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1

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

Microsoft Academic Search

The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF).\\u000a A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective\\u000a biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements\\u000a and improvements in grafting substances, the indications and use of PLIF and

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

2009-01-01

2

Treating Traumatic Lumbosacral Spondylolisthesis Using Posterior Lumbar Interbody Fusion with three years follow up  

PubMed Central

Objective: To analyze the surgical outcome of traumatic lumbosacral spondylolisthesis treated using posterior lumbar interbody fusion, and help spine surgeons to determine the treatment strategy. Methods: We reviewed retrospectively five cases of traumatic lumbosacral spondylolisthesis treated in our hospital from May 2005 to May 2010. There were four male and one female patient, treated surgically using posterior lumbar interbody fusion. The patients’ data including age, neurological status, operation time, blood loss, follow-up periods, X- radiographs and fusion status were collected. Results: All the cases were treated using posterior lumbar interbody fusion to realize decompression, reduction and fusion. Solid arthrodesis was found at the 12-month follow-up. No shift or breakage of the instrumentation was found, and all the patients were symptom-free at the last follow-up. Conclusion: Traumatic lumbosacral spondylolisthesis can be treated using posterior lumbar interbody fusion to realize the perfect reduction, decompression, fixation and fusion. PMID:25225542

Tang, Shujie

2014-01-01

3

Combined anterior interbody fusion and posterior pedicle screw fixation in patients with degenerative lumbar disc disease  

Microsoft Academic Search

We reviewed 47 consecutive patients with degenerative lumbar disc disease. All patients were treated by anterior interbody fusion using an autogenous iliac bone graft in combination with posterior pedicle fixation but without a posterior fusion. There were 32 men and 15 women with a mean age of 44 (range 23–56) years. One third ( n=15) of the patients had previous

M. A. El Masry; W. S. Badawy; P. Rajendran; D Chan

2004-01-01

4

Fusion rate after posterior lumbar interbody fusion with carbon fiber implant: 1-year follow-up of 51 patients  

Microsoft Academic Search

Problems associated with posterior lumbar interbody fusion (PLIF) have traditionally included the need for donor bone, prolonged healing time of donor bone, the difficulty of cutting precise bony channels, the risk of retropulsion of graft, postoperative collapse of the bone graft, and pseudarthrosis. To avoid these problems a carbon fiber reinforced polymer implant cage has been developed to facilitate interbody

T. Tullberg; B. Brandt; J. Rydberg; P. Fritzell

1996-01-01

5

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

PubMed

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

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

2015-03-01

6

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

PubMed

Few reports have described the combined use of unilateral pedicle screw fixation and interbody fusion for lumbar stenosis. We retrospectively reviewed 79 patients with lumbar stenosis. The rationale and effectiveness of unilateral pedicle screw fixation were studied from biomechanical and clinical perspectives, aiming to reduce stiffness of the implant. All patients were operated with posterior interbody fusion using a diagonal cage in combination with unilateral transpedicular screw fixation and had reached the 3-year follow-up interval after operation. The mean operating time was 115 minutes (range=95-150 min) and the mean estimated blood loss was 150 mL (range=100-200 mL). The mean duration of hospital stay was 10 days (range=7-15 days). Clinical outcomes were assessed prior to surgery and reassessed at intervals using Denis' pain and work scales. Fusion status was determined from X-rays and CT scans. At the final follow-up, the clinical results were satisfactory and patients showed significantly improved scores (p<0.01) either on the pain or the work scale. Successful fusion was achieved in all patients. There were no new postoperative radiculopathies, or instances of malpositioned or fractured hardware. Posterior interbody fusion using a diagonal cage with unilateral transpedicular fixation is an effective treatment for decompressive surgery for lumbar stenosis. PMID:21237659

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

2011-03-01

7

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

PubMed

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

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

2014-12-01

8

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

PubMed Central

Background Loss of lumbar lordosis has been reported after lumbar interbody fusion surgery and may portend poor clinical and radiographic outcome. The objective of this research was to measure changes in segmental and global lumbar lordosis in patients treated with presacral axial L4-S1 interbody fusion and posterior instrumentation and to determine if these changes influenced patient outcomes. Methods We performed a retrospective, multi-center review of prospectively collected data in 58 consecutive patients with disabling lumbar pain and radiculopathy unresponsive to nonsurgical treatment who underwent L4-S1 interbody fusion with the AxiaLIF two-level system (Baxano Surgical, Raleigh NC). Main outcomes included back pain severity, Oswestry Disability Index (ODI), Odom's outcome criteria, and fusion status using flexion and extension radiographs and computed tomography scans. Segmental (L4-S1) and global (L1-S1) lumbar lordosis measurements were made using standing lateral radiographs. All patients were followed for at least 24 months (mean: 29 months, range 24-56 months). Results There was no bowel injury, vascular injury, deep infection, neurologic complication or implant failure. Mean back pain severity improved from 7.8±1.7 at baseline to 3.3±2.6 at 2 years (p < 0.001). Mean ODI scores improved from 60±15% at baseline to 34±27% at 2 years (p < 0.001). At final follow-up, 83% of patients were rated as good or excellent using Odom's criteria. Interbody fusion was observed in 111 (96%) of 116 treated interspaces. Maintenance of lordosis, defined as a change in Cobb angle ? 5°, was identified in 84% of patients at L4-S1 and 81% of patients at L1-S1. Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change. Conclusions/Clinical Relevance Two-level axial interbody fusion supplemented with posterior fixation does not alter segmental or global lordosis in most patients. Patients with postoperative change in lordosis greater than 5° have similarly favorable long-term clinical outcomes and fusion rates compared to patients with less than 5° lordosis change. PMID:25694920

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

2014-01-01

9

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

PubMed Central

Objective Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance (R2=0.286, p=0.0005). Conclusion Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back. PMID:25371781

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

2014-01-01

10

Biomechanical analysis of cages for posterior lumbar interbody fusion.  

PubMed

Interbody fusions using intervertebral cages have become increasingly common in spinal surgery. Computational simulations were conducted in order to compare different cage designs in terms of their biomechanical interaction with the spinal structures. Differences in cage design and surgical technique may significantly affect the biomechanics of the fused spine segment, but little knowledge is available on this topic. In the present study, four 3D finite element models were developed, reproducing the human L4-L5 spinal unit in intact condition and after implantation of three different cage models. The intact model consisted of two vertebral bodies and relevant laminae, facet joints, main ligaments and disc. The instrumented models reproduced the post-operative conditions resulting after implant of the different cages. The three considered devices were hollow threaded titanium cages, the BAK (Zimmer Centerpulse, Warsaw, IN, USA), the Interfix and the Interfix Fly (both by Medtronic Sofamor Danek, Memphis, TN, USA). Simulations were run imposing various loading conditions, under a constant compressive preload. A great increase in the stiffness induced on the spinal segment by all cages was observed in all the considered loading cases. Stress distributions on the bony surface were evaluated and discussed. The differences observed between the biomechanics of the instrumented models were associated with the geometrical and surgical features of the devices. PMID:16563847

Fantigrossi, Alfonso; Galbusera, Fabio; Raimondi, Manuela Teresa; Sassi, Marco; Fornari, Maurizio

2007-01-01

11

Decompression, correction, and interbody fusion for lumbar burst fractures using a single posterior approach.  

