyloric muscle. Babies with IHPS present with non-bilious projectile vomiting which in turn leads to a hyponatraemic, hypokalaemic, hypochloraemic, metabolic alkalosis. Diagnosis is confirmed by abdominal examination during a ‘test-feed’ during which the hypertrophied pyloric muscle can be palpated as an
Paul RV Johnson
A total of 503 patients underwent 521 tracheal resections and reconstructions for postintubation stenosis from 1965 through 1992. Fifty-three had had prior attempts at surgical resection, 51 others had undergone various forms of tracheal or laryngeal repair, and 45 had had laser treatment. There were 251 cuff lesions, 178 stomal lesions, 38 at both levels, and 36 of indeterminate origin.
Hermes C. Grillo; Dean M. Donahue; Douglas J. Mathisen; John C. Wain; Cameron D. Wright
There are many issues to consider in evaluating the biomechanics of lumbar arthroplasty, which may consist of a nucleus replacement, a total disc replacement, or a mobile posterior device. The goal of spinal arthroplasty is to replicate or augment the function of the normal spinal elements, by taking into consideration both in the quantity and quality of motion that occurs across the replaced joint. This article describes the relevant parameters for studying the biomechanics of lumbar arthroplasty and briefly summarizes the current knowledge with regard to those parameters in some well-known lumbar nucleoplasty, facet replacement, and total disc arthroplasty devices. PMID:16326282
Crawford, Neil R
Lumbar spondylolysis, a well known cause of low back pain, usually affects the pars interarticularis of a lower lumbar vertebra and rarely involves the articular processes. We report a rare case of bilateral spondylolysis of inferior articular processes of L4 vertebra that caused spinal canal stenosis with a significant segmental instability at L4/5 and scoliosis. A 31-year-old male who had suffered from low back pain since he was a teenager presented with numbness of the right lower leg and scoliosis. Plain X-rays revealed bilateral spondylolysis of inferior articular processes of L4, anterolisthesis of the L4 vertebral body, and right lateral wedging of the L4/5 disc with compensatory scoliosis in the cephalad portion of the spine. MR images revealed spinal canal stenosis at the L4/5 disc level. Posterior lumbar interbody fusion of the L4/5 was performed, and his symptoms were relieved.
Morozumi, Naoki; Hoshikawa, Takeshi; Ogawa, Shinji; Ishii, Yushin; Itoi, Eiji
Lumbar spondylolysis, a well known cause of low back pain, usually affects the pars interarticularis of a lower lumbar vertebra and rarely involves the articular processes. We report a rare case of bilateral spondylolysis of inferior articular processes of L4 vertebra that caused spinal canal stenosis with a significant segmental instability at L4/5 and scoliosis. A 31-year-old male who had suffered from low back pain since he was a teenager presented with numbness of the right lower leg and scoliosis. Plain X-rays revealed bilateral spondylolysis of inferior articular processes of L4, anterolisthesis of the L4 vertebral body, and right lateral wedging of the L4/5 disc with compensatory scoliosis in the cephalad portion of the spine. MR images revealed spinal canal stenosis at the L4/5 disc level. Posterior lumbar interbody fusion of the L4/5 was performed, and his symptoms were relieved. PMID:22111522
Koakutsu, Tomoaki; Morozumi, Naoki; Hoshikawa, Takeshi; Ogawa, Shinji; Ishii, Yushin; Itoi, Eiji
Robotic assistance has gained increasing popularity in spinal surgery recently. Robotic assistance provides higher effectiveness and safety especially in conditions of complicated anatomy. It also enables the novel, previously unavailable surgical techniques, such as GO-Lif for lumbar spine fusion. The aim of the study is to assess the applicability and effectiveness of the robotic assistance in surgical treatment of degenerative lesion of lumbar spine. 16 patients were operated with robotic assistance device (SpineAssist; MAZOR Surgical Technologies, Caesarea, Israel) between August 2009 and February 2010 in Spinal Department of Burdenko Neurosurgical Institute (Moscow, Russia) with degenerative disc disease. Preoperative assessment included MRI, X-rays and high-resolution CT (slice < 1 mm). The CT is essential for preoperative planning using computed work station SpineAssist. The robot was utilized for automated intraoperative positioning of the instruments according to preoperatively planned trajectories. Basic parameters of surgeries were thoroughly recorded: overall surgery time, radiation dose (all manipulations were performed under fluoroscopic control), accuracy of screw placement relative to preoperative planning, which was assessed using postoperative high-resolution CT with 3D reconstruction. Particular interest of the study was focused on the novel fusion technique for lumbar spine: Go-Lif (Guided Oblique Lumbar Interbody Fusion). This fusion modality enables segment fixation with two screws only, it is comparable with pedicular screws in terms of stability, being far less invasive. It may be used standalone or together with TLIF techniques. Robotic assistance enabled optimal screw placement even in complex anatomical cases (thin pedicles and rotational deformity). No implant-related complications were recorded. Surgery time was much longer in first 2 cases, though in further it decreased nearly to conventional (without robot) surgery time. For radiation dose same tendency was observed--in first 2 cases all surgical steps were fluoroscopically controlled, in further cases--only for primary anatomy registration. Based on control CT, accuracy of implant placement with robotic assistance is 1 mm. PMID:21260933
Konovalov, N A; Shevelev, I N; Kornienko, V N; Nazarenko, A G; Zelenkov, P V; Isaev, K A; Asiutin, D S
Stenosis of the nerve root canal caused by isolated resorption of a lumbar disc is a frequently observed pathology, but one about which the orthopaedist still knows relatively little. Henry Crock was the first to reveal its principal pathogenetic factor, disc resorption, and to accurately describe the syndrome and its surgical treatment. A total of 22 patients operated according to Henry Crock's indications and followed-up after 2 years were reviewed. In 20 cases decompression alone was performed, while in 2 cases anterior fusion and MOSS instrumentation were associated. Of the 22 patients submitted to decompression 17 revealed complete regression of pain. Three cases failed: 1 patient had previously been treated with chymopapain, while 3 are awaiting anterior fusion to treat persistent lumbar pain. Follow-up is not sufficient for the two patients submitted to anterior fusion. PMID:1587162
Gallinaro, P; Indemini, E; Tabasso, G; Massazza, G
Lumbar radiculopathy is a common problem. Nerve root compression can occur at different places along a nerve root's course including in the foramina. Minimal invasive approaches allow easier exposure of the lateral foramina and decompression of the nerve root in the foramina. This video demonstrates a minimally invasive approach to decompress the lumbar nerve root in the foramina with a lateral to medial decompression. The video can be found here: http://youtu.be/jqa61HSpzIA. PMID:23829856
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 some companies that would
F. J. Robaina Padrón
Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.
Brisinda, Giuseppe; Vanella, Serafino; Cadeddu, Federica; Marniga, Gaia; Mazzeo, Pasquale; Brandara, Francesco; Maria, Giorgio
Of 46 patients who underwent a lumbar or lumbo-sacral anterior interbody fusion at one or two levels, 16 were available for a follow-up of 16-20 years. The indications for operation were instability, degenerative disc disease, pseudarthrosis of a posterior fusion, and spondylolisthesis. Preoperative roentgenograms were compared with those made at follow-up 16 years (or more) later. In only a minority of patients was discopathy or instability found. The roentgenographic findings of the operated patients at a follow-up of at least 16 years were compared with those of a group of age- and sex-matched controls not previously treated for backache. We found that most degenerative changes of the adjacent discs occurred at a rate nearly similar to that in the corresponding levels of the controls. These results may suggest that lumbar anterior interbody spondylodesis does not accelerate the development of degenerative changes in adjacent discs. PMID:1441964
Van Horn, J R; Bohnen, L M
Study design:?Systematic literature review.Rationale:?Many authors have postulated on various risk factors associated with the pathogenesis of degenerative spondylolisthesis (DS), yet controversies regarding those risk factors still exist.Objective:?To critically appraise and summarize evidence on risk factors for DS.Methods:?Articles published before October 15, 2011, were systematically reviewed using PubMed and bibliographies of key articles. Each article was subject to quality rating and was analyzed by two independent reviewers.Results:?From 382 citations, 30 underwent full-text review. Fourteen studies met inclusion criteria. All but two were considered poor quality. Female gender and higher facet joint angle were consistently associated with an increased risk of DS across multiple studies. Multiple studies also consistently reported no association between back pain and prolonged occupational sitting. Associations between age, parity, lumbosacral angle, lumbar lordosis, facet joint tropism, and pelvic inclination angles were inconsistent.Conclusions:?There appears to be consistent evidence to suggest that the risk of DS increases with increasing age and is greater for females and people with a greater facet joint angle. PMID:23230415
Devine, John G; Schenk-Kisser, Jeannette M; Skelly, Andrea C
Hypertrophic pyloric stenosis is a very common surgical problem in infants. It occurs most often in otherwise well babies with normal gestation and birth history. Rarely, pyloric stenosis has been described in babies with history of prior abdominal surgery. Below we discuss the management of hypertrophic pyloric stenosis in a child who remained hospitalized, recovering from repair of a congenital abdominal wall defect. PMID:24069986
Streit, Stephanie M; Dixon, Jennifer A; Hebra, André
It is probable that both genetic and environmental factors play some part in the aetiology of most cases of degenerative hip disease. Geneticists have identified some single gene disorders of the hip, but have had difficulty in identifying the genetics of many of the common causes of degenerative hip disease. The heterogeneity of the phenotypes studied is part of the problem. A detailed classification of phenotypes is proposed. This study is based on careful documentation of 2003 consecutive total hip replacements performed by a single surgeon between 1972 and 2000. The concept that developmental problems may initiate degenerative hip disease is supported. The influences of gender, age and body mass index are outlined. Biomechanical explanations for some of the radiological appearances encountered are suggested. The body weight lever, which is larger than the abductor lever, causes the abductor power to be more important than body weight. The possibility that a deficiency in joint lubrication is a cause of degenerative hip disease is discussed. Identifying the phenotypes may help geneticists to identify genes responsible for degenerative hip disease, and eventually lead to a definitive classification. PMID:22933490
Hamilton, H W; Jamieson, J
STUDY DESIGN:: retrospective analysis of prospectively collected clinical data. OBJECTIVE:: To assess the long-term outcome of patients with monosegmental L4/5 degenerative spondylolisthesis treated with the dynamic Dynesys device. SUMMARY OF BACKGROUND DATA:: The Dynesys® system has been used as a semirigid, lumbar dorsal pedicular stabilization device since 1994. Good short-term results have been reported, but little is known about the long-term outcome following treatment for degenerative spondylolisthesis at the L4/5 level. METHODS:: 39 consecutive patients with symptomatic degenerative lumbar spondylolisthesis at the L4/5 level were treated with bilateral decompression and Dynesys instrumentation. At a mean follow-up of 7.2 years (range 5.0-11.2?y) they underwent clinical and radiographic evaluation and quality of life assessment. RESULTS:: At final follow-up back pain improved in 89% and leg pain improved in 86% of patients compared to preoperative status. 83% of patients reported global subjective improvement. 92% would undergo the surgery again. 8 patients (21%) required further surgery due to symptomatic adjacent segment disease (6 cases), late onset infection (1 case), and screw breakage (1 case). In 9 cases radiological progression of spondylolisthesis at the operated segment was found. 74% of operated segments showed limited flexion-extension range of less than 4°. Adjacent segment pathology, though without clinical correlation, was diagnosed at the L5/S1 (17.9%) and L3/4 (28.2%) segments. In 4 cases asymptomatic screw loosening was observed. CONCLUSION:: Monosegmental Dynesys instrumentation of degenerative spondylolisthesis at L4/5 shows good long-term results. The rate of secondary surgeries is comparable to other dorsal instrumentation devices. Residual range of motion in the stabilized segment is reduced, and the rate of radiological and symptomatic adjacent segment degeneration is low. Patient satisfaction is high. Dynesys stabilization of symptomatic L4/5 degenerative spondylolisthesis is a possible alternative to other stabilization devices. PMID:23075857
Hoppe, Sven; Schwarzenbach, Othmar; Aghayev, Emin; Bonel, Harald; Berlemann, Ulrich
Hydrogels are currently applied in the treatment of numerous degenerative diseases because of their three dimensional (3D) nature, high water content and wide range of polymers that can be used for their fabrication. Hydrogels have been investigated and commercialized, for example, as soft contact lens-based ophthalmic drug delivery systems. These novel devices improved the bioavailability of ophthalmic drugs and their residence time. Hydrogels are also being investigated to facilitate and augment targeted delivery of chemotherapeutic agents. This approach minimizes significantly the side effects associated with conventional administration of anti-cancer therapeutics. The application of hydrogels as 3D scaffold has recently gained momentum because they can mimic key features of the extracellular matrix. For this reason, hydrogels are representing a viable alternative to traditional tumor xenograft in cancer biology studies. This review highlights recent advances in the development of hydrogels that are applied in degenerative diseases such as ocular, cancer, spine and cartilage degenerative pathologies. PMID:22512441
Mawad, Damia; Boughton, Elizabeth Anne; Boughton, Philip; Lauto, Antonio
Objective Osteoarthritis (OA) and osteoporosis are often considered to lie at opposite ends of a spectrum of bone phenotypes. Lumbar degenerative disc disease (LDD) may be associated with low back pain (LBP) and is similar in many ways to OA. LDD is reported in small studies to be associated with increased spine bone mineral density (BMD). The present work aimed to confirm this association in a large population sample using MRI and explore the relationship further, in particular to determine whether it is mediated genetically. Methods A population based sample (N=908, age range 32–74 years) of UK female twins having MRI of the lumbar spine was used in this study. LDD traits and summary measures and their relationship with BMD at the lumbar spine and hip were examined using multivariate multiple regression and maximum likelihood based variance decomposition. Results There was a significant positive correlation between LDD and BMD at the lumbar spine and hip, which remained significant after adjustment for confounders. Both traits were highly heritable and the associations between them were mediated genetically. Conclusions A clear, significant and independent association of BMD at hip and lumbar spine with LDD was found which is, in part, genetically mediated. The association with the non-axial site, the hip, is of particular interest and suggests a systemic bone effect. This should encourage the search for pleiotropic genes to help in the understanding of the bone–cartilage relationship. Moreover, genetic variants identified could provide novel therapeutic targets in the management of LBP.
Livshits, Gregory; Ermakov, Sergey; Popham, Maria; MacGregor, Alex J; Sambrook, Philip N; Spector, Timothy D; Williams, Frances M K
The rapid growth of spine degenerative surgery has led to unrelenting efforts to define and prevent possible complications, the incidence of which is probably higher than that reported and varies according to the region of the spine involved (cervical and thoracolumbar) and the severity of the surgery. Several issues are becoming progressively clearer, such as complication rates in primary versus revision spinal surgery, complications in the elderly, the contribution of minimally invasive surgery to the reduction of complication rate. In this paper the most common surgical complications in degenerative spinal surgery are outlined and discussed.
Papadakis, Michael; Aggeliki, Lianou; Papadopoulos, Elias C; Girardi, Federico P
Introduction. The use of extreme lateral interbody fusion (XLIF) and other lateral access surgery is rapidly increasing in popularity. However, limited data is available regarding its use in scoliosis surgery. The objective of this study was to evaluate the clinical outcomes of adults with degenerative lumbar scoliosis treated with XLIF. Methods. Thirty consecutive patients with adult degenerative scoliosis treated by a single surgeon at a major academic institution were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Validated clinical outcome scores were obtained on patients preoperatively and at most recent follow-up. Complications were recorded. Results. The study group demonstrated improvement in multiple clinical outcome scores. Oswestry Disability Index scores improved from 24.8 to 19.0 (P?0.001). Short Form-12 scores improved, although the change was not significant. Visual analog scores for back pain decreased from 6.8 to 4.6 (P?0.001) while scores for leg pain decreased from 5.4 to 2.8 (P?0.001). A total of six minor complications (20%) were recorded, and two patients (6.7%) required additional surgery. Conclusions. Based on the significant improvement in validated clinical outcome scores, XLIF is effective in the treatment of adult degenerative scoliosis.
Caputo, Adam M.; Michael, Keith W.; Chapman, Todd M.; Massey, Gene M.; Howes, Cameron R.; Isaacs, Robert E.; Brown, Christopher R.