PubMed

Burst fractures of the lumbar spine with instability or severe kyphosis are best served by surgical treatment. The question as to how these fractures should be approached and stabilized (anteriorly, posteriorly, or combined anteroposteriorly) is controversial. We performed decompression, correction, and interbody fusion using a single posterior approach for Denis type B or C lumbar burst fractures with severe kyphosis. The operative technique is as follows: after partial laminectomy, the bone fragment, which had migrated into the spinal canal, is impacted into the posterior wall of the vertebral body. After curetting the injured disk, bone chips and adapted lamina are inserted into the disk space for anterior support. Five Denis type B or C burst fractures demanding >20 degrees kyphosis correction were treated by this procedure. Mean follow-up was 41 months. We evaluated neurologic assessment and localized kyphotic angle. The neurologic function of all 5 patients improved by at least 1 grade, as measured by the Frankel grading scale. Mean values of localized kyphosis improved from a mean 23.0. before surgery to -3.0 degrees after surgery. At follow-up examination, average regional kyphosis was -2.4 degrees . No implant failure was observed at follow-up. Bony fusion was achieved in all patients. The advantages of this operative procedure are it is safe for the neural structures and complete spinal canal decompression and kyphosis correction are achieved, while providing anterior support and posterior stabilization. PMID:19824611

Sasagawa, Takeshi; Kawahara, Norio; Murakami, Hideki; Demura, Satoru; Tomita, Katsuro

2009-10-01

12

Posterior Lumbar Interbody Fusion Using an Unilateral Cage: A Prospective Study of Clinical Outcome and Stability  

PubMed Central

Objective The purpose of this study was to evaluate the clinical and radiological results of instrumented posterior lumbar interbody fusion (PLIF) using an unilateral cage. Methods Seventeen patients with unilateral radiculopathy who underwent bilateral percutaneous screw fixation with a single fusion cage inserted on the symptomatic side for treatment of focal degenerative lumbar spine disease were prospectively enrolled in this study. Their clinical results, radiological parameters, and related complications were assessed 10 days, 3 months, and 12 months postoperatively. Results There was no pseudarthrosis, instrumented fusion failure, significant cage subsidence, or retropulsion in any patient. The surgery restored the disc space height and maintained it as of 12 months postoperatively and did not exacerbate the lumbar lordotic and scoliotic angles. All patients had excellent or good outcomes according to the modified MacNab's criteria. The mean pain score according to the visual analogue scale was 7.5 preoperatively but had improved to 2.5 when reassessed 3 months postoperatively. The improvement was maintained as of 12 months postoperatively. Conclusion In cases of uncomplicated unilateral radiculopathy, PLIF using a single cage can be an effective and safe procedure with the advantage of preserving the posterior elements of the contralateral side. A shorter operative time and greater cost-effectiveness than for PLIF using bilateral cages can be expected. PMID:25110483

Lee, Seok Ki; Kim, Seok Won; Ju, Chang Il; Lee, Sung Myung

2014-01-01

13

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

Microsoft Academic Search

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

2010-01-01

14

Influence of Alendronate and Endplate Degeneration to Single Level Posterior Lumbar Spinal Interbody Fusion  

PubMed Central

Objective Using alendronate after spinal fusion is a controversial issue due to the inhibition of osteoclast mediated bone resorption. In addition, there are an increasing number of reports that the endplate degeneration influences the lumbar spinal fusion. The object of this retrospective controlled study was to evaluate how the endplate degeneration and the bisphosphonate medication influence the spinal fusion through radiographic evaluation. Methods In this study, 44 patients who underwent single-level posterior lumbar interbody fusion (PLIF) using cage were examined from April 2007 to March 2009. All patients had been diagnosed as osteoporosis and would be recommended for alendronate medication. Endplate degeneration is categorized by the Modic changes. The solid fusion is defined if there was bridging bone between the vertebral bodies, either within or external to the cage on the plain X-ray and if there is less than 5° of angular difference in dynamic X-ray. Results In alendronate group, fusion was achieved in 66.7% compared to 73.9% in control group (no medication). Alendronate did not influence the fusion rate of PLIF. However, there was the statistical difference of fusion rate between the endplate degeneration group and the group without endplate degeneration. A total of 52.4% of fusion rate was seen in the endplate degeneration group compared to 91.3% in the group without endplate degeneration. The endplate degeneration suppresses the fusion process of PLIF. Conclusion Alendronate does not influence the fusion process in osteoporotic patients. The endplate degeneration decreases the fusion rate. PMID:25620981

Rhee, Wootack; Ha, Seongil; Lim, Jae Hyeon; Jang, Il Tae

2014-01-01

15

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

PubMed Central

Study Design?Retrospective study. Objectives?Lumbar radiculopathy is rarely observed in patients who have achieved bony healing of vertebral fractures in the middle-lower lumbar spine. The objectives of the study were to clarify the clinical features of such radiculopathy and to evaluate the preliminary outcomes of treatment using a modified posterior lumbar interbody fusion (PLIF) procedure. Methods?Fourteen patients with at least 2-year follow-up were enrolled in this study. The radiologic and clinical features of radiculopathy were retrospectively reviewed. As part of our modified PLIF procedure, a bone block was laid on chipped bone to fill the cavity of the fractured end plate and to flatten the cage–bone interface. Results?The morphologic features of spinal deformity in our patients typically consisted of the intradiscal vacuum phenomenon, spondylolisthesis, and a retropulsed intervertebral disk with a vertebral rim in the damaged segment. Cranial end plate fracture resulted in radiculopathy of the traversing nerve roots due to lateral recess stenosis. On the other hand, caudal end plate fracture led to unilateral radiculopathy of the exiting nerve root due to foraminal stenosis. The mean recovery rate based on the Japanese Orthopaedic Association score was 65.0%. Solid fusion was achieved in all but one case. Conclusions?Because of severe deterioration of the anterior column following end plate fracture, the foraminal zone must be decompressed in caudal end plate fractures. The modified PLIF procedure yielded satisfactory clinical outcomes due to anterior reconstruction and full decompression for both foraminal and lateral recess stenoses. PMID:25396106

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

2014-01-01

16

Modified posterior lumbar interbody fusion for radiculopathy following healed vertebral collapse of the middle-lower lumbar spine.  

PubMed

Study Design?Retrospective study. Objectives?Lumbar radiculopathy is rarely observed in patients who have achieved bony healing of vertebral fractures in the middle-lower lumbar spine. The objectives of the study were to clarify the clinical features of such radiculopathy and to evaluate the preliminary outcomes of treatment using a modified posterior lumbar interbody fusion (PLIF) procedure. Methods?Fourteen patients with at least 2-year follow-up were enrolled in this study. The radiologic and clinical features of radiculopathy were retrospectively reviewed. As part of our modified PLIF procedure, a bone block was laid on chipped bone to fill the cavity of the fractured end plate and to flatten the cage-bone interface. Results?The morphologic features of spinal deformity in our patients typically consisted of the intradiscal vacuum phenomenon, spondylolisthesis, and a retropulsed intervertebral disk with a vertebral rim in the damaged segment. Cranial end plate fracture resulted in radiculopathy of the traversing nerve roots due to lateral recess stenosis. On the other hand, caudal end plate fracture led to unilateral radiculopathy of the exiting nerve root due to foraminal stenosis. The mean recovery rate based on the Japanese Orthopaedic Association score was 65.0%. Solid fusion was achieved in all but one case. Conclusions?Because of severe deterioration of the anterior column following end plate fracture, the foraminal zone must be decompressed in caudal end plate fractures. The modified PLIF procedure yielded satisfactory clinical outcomes due to anterior reconstruction and full decompression for both foraminal and lateral recess stenoses. PMID:25396106

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

2014-12-01

17

Posterior lumbar interbody fusion (PLIF) with cages and local bone graft in the treatment of spinal stenosis.  

PubMed

Posterior lumbar interbody fusion (PLIF) implants are increasingly being used for 360 degrees fusion after decompression of lumbar spinal stenosis combined with degenerative instability. Both titanium and PEEK (PolyEtherEtherKetone) implants are commonly used. Assessing the clinical and radiological results as well as typical complications, such as migration of the cages, is important. In addition, questions such as which radiological parameters can be used to assess successful fusion, and whether the exclusive use of local bone graft is sufficient, are frequently debated. We prospectively evaluated 30 patients after PLIF instrumentation for degenerative lumbar spinal canal stenosis, over a course of 42 months. In all cases, titanium cages and local bone graft were used for spondylodesis. The follow-up protocol of these 30 cases included standardised clinical and radiological evaluation at 3, 6, 12 and 42 months after surgery. Overall satisfactory results were achieved. With one exception, a stable result was achieved with restoration of the intervertebral space in the anterior column. After 42 months of follow-up in most cases, a radiologically visible loss of disc space height can be demonstrated. Clinically relevant migration of the cage in the dorsal direction was detected in one case. Based on our experience, posterior lumbar interbody fusion (PLIF) can be recommended for the treatment of monosegmental and bisegmental spinal stenosis, with or without segmental instability. Postoperative evaluation is mainly based on clinical parameters since the titanium implant affects the diagnostic value of imaging studies and is responsible for artefacts. The results observed in our group of patients suggest that local autologous bone graft procured from the posterior elements after decompression is an adequate material for bone grafting in this procedure. PMID:17009828

Trouillier, Hans; Birkenmaier, Christof; Rauch, Alexander; Weiler, Christoph; Kauschke, Thomas; Refior, Hans Jürgen

2006-08-01

18

A minimally invasive posterior lumbar interbody fusion using percutaneous long arm pedicle screw system for degenerative lumbar disease  