Over a 10-year period, we have performed pyloromyotomy on 260 infants with hypertrophic pyloric stenosis (HPS), 10 of whom had a history suggestive of pyloric stenosis but initially had neither the physical nor radiological findings to confirm the diagnosis. All 10 demonstrated pylorospasm on upper gastrointestinal series (UGIS), were treated medically without improvement, and subsequently developed classic HPS confirmed by
John R. Wesley; Michael A. DiPietro; Arnold G. Coran
In this study we evaluated the role of resistivity index (RI) in predicting the outcome (6–12-month follow up) of blood pressure (BP) and renal function (RF) in 104 hypertensive patients(HP)(50 females) with renovascular disease (78 atherosclerotic and 41 fibrodysplasic) submitted to successful percutaneous renal artery stenosis revascularization.HP underwent trans-lumbar duplex Ultrasound. RI was derived from the interlobular arteries and a
Stefania Pinto; Vinicio Napoli; Elena Daghini; Francesca Boresi; Carlo Bartolozzi; Antonio Salvetti
A prospective observational study was conducted on patients undergoing posterior lumbar spine surgery for degenerative spinal\\u000a disorders. The study purpose was to evaluate the effect of wait time to surgery on patient derived generic and disease specific\\u000a functional outcome following surgery. A prolonged wait to surgery may adversely affect surgical outcome. Although there is\\u000a literature on the effect of wait
Jason Braybrooke; Henry Ahn; Aimee Gallant; Michael Ford; Yigel Bronstein; Joel Finkelstein; Albert Yee
We present a two-part review article on the current state of knowledge of lumbar facet joint pathology. This first article\\u000a discusses the functional anatomy, biomechanics, and radiological grading systems currently in use in clinical practice and\\u000a academic medicine. Facet joint degeneration is presented within the larger context of degenerative disc disease to enable\\u000a the reader to better understand the anatomical
Gerard P. Varlotta; Todd R. Lefkowitz; Mark Schweitzer; Thomas J. Errico; Jeffrey Spivak; John A. Bendo; Leon Rybak
Segmental instability in degenerative disc disease is often treated with anterior lumbar interbody fusion (ALIF). Current\\u000a techniques require an additional posterior approach to achieve sufficient stability. The test device is an implant which consists\\u000a of a PEEK-body and an integrated anterior titanium plate hosting four diverging locking screws. The test device avoids posterior\\u000a fixation by enhancing stability via the locking
Philipp Schleicher; R. Gerlach; B. Schär; C. M. J. Cain; W. Achatz; R. Pflugmacher; N. P. Haas; F. Kandziora
BackgroundThe stability of the lumbar spine after ALIF with lateral plate fixation and\\/or posterior fixation has previously been investigated; however, stand-alone ALDF with plate has not. Previous clinical studies have demonstrated poor fusion rates with stand-alone anterior interbody fusion in the absence of posterior instrumentation. We review our initial experience with stand-alone ALDF with segmental plate fixation for degenerative disc
Henry E. Aryan; Daniel C. Lu; Frank L. Acosta; Christopher P. Ames
A retrospective study was conducted to evaluate degenerative joint disease (DJD) in captive waterfowl that died or were euthanized at Fresno's Chaffee Zoo in Fresno, California, USA from 2001 to 2005. Of these, 16 out of 33 birds (48%) had DJD in one or both stifle (femoral–tibiotarsal joint; n = 13), hock (tibiotarsal–tarsometatarsal joint; n = 4), or toe joints
L. A. Degernes; P. S. Lynch; H. L. Shivaprasad
Summary The authors examined 34 tendons under the electron microscope, excised within 48 h after rupture of the tendons. The tendons did not exhibit any signs of inflammation or lipomatosis, but fine-structurally marked hypoxic alterations in the tenocytes could be seen. The degenerative (hypoxic tendinopathy appears in three phases, and the hypoxic lesions of the tendon occur at multiple foci
L. Józsa; B. J. Bálint; A. Réffy; Z. Demel
Over the past decade, remarkable progress has been made in the study of molecular mechanisms involved in degenerative temporomandibular joint arthritides. Based on recent findings, models of degenerative temporomandibular joint disease predict that mechanical loads trigger a cascade of molecular events leading to disease in susceptible individuals. These events involve the production or release of free radicals, cytokines, fatty acid catabolites, neuropeptides, and matrix-degrading enzymes. Under normal circumstances, these molecules may be involved in the remodeling of articular tissues in response to changing functional demands. However, if functional demands exceed the adaptive capacity of the temporomandibular joint or if the affected individual is susceptible to maladaptive responses, then a disease state will ensue. An individual's susceptibility to degenerative temporomandibular joint disease may be determined by several factors, including genetic backdrop, sex, age, and nutritional status. It is hoped that, by furthering our understanding of the molecular events that underlie degenerative temporomandibular joint diseases, improved diagnostics and effective therapies for these debilitating conditions will be developed. PMID:16170470
Milam, Stephen B
Twenty patients with degenerative joint disease (DJD) of the hip were treated for prolonged periods with an extract of cartilage and bone marrow. Although clinical improvement, lessened joint pain and increased function, occurred in a majority of the patients, the most significant changes were in four who had concomitant x-ray improvement. These patients had roentgenographic evidence of recovery of joint
Charles W. Denko
Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K.), full golf swings were monitored without a corset (WOC), with a soft corset (SC), and with a hard corset (HC), with each subject taking 3 swings. Changes in the angle between the pelvis and the thorax (maximum range of motion and angular velocity) in 3 dimensions (lumbar rotation, flexion-extension, and lateral tilt) were analyzed, as was rotation of the hip joint. Peak changes in lumbar extension and rotation occurred just after impact with the ball. The extension angle of the lumbar spine at finish was significantly lower under SC (38°) or HC (28°) than under WOC (44°) conditions (p < 0.05). The maximum angular velocity after impact was significantly smaller under HC (94°/sec) than under SC (177°/sec) and WOC (191° /sec) conditions, as were the lumbar rotation angles at top and finish. In contrast, right hip rotation angles at top showed a compensatory increase under HC conditions. Wearing a lumbar corset while swinging a golf club can effectively decrease lumbar extension and rotation angles from impact until the end of the swing. These effects were significantly enhanced while wearing an HC. Key pointsRotational and extension forces on the lumbar spine may cause golf-related low back painWearing lumbar corsets during a 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
Hashimoto, Koji; Miyamoto, Kei; Yanagawa, Takashi; Hattori, Ryo; Aoki, Takaaki; Matsuoka, Toshio; Ohno, Takatoshi; Shimizu, Katsuji
Background Relationships between patient satisfaction with nursing and patient clinical data have not been fully resolved in a Polish sample. Our objectives were to determine clinical factors associated with patient satisfaction with nursing and investigate differences between patients treated surgically for cervical or lumbar discopathy and degenerative changes. Material/Methods This prospective and cross-sectional study included 63 consecutively selected patients treated surgically for lumbar discopathy and degenerative spine disease and 41 patients undergoing surgery for cervical discopathy and degenerative spine disease from 1st June 2009 to 31st September 2010 in the Department of Neurosurgery and Neurotraumatology of Poznan University of Medical Sciences. In the first stage of this study, socio-demographic data, medical history, and clinical patient characteristics were collected. A minimum 12-month follow-up formed the second part. Nineteen patients with lumbar discopathy were excluded because they were unable to answer the questionnaire. Finally, 44 consecutively selected patients treated surgically for lumbar discopathy and 41 patients undergoing surgery due to cervical discopathy were evaluated with the Polish version of the Newcastle Satisfaction with Nursing Scale (NSNS-PL). Results In patients with cervical and lumbar discopathy, the average Experiences of Nursing Care Subscale (ENCS) scores were 82.0 (SD 15.1) and 79.0 (SD 13.5), respectively, whereas the average Satisfaction with Nursing Care Subscale (SNCS) scores were 75.6 (SD 18.1) and 74.4 (SD 16.8), respectively. The study groups did not differ in regards to NSNS subscales. Associations between ENCS and SNCS scores were confirmed in both patient groups (rS=.73, p<0.001 and rS=.73, p<0.001, respectively). Conclusions Our study highlights the importance of assessing the association between patient characteristics and patient perception of quality of nursing care. Satisfaction with treatment outcome and conviction about undergoing the same treatment affected experiences and satisfaction with nursing in the cervical group only.
Garczyk, Danuta; Jankowski, Roman; Misterska, Ewa; Glowacki, Maciej; Zukiel, Ryszard; Kowalska, Anna M.
In patients with symptomatic severe aortic stenosis (AS) therapeutic decision is straightforward and aortic valve replacement is strongly recommended. In asymptomatic AS patients clinical strategy is controversial and challenging. Prospective studies suggest a watchful waiting approach in the majority of patients with regular follow-up exams. Defining symptomatic status related to the disease can be particularly difficult in the elderly and patients with comorbidities. A robust measurement of AS severity is mandatory in this context. Nevertheless some patients with asymptomatic AS benefit from early valve replacement and reliable risk stratification for identification of high-risk patients is of importance. This review article will outline relevant clinical studies and guidelines on management of asymptomatic AS patients. PMID:21674426
Bahlmann, E; Kuck, K-H; Nienaber, C A
Interbody fusion techniques have been used for many years for the treatment of a variety of lumbar spine diagnoses. Part of the interest in increasing methods of interbody fusion has stemmed from concern that posterior fusion alone may allow micro-motion, which may generate pain in a ruptured or degenerated disc. Stabilization of the anterior segment led to the development of
Scott L Blumenthal; Donna D Ohnmeiss
To evaluate the clinical outcome, effectiveness and safety of the surgical management of traumatic lumbar spondylolisthesis\\u000a with transforaminal lumbar interbody fusion (TLIF) with short segmental instrumentation fixation. A retrospective review of\\u000a a consecutive series of 24 patients with traumatic lumbar spondylolisthesis treated with TLIF procedure was carried out. Intraoperative\\u000a spinal cord monitoring was used to confirm the peripheral neural function
Jian-guang Xu; Bing-fang Zeng; Wei-qing Kong; Wei Zhou; Yi-shan Fu; Bi-zeng Zhao; Tao Zhang; Xiao-feng Lian
Little information is available regarding the long-term effects, if any, of running on the musculoskeletal system. The authors compared the prevalence of degenerative joint disease among 17 male runners with 18 male nonrunners. Running subjects (53% marathoners) ran a mean of 44.8 km (28 miles)/wk for 12 years. Pain and swelling of hips, knees, ankles and feet and other musculoskeletal complaints among runners were comparable with those among nonrunners. Radiologic examinations (for osteophytes, cartilage thickness, and grade of degeneration) also were without notable differences among groups. They did not find an increased prevalence of osteoarthritis among the runners. Our observations suggest that long-duration, high-mileage running need to be associated with premature degenerative joint disease in the lower extremities.
Panush, R.S.; Schmidt, C.; Caldwell, J.R.; Edwards, N.L.; Longley, S.; Yonker, R.; Webster, E.; Nauman, J.; Stork, J.; Pettersson, H.
Background/Objective: Pseudomeningocele is most commonly the result of a rent in the meninges during spine surgery. Noniatrogenic causes exist but are rare. Pseudomeningoceles may heal spontaneously, but they may also slowly enlarge. They rarely present as a mass within the abdomen. The objective of this study was to present the first case report of hydronephrosis secondary to lumbar pseudomeningocele. Design: Single case report and literature review. Methods: Single case report. Results: This man had undergone extensive lumbar spine surgery for pain and spondylolisthesis. He subsequently developed a pseudomeningocele that caused hydronephrosis of the left kidney. He was treated with surgical intervention and had resolution of his hydronephrosis and his flank and groin pain. He also had improvement of his back pain. Conclusions: This report shows an unusual cause of hydronephrosis—a pseudomeningocele presenting as an abdominal mass that compressed the ureter.
Hamilton, Rita G; Brown, Steven W; Goetz, Lance L; Miner, Michael
Little information is available regarding the long-term effects, if any, of running on the musculoskeletal system. The authors compared the prevalence of degenerative joint disease among 17 male runners with 18 male nonrunners. Running subjects (53% marathoners) ran a mean of 44.8 km (28 miles)\\/wk for 12 years. Pain and swelling of hips, knees, ankles and feet and other musculoskeletal
R. S. Panush; C. Schmidt; J. R. Caldwell; N. L. Edwards; S. Longley; R. Yonker; E. Webster; J. Nauman; J. Stork; H. Pettersson
Low back pain caused by degenerative disc disease is of such intensity in a low percentage of cases that surgery is indicated. Surgery must not only stabilize, but it must above all correct the deformity, recovering the disc space. Among all of the methods available circumferential fusion with a double combined approach, that is, anterior and posterior, is held to be the most effective. PMID:8076465
Gallinaro, P; Indemini, E; Tabasso, G; Abbate, M
Degenerative mitral valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in mitral valve regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, as opposed to valve replacement with a bioprosthetic or mechanical valve, because valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo mitral valve replacement. The debate around appropriate timing of intervention for asymptomatic severe mitral valve regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of mitral valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a ‘best practice revolution’ in the field of degenerative mitral valve regurgitation.
Adams, David H.; Rosenhek, Raphael; Falk, Volkmar
Congenital tracheal stenosis is an uncommon but life-threatening condition whose management is still debated. The rarity of this disease explains the lack of a standard management. Between 1986 and 1996, eight children younger than 1 year were referred to our Institution with a tracheal stenosis. The median age at operation was 3.15 months and the median weight was 4.5 kg.
Rémi Houël; Alain Serraf; Paulo Macchiarini; Jacqueline Bruniaux; Claude Planché
Interspinous implants are used to treat lumbar spinal stenosis or facet joint arthritis. The aims of implanting interspinous\\u000a devices are to unload the facet joints, restore foraminal height and provide stability especially in extension but still allow\\u000a motion. The aim of this in vitro study was to compare four different interspinous implants––Colfex, Wallis, Diam and X-Stop––in\\u000a terms of their three-dimensional
Hans-Joachim Wilke; J. Drumm; K. Häussler; C. Mack; W.-I. Steudel; A. Kettler
The goal of the study is to show the histological and biochemical changes that indicate the angiogenesis of the intervertebral disc in lumbar intervertebral disc hernia and the existence of epidemiological correlations between these changes and the risk factors of lumbar intervertebral disc hernia, as well as the patient's quality of life (QOL). We have studied 50 patients aged between 18 and 73 years old, who have undergone lumbar intervertebral disc hernia surgery, making fibroblast growth factor and vascular endothelial growth factor level measurements, as elements in the process of appreciating the disc angiogenesis. Also, pre–surgery and post–surgery QOL has been measured, as well as the intensity of the pain syndrome. We have identified factors capable of stimulating vascular endothelial growth (VEGF, FGF–2) for the examined disc material, but histological examination did not show angiogenesis. The process of angiogenesis at the degenerated intervertebral disc level affects the patient's quality of life both pre and postoperatively, and may be a predictive factor for the post–operative results. Patients can prevent the appearance of angiogenesis type degenerative processes of the intervertebral disc by avoiding angiogenesis correlated factors (weight control, physical effort, and smoking).
David, Gh; Iencean, SM; Mohan, A
The authors report two cases of thoracic spinal canal stenosis (SCS) and myelopathy. One is extremely unusual because of degenerative changes occurred in the upper thoracic spine. The other because of its multiple etiology among which calcification and ossification of the ligamentum flavum (OLF) in a Caucasian man. Both patients presented with an history of slowly progressive spastic paraparesis. In the first case computed tomography (CT) scans and magnetic resonance (MR) images revealed hypertrophy of the legamentum flavum and laminae causing compression of the spinal cord at T2-T3. In the second case diagnostic imaging showed three levels of stenosis in the lower thoracic spine due to degenerative changes, calcification and OLF with cord damage at T9-T10. A decompressive laminectomy and medial facetectomy was performed in both patients. The ligamentum flavum, hypertrophied and infolded in the first case and calcified and ossified in the second, was removed with careful dissection of the dural adhesions. Both patients showed a rapid post-operative recovery and regained autonomous walking within 1 month of surgery. Thoracic spinal cord stenosis is a rare and complex disorder because of differential diagnosis, neuroimaging features and treatment options. Regardless of its cause, prompt surgical decompression plays a key role in improving the functional outcome of myelopathy. PMID:23111299
Amato, V; Giannachi, L; Irace, C; Corona, C
Extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USA) is a minimally invasive lateral transpsoas approach to the thoracolumbar spine. Though the procedure is rapidly increasing in popularity, limited data is available regarding its use in deformity surgery. We aimed to evaluate radiographic correction using XLIF in adults with degenerative lumbar scoliosis. Thirty consecutive patients were followed for an average of 14.3months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Plain radiographs were obtained on all patients preoperatively, postoperatively, and at most recent follow-up. Plain radiographic measurements of coronal Cobb angle, apical vertebral translation, segmental lordosis, global lordosis, disc height, neuroforaminal height and neuroforaminal width were made at each time point. CT scans were obtained for all patients 1year after surgery to evaluate for fusion. There was significant improvement in multiple radiographic parameters from preoperative to postoperative. Cobb angle corrected 72.3%, apical vertebral translation corrected 59.7%, neuroforaminal height increased 80.3%, neuroforaminal width increased 7.4%, and disc height increased 116.7%. Segmental lordosis at L4-L5 increased 14.1% and global lordosis increased 11.5%. There was no significant loss of correction from postoperative to most recent follow-up. There was an 11.8% pseudoarthrosis rate at levels treated with XLIF. Complications included lateral incisional hernia (n=1), rupture of anterior longitudinal ligament (n=2), wound breakdown (n=2), cardiac instability (n=1), pedicle fracture (n=1), and nonunion requiring revision (n=1). XLIF significantly improves coronal plane deformity in patients with adult degenerative scoliosis. XLIF has the ability to correct sagittal plane deformity, although it is most effective at lower lumbar levels. PMID:23906522
Caputo, Adam M; Michael, Keith W; Chapman, Todd M; Jennings, Jason M; Hubbard, Elizabeth W; Isaacs, Robert E; Brown, Christopher R
The posterior median approach to the lumbar spine may cause significant injury to the erector spinae muscles (ESM) which is minimized using the paralateral approach suggested by Ray. We have adopted this approach and have extended it into the disc space to allow cage implantation from outside the foramen (EPLIF - extraforaminal posterior lumbar interbody fusion). The initial exposure of the posterior vertebral elements between the ESM and the deep lumbar fascia is sufficient to attain the entry points of pedicle screws. The intervertebral foramen and posterior annulus fibrosus are then exposed after which distant lateral disc herniations may be removed, the foramen/lateral recess may be decompressed or an EPLIF performed following clearing and vertical distraction of the disc space. This is followed by ipsilateral transpedicular fixation (TpF), contralateral fixation (second approach) by TpF or translaminar screws. Indications are given for foraminal and extraforaminal disc herniation, stenosis of the foramen and/or of the lateral recess, posterolateral fusion, TpF and EPLIF. The submuscular approach and EPLIF have proven to be valuable alternatives to standard techniques. PMID:21301809
Valvular aortic stenosis (AS) produces a slowly progressive obstruction in left ventricular outflow track. For this reason, aortic valve replacement is warranted when the valvular stenosis is hemodinamically significant, becoming the most common worldwide cause of aortic valve surgery. Recent epidemiologic studies have revealed an association between degenerative AS and cardiovascular risk factors for atherosclerosis, althought reducing the exposure to such factors and statin therapies both fail to delay or reverse the pathology. Hence, a deeper understanding of the pathophysiology of this disease is required to identify appropriate preventive measures. A proteomic analysis of plasma will permit to know and identify the changes in protein expression induced by AS in this tissue. Using two-dimensional difference gel electrophoresis (2D-DIGE) followed by mass spectrometry (MS), we compared the crude (not pre-fractioned) and pre-fractioned plasma from AS patients and control subjects. We sought to identify plasma proteins whose expression is modified in AS. In addition we investigated if crude plasma presented some alterations in the more abundant proteins since to date, has never been studied before. We also further investigated the link between this disease and atherosclerosis with a view to identifying new potential markers and therapeutic targets. PMID:22178735
Gil-Dones, Félix; Darde, Verónica M; Alonso-Orgaz, Sergio; Lopez-Almodovar, Luis F; Mourino-Alvarez, Laura; Padial, Luis R; Vivanco, Fernando; Barderas, Maria G
Introduction 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 30-50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgery for herniated lumbar disc? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics, antidepressants, bed rest, corticosteroids (epidural injections), cytokine inhibitors (infliximab), discectomy (automated percutaneous, laser, microdisectomy, standard), exercise therapy, heat, ice, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), percutaneous disc decompression, spinal manipulation, and traction.
There have been few reports describing cytokines in the cerebrospinal fluid (CSF) of patients with spinal degenerative disorders.\\u000a This study investigated whether interleukin-1? (IL-1?), interleukin-6 (IL-6), and tumor necrosis factor-? (TNF-?) could be\\u000a detected in CSF of patients with cervical myelopathy or lumbar radiculopathy and whether the concentrations of those cytokines\\u000a correlated with the severity of disease conditions. CSF samples
Hideki Nagashima; Yasuo Morio; Koji Yamane; Yoshiro Nanjo; Ryota Teshima
Two cases of congenital tracheal stenosis were managed conservatively despite mild to moderate initial respiratory symptomatology in infancy. Serial CT examinations were performed on each child, with tracheal dimensions and cross-sectional areas measured in the region of stenosis at each CT examination. The examinations document increases in tracheal cross-sectional area in the region of stenosis over time, confirming tracheal cartilage
D. Manson; R. Filler; R. Gordon
Study Design. Prospective clinical studyObjective. Compare fusion rates between rhBMP-2 and iliac crest autograft (ICBG) to rh-BMP-2 with local bone graft (+/-bone graft extenders) in posterolateral fusion (PLF).Summary of Background Data. Previous reports have shown higher fusion rates when adding rhBMP-2 to ICBG in lumbar PLF, compared to ICBG alone. We compared the fusion success rates between rhBMP-2 delivered with ICBG versus that with local bone graft.Methods. Fusion rates were compared in patients with degenerative spondylolisthesis (1-2 levels) with accompanying lumbar stenosis. RhBMP-2 (InFuse, Medtronic) was delivered on an absorbable collagen sponge (6 mg/side @ 1.5 mg/mL) with ICBG alone or with local bone graft wrapped inside the sponge. Thin slice CT scans were assessed at 6, 12, and 24 months.Results. In a consecutive series, sixteen patients (30 levels) received ICBG with rhBMP-2 and 35 patients (49 levels) received local bone graft with rhBMP-2. For the ICBG cohort, 80.0%, 93.4%, 96.7% of levels were fused at 6, 12, and 24 months. In contrast, for the local bone with rhBMP-2 cohort, 87.7%, 98.0%, and 98.0% were fused at 6, 12, and 24 months. There was no statistically significant difference in fusion success rates between the two groups at any time point. As for fusion quality, the fusion mass showed superior quality in ICBG group than in the local bone group at each time point.Conclusion. This study validates the high fusion success rates previously reported by adding rhBMP-2 to ICBG and shows that local bone may be safely substituted for ICBG in 1-2 level PLF. The fusion rates were comparable. The avoidance of ICBG harvest has implications for operative time, blood loss, and morbidity. Lastly, this is the first study that directly compares the fusion success rate and quality using local bone with rhBMP-2 versus ICBG with rhBMP-2 at various times. PMID:23474598
Park, Daniel K; Kim, Sung S; Thakur, Nikhil; Boden, Scott D
Study Design This is a retrospective study that was done according to clinical and radiological evaluation. Purpose We analyzed the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion. Overview of Literature Minimally invasive transforaminal lumbar interbody fusion is effective surgical method for treating degenerative lumbar disease. Methods The study was conducted on 56 patients who were available for longer than 2 years (range, 24 to 45 months) follow-up after undergoing minimally invasive transforminal lumbar interbody single level fusion. Clinical evaluation was performed by the analysis of the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) and the Kirkaldy-Willis score. For the radiological evaluation, the disc space height, the segmental lumbar lordotic angle and the whole lumbar lordotic angle were analyzed. At the final follow-up after operation, the fusion rate was analyzed according to Bridwell's anterior fusion grade. Results For the evaluation of clinical outcomes, the VAS score was reduced from an average of 6.7 prior to surgery to an average of 1.8 at the final follow-up. The ODI was decreased from an average of 36.5 prior to surgery to an average of 12.8 at the final follow-up. In regard to the clinical outcomes evaluated by the Kirkaldy-Willis score, better than good results were obtained in 52 cases (92.9%). For the radiological evaluation, the disc space height (p = 0.002), and the whole lumbar lordotic angle (p = 0.001) were increased at the final follow-up. At the final follow-up, regarding the interbody fusion, radiological union was obtained in 54 cases (95.4%). Conclusions We think that if surgeons become familiar with the surgical techniques, this is a useful method for minimally invasive spinal surgery.
Chung, Hung-Tae; Kim, Dong-Jun; Kim, Sang-Hyuk; Jeon, Sang-Ho
ABSTRACT: Study Design. A descriptive CT study of lumbar facet joint (FJ) arthrosis in general and spinal stenosis populations.Objective. To reveal the prevalence of FJ arthrosis in general and stenosis populations and to establish its relationship to age and gender.Summary of Background Data. FJ arthrosis is a common radiographic finding and has been suggested as a cause of low back and lower extremity pain. It is also considered a dominant player in the genesis of lumbar spinal stenosis. Although it is well accepted that FJ arthrosis is an age dependent phenomenon, controversies still exist as to its association with gender and its prevalence at different spine levels. Additionally, data on FJ arthrosis frequency in spinal stenosis population are missing.Methods. Two groups were studied. The first included 65 individuals with LSS (mean age 66 ± 10 years) and the second, 150 individuals (mean age 52 ± 19 years) without LSS related symptoms. Both left and right FJ arthrosis for each vertebral level (L3 to S1) were evaluated on CT images (Brilliance 64, Philips Medical System, Cleveland Ohio). Chi-Square, Linear-by-Linear Association and McNemar test were carried out to reveal the correlation between FJ arthrosis and demographic factors (age, gender) and prevalence at different lumbar levels in both stenosis and non-stenosis groups. Additionally, a 2-way ANOVA was used to determine the association between BMI and FJ arthrosis.Results. The rate of FJ arthrosis at L3-4 and L4-5 were significantly higher (P<0.001) in the stenotic group compared to the control. In the control group the prevalence of FJ arthrosis increases cephalo-caudally (L3-L4 = 16%, L4-L5 = 28%, L5-S1 = 55%), whereas in the stenotic group there is a sharp increase from L3-4 (27%) to L4-5 (58%), but not from L4-5 to L5-S1 (55%). No association between FJ arthrosis and gender was noted. Although, mean BMI was significantly smaller in the control group compared to the stenotic group, no association between BMI and facet arthrosis was found. In the general population the prevalence of FJ arthrosis at all three levels was greater for the right side; however, significant difference (P = 0.004) was obtained only for L3-4. In all joints studied, the prevalence of FJ arthrosis increases considerably from the young age cohort (18-39) to the old age cohort (>60). Nevertheless, 10% of the young individuals (18-39) have already manifested FJ arthrosis at L5-S1. No arthrosis at that age was observed at L3-4.Conclusion. FJ arthrosis is an age-dependent and BMI and gender-independent phenomenon. In the general population, the prevalence of FJ arthrosis increases cephalo-caudally with the highest frequency at L5-S1. In the stenotic group, the highest frequency was observed at the two caudal levels; L4-5 and L5-S1. The prevalence of FJ arthrosis was greater for the right side. PMID:21270678
J, Abbas; K, Hamoud; S, Peleg; H, May; Y, Masharawi; H, Cohen; N, Peled; I, Hershkovitz
We have used six different techniques in 61 operations performed at Children's Memorial Hospital (Chicago, IL) between 1982 and 2001 on 54 infants with complete tracheal rings and primary or recurrent tracheal stenosis. Short-term and long-term outcomes are reviewed for all techniques including pericardial tracheoplasty, tracheal autograft, tracheal resection, cartilage tracheoplasty, slide tracheoplasty, and aortic homograft patch tracheoplasty. Patients' ages
Carl L. Backer; Constantine Mavroudis; Lauren D. Holinger
Objective: To evaluate the treatment, perioperative man- agement, and outcome of infants who underwent repair of congenital tracheal stenosis. We hypothesized that early resection and tracheoplasty with early weaning of ven- tilatory support results in less mucosal injury, and thus better outcome. Design: Retrospective study from 1986 to 1996. Setting: Tertiary care children's hospital. Patients: Seventeen consecutive infants with congeni-
Cheryl S. Cotter; Dwight T. Jones; Roger C. Nuss; Richard Jonas
The discrete form of subaortic stenosis is thought to be an acquired lesion, the aetiology of which may be a combination of factors which include an underlying genetic predisposition, turbulence in the left ventricular outflow tract, and various geometric and anatomical variations of the left ventricular outflow tract. A review of hypotheses relating to its aetiology is provided
Cilliers, A M; Gewillig, M
Chronic low back pain is a major social, economic, and healthcare issue in the United States. Various techniques are utilized in managing discogenic pain, with or without disc herniation. Percutaneous techniques are rapidly replacing traditional open surgery in operations requiring discectomy, decompression, and fusion. The percutaneous access to the disc was first used in the 1950s to biopsy the disc with needles. Percutaneous access to the disc using endoscopic techniques was developed in the 1970s. Technical advances in the use of intradiscal therapies led to the development of intradiscal electrothermal annuloplasty (IDET), DISC Nucleoplasty, and DeKompressor, along with laser-assisted, endoscopic, and Nucleotome disc decompressions. The indications for percutaneous lumbar disc decompression include low back and lower extremity pain caused by a symptomatic disc. Internal disc disruptions and disc herniations are common causes of low back and/or lower extremity pain which may become chronic, if not diagnosed and treated. Annular tears lead to migration of the nuclear material and deranged internal architecture. In the chronically damaged intervertebral disc, leakage of nuclear material from annular tears can initiate, promote, and continue the inflammatory process and delay or stop recovery of vital remaining intradiscal tissue. The most often stated goal of central nuclear decompression is to lower the pressure in the nucleus and to allow room for the herniated fragment to implode inward. Provocative discography prior to percutaneous lumbar disc decompression is recommended. Percutaneous disc decompression may result in a small number of complications but occasionally, these could be serious. PMID:16703975
Singh, Vijay; Derby, Richard
Background Exposure of the anterior or lateral lumbar via the retroperitoneal approach easily causes injuries to the lumbar plexus. Lumbar\\u000a plexus injuries which occur during anterior or transpsoas lumbar spine exposure and placement of instruments have been reported.\\u000a This study aims is to provide more anatomical data and surgical landmarks in operations concerning the lumbar plexus in order\\u000a to prevent lumbar
Sheng Lu; Shan Chang; Yuan-zhi Zhang; Zi-hai Ding; Xin Ming Xu; Yong-qing Xu
Background. Recent advances in surgical technique allow repair of most mitral valves with degenerative disease. However, few long-term data exist to support the superiority of repair versus prosthetic valve replacement, and repair could be limited by late durability or other problems. This study was designed to compare survival characteristics of mitral valve repair versus prosthetic replacement for degenerative disorders during
Mani A. Daneshmand; Carmelo A. Milano; J. Scott Rankin; Emily F. Honeycutt; Madhav Swaminathan; Linda K. Shaw; Peter K. Smith; Donald D. Glower
\\u000a Methods of spinal arthrodesis continue to evolve in efforts to treat back pain. The latest techniques include approaching\\u000a from the anterior, posterior, lateral, and posterolateral. The transforaminal interbody lumbar fusion (TLIF) developed by\\u000a Harms  is a modification of the posterior lumbar interbody fusion (PLIF). The procedure varies primarily in the access\\u000a to the spine, being a unilateral, posterolateral approach
Burak M. Ozgur; Scott C. Berta; Samuel A. Hughes
In recent years the general trend in spinal surgery has been one of reductionism and minimalization. A number of techniques have recently been developed that are applicable in the treatment of lumbar disc herniation and discogenic pain due to degenerative disc disease. The purpose of this manuscript is to examine two newer percutaneous disc treatment techniques, intradiscal electrothermal therapy (IDET) anuloplasty and nucleoplasty. The authors review the appropriate clinical treatment criteria, techniques, and lessons learned after performing these procedures in more than 100 patients. The IDET involves the percutaneous insertion of a specially designed thermal resistance probe followed by controlled heating of the intervertebral disc. This may result in disc shrinkage and reduction in pain. The nucleoplasty procedure involves the percutaneous removal of disc material by using a low-temperature resister probe to disintegrate and evacuate disc material, followed by thermal treatment of adjacent residual disc material. To date, no study has been published in which investigators examine the outcomes of this procedure for the treatment of radicular leg pain and low-back pain. Both IDET and nucleoplasty appear to be safe procedures. The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with discogenic low-back pain. Nucleoplasty may provide a percutaneous alternative to microdiscectomy in selected cases. PMID:15916404
Welch, William C; Gerszten, Peter C
Computed tomography (CT) of the lumbar spine was performed with selectively positioned 5-mm-thick axial cross sections to examine each disk level from the top of the neural foramen to the pedicle of the next caudad vertebra. One hundred consecutive patients with 116 surgical disk explorations were reviewed. There was agreement between the CT and surgical findings in 89 patients (104 explorations) in determination of presence or absence of a herniated nucleus pulposus (HNP). Discrepancy occurred in 12 instances (11 patients): two because of incorrect interpretations, five in previously operated patients, three in spondylolisthesis, and two in spinal stenosis. There were 97 true-positives, eight false-negatives, seven true-negatives, and four false-positives. If nine previously operated patients are excluded from the study, then CT was accurate in detection of presence or absence of an HNP in 93% of the disk explorations.
Firooznia, H.; Benjamin, V.; Kricheff, I.I.; Rafii, M.; Golimbu, C.