PubMed Central

The aim of this study is to evaluate the therapeutic efficacy of patients with lumbar degeneration and instability treated with percutaneous pedicle screw fixation and minimally invasive lumbar interbody fusion. Twenty-one patients were selected in our hospital from November, 2012 to March, 2013. The patients with an average age 55.62 years, including 8 vertebral spondylolisthesis, 4 lumbar intervertebral disc herniation, and 9 lumbar spinal canal stenosis cases. All the patients were managed to take the lumbar MRI and radiographs. The comparison of preoperative and postoperative (3 days, 2 weeks, 3 months) VAS and ODI score were analyzed. The results indicated that VAS scores were 7.14 ± 0.79 before operation, and 5.19 ± 0.81 in 3 days after operation, 4 ± 0.84 after 2 weeks, and 2.67 ± 0.66 after 3 months. The pain was relieved, and the postoperative VAS score was lower than that before treatment (P < 0.05). ODI score was 55.8 ± 11.4 before operation, 47.38 ± 9.38 after 3 days, 41.38 ± 8.09 after 2 weeks, 35.76 ± 4.50 after 3 months. ODI score was obviously decreased (P < 0.05). In conclusion, percutaneous pedicle screw fixation combined with minimally invasive interbody fusion is a safe, effective, feasible minimally invasive spine operation, with worthy for spreading. PMID:25550904

He, Er-Xing; Cui, Ji-Hao; Yin, Zhi-Xun; Li, Chuang; Tang, Cheng; He, Yi-Qian; Liu, Cheng-Wei

2014-01-01

19

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

PubMed Central

We reviewed the records of a prospective consecutive cohort to evaluate the clinical performance of anterior lumbar interbody fusion with a titanium box cage and posterior fixation, with emphasis on long-term functional outcome. Thirty-two patients with chronic low back pain underwent anterior lumbar interbody fusion and posterior fixation. Radiological and functional results (visual analogue scale [VAS] and Oswestry score) were evaluated. Adjacent segment degeneration (ASD) was evaluated radiologically and by magnetic resonance imaging (MRI). Twenty-five patients (78%) were available for follow-up. Functional scores showed significant improvement in pain and function up to the 2-year follow-up observation. At 4 years, there was some deterioration of the clinical results. At 10-year follow-up, results remained stable compared with 4-year results. MRI showed ASD in 3/25 (12%) above and 2/10 (20%) below index level (compared with absent preoperatively). ASD could not be related to clinical outcome in this study. Anterior lumbar interbody fusion and posterior fixation is safe and effective. Initial improvement in VAS and Oswestry scores is partly lost at the 4-year follow-up. Good clinical results are maintained at 10-year follow-up and are not related to adjacent segment degeneration. PMID:24353942

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

2012-01-01

20

Posterior lumbar interbody fusion and posterolateral fusion: Analogous procedures in decreasing the index of disability in patients with spondylolisthesis  

PubMed Central

Objective: The purpose of this study was to evaluate the disability in patients with spondylolisthesis who assigned either to posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) and to compare it between two groups. Methods: In a prospective observational study, 102 surgical candidates with low-grade degenerative and isthmic spondylolisthesis enrolled from 2012 to 2014, and randomly assigned into two groups: PLF and PLIF. Evaluation of disability has been done by a questionnaire using Oswestry Disability Index (ODI). The questionnaire was completed by all patients before the surgery, the day after surgery, after 6 months and after 1-year. Results: There were no statistically significant differences in terms of age and sex distribution and pre-operation ODI between groups (P > 0.05). Comparison of the mean ODI scores of two groups over the whole study period showed no significant statistical difference (P = 0.074). ODIs also showed no significant differences between two groups the day after surgery, 6th months and 1-year after surgery (P = 0.385, P = 0.093, P = 0.122 and P = 433) respectively. Analyzing the course of ODI over the study period, showed a significant descending pattern for either of groups (P < 0.0001). Conclusion: Both surgical fusion techniques (PLF and PLIF) were efficient to lessen the disability of patients with spondylolisthesis, and none of the fusion techniques were related to a better outcome in terms of disability.

Alijani, Babak; Emamhadi, Mohamahreza; Behzadnia, Hamid; Aramnia, Ali; Chabok, Shahrokh Yousefzadeh; Ramtinfar, Sara; Leili, Ehsan Kazemnejad; Golmohamadi, Shabnam

2015-01-01

21

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

PubMed Central

Study Design A case controlled study with prospective data collection. Purpose To evaluate the early influence and the final consequence of demineralized bone matrix (DBM) on auto-local bone as a graft enhancer in posterior lumbar interbody fusion (PLIF). Overview of Literature DBM is known as an osteoinductive material; however, it has not been clearly recognized to enhance auto-local bone with a small amount. Methods Patients who had a PLIF were allocated into two groups. Group I (70 cases) used auto-local bone chips and group II (44 cases) used DBM as an additive to auto-local bone, 1 mL per a segment. Group selection was alternated. Early assessment was performed by computed tomography at 6 months and final assessment was done by simple radiography after 24 months at least. The degree of bone formation was assessed by 4 grade scale. Results The subjects of both groups were homogenous and had similar Oswestry Disability Index at final assessment. The ratio of auto-local bone chips and DBM was 6:1. The degree of bone formation at 6 months after surgery was superior in group II. However, there was no significant difference between the two groups at the final assessment. Conclusions DBM was not recognized to enhance auto-local bone with small amount. PMID:24761193

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

2014-01-01

22

A carbon fiber implant to aid interbody lumbar fusion. Mechanical testing.  

PubMed

A carbon-fiber-reinforced polymer implant has been designed to aid interbody lumbar fusion. The cage-like implant has ridges or teeth to resist pullout or retropulsion, struts to support weight bearing, and a hollow center for packing of autologous bone graft. Because carbon is radiolucent, bony healing can be imaged by standard radiographic techniques. The device has been mechanically tested in cadaver spines and compared with posterior lumbar interbody fusion performed with donor bone. The carbon device required a pullout force of 353 N compared with 126 N for donor bone. In compression testing, posterior lumbar interbody fusion performed with the carbon device bore a load of 5,288 N before failure of the vertebral bone. Posterior lumbar interbody fusion performed with donor bone failed at 4,628 N, and unmodified motion segments failed at 6,043 N. The carbon fiber implant separates the mechanical and biologic functions of posterior lumbar interbody fusion. PMID:1862425

Brantigan, J W; Steffee, A D; Geiger, J M

1991-06-01

23

Differences in the outcomes of anterior versus posterior interbody fusion surgery of the lumbar spine: A propensity score-controlled cohort analysis of 10,941 patients.  

PubMed

Few studies have measured outcome differences between the various available spinal fusion techniques. We compare long-term outcomes of anterior versus posterior lumbar interbody fusion. Using the MarketScan database (Truven Health Analytics, Ann Arbor, MI, USA) we selected patients ?18years old who underwent lumbar fusion surgery from 2000-2009 using either approach. Exclusion criteria included circumferential fusion, and having less than 1year of preoperative or less than 2years of postoperative follow-up. Using an inverse probability-weighted propensity-score model we compared reoperation and 90day complication rates, and postoperative health resource utilization of both approaches. A total of 10,941 patients were identified. Of these, 7460 (68.2%) and 3481 (31.8%) underwent posterior and anterior interbody fusion, respectively. Anterior fusion patients had a higher 2year reoperation rate (odds ratio 1.43, 95% confidence interval [CI]: 1.21-1.70, p<0.0001), although differences became non-significant at maximum follow-up (p=0.0877). The 90day complication rate was 15.7%, with anterior fusion patients being more likely to experience complications (relative risk 1.24, 95%CI: 1.13-1.36, p<0.0001). Anterior fusion patients also had greater levels of postoperative health utilization, surpassing posterior fusion patients by an average of $US7450 in total charges (95% CI: $4670-$10,220, p<0.0001). As currently practiced in the USA, anterior lumbar surgical approaches may be associated with higher postoperative morbidity and reoperation rates than posterior fusion approaches. PMID:25691076

Huang, Kevin T; Hazzard, Matthew; Thomas, Steven; Chagoya, Gustavo; Berg, Rand Wilcox Vanden; Adogwa, Owoicho; Bagley, Carlos A; Isaacs, Robert; Gottfried, Oren N; Lad, Shivanand P

2015-05-01

24

Indications for anterior lumbar interbody fusion.  