A 63-year-old male patient with subaortic stenosis (Pmax 105 mmHg, Pmean 55 mmHg) and an aneurysm of the ascending aorta was referred to our hospital due to progressive angina pectoris. Transesophageal echocardiography demonstrated high and turbulent subaortic flow velocities. A calcified subaortic membrane was identified. The membrane was removed and the aneurysm was treated with a Bentall procedure. The patient recovered smoothly from surgery and was doing well 6 months after discharge. PMID:23196660
Weymann, Alexander; Schmack, Bastian; Rosendal, Christian; Karck, Matthias; Szabó, Gábor
The aim of this study was to compare our experience with minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open midline transforaminal lumbar interbody fusion (TLIF). A total of 36 patients suffering from isthmic spondylolisthesis or degenerative disc disease were operated with either a MITLIF (n = 18) or an open TLIF technique (n = 18) with an average follow-up of 22 and 24 months, respectively. Clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). There was no difference in length of surgery between the two groups. The MITLIF group resulted in a significant reduction of blood loss and had a shorter length of hospital stay. No difference was observed in postoperative pain, initial analgesia consumption, VAS or ODI between the groups. Three pseudarthroses were observed in the MITLIF group although this was not statistically significant. A steeper learning effect was observed for the MITLIF group. PMID:19023571
Schizas, Constantin; Tzinieris, Nicolas; Tsiridis, Elefterios; Kosmopoulos, Victor
Low back pain affects approximately 60.85% of adults during some point of their life and 10% of this is because of Lumbar Spondylosis (LS). Kati Graha which is correlated with LS is a degenerative condition affecting the discs, vertebral bodies, and/or associated joints of the lumbar spine. In current study, assessment of Eranda Muladi Yapana Basti in the management of Kati Graha with special reference to LS has been attempted. 23 patients of either sex in the age between 20 to 65 years having signs and symptoms of LS were selected and were administered Yapana Basti for a period of 15 days. Highly significant results were observed and improvement in cardinal symptoms of Kati Graha was observed. It also provided highly significant results in improving Oswestry Disability Index Scale, range of movements and pain intensity This procedure appears to provide good clinical improvement in pacifying pure Vataja or Vata Kaphaja type of Kati Graha.
Damayanthie Fernando, K. P.; Thakar, Anup B.; Shukla, Vageesha Datta
Catabolic cytokine and anabolic growth factor pathways control destruction and repair in osteoarthritis (OA). A unidirectional TNF-alpha/IL-1-driven cytokine cascade disturbs the homeostasis of the extracellular matrix of articular cartilage in OA. Although chondrocytes in OA cartilage overexpress anabolic insulin-like growth factor (IGF) and its specific receptor (IGFRI) autocrine TNF-alpha released by apoptotic articular cartilage cells sets off an auto/paracrine IL-1-driven cascade that overrules the growth factor activities that sustain repair in degenerative joint disease. Chondroprotection with reappearance of a joint space that had disappeared has been documented unmistakably in peripheral joints of patients suffering from spondyloarthropathy when treated with TNF-alpha-blocking agents that repressed the unidirectional TNF-alpha/IL-1-driven cytokine cascade. A series of connective tissue structure-modifying agents (CTSMAs) that directly affect IL-1 synthesis and release in vitro and down-modulate downstream IL-1 features, e.g. collagenase, proteoglycanase and matrix metalloproteinase activities, the expression of inducible nitric oxide synthase, the increased release of nitric oxide, and the secretion of prostaglandin E(2), IL-6 and IL-8, have been shown to possess disease-modifying OA drug (DMOAD) activities in experimental models of OA and in human subjects with finger joint and knee OA. Examples are corticosteroids, some sulphated polysaccharides, chemically modified tetracyclines, diacetylrhein/rhein, glucosamine and avocado/soybean unsaponifiables. PMID:16278282
Objective To investigate clinical-radiological features of cervical myelopathy due to degenerative spondylolisthesis (DSL). Methods A total of 448 patients were operated for cervical myelopathy at Nishitaga National Hospital between 2000 and 2003. Of these patients, DSL at the symptomatic disc level was observed in 22 (4.9%) patients. Clinical features were investigated by medical records, and radiological features were investigated by radiographs. Results Disc levels of DSL were C3/4 in 6 cases and C4/5 in 16 cases. Distance of anterior slippage was 2 to 5 mm (average 2.9 mm) in flexion position. Space available for the spinal cord (SAC) was 11 to 15 mm (average 12.8 mm) in flexion position and 11 to 18 mm (average14.6 mm) in extension position; 11 cases were reducible and 11 cases were irreducible in extension position. Myelograms demonstrated compression of spinal cord by the ligamentum flavum in extension position. Compression of spinal cord was not demonstrated in flexion position. C5-7 lordosis angle was lower than control. C5-7 range of motion (ROM) was reduced compared to controls. These alterations were statistically significant. Conclusions DSL occurs in the mid-cervical spine. Lower cervical spine demonstrated restricted ROM and lower lordosis angle. Pathogenesis of cervical myelopathy due to DSL is compression of spinal cord by the ligamentum flavum in extension position and not by reduced SAC in flexion position.
In the complex called vagal indigestion two main types of stenosis can be distinguished, pyloric stenosis and stenosis between the reticulum and omasum or reticulo-omasal stenosis. Laboratory examinations of blood and rumen fluid were carried out in 10 cows with reticulo-omasal stenosis. The results are discussed with respect to the differential diagnoses of pyloric stenosis. In the cows with reticulo-omasal stenosis no metabolic alkalosis occurred and consequently dehydration and uraemia did not develop. For the clinician valuable points of difference were a more prolonged and chronic course and, on physical examination, the absence of serious circulatory disturbances and the absence of an ammoniacal-uraemic odour in the expired air. The clinical picture of reticulo-omasal stenosis strongly resembles a syndrome described as failure of omasal transport. PMID:3776066
Kuiper, R; Breukink, H J
Hemodialysis-associated subclavian vein stenosis. This study was undertaken to evaluate hemodialysis-associated subclavian vein stenosis (SVS) and to clarify treatment of this condition. Forty-seven patients underwent upper arm venography to evaluate fistula dysfunction. Subclavian vein stenosis was documented in 12. Eleven of 12 had elevated venous dialysis pressure (196 ± 8.9 mm Hg), and six had arm edema. All 12 had
Steve J Schwab; L Darryl Quarles; John P Middleton; Richard H Cohan; Moshin Saeed; Vincent W Dennis
The purpose of this review is to update the reader on more recent, less invasive lumbar interbody fusion procedures. The article contains a brief history on the development of lumbar interbody fusion methods, as well as the indications and descriptions of the various open and minimally invasive procedures, their complications, and outcomes. In contrast to the more traditional open methods of performing anterior and posterior interbody fusions, surgeons doing the less invasive techniques of transforaminal lumbar interbody fusion, extreme lateral and direct lateral interbody fusion, and the presacral axial approach are reporting less morbidity, shorter hospital stays, high rates of fusion, and improved patient outcomes. Although each technique has a different anatomical plane of approach, the goal is to achieve a solid interbody fusion of the pain generating segment(s) without complications. PMID:23628562
Nasca, Richard J
Objective The purpose of this study was to analyze the differences of spinopelvic parameters between degenerative spondylolisthesis (DSPL) and isthmic spondylolisthesis (ISPL) patients. Methods Thirty-four patients with DSPL and 19 patients with ISPL were included in this study. Spinopelvic parameters were evaluated on whole spine X-rays in a standing position. The following spinopelvic parameters were measured : pelvic incidence (PI), sacral slope, pelvic tilt (PT), lumbar lordosis (LL), and sagittal vertical axis from C7 plumb line (SVA). The population of patients was compared with a control population of 30 normal and asymptomatic adults. Results There were statistically significant differences in LL (p=0.004) and SVA (p=0.005) between the DSPL and ISPL group. The LL of DSPL (42±13°) was significantly lower than that of the control group (48±11°; p=0.029), but that of ISPL (55±6°) was significantly greater than a control group (p=0.004). The SVA of DSPL (55±49 mm) was greater than that of a control group (<40 mm), but that of ISPL (21±22 mm) was within 40 mm as that of a control group. The PT of DSPL (24±7°) and ISPL (21±7°) was significantly greater than that of a control group (11±6°; p=0.000). Conclusion Both symptomatic DSPL and ISPL patients had a greater PI than that of the asymptomatic control group. In conclusion, DSPL populations are likely to have global sagittal imbalance (high SVA) compared with ISPL populations because of the difference of lumbar lordosis between two groups.
Lim, Jae Kwan
The initial step performed by neurologists in the evaluation of patients with potential carotid disease is to establish whether patients have had carotid territory symptoms. Symptoms are most often believed to be caused by emboli passing onto the cerebral circulation. Despite some limitations, conventional angiography remains the gold standard test to evaluate the carotid bifurcation. Because of the costs and risks of angiography, some combination of carotid duplex ultrasonography and MR angiography is chosen to select patients for angiography. Future research will focus on markers other than percent stenosis to assess stroke risk and treatments, such as angioplasty and stenting, for carotid lesions. PMID:8824134
Wilterdink, J L; Feldmann, E
Objective. The purpose of this study was to display the relationships between the forces transmitted in the spine and the accelerations of the vibrating seat.Background. Investigations reveal that exposure to whole-body vibration can induce degenerative changes in the lumbar spine. Elevated spinal forces are probably the crucial component in the pathogenesis of this disease.Design and methods. The spinal forces are
Two infants with recurrent episodes of vomiting had upper gastrointestinal barium studies that did not show radiographic features of pyloric stenosis. However, follow-up abdominal sonograms done 1–2 weeks later documented hypertrophic pyloric stenosis, which led to surgery. This entity is not congenital, but an evolving acquired lesion. Therefore, ultrasound is an excellent modality to evaluate and monitor patients clinically suspected
Deborah A. Weiskittel; Dana L. Leary; Caroline E. Blane
Although the incidence of post-intubation tracheal stenosis has markedly decreased with the advent of large volume, low pressure endotracheal tube cuffs, it still occurs, commonly in patients after prolonged intubation. We report a case of tracheal stenosis that developed after a brief period of endotracheal intubation, and that was misdiagnosed and treated as asthma and panic attacks. PMID:23345469
Barreiro, Timothy J; Ghattas, Christian; Ann Valino, Cherry
Optimal management of patients with asymptomatic carotid artery stenosis remains unclear. Although 2 high-quality randomized clinical trials demonstrated reductions in ispsilateral stroke rates in patients without symptoms after carotid endarterectomy, medical therapy of asymptomatic carotid artery stenosis has reduced rates of stroke to approximately 1% per year, raising questions about the generalizability of these previous trials to current medical practice. However, reductions in adverse events after revascularization can make revascularization more attractive. The emergence of percutaneous revascularization for carotid artery stenosis has raised further questions about optimal management of asymptomatic carotid artery stenosis. This Grand Rounds summarizes the factors to consider when counseling patients and making clinical decisions regarding medical therapy and revascularization for patients with asymptomatic carotid artery stenosis. This information should provide clinicians with the knowledge base to counsel patients about the risks and benefits of treatment options. PMID:24129465
Beckman, Joshua A
Cephalic arch is a frequent site for the development of stenosis in patients with brachiocephalic fistulae. This is in part owing to the anatomic constraints of the cephalic arch region and the exertion of hemodynamic forces at this site caused by the creation of a brachiocephalic fistula. Multiple interventions have been used to correct stenosis and subsequent fistula dysfunction. These include percutaneous balloon angioplasty using conventional and cutting balloons, endovascular stent insertion, and surgical interventions. It is important to emphasize that the stenosis in this region frequently recurs, is more resistant to angioplasty, and shows a higher rate of rupture during the percutaneous balloon angioplasty procedure compared with peripheral lesions at other sites. Because hemodynamic forces have been postulated to be one of the culprits for the development of stenosis, a new technique of flow reduction has been introduced to combat this problem. This article discusses the etiology, pathophysiology, and current management of cephalic arch stenosis. PMID:23217333
Daoui, Rachid; Asif, Arif
In this report, we describe a case of coarctation of the aorta, congenital aortic stenosis with bicuspid valve, and supravalvar aortic stenosis with left coronary artery ostial stenosis. The child underwent staged treatment using a hybrid approach employing both surgical and interventional cardiology methods. A single pericardial patch repair technique for supravalvar aortic stenosis associated with left coronary ostial stenosis is also described. PMID:11123140
Goel, P; Madhu Sankar, N; Rajan, S; Cherian, K M
Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT) allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies.
The objective is to evaluate the geometric parameters of vertebral bodies and intervertebral discs in spinal segments adjacent to spondylolysis and spondylolisthesis. This pilot cross-sectional study was an ancillary project to the Framingham Heart Study. The presence of spondylolysis and spondylolisthesis as well as measurements of spinal geometry were identified on CT imaging of 188 individuals. Spinal geometry measurements included lordosis angle, wedging of each lumbar vertebra and intervertebral disc. Last measurements were used to calculate ?B, the sum of the lumbar L1-L5 body wedge angles; and ?D, the sum of the lumbar L1-L5 intervertebral disc angles. Using Wilcoxon-Mann-Whitney test we compared the geometric parameters between individuals with no pathology and ones with spondylolysis (with no listhesis) at L5 vertebra, ones with isthmic spondylolisthesis at L5-S1 level, and ones with degenerative spondylolisthesis at L5-S1 level. Spinal geometry in individuals with spondylolysis or listhesis at L5 shows three major patterns: In spondylolysis without listhesis, spinal morphology is similar to that of healthy individuals; In isthmic spondylolisthesis there is high lordosis angle, high L5 vertebral body wedging and very high L4-5 disc wedging; In degenerative spondylolisthesis, spinal morphology shows more lordotic wedging of the L5 vertebral body, and less lordotic wedging of intervertebral discs. In conclusion, there are unique geometrical features of the vertebrae and discs in spondylolysis or listhesis. These findings need to be reproduced in larger scale study. PMID:21181481
Been, Ella; Li, Ling; Hunter, David J; Kalichman, Leonid
Sacro-lumbar fusion must be carefully planned: to avoid alterations of the adjacent motion segments. This is a retrospective study to evaluate the fate of transitional segments at mid and long-term. The aim was to discuss the value of systematic preoperative MRI before spine fusion. The study group comprises 68 patients who sustained a lumbar or sacro-lumbar fusion for degenerative discopathy or spondylolysis with spondylolisthesis between January 2000 and December 2005. The preoperative evaluation included standard radiographs and MRI. Postoperative follow-up averaged 51 months and ranged from 6 to 121 months. 72% of the patients had no clinical or radiological complications, 18% developed mild lesions such as a moderate disk space narrowing or osteophyte formation and only 10% developed a significant adjacent motion segment alteration. The risk of degeneration increased with age, female sex, length of fusion and when the indication for fusion was a degenerative pathology. Compared with other studies, this work reports few true adjacent motion segment alterations because preoperative MRI allowed a better selection of the future adjacent segment. PMID:22141259
Tromme, A; Georis, P; Gillet, P
Background: The prosthetic disc nucleus (PDN) device offers an adjunct treatment for patients with degenerative disc disease and herniation, who necessitate surgical intervention, avoiding total-disc replacement or fusion. This prospective, clinical study aimed to gauge the long-term effectiveness of microdiscectomy followed by PDN implantation in relieving pain and improving functional status in patients with symptomatic degenerative lumbar disc disease and herniation. Methods: Ten patients with a) at least 6 months low back pain and/or sciatica resistant to conservative treatment and b) radiologically documented degenerative lumbar disc disease and herniation have been selected. Follow-up at 6 weeks, 3, 12, 48, and 96 months postoperatively included physical examination, radiological investigation (plain and dynamic radiographs and magnetic resonance imaging), and self-completion of outcome scales (visual analogue, Oswestry, and Prolo functional status). Short Form-36 version 2 Health Survey patient profile at 96 months completed the image of health related quality of life. Results: Patients' mean follow-up was 100.6 months. Significant improvements in Oswestry, Prolo, and VAS scores were documented (p: 0.004 in all scales at 48 months). Generic health status was rated within the average lumbar disease population (46.36.8 for physical component summary and 45.29.6 for mental component summary). Lumbar spine range of motion (20.211.8 at 96 months) was restricted in relation to normal, but maintained considerable mobility. Treated disc height increased postoperatively (p:0.002) and its maintenance could also be documented in all cases. Disc height at the level above did not show any significant modification. All postoperative MRI showed a non-clinically significant high signal of end-plate on T2 sequences. Clinically relevant complications included one case of pulmonary thrombosis and one case of device extrusion, which was subsequently explanted. Conclusions: After implantation, most patients continue to enjoy significant pain relief, a considerable amount of mobility is conserved and the disease specific functional outcome is excellent and remains for long, although it could not be supported that the generic health related quality of life is that of the general population.