PubMed

Anterior lumbar interbody fusion (ALIF) has become a widely recognized surgical technique for degenerative pathology of the lumbar spine. Spinal fusion has evolved dramatically ever since the first successful internal fixation by Hadra in 1891 who used a posterior approach to wire adjacent cervical vertebrae in the treatment of fracture-dislocation. Advancements were made to reduce morbidity including bone grafting substitutes, metallic hardware instrumentation and improved surgical technique. The controversy regarding which surgical approach is best for treating various pathologies of the lumbar spine still exists. Despite being an established treatment modality, current indications of ALIF are yet to be clearly defined in the literature. This article discusses the current literature on indications on ALIF surgery. PMID:24002831

Mobbs, Ralph J; Loganathan, Aji; Yeung, Vivian; Rao, Prashanth J

2013-08-01

25

Soft Stabilization With an Artificial Intervertebral Ligament in Grade I Degenerative Spondylolisthesis: Comparison With Instrumented Posterior Lumbar Interbody Fusion  

PubMed Central

Background The purpose of this retrospective study was to evaluate the efficacy of soft stabilization with an artificial intervertebral ligament after microdecompression for the treatment of grade I degenerative spondylolisthesis. Methods From a total of 54 patients with degenerative spondylolisthesis who were treated surgically from May 2000 to April 2003, 36 patients who showed grade I spondylolisthesis without evidence of concomitant disc herniation necessitating discectomy were enrolled in the study. After decompression, the patients had undergone either soft stabilization with an artificial intervertebral ligament (n = 17) or instrumented posterior lumbar interbody fusion (PLIF; n = 19). Results The average follow-up period was 24 months for the PLIF group and 16 months for the soft stabilization group. In the PLIF group, preoperative mean scores of 60% on the Oswestry Disability Index, 8.8 on the visual analog scale (VAS) for low-back pain, and 9.3 on the VAS for leg pain improved to 28%, 4.1, and 2.6, respectively, after surgery. Corresponding scores in the soft stabilization group were 55%, 8.4, and 8.9, improving to 25%, 4.1, and 2.2 after surgery. There were no significant differences between the 2 groups in any of these clinical parameters. Patients’ subjective improvement rates and satisfaction with the surgical procedure were higher in the soft stabilization group, but the differences were not significant. Mean operation time and mean blood loss were significantly lower in the soft stabilization group than in the PLIF group. In the soft stabilization group, there were 3 cases of progression of slippage in patients who had had preoperative slippage of more than 20%; there was 1 dural tear in the PLIF group. Conclusions Patients with grade I degenerative spondylolisthesis who received soft stabilization with an artificial intervertebral ligament after microdecompression had clinical outcomes similar to those of patients who received PLIF. Since soft stabilization can be done in a much less invasive way than fusion, if slippage is 20% or less, soft stabilization with an artificial ligament is a viable alternative to fusion for patients who are elderly or who have significant comorbidities that make a prolonged operation inadvisable. Level of Evidence This study was a retrospective comparative study with a very limited population (level III evidence).

Lee, Sang-Ho; Park, Sun-Hee; Whang, Ji-Hee

2007-01-01

26

Evaluation of Functional Outcomes in Individuals 10 Years after Posterior Lumbar Interbody Fusion with Corundum Implants and Decompression: A Comparison of 2 Surgical Techniques  

PubMed Central

Background The purpose of this study was to evaluate lumbar spine-related functional disability in individuals 10 years after lumbar decompression and lumbar decompression with posterior lumbar interbody fusion (PLIF) with corundum implants surgery for degenerative stenosis and to compare the long-term outcome of these 2 surgical techniques. Material/Methods From 1998 to 2002, 100 patients with single-level lumbar stenosis were surgically treated. The patients were randomly divided into 2 groups that did not differ in terms of clinical or neurological symptoms. Group A consisted of 50 patients who were treated with PLIF and the use of porous ceramic corundum implants; the mean age was 57.74 and BMI was 27.34. Group B consisted of 50 patients treated with decompression by fenestration; mean age was 51.28 and the mean BMI was 28.84. Results There was no statistical significance regarding age, BMI, and sex. Both treatments revealed significant improvements. In group A, ODI decreased from 41.01% to 14.3% at 1 year and 16.3 at 10 years. In group B, ODI decreased from 63.8% to 18.36% at 1 year and 22.36% at 10 years. The difference between groups was statistically significant. There were no differences between the groups regarding the Rolland-Morris disability questionnaire and VAS at 1 and 10 years after surgery. Conclusions Long-term results evaluated according to the ODI, the Rolland-Morris disability questionnaire, and the VAS showed that the both methods significantly reduce patient disability, and this was maintained during next 10 years. The less invasive fenestration procedure was only slightly less favorable than surgical treatment of stenosis by both PLIF with corundum implants and decompression. PMID:25106708

Truszczy?ska, Aleksandra; R?pa?a, Kazimierz; ?ukawski, Stanislaw; Trzaskoma, Zbigniew; Tarnowski, Adam; Drzal-Grabiec, Justyna; Cabak, Anna

2014-01-01

27

Comparison of the different surgical approaches for lumbar interbody fusion.  

PubMed

This review will outline the history of spinal fusion. It will compare the different approaches currently in use for interbody fusion. A comparison of the techniques, including minimally invasive surgery and graft options will be included. Lumbar interbody fusion is a commonly performed surgical procedure for a variety of spinal disorders, especially degenerative disease. Currently this procedure is performed using anterior, lateral, transforaminal and posterior approaches. Minimally invasive techniques have been increasing in popularity in recent years. A posterior approach is frequently used and has good fusion rates and low complication rates but is limited by the thecal and nerve root retraction. The transforaminal interbody fusion avoids some of these complications and is therefore preferable in some situations, especially revision surgery. An anterior approach avoids the spinal cord and cauda equina all together, but has issues with visceral exposure complications. Lateral lumbar interbody fusion has a risk of lumbar plexus injury with dissection through the psoas muscle. Studies show less intraoperative blood loss for minimally invasive techniques, but there is no long-term data. Iliac crest is the gold standard for bone graft, although adjuncts such as bone morphogenetic proteins are being used more frequently, despite their controversial history. More high-level studies are needed to make generalisations regarding the outcomes of one technique compared with another. PMID:25439753

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

2015-02-01

28

Assessment of bone graft incorporation by 18?F-fluoride positron-emission tomography/computed tomography in patients with persisting symptoms after posterior lumbar interbody fusion  

PubMed Central

Background Posterior lumbar interbody fusion (PLIF) is a method that allows decompression of the spinal canal and nerve roots by laminectomy combined with fusion by means of intervertebral cages filled with bone graft and pedicle screw fixation. Conventional imaging techniques, such as plain radiography and computed tomography (CT), have limitations to assess bony fusion dynamics. Methods In 16 PLIFs of 15 patients with persisting symptoms, positron-emission tomography (PET)/CT scans were made 60?min after intravenous administration of 156 to 263?MBq of 18?F-fluoride, including 1-mm sliced, high-dose, non-contrast-enhanced CT scanning. Maximal standard uptake values (SUVmax) of various regions were calculated and correlated with abnormalities on CT. Results Subsidence of the cages into the vertebral endplates was the most frequently observed abnormality on CT (in 16 of 27 or 59% of evaluable endplates). Endplate SUVmax values were significantly higher for those patients with pronounced (p?posterior transmission of increased bone stress. In our patient group, intercorporal fusion was seen on CT in 63% but showed no correlation to intercorporal SUVmax values. Conclusions With the use of 18?F-fluoride PET/CT, intervertebral cage subsidence appeared to be a prominent finding in this patient group with persisting symptoms, and highly correlating with the degree of PET hyperactivity at the vertebral endplates and pedicle screw entry points. Further study using 18?F-fluoride PET/CT should specifically assess the role of metabolically active subsidence in a prospective patient group, to address its role in nonunion and as a cause of persisting pain. PMID:22846374

2012-01-01

29

Anterior Lumbar Interbody Fusion: Two-Year Results with a Modular Interbody Device  

PubMed Central

Study Design Retrospective case series. Purpose To present radiographic outcomes following anterior lumbar interbody fusion (ALIF) utilizing a modular interbody device. Overview of Literature Though multiple anterior lumbar interbody techniques have proven successful in promoting bony fusion, postoperative subsidence remains a frequently reported phenomenon. Methods Forty-three consecutive patients underwent ALIF with (n=30) or without (n=11) supplemental instrumentation. Two patients underwent ALIF to treat failed posterior instrumented fusion. The primary outcome measure was presence of fusion as assessed by computed tomography. Secondary outcome measures were lordosis, intervertebral lordotic angle (ILA), disc height, subsidence, Bridwell fusion grade, technical complications and pain score. Interobserver reliability of radiographic outcome measures was calculated. Results Forty-three patients underwent ALIF of 73 motion segments. ILA and disc height increased over baseline, and this persisted through final follow-up (p<0.01). Solid anterior interbody fusion was present in 71 of 73 motion segments (97%). The amount of new bone formation in the interbody space increased over serial imaging. Subsidence >4 mm occurred in 12% of patients. There were eight surgical complications (19%): one major (reoperation for nonunion/progressive subsidence) and seven minor (five subsidence, two malposition). Conclusions The use of a modular interbody device for ALIF resulted in a high rate of radiographic fusion and a low rate of subsidence. The large endplate and modular design of the device may contribute to a low rate of subsidence as well as maintenance of ILA and lordosis. Previously reported quantitative radiographic outcome measures were found to be more reliable than qualitative or categorical measures. PMID:25346811

Yeoman, Chevas; Chung, Woosik M.; Chappuis, James L; Freedman, Brett

2014-01-01

30

Finite element analysis of minimal invasive transforaminal lumbar interbody fusion.  