Selviaridis, P; Foroglou, N; Tsitlakidis, A; Hatzisotiriou, A; Magras, I; Patsalas, I
Study Design A cross-sectional imaging study. Purpose The objective was to assess the degree of degeneration and the associated factors through imaging studies of the lesion segment and the adjacent superior and inferior segments of isthmic and degenerative spondylolisthesis. Overview of Literature Few articles existed for degeneration and related factors in isthmic and degenerative spondylolisthesis. Methods The subjects were 95 patients diagnosed with spondylolisthesis. Simple plain radiographs including flexion and extension and magnetic resonance imaging were used to investigate the degree of translation, disc degeneration, high intensity zone (HIZ) lesion, Schmorl's node (SN) and Modic changes. Results Advanced disc degeneration, grade 5, was shown to be significant in the index segment of the isthmic type (p=0.034). Overall, type 2 Modic change was most common in both groups and also, it was observed more in the isthmus group, specifically, the index segment compared to the degenerative group (p=0.03). For the SN, compared to the degenerative type, the isthmus type had a significantly high occurrence in the index segment (p=0.04). For the HIZ lesions, the isthmus type had a higher occurrence than the degenerative type, especially in the upper segment (p=0.03). Conclusions Most advanced disc degeneration, fifth degree, SN and Modic change occurred more frequently in the lesions of the isthmus type. HIZ lesions were observed more in the isthmus type, especially in the segment superior to the lesion.
Jeong, Hyun-Yoon; Sohn, Hong-Moon; Park, Sang-Ha
Objective To compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensors, pain severity and functional disability in patients with chronic low back pain (LBP). Methods Patients suffering nonspecific LBP for more than 3 months were included prospectively and randomized into lumbar stabilization exercise group (n=11) or lumbar dynamic strengthening exercise group (n=10). Exercises were performed for 1 hour, twice weekly, for 8 weeks. The strength of the lumbar extensors was measured at various angles ranging from 0° to 72° at intervals of 12°, using a MedX. The visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ) were used to measure the severity of LBP and functional disability before and after the exercise. Results Compared with the baseline, lumbar extension strength at all angles improved significantly in both groups after 8 weeks. The improvements were significantly greater in the lumbar stabilization exercise group at 0° and 12° of lumbar flexion. VAS decreased significantly after treatment; however, the changes were not significantly different between the groups. ODQ scores improved significantly in the stabilization exercise group only. Conclusion Both lumbar stabilization and dynamic strengthening exercise strengthened the lumbar extensors and reduced LBP. However, the lumbar stabilization exercise was more effective in lumbar extensor strengthening and functional improvement in patients with nonspecific chronic LBP.
Moon, Hye Jin; Kim, Dae Ha; Kim, Ha Jeong; Cho, Young Ki; Lee, Kwang Hee; Kim, Jung Hoo; Choi, Yoo Jung
Fractional flow reserve (FFR) is considered nowadays as the gold standard for invasive assessment of physiologic stenosis significance and an indispensable tool for decision making in coronary revascularization. Use of FFR in the catheterization laboratory accurately identifies which lesions should be stented and improves the outcome in most elective clinical and angiographic conditions. Recently, FFR has been upgraded to a class IA classification in multivessel percutaneous coronary intervention in the guidelines on coronary revascularization of the European Society of Cardiology. In this state-of-the-art paper, the basic concept of FFR and its application, characteristics, and use in several subsets of patients are discussed from a practical point of view. PMID:22421298
Pijls, Nico H J; Sels, Jan-Willem E M
The Gateway balloon-Wingspan stent system is the first, and currently the only "on-label" device for the treatment of symptomatic intracranial stenosis in the United States. In initial single-arm studies, investigators have indicated that this system can be used for the treatment of symptomatic intracranial atherosclerotic disease with high levels of technical success and acceptable periprocedural complication rates, which are comparable with, or better than, those reported for other endovascular techniques. Intermediate- and long-term follow-up data for patients treated with the Wingspan device remain sparse. We critically review the existing data, which characterize the risk profile and efficacy of endovascular interventions for intracranial atherosclerotic disease, as well as the available clinical evidence that could be used to select appropriate patients for treatment. PMID:22182273
BACKGROUND CONTEXT The presence of retrolisthesis has been associated with the degenerative changes of the lumbar spine. However, retrolisthesis in patients with L5–S1 disc herniation has not been shown to have a significant relationship with worse baseline pain or function. Whether it can affect the outcomes after discectomy, is yet to be established. PURPOSE The purpose of this study was to determine the relationship between retrolisthesis (alone or in combination with other degenerative conditions) and postoperative low back pain, physical function, and quality of life. This study was intended to be a follow-up to a previous investigation that looked at the preoperative assessment of patient function in those with retrolisthesis and lumbar disc herniation. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE Patients enrolled in SPORT (Spine Patient Outcomes Research Trial) who had undergone L5–S1 discectomy and had a complete magnetic resonance imaging scan available for review (n=125). Individuals with anterolisthesis were excluded. OUTCOME MEASURES Time-weighted averages over 4 years for the Short Form (SF)-36 bodily pain scale, SF-36 physical function scale, Oswestry Disability Index (ODI), and Sciatica Bothersomeness Index (SBI). METHODS Retrolisthesis was defined as a posterior subluxation of 8% or more. Disc degeneration was defined as any loss of disc signal on T2 imaging. Modic changes were graded 1 to 3 and collectively classified as vertebral end plate degenerative changes. The presence of facet arthropathy and ligamentum flavum hypertrophy was classified jointly as posterior degenerative changes. Longitudinal regression models were used to compare the time-weighted outcomes over 4 years. RESULTS Patients with retrolisthesis did significantly worse with regard to bodily pain and physical function over 4 years. However, there were no significant differences in terms of ODI or SBI. Similarly, retrolisthesis was not a significant factor in the operative time, blood loss, lengths of stay, complications, rate of additional spine surgeries, or recurrent disc herniations. Disc degeneration, modic changes, and posterior degenerative changes did not affect the outcomes. CONCLUSIONS Although retrolisthesis in patients with L5–S1 disc herniation did not affect the baseline pain or function, postoperative outcomes appeared to be somewhat worse. It is possible that the contribution of pain or dysfunction related to retrolisthesis became more evident after removal of the disc herniation.
Kang, Kevin K.; Shen, Michael S.; Zhao, Wenyan; Lurie, Jon D.; Razi, Afshin E.
Retinal degenerative diseases that target photoreceptors or the adjacent retinal pigment epithelium (RPE) affect millions of people worldwide. Retinal degeneration (RD) is found in many different forms of retinal diseases including retinitis pigmentosa (RP), age-related macular degeneration (AMD), diabetic retinopathy, cataracts, and glaucoma. Effective treatment for retinal degeneration has been widely investigated. Gene-replacement therapy has been shown to improve visual function in inherited retinal disease. However, this treatment was less effective with advanced disease. Stem cell-based therapy is being pursued as a potential alternative approach in the treatment of retinal degenerative diseases. In this review, we will focus on stem cell-based therapies in the pipeline and summarize progress in treatment of retinal degenerative disease. PMID:20859770
Huang, Yiming; Enzmann, Volker; Ildstad, Suzanne T
Retinal degenerative diseases that target photoreceptors or the adjacent retinal pigment epithelium (RPE) affect millions of people worldwide. Retinal degeneration (RD) is found in many different forms of retinal diseases including retinitis pigmentosa (RP), age-related macular degeneration (AMD), diabetic retinopathy, cataracts, and glaucoma. Effective treatment for retinal degeneration has been widely investigated. Gene-replacement therapy has been shown to improve visual function in inherited retinal disease. However, this treatment was less effective with advanced disease. Stem cell-based therapy is being pursued as a potential alternative approach in the treatment of retinal degenerative diseases. In this review, we will focus on stem cell-based therapies in the pipeline and summarize progress in treatment of retinal degenerative disease.
Huang, Yiming; Enzmann, Volker; Ildstad, Suzanne T.
Neurogenic positional pedal neuritis is a presentation of neuritic symptoms in one or both feet usually affected by body position, specifically, the position of the spine. Its etiology is similar to that of neurogenic-induced claudication caused by spinal stenosis in that the symptoms are caused by compression or irritation of nerves of the lower lumbosacral spine, usually the fifth lumbar and first sacral nerve roots. Burning, stabbing, a cold feeling, aching, numbness, paresthesia, or a weak or tired feeling of the feet (during some part of the disease process) depend on spinal position and may occur during standing, walking, or even lying in bed. Symptoms may be severe and are often eliminated by lumbosacral spine flexion, such as by walking with wheeled support such as a grocery cart or walker; less frequently by negative-heel shoe modification, which can change the position of the lumbosacral spine in stance; or by alteration of sleeping position. This condition, which can include loss of protective sensation, is often misdiagnosed as neuropathy (especially in diabetic patients) or less frequently as biomechanical in origin. In diabetic patients, this condition is frequently the cause of failure of monochromatic infrared energy therapy for diabetic peripheral neuropathy. Treatment is aimed at reducing the spinal nerve or nerve root irritation. Clear definition of the pedal symptoms of spinal nerve compression within a single diagnostic category should facilitate identification and treatment. PMID:12756307
Goldman, Stuart M
Slide tracheoplasty has become a standard procedure to treat long-segment congenital tracheal stenosis because it is a reasonable and simple technique. Slide tracheoplasty does not affect the carina during long-segment congenital tracheal stenosis management, and thus lesions of the carina, such as stenosis and tracheobronchomalacia can become important causes of extubation failure after surgery. In this manusript, we describe the effectiveness of our modified slide tracheoplasty, which includes reconstruction of the carina. We have performed this technique on three patients, all of whom were extubated without developing any respiratory symptoms. PMID:19853766
Toma, Miki; Kamagata, Shoichiro; Hirobe, Seiichi; Komori, Koji; Okumura, Kenji; Mutoh, Mitsuru; Hayashi, Akira
Tracheobronchial stenosis, narrowing of the airways by neoplastic or nonneoplastic processes, may be focal, as occurs with postintubation tracheal stenosis or a focal narrowing from a tumor, or more diffuse, such as those caused by inflammatory diseases. Symptoms develop when the narrowing impedes flow and increases resistance within the airways. Computed tomography defines the extent and severity of disease; endoscopy facilitates understanding of the cause so that an algorithm for treatment can be devised. Bronchoscopic interventions include balloons, ablative treatment, and stenting to provide symptomatic relief. Surgical resection may be curative and a multidisciplinary approach to tracheobronchial stenosis is required. PMID:23993823
Puchalski, Jonathan; Musani, Ali I
Background To investigate how unilateral cage-instrumented posterior lumbar interbody fusion (PLIF) affects the three-dimensional flexibility in degenerative disc disease by comparing the biomechanical characteristics of unilateral and bilateral cage-instrumented PLIF. Methods Twelve motion segments in sheep lumbar spine specimens were tested for flexion, extension, axial rotation, and lateral bending by nondestructive flexibility test method using a nonconstrained testing apparatus. The specimens were divided into two equal groups. Group 1 received unilateral procedures while group 2 received bilateral procedures. Laminectomy, facectomy, discectomy, cage insertion and transpedicle screw insertion were performed sequentially after testing the intact status. Changes in range of motion (ROM) and neutral zone (NZ) were compared between unilateral and bilateral cage-instrumented PLIF. Results Both ROM and NZ, unilateral cage-instrumented PLIF and bilateral cage-instrumented PLIF, transpedicle screw insertion procedure did not revealed a significant difference between flexion-extension, lateral bending and axial rotation direction except the ROM in the axial rotation. The bilateral group's ROM (-1.7 ± 0. 8) of axial rotation was decreased significantly after transpedicle screw insertion procedure in comparison with the unilateral group (-0.2 ± 0.1). In the unilateral cage-instrumented PLIF group, the transpedicle screw insertion procedure did not demonstrate a significant difference between right and left side in the lateral bending and axial rotation direction. Conclusions Based on the results of this study, unilateral cage-instrumented PLIF and bilateral cage-instrumented PLIF have similar stability after transpedicle screw fixation in the sheep spine model. The unilateral approach can substantially reduce exposure requirements. It also offers the biomechanics advantage of construction using anterior column support combined with pedicle screws just as the bilateral cage-instrumented group. The unpleasant effect of couple motion resulting from inherent asymmetry was absent in the unilateral group.
The lordotic curvature of the lumbar spine (lumbar lordosis) in humans is a critical component in the ability to achieve upright posture and bipedal gait. Only general estimates of the lordotic angle (LA) of extinct hominins are currently available, most of which are based on the wedging of the vertebral bodies. Recently, a new method for calculating the LA in skeletal material has become available. This method is based on the relationship between the lordotic curvature and the orientation of the inferior articular processes relative to vertebral bodies in the lumbar spines of living primates. Using this relationship, we developed new regression models in order to calculate the LAs in hominins. The new models are based on primate group-means and were used to calculate the LAs in the spines of eight extinct hominins. The results were also compared with the LAs of modern humans and modern nonhuman apes. The lordotic angles of australopithecines (41° ± 4), H. erectus (45°) and fossil H. sapiens (54° ± 14) are similar to those of modern humans (51° ± 11). This analysis confirms the assumption that human-like lordotic curvature was a morphological change that took place during the acquisition of erect posture and bipedalism as the habitual form of locomotion. Neandertals have smaller lordotic angles (LA = 29° ± 4) than modern humans, but higher angles than nonhuman apes (22° ± 3). This suggests possible subtle differences in Neandertal posture and locomotion from that of modern humans. PMID:22052243
Been, Ella; Gómez-Olivencia, Asier; Kramer, Patricia A
The microendoscopic discectomy (MED) technique has been one of the promising surgeries for lumbar disc herniation in the last few years. The purpose of this study is to report the feasibility of a minimally invasive technique for extraforaminal lumbar disc herniation. Ten patients with extraforaminal lumbar disc herniation (one at L3-4, four at L4-5, and five at L5-S1) underwent MED
Yuichi Takano; Nobuhiro Yuasa
Purpose of study: To date, there are few published data concerning work-related outcomes in patients undergoing lumbar fusion. The present observational study was designed to evaluate specific work-related outcomes in a population-based cohort of patients undergoing lumbar fusion.Methods used: A population-based database of 815 prospectively identified lumbar fusion patients was queried for patients with complete 2-year follow-up. From the resultant
William R. Klemme; Leila S. Nelson; Edgar G. Dawson; J. Kenneth Burkus; Kevin T. Foley; Stephen M. Papadopoulos
Adjacent segment degeneration (ASD) is discussed to impair long-term outcome after lumbar interbody fusion. Nevertheless the amount and origin of degeneration and its clinical relevance remain unclear. Only little data is published studying quantitative disc height reduction (DHR) as indicator for ASD in long-term follow-up. Forty patients (23 men, 17 women) (group 1: degenerative disc disease, n = 27; group 2: lytic spondylolisthesis, n = 13) underwent lumbar 360° instrumentation and fusion between 1991 and 1997. Preoperative and follow-up lateral lumbar radiographs were studied. Disc heights of first and second cephalad adjacent segments were measured by Farfan’s technique and Hurxthal’s technique modified by Pope. Clinical outcome was studied using Oswestry disability index (ODI) and visual analogue scale (VAS). Age, gender, prior surgery, fusion rate and number of fusion levels were investigated as potential factors affecting the outcome. Mean follow-up was 114 (72–161) months. Clinical outcome showed an improvement of 44.6% in ODI and 43.8% in VAS with a tendency towards better results in group 2. Fusion rate was 95%. Disc height of the first cephalad adjacent segment in all patients was reduced by on average 21% (Farfan, P < 0.001) and 19% (Pope, P < 0.001), respectively, and that of the second adjacent level by on average 16% (Farfan, P < 0.001) and 14% (Pope, P < 0.001), respectively. A tendency towards more disc height reduction (DHR) in the degenerative group was observed. Advanced age correlated with advanced DHR (P ? 0.003, r = 0.5). Multiple level fusion led to a more pronounced DHR than 1-level fusion (P = 0.028). There was a tendency towards more DHR in the first adjacent disc compared to the second. Gender, prior surgery of the fused segment and fusion level did not affect the amount of DHR. There was no correlation between the clinical outcome and DHR. Lumbar fusion is associated with DHR of adjacent discs. This may be induced by additional biomechanical stress, ongoing degeneration affecting the lumbar spine and advancing age. However, clinical outcome is not correlated with adjacent DHR.