PubMed

The purpose of our study is to develop and validate three-dimensional finite element models of transforaminal lumbar interbody fusion, and explore the most appropriate method of fixation and fusion by comparing biomechanical characteristics of different fixation method. We developed four fusion models: bilateral pedicle screws fixation with a single cage insertion model (A), bilateral pedicle screws fixation with two cages insertion model (B), unilateral pedicle screws fixation with a single cage insertion model (C), and unilateral pedicle screws fixation with two cages insertion model (D); the models were subjected to different forces including anterior bending, posterior extension, left bending, right bending, rotation, and axial compressive. The von Mises stress of the fusion segments on the pedicle screw and cages was recorded. Angular variation and stress of pedicle screw and cage were compared. There were differences of Von Mises peak stress among four models, but were within the range of maximum force. The angular variation in A, B, C, and D decreased significantly compared with normal. There was no significant difference of angular variation between A and B, and C and D. Bilateral pedicle screws fixation had more superior biomechanics than unilateral pedicle screws fixation. In conclusion, the lumbar interbody fusion models were established using varying fixation methods, and the results verified that unilateral pedicle screws fixation with a single cage could meet the stability demand in minimal invasive transforaminal interbody fusion. PMID:24782059

Zhao, Chuncheng; Wang, Xinhu; Chen, Changchun; Kang, Yanzhong

2014-09-01

31

Failed anterior lumbar interbody fusion due to incomplete foraminal decompression  

Microsoft Academic Search

Background  Anterior lumbar interbody fusion (ALIF) has gained widespread popularity for spinal disorders requiring fusion. The purpose\\u000a of this study was to analyze ALIF failures.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The medical records of 223 patients treated with ALIF between January 2007 and June 2008 were retrospectively reviewed. Patients\\u000a with unfavorable outcomes, including subsequent posterior decompression at the index level or poor outcomes after ALIF were

Kyung-Chul Choi; Yong Ahn; Byung-Uk Kang; Joo-Hee Jang; Kyeong-Ki Kim; Yong Hwan Shin; Jong-Oh Choi; Sang-Ho Lee

2011-01-01

32

Minimally invasive transforaminal lumbar interbody fusion  

PubMed Central

Background: The use of minimally invasive surgical (MIS) techniques represents the most recent modification of methods used to achieve lumbar interbody fusion. The advantages of minimally invasive spinal instrumentation techniques are less soft tissue injury, reduced blood loss, less postoperative pain and shorter hospital stay while achieving clinical outcomes comparable with equivalent open procedure. The aim was to study the clinicoradiological outcome of minimally invasive transforaminal lumbar interbody fusion. Materials and Methods: This prospective study was conducted on 23 patients, 17 females and 6 males, who underwent MIS-transforaminal lumbar interbody fusion (TLIF) followed up for a mean 15 months. The subjects were evaluated for clinical and radiological outcome who were manifested by back pain alone (n = 4) or back pain with leg pain (n = 19) associated with a primary diagnosis of degenerative spondylolisthesis, massive disc herniation, lumbar stenosis, recurrent disc herniation or degenerative disc disease. Paraspinal approach was used in all patients. The clinical outcome was assessed using the revised Oswestry disability index and Macnab criteria. Results: The mean age of subjects was 55.45 years. L4-L5 level was operated in 14 subjects, L5-S1 in 7 subjects; L3-L4 and double level was fixed in 1 patient each. L4-L5 degenerative listhesis was the most common indication (n = 12). Average operative time was 3 h. Fourteen patients had excellent results, a good result in 5 subjects, 2 subjects had fair results and 2 had poor results. Three patients had persistent back pain, 4 patients had residual numbness or radiculopathy. All patients had a radiological union except for 1 patient. Conclusion: The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF. It is also superior in terms of postoperative back pain, blood loss, hospital stay, recovery time as well as medication use. PMID:25404767

Jhala, Amit; Singh, Damandeep; Mistry, MS

2014-01-01

33

Biomechanical Characteristics of an Integrated Lumbar Interbody Fusion Device  

PubMed Central

Introduction We hypothesized that an Integrated Lumbar Interbody Fusion Device (PILLAR SA, Orthofix, Lewisville, TX) will function biomechanically similar to a traditional anterior interbody spacer (PILLAR AL, Orthofix, Lewisville, TX) plus posterior instrumentation (FIREBIRD, Orthofix, Lewisville, TX). Purpose of this study was to determine if an Integrated Interbody Fusion Device (PILLAR SA) can stabilize single motion segments as well as an anterior interbody spacer (PILLAR AL) + pedicle screw construct (FIREBIRD). Methods Eight cadaveric lumbar spines (age: 43.9±4.3 years) were used. Each specimen's range of motion was tested in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) under intact condition, after L4-L5 PILLAR SA with intervertebral screws and after L4-L5 360° fusion (PILLAR AL + Pedicle Screws and rods (FIREBIRD). Each specimen was tested in flexion (8Nm) and extension (6Nm) without preload (0 N) and under 400N of preload, in lateral bending (±6 Nm) and axial rotation (±5 Nm) without preload. Results Integrated fusion using the PILLAR SA device demonstrated statistically significant reductions in range of motion of the L4-L5 motion segment as compared to the intact condition for each test direction. PILLAR SA reduced ROM from 8.9±1.9 to 2.9±1.1° in FE with 400N follower preload (67.4%), 8.0±1.7 to 2.5±1.1° in LB, and 2.2±1.2 to 0.7±0.3° in AR. A comparison between the PILLAR SA integrated fusion device versus 360° fusion construct with spacer and bilateral pedicle screws was statistically significant in FE and LB. The 360° fusion yielded motion of 1.0±0.5° in FE, 1.0±0.8° in LB (p0.05). Conclusions The PILLAR SA resulted in motions of less than 3° in all modes of motion and was not as motion restricting as the traditional 360° using bilateral pedicle screws. The residual segmental motions compare very favorably with published biomechanical studies of other interbody integrated fusion devices. PMID:25694931

Voronov, Leonard I.; Vastardis, Georgios; Zelenakova, Julia; Carandang, Gerard; Havey, Robert M.; Waldorff, Erik I.; Zindrick, Michael R.

2014-01-01

34

Sequential Changes of Plasma C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Spine Surgery : Comparison between Lumbar Open Discectomy and Posterior Lumbar Interbody Fusion  

PubMed Central

Objective C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often utilized to evaluate for postoperative infection. Abnormal values may be detected after surgery even in case of non-infection because of muscle injury, transfusion, which disturbed prompt perioperative management. The purpose of this study was to evaluate and compare the perioperative CRP, ESR, and white blood cell (WBC) counts after spine surgery, which was proved to be non-infection. Methods Twenty patients of lumbar open discectomy (LOD) and 20 patients of posterior lumbar interbody fusion (PLIF) were enrolled in this study. Preoperative and postoperative prophylactic antibiotics were administered routinely for 7 days. Blood samples were obtained one day before surgery and postoperative day (POD) 1, POD3, and POD7. Using repeated measures ANOVA, changes in effect measures over time and between groups over time were assessed. All data analysis was conducted using SAS v.9.1. Results Changes in CRP, within treatment groups over time and between treatment groups over time were both statistically significant F(3,120)=5.05, p=0.003 and F(1,39)=7.46, p=0.01, respectively. Most dramatic changes were decreases in the LOD group on POD3 and POD7. Changes in ESR, within treatment groups over time and between treatment groups over time were also found to be statistically significant, F(3,120)=6.67, p=0.0003 and F(1,39)=3.99, p=0.01, respectively. Changes in WBC values also were be statistically significant within groups over time, F(3,120)=40.52, p<0.001, however, no significant difference was found in between groups WBC levels over time, F(1,39)=0.02, p=0.89. Conclusion We found that, dramatic decrease of CRP was detected on POD3 and POD7 in LOD group of non-infection and dramatic increase of ESR on POD3 and POD7 in PLIF group of non-infection. We also assumed that CRP would be more effective and sensitive parameter especially in LOD than PLIF for early detection of infectious complications. Awareness of the typical pattern of CRP, ESR, and WBC may help to evaluate the early postoperative course. PMID:25368764

Choi, Man Kyu; Kim, Kee D; Ament, Jared D.

2014-01-01

35

Endoscopic Foraminal Decompression Preceding Oblique Lateral Lumbar Interbody Fusion To Decrease The Incidence Of Post Operative Dysaesthesia  

PubMed Central

Background Lumbar interbody fusion has become a well established method to diminish axial back pain as well as radiculopathy in patients with degenerative disc disease, stenosis, and instability. The concept of indirect decompression of the neural foramen and spinal canal while performing fusion became popular in the mid 1990’s with description of ALIF techniques. Morphometric analysis confirmed the extent of decompression of posterior elements with interbody height restoration. In an attempt to diminish potential complications associated with anterior or posterior approaches to the spine for interbody fusion, and with the hope of accomplishing fusion in a less invasive manner, lateral lumbar interbody fusion has become quite popular. This transpsoas approach to the disc space has been associated with a high incidence of neurologic complications. Even though this is the first technique to routinely recommend EMG monitoring to increase safety in the approach, neurologic injuries still occur. A newer oblique lateral lumbar interbody (OLLIF) approach has recently been described to lessen the incidence of neurologic injury. This technique also advocates use of EMG testing to lessen neurologic trauma. In spite of this precaution, neurologic insult has not been eliminated. In fact, even in patients whose electrical stimulation thresholds suggested a safe entry space into the disc, transient dysaesthesia continues to occur in 20-25 percent of cases. Purpose This pilot study reflects data and observations of a subset of patients treated with endoscopic foraminotomy preceding oblique lateral lumbar interbody fusion (OLLIF) to assess specifically potential improvements in dysaesthesia rates. Methods A select subset of patients undergoing OLLIF failed to meet electrodiagnostic criteria for safe disc access through Kambin’s triangle. These patients underwent an endoscopic foraminotomy and exiting nerve decompression prior to discectomy, endplate preparation and cage insertion. Results Dysaesthesia did not occur in these patients whom otherwise would have likely been at risk for neurologic deficit. Conclusions These findings suggest that patients at risk for neurologic insult during oblique lateral lumbar interbody fusion can be protected by foraminoplasty. PMID:25694923

Katzell, Jeffrey

2014-01-01

36

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

PubMed Central

Objective The use of direct lumbar interbody fusion (DLIF) has gradually increased; however, no studies have directly compared DLIF and transforaminal lumbar interbody fusion (TLIF). We compared DLIF and TLIF on the basis of clinical and radiological outcomes. Methods A retrospective review was performed on the medical records and radiographs of 98 and 81 patients who underwent TLIF and DLIF between January 2011 and December 2012. Clinical outcomes were compared with a visual analog scale (VAS) and the Oswestry disability index (ODI). The preoperative and postoperative disc heights, segmental sagittal/coronal angles, and lumbar lordosis were measured on radiographs. Fusion rates, operative time, estimated blood loss (EBL), length of hospital stay, and complications were assessed. Results DLIF was superior to TLIF regarding its ability to restore disc height, foraminal height, and coronal balance (p<0.001). As the extent of surgical level increased, DLIF displayed significant advantages over TLIF considering the operative time and EBL. However, fusion rates at 12 months post-operation were lower for DLIF (87.8%) than for TLIF (98.1%) (p=0.007). The changes of VAS and ODI between the TLIF and DLIF were not significantly different (p>0.05). Conclusion Both DLIF and TLIF are less invasive and thus good surgical options for treating degenerative lumber diseases. DLIF has higher potential in increasing neural foramina and correcting coronal balance, and involves a shorter operative time and reduced EBL, in comparison with TLIF. However, DLIF displayed a lower fusion rate than TLIF, and caused complications related to the transpsoas approach. PMID:25628805

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

2014-01-01

37

Radiological and functional outcome after anterior lumbar interbody spinal fusion  

Microsoft Academic Search

Outcome after anterior spinal fusion has mainly been studied radiologically and reported fusion rates vary greatly. The aim of this study was to investigate radiological and long-term clinical outcome. The study comprised 120 consecutive patients, operated on during the period 1979–1987, with single-or two-level anterior interbody spinal fusion due to disc degeneration or isthmic spondylolisthesis with lumbar instability. In 64

F. B. Christensen; B. Karlsmose; E. S. Hansen; C. E. Bringer

1996-01-01

38

Does Transforaminal Lumbar Interbody Fusion Have Advantages over Posterolateral Lumbar Fusion for Degenerative Spondylolisthesis?  

PubMed Central

Study Design?Retrospective cohort study. Objective?To compare the clinical and radiographic outcomes of transforaminal lumbar interbody fusion (TLIF) and posterolateral lumbar fusion (PLF) in the treatment of degenerative spondylolisthesis. Methods?This study compared 24 patients undergoing TLIF and 32 patients undergoing PLF with instrumentation. The clinical outcomes were assessed by visual analog scale (VAS) for low back pain and leg pain, physical component summary (PCS) of the 12-item Short-Form Health Survey, and the Oswestry Disability Index (ODI). Radiographic parameters included slippage of the vertebra, local disk lordosis, the anterior and posterior disk height, lumbar lordosis, and pelvic parameters. Results?The improvement of VAS of leg pain was significantly greater in TLIF than in PLF unilaterally (3.4 versus 1.0; p?=?0.02). The improvement of VAS of low back pain was significantly greater in TLIF than in PLF (3.8 versus 2.2; p?=?0.02). However, there was no significant difference in improvement of ODI or PCS between TLIF and PLF. Reduction of slippage and the postoperative disk height was significantly greater in TLIF than in PLF. There was no significant difference in local disk lordosis, lumbar lordosis, or pelvic parameters. The fusion rate was 96% in TLIF and 84% in PLF (p?=?0.3). There was no significant difference in fusion rate, estimated blood loss, adjacent segmental degeneration, or complication rate. Conclusions?TLIF was superior to PLF in reduction of slippage and restoring disk height and might provide better improvement of leg pain. However, the health-related outcomes were not significantly different between the two procedures. PMID:25844282

Fujimori, Takahito; Le, Hai; Schairer, William W.; Berven, Sigurd H.; Qamirani, Erion; Hu, Serena S.

2014-01-01

39

Complications with axial presacral lumbar interbody fusion: A 5-year postmarketing surveillance experience  

PubMed Central

Background Open and minimally invasive lumbar fusion procedures have inherent procedural risks, with posterior and transforaminal approaches resulting in significant soft-tissue injury and the anterior approach endangering organs and major blood vessels. An alternative lumbar fusion technique uses a small paracoccygeal incision and a presacral approach to the L5-S1 intervertebral space, which avoids critical structures and may result in a favorable safety profile versus open and other minimally invasive fusion techniques. The purpose of this study was to evaluate complications associated with axial interbody lumbar fusion procedures using the Axial Lumbar Interbody Fusion (AxiaLIF) System (TranS1, Wilmington, North Carolina) in the postmarketing period. Methods Between March 2005 and March 2010, 9,152 patients underwent interbody fusion with the AxiaLIF System through an axial presacral approach. A single-level L5-S1 fusion was performed in 8,034 patients (88%), and a 2-level (L4-S1) fusion was used in 1,118 (12%). A predefined database was designed to record device- or procedure-related complaints via spontaneous reporting. The complications that were recorded included bowel injury, superficial wound and systemic infections, transient intraoperative hypotension, migration, subsidence, presacral hematoma, sacral fracture, vascular injury, nerve injury, and ureter injury. Results Complications were reported in 120 of 9,152 patients (1.3%). The most commonly reported complications were bowel injury (n = 59, 0.6%) and transient intraoperative hypotension (n = 20, 0.2%). The overall complication rate was similar between single-level (n = 102, 1.3%) and 2-level (n = 18, 1.6%) fusion procedures, with no significant differences noted for any single complication. Conclusions The 5-year postmarketing surveillance experience with the AxiaLIF System suggests that axial interbody lumbar fusion through the presacral approach is associated with a low incidence of complications. The overall complication rates observed in our evaluation compare favorably with those reported in trials of open and minimally invasive lumbar fusion surgery.