Leistra, Freek; Bullmann, Viola; Osada, Nani; Vieth, Volker; Marquardt, Bjorn; Lerner, Thomas; Liljenqvist, Ulf; Hackenberg, Lars
The lumbar epidural veins are opacified by injection of the lateral sacral and ascending lumbar veins with abdominal compression. This technique provides a good opacification of the entire lumbar epidural venous system. Some anatomical points are discussed and clarified. The interest of the technique in the diagnosis of discal herniations is emphasized. PMID:958619
Theron, J; Houtteville, J P; Ammerich, H; Alves de Souza, A; Adam, H; Thurel, C; Rey, A; Houdart, R
Background The objective of this clinical study is to evaluate the safety and effectiveness of the Activ-L Artificial Disc for treatment of single-level degenerative disc disease of the lumbar spine in patients who have been unresponsive to at least six months of prior conservative care. The hypothesis of the study is that the Activ-L Disc is non-inferior to the control (the Charité® Artificial Disc [DePuy Spine] or ProDisc-L® Total Disc Replacement [Synthes Spine]) with respect to the rate of individual subject success at 24 months. Individual subject success is a composite of effectiveness and safety. Methods/Design The study proposed is a prospective, randomized, single-masked, controlled, multi-center clinical trial consisting of an estimated 414 subjects with single-level DDD of the lumbar spine (L4/L5, or L5/S1) who have failed to improve with conservative treatment for at least six months prior to enrollment. After enrollment, subjects will be randomized in a 2:1 ratio to either the Activ-L Disc (investigational device) or the control (Charité or ProDisc-L). Radiographic endpoints will be evaluated by an independent reviewer at an imaging core laboratory. Each subject will be followed for 5 years post-treatment. Discussion The safety and effectiveness of the Activ-L Artificial Disc for treatment of single-level degenerative disc disease of the lumbar spine will be equivalent to Charité® Artificial Disc [DePuy Spine] or ProDisc-L® Total Disc Replacement [Synthes Spine] at 24 months. Trial Registration Current Controlled Trials NCT00589797.
This vignette illustrates a classic case of congenital mitral stenosis (Ruckman-VanPraagh type 1) presenting in adulthood and demonstrates the benefits of multimodality cardiac imaging prior to successful surgical intervention. PMID:19054046
Hamilton-Craig, Christian; Anscombe, Russell; Platts, David; Burstow, Darryl; Slaughter, Richard
We describe a successful percutaneous transluminal dilatation (PTD) of an innominate artery stenosis in a 40-year-old patient with aortic arch syndrome. Five years earlier both a left central carotid artery occlusion and an innominate and left subclavian artery stenosis were treated by grafting from the aorta to the distal vessels. At recurrence of the neurological symptoms, reocclusion of the graft to the innominate artery and subtotal stenosis of the left carotid anastomosis were noted. To prevent the hazards of a reoperation, the innominate artery stenosis was dilated by means of PTD via the right brachial artery. Success of the procedure was demonstrated by Doppler sonography and angiography. It appears that PTD serves as an excellent method of treating stenoses of the aortic arch branches in aortic arch syndrome.
Kobinia, G.S.; Bergmann, H. Jr.
Idiopathic subglottic stenosis is a narrowing of the trachea at the level of the cricoid cartilage of unknown etiology. It is a rare condition for which the real incidence has never been established owing to the difficulty of making the diagnosis. Although there is a female preponderance, no familial cases have been reported in the literature. We describe two pairs of sisters as well as a mother and daughter presenting with idiopathic subglottic stenosis. All known causes of tracheal stenosis were excluded, including prolonged intubation, surgery, autoimmune and inflammatory disorders, infection and gastroesophageal reflux disease. These are the first cases reported in the literature that suggest a genetic predisposition for idiopathic subglottic stenosis. PMID:23438539
Dumoulin, Elaine; Stather, David R; Gelfand, Gary; Maranda, Bruno; Maceachern, Paul; Tremblay, Alain
There is significant variation in practice patterns in managing congenital aortic valve stenosis. Review of medical literature\\u000a reveals no significant information regarding the current practice methods in the treatment of a simple lesion such as aortic\\u000a stenosis (AS). Therefore, this survey-based study was conducted in an attempt to better understand the uniformity or heterogeneity\\u000a of practice in treating AS. A
O. Khalid; D. M. Luxenberg; C. Sable; O. Benavidez; T. Geva; B. Hanna; R. Abdulla
Congenital esophageal stenosis (CES) is associated with oesophageal atresia and tracheoesophageal fistula (EA-TEF). Tracheobronchial (cartilaginous) rests are typically found within the area of stenosis. The authors present a case report of EA-TEF associated with CES and present a modification of a novel technique to facilitate the management of CES. The impact of gastro-oesophageal reflux disease is discussed in this unique entity. Finally, the literature is reviewed for this unique entity. PMID:23696146
Escobar, Mauricio Antonio; Pickens, Michael K; Holland, Randall M; Caty, Michael G
Dynamometric devices used to assess back function are becoming increasingly used in research as well as in clinical practice. These devices provide values for a variety of movement variables such as torque, displacement, and velocity, but they also enable the study of movement patterns. The purpose of this study was to determine the movement patterns of patients presenting with specific
M. Szpalski; F. Michel; J.-P. Hayez
BACKGROUNDPatients diagnosed with spina bifida may show late deterioration. This worsening in their clinical symptoms has been attributed to a multiplicity of causes such as secondary tethering of the spinal cord, Chiari II anomaly, hydromyelia, diastematomyelia, arachnoid cysts, and dermoid tumors.METHODSWe searched the clinical records of patients diagnosed with spina bifida who were treated at our hospital for a period
Juan F Martinez-Lage; Claudio Piqueras; Máximo Poza
Purpose: We evaluated the safety and effectiveness of the minimally invasive Superion® Interspinous Spacer (VertiFlex, Inc., San Clemente, CA) in patients with moderate LSS. Methods: This single-arm prospective study enrolled 121 patients with moderate LSS between February 2008 and August 2009 and were followed up at 1 (n=111), 3 (n=96), 6 (n=81), and 12 (n=52) months. All patients were treated with the Superion Interspinous Spacer. Main outcomes were back function with the Oswestry Disability Index (ODI), extremity and axial pain severity with an 11-point scale, health-related quality of life with the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36, and adverse events through 12 months. Results: ODI improved 64% (p<0.001) through 12 months and clinical success was 92%. Extremity and axial pain improved 53% and 49% (both p<0.001), respectively, through 12 months with clinical success of 76% for axial pain and 86% for extremity pain. Health-related quality of life improved 41% for PCS and 22% for MCS (both p<0.001) through 12 months. PCS clinical success was 81% and MCS clinical success was 62% at 12 months. Four (5.9%) explants were performed although 3 were unrelated to the device. Eight procedure-related adverse events, observed in 6 (5.0%) patients, included superficial incision seroma (n=5), minor wound pain (n=2), and infection (n=1). Conclusions: Preliminary results with the Superion Interspinous Spacer suggest that it is an effective and safe treatment option for patients with moderate LSS who are unresponsive to conservative care.
Bini, Walter; Miller, Larry E; Block, Jon E
Summary ??Study Design. Retrospective analysis of 357 cases of degenerative disc disease treated by interbody fusion with threaded titanium cages.\\u000a \\u000a ?Objective. To determine the safety and efficiency of cervical and lumbar interbody fusions using threaded titanium cages and autogenous\\u000a bone.\\u000a \\u000a \\u000a \\u000a ?Summary of Background Data. Stabilizing the anterior column by interbody fusion, though reported over 50 years ago, is less commonly done
G. Matgé; T. A. Leclercq
Summary Observation of cytopathological similarities between the changes of Alzheimer-type dementia, Parkinson's disease and motor neuron disease, as well as of some degree of clinical association between these conditions, has led to the suggestion that all three belong to a common class of degenerative neurological disorders, each of which as a rule first becomes manifest when agerelated neuronal attrition is
Thoracic spondylosis, better termed 'degenerative thoracic spine disease', is rare and failure to recognize it is mainly due to its rarity and to the complexity of symptomatology which can lead to prolonged and continued morbidity. During the past 4 years, the authors have treated 28 patients with thoracic spine degeneration with varied clinical manifestations, ranging from local pain, radiculopathy to
S R Mitra; S G Gurjar; K R Mitra
Myocardial degeneration and necrosis in an adult female Australian kangaroo (Macropus giganteus) are described. The animal was housed in a zoo at Kano, Nigeria for approximately five years before death. This is believed to be the first reported case of degenerative cardiomyopathy in a captive marsupial in Nigeria. PMID:633516
Chineme, C N; Njoku, C O; Evbuoma, N
Many age-related degenerative diseases, including Alzheimer's, Parkinson's, Huntington's diseases and type II diabetes, are associated with the accumulation of amyloid fibrils. The protein components of these amyloids vary widely and the mechanisms of pathogenesis remain an important subject of competing hypotheses and debate. Many different mechanisms have been postulated as significant causal events in pathogenesis, so understanding which events are
Charles G. Glabe
Renal artery stenosis (RAS) is a common form of peripheral arterial disease. The most common cause of RAS is atherosclerosis. It is predominantly unilateral. The pathophysiologic mechanism stems from renal underperfusion resulting in the activation of the renin- angiotensin-aldosterone pathway. Even though the majority of patients with RAS are asymptomatic, it can clinically present with hypertension, nephropathy and congestive heart failure. This progressive disease can lead to resistant hypertension and end stage kidney failure. Screening patients for RAS with either Doppler ultrasonography, computed tomographic angiography, or magnetic resonance angiography is preferred. Adequate blood pressure control, goal-directed lipid-lowering therapy, smoking cessation, and other preventive measures form the foundation of management of patients with RAS. Catheter-based percutaneous revascularization with angioplasty and stenting showed modest clinical benefit for patients in small retrospective studies, but data from randomized clinical trials failed to confirm these beneficial results. The current ongoing Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial may provide more concrete data regarding the role of stenting in RAS. Surgical revascularization is considered only if catheter-based revascularization is unsuitable or unsuccessful. The American College of Cardiology/American Heart Association guidelines on evaluation and management of patients with RAS provide the framework for determining individualized assessment and treatment plans for patients with RAS. PMID:24113662
Sattur, Sudhakar; Prasad, Hari; Bedi, Updesh; Kaluski, Edo; Stapleton, Dwight D
The ideal surgical treatment of spondylolisthesis still remains controversial. There are several methods of treatment and posterior lumbar interbody fusion (PLIF) is one of them. We analyze the results of spondylolisthesis treated by PLIF in term of radiological union, improvement of pre-operative symptoms like back pain, radiating pain and return to normal activities including that of employment, by the review of the medical records. Total of 72 patients, 20 male and 52 female and the age ranges from 15 to 68 years with the mean age being 44.38 years were included in the study. Thirty (41.66%) patients had isthmic spondylolisthesis, 26 (36.12%) had congenital spondylolisthesis, and 16 (22.22%) cases had degenerative spondylolisthesis. There were 38 (52.77%) cases of grade I, 14 (19.44%) cases of grade II and 20 (27.77%) cases of grade III according to the grading criteria of Meyerding. According to the evaluation criteria used by Stauffer and Coventry, 59 patients (81.94%) got good results, eight patients (11.11%) belonged to the fair group and five cases (6.94%) had the poor results. This study showed that PLIF is one of the effective and reliable techniques for the management of spondylolisthesis. PMID:21991702
Devkota, P; Shrestha, S K; Krishnakumar, R; Renjithkumar, J
Microendoscopic discectomy (MED), which combines traditional lumbar microsurgical techniques with endoscopy, is being used as a minimally invasive procedure for lumbar disc herniation. We reviewed 30 patients who underwent MED at our institution and compared their outcome with that of patients subjected to the conventional method. Laboratory data suggested that MED was less invasive surgery. Moreover, MED allowed an early
Hiroyuki Nakagawa; Mikio Kamimura; Shigeharu Uchiyama; Kenji Takahara; Toshiro Itsubo; Tadaatsu Miyasaka
Lumbar punctures (LP) are complex, precise procedures done to obtain cerebro-spinal fluid from a patient for diagnostic purposes. Incorrect techniques resulting from inadequate training or supervision can result in sub-optimal outcomes. As tactile feedback is crucial for a successful lumbar puncture, this procedure serves as an ideal candidate for the development of a haptic training simulator. The intent of this
Paul Gorman; Thomas Krummel; Roger Webster; Monica Smith; David Hutchens
Objective The aim of this study is to implement a critical pathway (CP) for patients undergoing lumbar laminectomy or microdiscectomy and describe the results before and after the CP in terms of length of hospital stay and cost. Methods From March 2008 to February 2009, 61 patients underwent lumbar laminectomy or microdiscectomy due to stenosis or one- or two-level disc herniation in our department and were included in the prepathway group. After development and implementation of the CP in March 2009, 58 patients were applicable for the CP, and these were classified as the postpathway group. Results The CP, which established a 6-day hospital stay (5 bed-days), was fulfilled by 42 patients (72.4%) in the postpathway group. The mean length of stay was 5.4 days in the postpathway group compared to 6.9 days in the prepathway group, demonstrating a 20% reduction, which was a statistically significant difference (p?0.000). There was a statistically significant reduction in charges for bed and nursing care (p=0.002). Conclusion Implementation of a CP for lumbar laminectomy or microdiscectomy produced significant decreases in length of hospitalization and charges for bed and nursing care. We believe that this CP reduces the unnecessary use of hospital resources without increasing risk of adverse events.
Chung, Sang-Bong; Lee, Sun-Ho; Kim, Eun-Sang
Echocardiographic analysis of the movement of the posterior mitral valve leaflet in 60 patients with lone mitral stenosis, 35 patients with aortic stenosis, and 18 patients with aortic and mitral stenosis showed a spectrum of initial posterior mitral valve leaflet movement in early diastole. The classical anterior movement was seen in 36 out of 60 patients with mitral stenosis (60%), and 8 out of 16 patients with aortic and mitral stenosis (50%). Normal posterior movement was present in all patients with lone aortic stenosis but was also seen in 10 patients (17%) with mitral stenosis and 6 patients (33%) with aortic and mitral stenosis. The remaining patients with mitral stenosis or aortic stenosis and mitral stenosis showed a biphasic type of initial movement. Patients with anterior movement had a mean calculated mitral valve area from cardiac catheterisation significantly smaller than the rest (P less than 0.001), but neither biphasic nor posterior movement excluded severe mitral stenosis. The distinction between patients with mitral stenosis and initial movement of the posterior mitral valve leaflet and patients with left ventricular discompliance is possible when there is sinus rhythm. Late diastolic anterior movement of the posterior mitral valve leaflet during atrial contraction is diagnostic of true mitral stenosis.
Shiu, M F; Jenkins, B S; Webb-Peploe, M M
Purpose: To retrospectively examine the association between the inclusion of epidemiologic information in lumbar spine magnetic resonance (MR) imaging reports regarding findings in asymptomatic individuals and the rates of subsequent cross-sectional imaging and treatments in patients with low back pain or radiculopathy referred for imaging by primary care providers. Materials and Methods: Institutional review board approval was received for a retrospective chart review, with waiver of informed consent and HIPAA authorization. During 3 years, an epidemiologic statement was routinely but arbitrarily included in lumbar spine MR imaging reports. Two hundred thirty-seven reports documenting uncomplicated degenerative changes on initial lumbar spine MR images were identified, 71 (30%) of which included the statement (statement group) and 166 (70%) did not (nonstatement group). The rates of repeat cross-sectional imaging and treatments within 1 year were compared between groups by using logistic regression controlling for severity of MR imaging findings. Results: Patients in the statement group were significantly less likely to receive a prescription for narcotics for their symptoms than patients in the nonstatement group (odds ratio = 0.29, P = .01). Repeat cross-sectional imaging and physical therapy referrals were also less common in the statement group than in the nonstatement group (odds ratio = 0.22 and 0.55, respectively), but these differences were not statistically significant (P = .14 and .06, respectively). Rates of steroid injections, surgical consultations, and surgeries were similar between groups. Conclusion: Patients were less likely to receive narcotics prescriptions from primary care providers when epidemiologic information was included in their lumbar spine MR imaging reports. © RSNA, 2012
McCullough, Brendan J.; Johnson, Germaine R.; Martin, Brook I.