Gundanna, Mukund I.; Miller, Larry E.; Block, Jon E.

2011-01-01

40

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

PubMed

Lumbar spinal fusion is advancing with minimally invasive techniques, bone graft alternatives, and new implants. This has resulted in significant reductions of operative time, duration of hospitalization, and higher success in fusion rates. However, costs have increased as many new technologies are expensive. This study was carried out to investigate the clinical outcomes and fusion rates of a low implant load construct of unilateral pedicle screws and a translaminar screw in transforaminal lumbar interbody fusion (TLIF) which reduced the cost of the posterior implants by almost 50%. Nineteen consecutive patients who underwent single level TLIF with this construct were included in the study. Sixteen patients had a TLIF allograft interbody spacer placed, while in three a polyetheretherketone (PEEK) cage was used. Follow-up ranged from 15 to 54 months with a mean of 32 months. A clinical and radiographic evaluation was carried out preoperatively and at multiple time points following surgery. An overall improvement in Oswestry scores and visual analogue scales for leg and back pain (VAS) was observed. Three patients underwent revision surgery due to recurrence of back pain. All patients showed radiographic evidence of fusion from 9 to 26 months (mean 19) following surgery. This study suggests that unilateral pedicle screws and a contralateral translaminar screw are a cheaper and viable option for single level lumbar fusion. PMID:19015896

Sethi, Anil; Lee, Sandra; Vaidya, Rahul

2009-03-01

41

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

PubMed Central

Lumbar spinal fusion is advancing with minimally invasive techniques, bone graft alternatives, and new implants. This has resulted in significant reductions of operative time, duration of hospitalization, and higher success in fusion rates. However, costs have increased as many new technologies are expensive. This study was carried out to investigate the clinical outcomes and fusion rates of a low implant load construct of unilateral pedicle screws and a translaminar screw in transforaminal lumbar interbody fusion (TLIF) which reduced the cost of the posterior implants by almost 50%. Nineteen consecutive patients who underwent single level TLIF with this construct were included in the study. Sixteen patients had a TLIF allograft interbody spacer placed, while in three a polyetheretherketone (PEEK) cage was used. Follow-up ranged from 15 to 54 months with a mean of 32 months. A clinical and radiographic evaluation was carried out preoperatively and at multiple time points following surgery. An overall improvement in Oswestry scores and visual analogue scales for leg and back pain (VAS) was observed. Three patients underwent revision surgery due to recurrence of back pain. All patients showed radiographic evidence of fusion from 9 to 26 months (mean 19) following surgery. This study suggests that unilateral pedicle screws and a contralateral translaminar screw are a cheaper and viable option for single level lumbar fusion. PMID:19015896

Lee, Sandra; Vaidya, Rahul

2008-01-01

42

Anterior lumbar fusion using a hybrid interbody graft. A preliminary radiographic report.  

PubMed

This is a radiographic report of 40 patients (20 men, 20 women) who underwent anterior lumbar interbody fusions (73 levels) utilizing a "hybrid" interbody graft composed of femoral cortical allograft (FCA) bone and iliac crest cancellous autograft bone. The average age at surgery was 38 years (range 17-64 years), and follow-up averaged 1.4 years (range 1.0-2.4 years). Nineteen of the patients had undergone previous lumbar surgery. Thirty-two patients (63 levels) underwent anterior fusion combined with some type of posterior fixation, and eight patients (10 levels) had no posterior fixation. Types of posterior fixation included: for 20 patients (36 levels) Steffee variable screw placement fixation, for 10 patients (23 levels) translaminar facet screws (TFS), for 1 patient (3 levels) Knodt rods and for 1 patient (1 level) facet screws. Based on the persistence of lucent lines at the graft-host interface, three patients (one level each) were felt to have non-unions at their latest follow-ups at 1.4, 1.5 and 2.0 years, respectively. Two of these patients had no posterior fixation, and the other had TFS fixation. The overall fusion rate was 96% (70 of 73 levels). The fusion rate for all levels treated with posterior fixation was 98% compared with 75% for those without fixation. Intervertebral disc heights (IVDH) were measured on all films and corrected for magnification with computer assistance. On average, the IVDH was increased postoperatively but returned to preoperative values at follow-up. IVDH loss was independent of the type of instrumentation used. No complications arose from the use of the hybrid graft.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7874539

Holte, D C; O'Brien, J P; Renton, P

1994-01-01

43

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

PubMed Central

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

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

2015-01-01

44

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

PubMed

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

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

2015-01-01

45

Fusion after minimally disruptive anterior lumbar interbody fusion: Analysis of extreme lateral interbody fusion by computed tomography  

PubMed Central

Background Less invasive fusion approaches, such as extreme lateral interbody fusion (XLIF), have proliferated, but few reports have critically assessed fusion rates. To date, no studies have reported computed tomography (CT) documented fusion rates following XLIF. Methods An institutional review board-approved prospective radiographic and CT assessment of minimally disruptive anterior lumbar interbody fusion (mini-ALIF) fusions performed through the XLIF approach. Sixty-six patients (88 operative levels) were examined 12 months after XLIF to determine the rate and quality of anterior lumbar fusion. Results Eighty five of the 88 levels (96.6%) were judged fused by CT. Sixty-four of the 66 patients (97.0%) were judged fused by CT. Patient satisfaction at 12 months after surgery was high, with 89.4% reportedly “satisfied or very satisfied” with their results. No revisions were necessary for pseudarthrosis. Conclusion Mini-ALIF using an XLIF approach reliably results in anterior lumbar fusion.

Rodgers, W. B.; Gerber, Edward J.; Patterson, Jamie R.

2010-01-01

46

Minimally invasive versus open transforaminal lumbar interbody fusion  

PubMed Central

Background Available clinical data are insufficient for comparing minimally invasive (MI) and open approaches for transforaminal lumbar interbody fusion (TLIF). To date, a paucity of literature exists directly comparing minimally invasive (MI) and open approaches for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to directly compare safety and effectiveness for these two surgical approaches. Materials and Methods Open or minimally invasive TLIF was performed in 63 and 76 patients, respectively. All consecutive minimally invasive TLIF cases were matched with a comparable cohort of open TLIF cases using three variables: diagnosis, number of spinal levels, and history of previous lumbar surgery. Patients were treated for painful degenerative disc disease with or without disc herniation, spondylolisthesis, and/or stenosis at one or two spinal levels. Clinical outcome (self-report measures, e.g., visual analog scale (VAS), patient satisfaction, and MacNab's criteria), operative data (operative time, estimated blood loss), length of hospitalization, and complications were assessed. Average follow-up for patients was 37.5 months. Results: The mean change in VAS scores postoperatively was greater (5.2 vs. 4.1) in theopen TLIF patient group (P = 0.3). MacNab's criteria score was excellent/good in 67% and 70% (P = 0.8) of patients in open and minimally invasive TLIF groups, respectively. The overall patient satisfaction was 72.1% and 64.5% (P = 0.4) in open and minimally invasive TLIF groups, respectively. The total mean operative time was 214.9 min for open and 222.5 min for minimally invasive TLIF procedures (P = 0.5). The mean estimated blood loss for minimally invasive TLIF (163.0 ml) was significantly lower (P < 0.0001) than the open approach (366.8 ml). The mean duration of hospitalization in the minimally invasive TLIF (3 days) was significantly shorter (P = 0.02) than the open group (4.2 days). The total rate of neurological deficit was 10.5% in the minimally invasive TLIF group compared to 1.6% in the open group (P = 0.02). Conclusions: Minimally invasive TLIF technique may provide equivalent long-term clinical outcomes compared to open TLIF approach in select population of patients. The potential benefit of minimized tissue disruption, reduced blood loss, and length of hospitalization must be weighted against the increased rate of neural injury-related complications associated with a learning curve. PMID:20657693