Cricket fast bowlers have a high incidence of serious lumbar injuries, such as lesions in the pars interarticularis. As lumbar loading is the causal mechanism of such injuries, the purpose of this study was to find relationships between lumbar spine kinetics, selected kinematic variables and the subsequent development of lumbar spine injury. At the beginning of the cricket season, the
René E D Ferdinands; Max Stuelcken; Andy Greene; Peter Sinclair; Richard Smith
Background Available information suggests a mismatch between radiographic and orthopedic examination findings in cats with DJD. However, the extent of the discrepancy between clinical and radiographic signs of OA in companion animals has not been described in detail. This study aimed to evaluate the relationship between orthopedic examination findings, joint goniometry, and radiographic signs of DJD in 100 cats, in a prospective observational design. Cat temperament, pain response to palpation, joint crepitus, effusion and thickening were graded. Radiographs of appendicular joints and the axial skeleton were made under sedation. Joint motion was measured by use of a plastic goniometer before and after sedation. Associations between radiographic degenerative joint disease (DJD) and examination findings were assessed to determine sensitivity, specificity and likelihood estimations. Results Pain response to palpation was elicited in 0-67% of the joints with DJD, with a specificity ranging from 62-99%; crepitus was detected in 0-56% of the joints and its specificity varied between 87 and 99%; for effusion, values ranged between 6 and 38% (specificity, 82-100%), and thickening, 0-59% (specificity, 74-99%). Joints with DJD tended to have a decreased range of motion. The presence of pain increased the odds of having DJD in the elbow (right: 5.5; left: 4.5); the presence of pain in the lower back increased the odds of spinal DJD being present (2.97 for lumbar; 4.67 for lumbo-sacral). Conclusions Radiographic DJD cannot be diagnosed with certainty using palpation or goniometry. However, negative findings tend to predict radiographically normal joints. Palpation and goniometry may be used as a tool to help to screen cats, mostly to rule out DJD.
In this review we discuss insights into therapeutic stratagems that can selectively target the choroid, retinal cells and vitreoretinal space for the treatment of vision-threatening vascular degenerative disorders of the posterior eye. Despite the relative success of these novel drugs, new problems related to its delivery remain. Systems carrying drugs to the target site, such as nanoparticles, liposomes, vectosomes, spanlastics, micelles, dendrimers and implants are also discussed. Further, we also consider drug penetration enhancement approaches along with cutting-edge strategies for regaining vision during vision-threatening vascular degenerative disorders of the eye. Finally, challenges, such as ocular or even systemic complications associated with use of prolonged therapies and future prospects, such as combination of approaches with multidisciplinary integration to optimize delivery to the posterior eye are also addressed. PMID:22504325
Jain, Gaurav K; Warsi, Musarrat H; Nirmal, Jayabalan; Garg, Vaidehi; Pathan, Shadab A; Ahmad, Farhan J; Khar, Roop K
In the present study, 80 patients with degenerative joint disease, spondylosis deformans, and\\/or osteoarthritis of the knee\\u000a with back or joint pain, especially on movement and strain, were randomly divided into four groups. Group A received no etidronate,\\u000a while groups B, C and D received 66, 133 and 200 mg\\/day etidronate, respectively, for 12 months. Every 3 months, after evaluating
Takuo Fujita; Yoshio Fujii; Seiko F. Okada; Akimitsu Miyauchi; Yasuyuki Takagi
With the development of stem cell technology, stem cell-based therapy for retinal degeneration has been proposed to restore\\u000a the visual function. Many animal studies and some clinical trials have shown encouraging results of stem cell-based therapy\\u000a in retinal degenerative diseases. While stem cell-based therapy is a promising strategy to replace damaged retinal cells and\\u000a ultimately cure retinal degeneration, there are
Ian Yat-Hin Wong; Ming-Wai Poon; Rosita Tsz-Wai Pang; Qizhou Lian; David Wong
Retinal degenerative diseases that target photoreceptors or the adjacent retinal pigment epithelium (RPE) affect millions\\u000a of people worldwide. Retinal degeneration (RD) is found in many different forms of retinal diseases including retinitis pigmentosa\\u000a (RP), age-related macular degeneration (AMD), diabetic retinopathy, cataracts, and glaucoma. Effective treatment for retinal\\u000a degeneration has been widely investigated. Gene-replacement therapy has been shown to improve visual
Yiming Huang; Volker Enzmann; Suzanne T. Ildstad
Summary ¶?The Cloward ventral interbody fusion is often employed for treatment of cervical degenerative disease. The present study\\u000a was aimed at evaluating results and complications in this classical type of autologous bone graft procedure in a cohort of\\u000a patients with radiculopathy (RP) or myeloradiculopathy (MRP). Indications for and limitations of the technique were investigated\\u000a by retrospective data analysis in a series
V. Heidecke; N. G. Rainov; T. Marx; W. Burkert
Mitochondria are intracellular organelles involved in ATP synthesis, apoptosis, calcium signaling, metabolism, and the synthesis of critical metabolic cofactors. Mitochondrial dysfunction is associated with age-related degenerative diseases. How mitochondrial dysfunction causes cell degeneration is not well understood. Recent studies have shown that mutations in the adenine nucleotide translocase (Ant) cause aging-dependent degenerative cell death (DCD) in yeast, which is sequentially manifested by inner membrane stress, mitochondrial DNA (mtDNA) loss, and progressive loss of cell viability. Ant is an abundant protein primarily involved in ADP/ATP exchange across the mitochondrial inner membrane. It also mediates basal proton leak and regulates the mitochondrial permeability transition pore. Missense mutations in the human Ant1 cause several degenerative diseases which are commonly manifested by fractional mtDNA deletions. Multiple models have been proposed to explain the Ant1-induced pathogenesis. Studies from yeast have suggested that in addition to altered nucleotide transport properties, the mutant proteins cause a global stress on the inner membrane. The mutant proteins likely interfere with general mitochondrial biogenesis in a dominant-negative manner, which secondarily destabilizes mtDNA. More recent work revealed that the Ant-induced DCD is suppressed by reduced cytosolic protein synthesis. This finding suggests a proteostatic crosstalk between mitochondria and the cytosol, which may play an important role for cell survival during aging.
We present a retrospective evaluation of our experience in the period that goes from January 1992 to December 1998, clinical records of 58 patients ages from 2 months old to 15 years, male and female, who were treated at the GI service of Instituto de Salud del Ni o, were reviewed. All of them had esophageal stenosis and were included in the Esophageal Dilatation Program with Savary-Gilliard bougies. The causes of Esophageal Stenosis in the study were: Caustic agents 37.9%, gastro esophageal reflux (GER) 20.7%, surgery sequela 19.0%, related to esophageal esclerotherapy 12.1%, foreign body itself or maneuvers to retrieve them 8.6%, stomach adenocarcinoma invading the esophagus. Patients were classified in three groups: Group 1: stenosis due to caustic agents Group 2: stenosis due to GER Group 3: The remaining causes mentioned above., In each the following was calculated: the arithmetical media, the range of dilatations sessions and the total number of them. The higher figures took place in group 1. So we conclude that the number of sessions is directly related with the cause of the stenosis, requiring more number of dilatations to get a better response. Finally the response to treatment is evaluated considering a good response in 72.4%. A mild response in 15.5% and therapeutic failure in 12.1% of patients. The rate of complications was 10.3 per patient and 1.1 in relation to the total number of dilatation sessions. The main complications were: gastric perforation, duodenal perforation, pneumomediastinum, esophago-tracheal fistulae andi pseudodiverticulum formation, with resolution as seen in posterior controls. These complications occured after the proceeding took place. The treatment was installed according to each case. The patients with duodenal perforation died. We conclude that esophageal dilatations in infants with esophageal stenosis, of different ethiology, are secure and efficient. PMID:12181577
Alarcón, Anibal; Talavera, Godofredo; Gonzales, Jóse; Rivera, Juan
... and Answers About Treating Arterial Stenosis and Preventing Stroke A stroke is any sudden event affecting the ... and high cholesterol. How does stenosis contribute to stroke? Atherosclerosis can activate cells involved in blood clotting. ...
PurposeTo evaluate the efficacy of percutaneous angioplasty and stenting in cases of artery stenosis of the transplanted kidney or proximal iliac artery stenosis causing transplant dysfunction and\\/or increase of the arterial blood pressure.
P. Pappas; G. Zavos; S. Kaza; P. Leonardou; E. Theodoropoulou; J. Bokos; J. Boletis; A. Kostakis
Cell transplantation is a promising strategy for the treatment of neurodegenerative and muscle degenerative diseases. Many kinds of cells, including embryonic stem cells and tissue stem cells, have been considered as candidates for transplantation therapy. Bone marrow stromal cells (MSCs) have great potential as therapeutic agents since they are easy to isolate and can be expanded from patients without serious ethical or technical problems. We discovered a new method for the highly efficient and specific induction of functional Schwann cells, neurons and skeletal muscle lineage cells from both rat and human MSCs. These induced cells were transplanted into animal models of neurotraumatic injuries, Parkinson’s disease, stroke and muscle dystrophies, resulting in the successful integration of transplanted cells and an improvement in behavior of the transplanted animals. Here we focus on the respective potentials of MSC-derived cells and discuss the possibility of clinical application in degenerative diseases.
Dezawa, Mari; Ishikawa, Hiroto; Hoshino, Mikio; Itokazu, Yutaka; Nabeshima, Yo-ichi
Study Design Clinical trial sub-group analysis Objective To compare outcomes of different fusion techniques treating degenerative spondylolisthesis (DS). Summary of Background Data Surgery has been shown to be more effective than non-operative treatment out to four years.1,2 Questions remain regarding the differential effect of fusion technique. METHODS Surgical candidates from 13 centers in 11 states with at least 12 weeks of symptoms and confirmatory imaging showing stenosis and DS were studied. In addition to standard decompressive laminectomy, one of three fusion techniques was employed at the surgeon’s discretion: posterolateral in situ fusion (PLF); posterolateral instrumented fusion with pedicle screws (PPS); or PPS plus interbody fusion (360°). Main outcome measures were the SF-36 Bodily Pain (BP) and Physical Function (PF) scales and the modified Oswestry Disability Index (ODI) assessed at 6 weeks, 3 months, 6 months, and yearly to 4 years. The as-treated analysis combined the randomized and observational cohorts using mixed longitudinal models adjusting for potential confounders. RESULTS Of 380 surgical patients, 21% (N= 80) received a PLF; 56% (N=213) received a PPS; 17% (N=63) received a 360°; and 6% (N=23) had decompression only without fusion. Early outcomes varied, favoring PLF compared to PPS at 6 weeks (PF: 12.73 vs. 6.22, p<0.020) and 3 months (PF: 25.24 vs.18.95, p<0.025) and PPS compared to 360° at 6 weeks (ODI: ?14.46 vs. ?9.30, p<0.03) and 3 months (ODI: ?22.30 vs. ?16.78, p<0.02). At two years, 360° had better outcomes: BP: 39.08 vs. 29.17 PLF, p<0.011; and vs. 29.13 PPS, p<0.002; PF; 31.93 vs. 23.27 PLF, p<0.021; and vs. 25.29 PPS, p<0.036. However, these differences were not maintained at 3- and 4-year follow-up, when there were no statistically significant differences between the three fusion groups. CONCLUSIONS In patients with degenerative spondylolisthesis and associated spinal stenosis, no consistent differences in clinical outcomes were seen among fusion groups over four years.
Abdu, William A.; Lurie, Jon D.; Spratt, Kevin F.; Tosteson, Anna N.A.; Zhao, Wenyan; Tosteson, Tor D.; Herkowitz, Harry; Longely, Michael; Boden, Scott D.; Emery, Sanford; Weinstein, James N.
The role of carotid stenosis in vascular cognitive impairment was reviewed using Medline, EMBASE, PsychLit and PsychInfo databases using the words ‘carotid stenosis’, ‘neuropsychological tests’ and ‘endarterectomy’. Limited evidence exists for frontal lobe dysfunction associated with carotid stenosis, but there is a lack of systematic and prospective studies carried out in consecutive patients, including appropriate neuropsychological and MRI assessment. Possible
Background: Subglottic stenosis is an ancient but persistent problem as a cause of airway obstruction. The etiology and the results of surgical treatment with thyrotracheal anastomosis were reviewed. Methods: Fifty-six patients with subglottic stenosis were studied. All were subjected to laryngotracheal reconstruction by thyrotracheal anastomosis with partial resection of the cricoid. Results: Of all 56 cases of subglottic stenosis, 48
Juan Peña; Raúl Cicero; José Mar??n; Martha Ram??rez; Sergio Cruz; Francisco Navarro
The objective of this study was to assess the percent stenosis of the culprit lesion responsible for subsequent myocardial infarction in the Program on the Surgical Control of the Hyperlipidemias (POSCH). It is unknown if the susceptible coronary artery culprit lesion responsible for an acute myocardial infarction is relatively large (?50% arteriographic stenosis) and hemodynamically significant (?70% stenosis), or small
Henry Buchwald; David W. Hunter; Naip Tuna; Stanley E. Williams; James R. Boen; Betty J. Hansen; Jack L. Titus; Christian T. Campos
Background: A lumbar pedicular dynamic stabilization system (LPDSS) is an alternative to fusion for treatment of degenerative disc disease (DDD). In this study, clinical and radiological results of one LPDSS (Saphinaz, Medikon AS, Turkey) were compared with results of rigid fixation after two-year follow-up. Methods: All patients had anteroposterior and lateral standing x-rays of the lumbar spine preoperatively and at 3 months, 12 months and 24 months after surgery. Lordosis of the lumbar spine, segmental lordosis and ratio of the height of the intervertebral disc spaces (IVS) measured preoperatively and at 3 months, 12 months and 24 months after surgery. All patients underwent MRI and/or CT preoperatively, 3months, 12 months and 24 months postoperatively. The ratio of intervertebral disc space to vertebral body height (IVS) and segmental and lumbar lordosis were evaluated preoperatively and postoperatively. Pain scores were evaluated via Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) preoperatively and postoperatively. Results: In both groups, the VAS and ODI scores decreased significantly from preoperatively to postoperatively. There was no difference in the scores between groups except that a lower VAS and ODI scores were observed after 3 months in the LPDSS group. In both groups, the IVS ratio remained unchanged between preoperative and postoperative conditions. The lumbar and segmental lordotic angles decreased insignificantly to preoperative levels in the months following surgery. Conclusions: Patients with LPDSS had equivalent relief of pain and maintenance of sagittal balance to patients with standard rigid screw-rod fixation. LPDSS appears to be a good alternative to rigid fixation.
Ozer, Ali Fahir; Crawford, Neil R; Sasani, Mehdi; Oktenoglu, Tunc; Bozkus, Hakan; Kaner, Tuncay; Aydin, Sabri
Lumbar disk herniation is a significant cause of lumbar radiculopathy and results in billions of dollars in health care expenditure. Herniated lumbar disks cause mechanical and chemical irritation of the nerve roots leading to complaints of sciatica. Surgeons have several surgical options when approaching herniated disks, including various microsurgical procedures. The 3 most prominent studies to date on surgical and nonsurgical management of herniated disks agree on the efficacy of surgery over medical management in the short term but have some discrepancies when looking at long-term results. Cauda equina syndrome is a variation of lumbar disk herniation in which patients experience a combination of saddle anesthesia, abnormal lower extremity reflexes, and neurogenic bowel or bladder symptoms. PMID:21292152
Bruggeman, Adam J; Decker, Robert C
Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots.
Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent
Two case reports of emergent anesthesia of critical tracheal stenosis are presented. The use of extracorporeal circulation may be a lifesaving method for these patients. Two patients both with severe lower tracheal stenosis were admitted with severe inspiratory dyspnea. The first patient had a tracheal tube inserted above the stenosis in the operating room, but ventilation was unsatisfactory, high airway pressure and severe hypercarbia developed, therefore extracorporeal circulation was immediately initiated. For the second patient, we established femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia, and intubated above the tracheal tumor orally under general anesthesia, then adjusted the endotracheal tube to appropriate depth after the tumor had been resected. The patient was gradually weaned from cardiopulmonary bypass. The two patients all recovered very well after surgery. Surgery is lifesaving for patients with critical tracheal stenosis, but how to ensure effective gas exchange is crucial to the anesthetic management. Extracorporeal circulation by the femoral artery and femoral vein cannulation can gain good gas exchange even if the trachea is totally obstructed. Therefore, before the induction of anesthesia, we should assess the site and degree of obstruction carefully and set up cardiopulmonary bypass to avoid exposing the patient to unexpected risks and the anesthesiologist to unexpected challenges.
Zhou, Yang-feng; Zhu, Shao-jun; Zhu, Sheng-mei; An, Xiao-xia
To test the hypothesis that disturbed flow can impede the transport of nitric oxide (NO) in the artery and hence induce atherogenesis, we used a lumen–wall model of an idealized arterial stenosis with NO produced at the blood vessel–wall interface to study the transport of NO in the stenosis. Blood flows in the lumen and through the arterial wall were simulated by Navier–Stokes equations and Darcy's Law, respectively. Meanwhile, the transport of NO in the lumen and the transport of NO within the arterial wall were modelled by advection–diffusion reaction equations. Coupling of fluid dynamics at the endothelium was achieved by the Kedem–Katchalsky equations. The results showed that both the hydraulic conductivity of the endothelium and the non-Newtonian viscous behaviour of blood had little effect on the distribution of NO. However, the blood flow rate, stenosis severity, red blood cells (RBCs), RBC-free layer and NO production rate at the blood vessel–wall interface could significantly affect the transport of NO. The theoretical study revealed that the transport of NO was significantly hindered in the disturbed flow region distal to the stenosis. The reduced NO concentration in the disturbed flow region might play an important role in the localized genesis and development of atherosclerosis.
Liu, Xiao; Fan, Yubo; Xu, X. Yun; Deng, Xiaoyan
Background\\/purposeThe aim of this study was to add to the experience of slide tracheoplasty in infants with congenital tracheal stenosis (CTS), to review the recent literature on this subject, and to evaluate the diagnostic workup in infants with CTS.
J. P Koopman; A. J. J. C Bogers; M Witsenburg; M. H Lequin; D Tibboel; L. J Hoeve
Objective: Congenital tracheal stenosis (CTS) is a very infrequent malformation. Till recently, the outlook for these patients was dismal because medical management was the only way of treatment. Surgical and endoscopical techniques developed in the last years have improved the prognosis. We review the short- and long-term outcomes of a single institution experience in the management of children with CTS,
Juan L. Antón-Pacheco; Indalecio Cano; Juan Comas; Lorenzo Galletti; Luz Polo; Araceli García; María López; Daniel Cabezalí
Laryngotracheal stenosis (LTS) is a serious challenge for the otolaryngologist. Although progress has been made in preventing and treating LTS, more research is required. Existing canine models for LTS incur high mortality and morbidity, require relatively complicated procedures or costly equipment, entail lengthy waiting periods, or have unpredictable results. A simple, reliable, and inexpensive procedure, requiring no tracheotomy, is described
RON ELIASHAR; ISAAC ELIACHAR; TERRY GRAMLICH; RAMON ESCLAMADO; MARSHAL STROME
Objectives: To determine the incidence of gastroesopha- geal reflux in patients with subglottic stenosis (SGS) and to determine if upper esophageal reflux occurs in addi- tion to lower esophageal reflux in these patients. Design: Esophageal pH probe studies were reviewed in patients diagnosed as having SGS. Setting: A tertiary care pediatric medical center. Patients: All patients diagnosed as having SGS
David L. Walner; Yoram Stern; Mark E. Gerber; Colin Rudolph; Constance Y. Baldwin; Robin T. Cotton
Until recently, cricotracheal resection (CTR) has not been commonly accepted as a treatment modality for severe subglottic stenosis in the pediatric age group. The reasons have included the risk of a possible dehiscence at the site of the anastomosis, the likelihood of injury to the recurrent laryngeal nerves, and the interference with normal growth of the larynx. Thirty-eight infants and
Philippe Monnier; Florian Lang; Marcel Savary
Objectives: To determine whether there are any changes in the incidence and management of neonatal subglottic stenosis (SGS). Methods: A retrospective chart review of 416 infants who were admitted to the neonatal intensive care unit of the Children’s National Medical Center between July 1, 1995, and June 30, 1996, was carried out. The incidence of airway obstruction requiring anterior cricoid
SUKGI S. CHOI; GEORGE H. ZALZAL
Idiopathic tracheal stenosis (ITS) is an extremely rare disease. We report the case of a 32-year-old woman with ITS. She had no history of previous surgery, endotracheal intubation, neck trauma, granulomatous disease, or any other severe respiratory tract infections. She presented with progressive dyspnea on effort and had been treated for bronchial asthma for 3 years. Chest radiography and laboratory
Chihiro Hatta; Tomonori Terada; Masao Kakibuchi; Hiroshi Ogasawara; Keiji Nakasho; Masafumi Sakagami
Summary ?Object. This study was undertaken to determine whether a special postoperative pain administration of tramadol and diclofenac provides\\u000a any benefits in patients who underwent microsurgical lumbar discectomy.\\u000a \\u000a ?Methods. The study consisted of 60 patients undergoing microsurgical lumbar discectomy. Patients were randomly divided into two groups\\u000a based on the postoperative pain management: 1) Group A (n=30): no standardized pain therapy; these
R. Filippi; J. Laun; J. Jage; A. Perneczky
Summary Annular margin shape is used to characterize lumbar disc abnormality on CT/MR imaging studies. Abnormal discs also have internal derangement including annular degeneration and radial defects. The purpose of this study was to evaluate potential correlation between disc-margin shape and annular internal derangement on post-discogram CT in significantly painful discs encountered at provocation lumbar discography (PLD). Significantly painful discs were encountered at 126 levels in 86 patients (47 male, 39 female) studied by PLD where no prior surgery had been performed and response to intradiscal lidocaine after provocation resulted in either substantial/total relief or no improvement after lidocaine administration. Post-discogram CT and discogram imaging was evaluated for disc-margin characteristics (bulge/protrusion), features of disc internal derangement (radial annular defect [RD: radial tear/fissure/annular gap], annular degeneration) and presence/absence of discographic contrast leakage. In discs with focal protrusion, 50 of 63 (79%) demonstrated Grade 3 RD with 13 (21%) demonstrating severe degenerative change only. In discs with generalized-bulge-only, 48 of 63 (76%) demonstrated degenerative change only (primarily Dallas Grade 3) with 15 of 63 (24%) demonstrating a RD (Dallas Grade 3). Differences were highly statistically significant (p<0.001). Pain elimination with intra-discal lidocaine correlated with discographic contrast leakage (p<0.001). Disc-margin shape correlates with features of internal derangement in significantly painful discs encountered at PLD. Discs with focal protrusion typically demonstrate RD while generalized bulging discs typically demonstrated degenerative changes only (p<0.001). Disc-margin shape may provide an important imaging clue to the cause of chronic discogenic low back pain.
Bartynski, W.S.; Rothfus, W.E.
Annular margin shape is used to characterize lumbar disc abnormality on CT/MR imaging studies. Abnormal discs also have internal derangement including annular degeneration and radial defects. The purpose of this study was to evaluate potential correlation between disc-margin shape and annular internal derangement on post-discogram CT in significantly painful discs encountered at provocation lumbar discography (PLD). Significantly painful discs were encountered at 126 levels in 86 patients (47 male, 39 female) studied by PLD where no prior surgery had been performed and response to intradiscal lidocaine after provocation resulted in either substantial/total relief or no improvement after lidocaine administration. Post-discogram CT and discogram imaging was evaluated for disc-margin characteristics (bulge/protrusion), features of disc internal derangement (radial annular defect [RD: radial tear/fissure/annular gap], annular degeneration) and presence/absence of discographic contrast leakage. In discs with focal protrusion, 50 of 63 (79%) demonstrated Grade 3 RD with 13 (21%) demonstrating severe degenerative change only. In discs with generalized-bulge-only, 48 of 63 (76%) demonstrated degenerative change only (primarily Dallas Grade 3) with 15 of 63 (24%) demonstrating a RD (Dallas Grade 3). Differences were highly statistically significant (p<0.001). Pain elimination with intra-discal lidocaine correlated with discographic contrast leakage (p<0.001). Disc-margin shape correlates with features of internal derangement in significantly painful discs encountered at PLD. Discs with focal protrusion typically demonstrate RD while generalized bulging discs typically demonstrated degenerative changes only (p<0.001). Disc-margin shape may provide an important imaging clue to the cause of chronic discogenic low back pain. PMID:22681741
Bartynski, W S; Rothfus, W E
The widespread use of MRI in the assessment of low back pain has led to increased detection of degenerative cysts of the spine, which was essentially a surgical diagnosis earlier. The awareness of degenerative cysts, the significance of their role in the etiology of radicular and back pain and their effective management is evolving. We describe a case of bilateral, gas-filled lumbar facet synovial/ ganglion cysts causing focal arachnoid inflammation and lateral lumbar canal stenosis. PMID:23859245
El Beltagi, A H; Swamy, N; Dashti, F
One of the major challenges in cardiovascular medicine is to identify candidate biomarker proteins. Secretome analysis is particularly relevant in this search as it focuses on a subset of proteins released by a cell or tissue under certain conditions. The sample can be considered as a plasma subproteome and it provides a more direct approximation to the in vivo situation. Degenerative aortic stenosis is the most common worldwide cause of valve replacement. Using a proteomic analysis of the secretome from aortic stenosis valves we could identify candidate markers related to this pathology, which may facilitate early diagnosis and treatment. For this purpose, we have designed a method to validate the origin of secreted proteins, demonstrating their synthesis and release by the tissue and ruling out blood origin. The nLC-MS/MS analysis showed the labeling of 61 proteins, 82% of which incorporated the label in only one group. Western blot and selective reaction monitoring differential analysis, revealed a notable role of the extracellular matrix. Variation in particular proteins such as PEDF, cystatin and clusterin emphasizes the link between aortic stenosis and atherosclerosis. In particular, certain proteins variation in secretome levels correlates well, not only with label incorporation trend (only labeled in aortic stenosis group) but, more importantly, with alterations found in plasma from an independent cohort of samples, pointing to specific candidate markers to follow up in diagnosis, prognosis, and therapeutic intervention. PMID:23704777
Alvarez-Llamas, Gloria; Martín-Rojas, Tatiana; de la Cuesta, Fernando; Calvo, Enrique; Gil-Dones, Felix; Dardé, Veronica M; Lopez-Almodovar, Luis F; Padial, Luis R; Lopez, Juan-Antonio; Vivanco, Fernando; Barderas, Maria G
The study design included an in vivo laboratory study. The objective of the study is to quantify the kinematics of the lumbar spinous processes in asymptomatic patients during un-restricted functional body movements with physiological weight bearing. Limited data has been reported on the motion patterns of the posterior spine elements. This information is necessary for the evaluation of traumatic injuries and degenerative changes in the posterior elements, as well as for improving the surgical treatment of spinal diseases using posterior procedures. Eight asymptomatic subjects with an age ranging from 50 to 60 years underwent MRI scans of their lumbar segments in a supine position and 3D models of L2–5 were constructed. Next, each subject was asked to stand and was positioned in the following sequence: standing, 45° flexion, maximal extension, maximal left and right twisting, while two orthogonal fluoroscopic images were taken simultaneously at each of the positions. The MRI models were matched to the osseous outlines of the images from the two orthogonal views to quantify the position of the vertebrae in 3D at each position. The data revealed that interspinous process (ISP) distance decreased from L2 to L3 to L4 to L5 when measured in the supine position; with significantly higher values at L2–3 and L3–4 compared with L4–5. These differences were not seen with weight-bearing conditions. During the maximal extension, the ISP distance at the L2–3 motion segment was significantly reduced, but no significant changes were detected at L3–4 and L4–5. During flexion the ISP distances were not significantly different than those measured in the MRI position at all segments. Going from the left to right twist positions, the L4–5 segment had greater amounts of ISP rotation, while all segments had similar ranges of translation in the transverse plane. The interspinous process distances were dependent on body posture and vertebral level.
Xia, Qun; Wang, Shaobai; Passias, Peter G.; Kozanek, Michal; Li, Gang; Grottkau, Brian E.; Wood, Kirkham B.
\\u000a \\u000a Purpose: To evaluate the usefulness of the DIAM device in patients affected by low back pain due to degenerative disc disease.\\u000a \\u000a \\u000a \\u000a Background: Recently a number of interspinous devices for dynamic interspinous distraction-stabilization have entered the clinical practice\\u000a in Europe. All of these devices have a common property of acting on the posterior part of the functional spinal unit by distracting
Josip Buric; Massimiliano Pulidori; Tariq Sinan; Sheikh Mehraj
Lipoblastic nerve sheath tumor is a recently described benign soft tissue tumor consisting of lipoblasts in a neural/schwannian background. The 6 reported cases have exclusively comprised signet ring lipoblasts and showed no cellular atypia. The authors describe the first lipoblastic nerve sheath tumor to harbor multivacuolated lipoblasts and degenerative atypia, underscoring its important differential diagnosis with well-differentiated liposarcoma. The purpose of this report is to expand the morphologic spectrum of this unusual neoplasm, and reemphasize the potential of benign nonadipocytic tumors to harbor multivacuolated lipoblasts and mimic liposarcoma. PMID:21873411
Fedda, Faysal A; Tawil, Ayman N; Boulos, Fouad I
Degenerative joint disease, primarily in the form of osteoarthrosis, affects the temporomandibular joints (TMJs) with symptoms similar to those found in other body joints. These symptoms include stiffness, pain, restriction of movement, inflammation, crepitus and radiographic changes. Symptoms can occur in both males and females at any age, starting with pre-adolescent, but most often occur in females age 30 and over. Most symptoms will last nine to 18 months (followed by remission) and are managed using anti-inflammatory medications, physical therapy, occlusal splints and dietary changes. Major areas for consideration in this article include epidemiology, signs and symptoms, radiography, etiopathology and symptom management. PMID:8118899
Bates, R E; Gremillion, H A; Stewart, C M
Degenerative disk disease is a strong etiologic risk factor of chronic low back pain (LBP). A multidisciplinary approach to treatment is often warranted. Patient education, medication, and cognitive behavioral therapies are essential in the treatment of chronic LBP sufferers. Surgical intervention with a rehabilitation regime is sometimes advocated. Prognostic factors related to the outcome of different treatments include maladaptive pain coping and genetics. The identification of pain genes may assist in determining individuals susceptible to pain and in patient selection for appropriate therapy. Biologic therapies show promise, but clinical trials are needed before advocating their use in humans. PMID:21944588
Karppinen, Jaro; Shen, Francis H; Luk, Keith D K; Andersson, Gunnar B J; Cheung, Kenneth M C; Samartzis, Dino
The anatomy of the arteries of 93 adult human lumbar vertebral bodies was studied microarteriographically. There is a network of periosteal arteries joining the arteries of adjacent vertebrae on the anterolateral and posterior surfaces. These are prominent between the fourth and fifth lumbar arteries. There are three types of intra-osseous arteries: equatorial, metaphyseal and peripheral. Each supplies a separate zone. The peripheral arteries are short, branch early and have centripetally directed terminal branches; they supply the outer collar of the vertebral body. The equatorial and metaphyseal arteries are morphologically similar, having straight unbranching stems, pre-terminal coils and centrifugal terminal branches. The equatorial arteries supply the central core of the vertebral body subjacent to the nucleus pulposus, and the metaphyseal arteries supply an annular zone between the other two types. Some circumstantial evidence that discal degenerative disease is associated with discal, or vertebral body, anoxia is presented. The present study adds to this evidence. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 (cont.) Fig. 8 Fig. 9 Fig. 10(cont.) Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17
Ratcliffe, J F
This article describes the development of minimally invasive methods in the treatment of lumbar discopathy, with particular attention to percutaneous laser disc decompression (PLDD). The authors discus the therapeutic operating mechanism of PLDD, emphasizing the importance of the thermal characteristics of laser light, which is responsible for the vaporization and ablation of a small amount of tissue from the nucleus pulposus. This causes a significant reduction in pressure in the closed structure of the disc, and consequently reduced compression exerted by the disk on the dural sac and the nerve roots. Improvement in the flow of cerebro-spinal fluid has also been observed on the level at which the operation is performed. On the basis of our own experience and the reports of other authors, we have specified indications and contra-indications for PLDD. Our conclusion is that PLDD is an effective treatment method for low back pain and ischialgia caused by protrusion or herniation of the nucleus pulposus, with elimination or significant reduction in symptoms in over 75% of those treated; reduction or resolution of neurological deficits that arise in the course of lumbar discopathy has also been observed. This method enables one-stage treatment of multi-level degenerative changes in the intervertebral disc. The only absolute contraindications for PLDD are the presence of sequestration, disturbances in blood coagulation, and bacterial infection. PMID:17675991
Maksymowicz, Wojciech; Barczewska, Monika; Sobieraj, Andrzej
Lumbar nerve root anomalies are uncommon phenomena that must be recognized to avoid neural injury during surgery. The authors describe 2 cases of nerve root anomalies encountered during mini-open transforaminal lumbar interbody fusion (TLIF) surgery. One anomaly was a confluent variant not previously classified; the authors suggest that this variant be reflected in an amendment to the Neidre and Macnab classification system. They also propose strategies for identifying these anomalies and avoiding injury to anomalous nerve roots during TLIF surgery. Case 1 involved a 68-year-old woman with a 2-year history of neurogenic claudication. An MR image demonstrated L4-5 stenosis and spondylolisthesis and an L-4 nerve root that appeared unusually low in the neural foramen. During a mini-open TLIF procedure, a nerve root anomaly was seen. Six months after surgery this patient was free of neurogenic claudication. Case 2 involved a 60-year-old woman with a 1-year history of left L-4 radicular pain. Both MR and CT images demonstrated severe left L-4 foraminal stenosis and focal scoliosis. Before surgery, a nerve root anomaly was not detected, but during a unilateral mini-open TLIF procedure, a confluent nerve root was identified. Two years after surgery, this patient was free of radicular pain. PMID:23905960
Burke, Shane M; Safain, Mina G; Kryzanski, James; Riesenburger, Ron I
We present a case of an acute psoas muscle hemat