Villavicencio, Alan T.; Roeca, Cassandra M.; Nelson, E. Lee; Mason, Alexander

2010-01-01

47

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

PubMed Central

Minimally invasive approaches for lumbar interbody fusion have been popularized in recent years. The retroperitoneal transpsoas approach to the lumbar spine is a technique that allows direct lateral access to the intervertebral disc space while mitigating the complications associated with traditional anterior or posterior approaches. However, a common complication of this procedure is iatrogenic injury to the psoas muscle and surrounding nerves, resulting in postsurgical motor and sensory deficits. The TranS1 VEO system (TranS1 Inc, Raleigh, NC, USA) utilizes a novel, minimally invasive transpsoas approach to the lumbar spine that allows direct visualization of the psoas and proximal nerves, potentially minimizing iatrogenic injury risk and resulting clinical morbidity. This paper describes the clinical uses, procedural details, and indications for use of the TranS1 VEO system. PMID:23766663

Hardenbrook, Mitchell A; Miller, Larry E; Block, Jon E

2013-01-01

48

Digitalized Design of Extraforaminal Lumbar Interbody Fusion: A Computer-Based Simulation and Cadaveric Study  

PubMed Central

Purpose This study aims to investigate the feasibility of a novel lumbar approach named extraforaminal lumbar interbody fusion (ELIF), a newly emerging minimally invasive technique for treating degenerative lumbar disorders, using a digitalized simulation and a cadaveric study. Methods The ELIF surgical procedure was simulated using the Mimics surgical simulator and included dissection of the superior articular process, dilation of the vertebral foramen, and placement of pedicle screws and a cage. ELIF anatomical measures were documented using a digitalized technique and subsequently validated on fresh cadavers. Results The use of the Mimics allowed for the vivid simulation of ELIF surgical procedures, while the cadaveric study proved the feasibility of this novel approach. ELIF had a relatively lateral access approach that was located 8–9 cm lateral to the median line with an access depth of approximately 9 cm through the intermuscular space. Dissection of the superior articular processes could fully expose the target intervertebral discs and facilitate a more inclined placement of the pedicle screws and cage with robust enhancement. Conclusions According to the computer-based simulation and cadaveric study, it is feasible to perform ELIF. Further research including biomechanical study is needed to prove ELIF has a superior ability to preserve the posterior tension bands of the spinal column, with similar effects on spinal decompression, fixation, and fusion, and if it can enhance post-fusion spinal stability and expedites postoperative recovery. PMID:25157907

Yang, Mingjie; Zeng, Cheng; Guo, Song; Pan, Jie; Han, Yingchao; Li, Zeqing; Li, Lijun; Tan, Jun

2014-01-01

49

Coblation of spinal endplates in preparation for interbody spinal fusion  

Microsoft Academic Search

Posterior lumbar interbody fusion (PLIF) and anterior lumbar interbody fusion (ALIF) have become routine alternatives to intertransverse process fusion. The use of Coblation® (ArthroCare Corporation, Sunnyvale, CA) allows for routine and reproducible removal of cartilaginous endplate down to the bony endplate. Our experience with this new technology is reviewed. The authors used Coblation® to prepare endplates of 10 consecutive patients

Henry E. Aryan; Christopher P. Ames; Bartek Szandera; Andrew D. Nguyen; Frank L. Acosta; William R. Taylor

2006-01-01

50

Current status of bone graft options for anterior interbody fusion of the cervical and lumbar spine.  

PubMed

Anterior cervical discectomy and fusion (ACDF) and anterior lumbar interbody fusion (ALIF) are common surgical procedures for degenerative disc disease of the cervical and lumbar spine. Over the years, many bone graft options have been developed and investigated aimed at complimenting or substituting autograft bone, the traditional fusion substrate. Here, we summarise the historical context, biological basis and current best evidence for these bone graft options in ACDF and ALIF. PMID:23743981

Chau, Anthony Minh Tien; Xu, Lileane Liang; Wong, Johnny Ho-Yin; Mobbs, Ralph Jasper

2014-01-01

51

Perioperative thrombotic occlusion of left external iliac artery during anterior lumbar interbody fusion  

Microsoft Academic Search

We report a case of thrombotic occlusion of left external iliac artery during the procedure of anterior lumbar interbody fusion.\\u000a The diagnosis was confirmed by computed tomography angiography. The patient also developed severe rhabdomyolysis postoperatively.\\u000a In spite of receiving emergent thromboendarterectomy, the patient expired on postoperative day 3. This report attempts to\\u000a remind spinal surgeons and anesthesiologists of this rare but

Jen-Hsuan Huang; Cheng-Hung Lee; Tzung-chieh Tsai; Shih-Yen Peng

2008-01-01

52

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

PubMed Central

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

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

2014-01-01

53

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  

Microsoft Academic Search

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

2011-01-01

54

CT Evaluation of Lumbar Interbody Fusion: Current Concepts  

Microsoft Academic Search

Operative techniques for fusing an unstable por- tion of the lumbar spine or immobilizing a painful vertebral motion segment have been in use for many years. Lumbar fusion procedures initially were used to treat patients with infections (tuberculous spondy- litis) or misaligned spines (isthmic spondylolisthesis) (1-8). Early techniques involving the use of harvested autogenous bone graft without instrumentation were largely

Alan L. Williams; Matthew F. Gornet; J. Kenneth Burkus

55

Lateral Lumbar Interbody Fusion for the Correction of Spondylolisthesis and Adult Degenerative Scoliosis in High-Risk Patients: Early Radiographic Results and Complications  

PubMed Central

Background Lateral lumbar interbody fusion (LLIF) is not associated with many of the complications seen in other interbody fusion techniques. This study used computed tomography (CT) scans, the radiographic gold standard, to assess interbody fusion rates achieved utilizing the LLIF technique in high-risk patients. Methods We performed a retrospective review of patients who underwent LLIF between January 2008 and July 2013. Forty-nine patients underwent nonstaged or staged LLIF on 119 levels with posterior correction and augmentation. Per protocol, patients received CT scans at their 1-year follow-up. Of the 49 patients, 21 patients with LLIF intervention on 54 levels met inclusion criteria. Two board-certified musculoskeletal radiologists and the senior surgeon (JZ) assessed fusion. Results Of the 21 patients, 6 patients had had previous lumbar surgery, and the cohort's comorbidities included osteoporosis, diabetes, obesity, and smoking, among others. Postoperative complications occurred in 12 (57.1%) patients and included anterior thigh pain and weakness in 6 patients, all of which resolved by 6 months. Two cases of proximal junctional kyphosis occurred, along with 1 case of hardware pullout. Two cases of abdominal atonia occurred. By CT scan assessment, each radiologist found fusion was achieved in 53 of 54 levels (98%). The radiologists' findings were in agreement with the senior surgeon. Conclusion Several studies have evaluated LLIF fusion and reported fusion rates between 88%-96%. Our results demonstrate high fusion rates using this technique, despite multiple comorbidities in the patient population. Spanning the ring apophysis with large LLIF cages along with supplemental posterior pedicle screw augmentation can enhance stability of the fusion segment and increase fusion rates. PMID:24688329

Waddell, Brad; Briski, David; Qadir, Rabah; Godoy, Gustavo; Houston, Allison Howard; Rudman, Ernest; Zavatsky, Joseph

2014-01-01

56

Clinical and Radiological Outcomes of Segmental Spinal Fusion in Transforaminal Lumbar Interbody Fusion with Spinous Process Tricortical Autograft  

PubMed Central

Study Design A retrospective study. Purpose To investigate clinical and radiological outcomes when using spinous process as a tricortical autograft for segmental spinal fusion in transforaminal lumbar interbody fusion (TLIF). Overview of Literature Interbody spinal fusion is one of the important procedures in spinal surgery. Many types of autografts are harvested at the expense of complications. Clinical and radiographic results of patients who underwent TLIF with intraoperative harvested spinous process autograft in Prasat Neurological Institue, Bangkok, Thailand, were assessed as new technical innovation. Methods Between October 2005 to July 2009, 30 cases of patients who underwent TLIF with spinous process tricortical autograft were included. Clinical evaluations were assessed by visual analog scales (VAS) and Prolo functional and economic scores at the preoperation and postoperation and at 2 years postoperation. Static and dynamic plain radiograph of lumbar spine were reviewed for achievement of fusion. Results Initial successful fusion time in lumbar interbody fusion with spinous process tricortical autograft was 4.72 months (range, 3.8-6.1 months) postoperation and 100% fusion rate was reported at 2 years. Our initial successful fusion time in lumbar interbody fusion was compared to the other types of grafts in previous literatures. Conclusions The use of intraoperative harvested spinous process tricortical autograft has overcome many disadvantages of harvesting autograft with better initial successful fusion time (4.72 months). VAS and Prolo scores showed some improvement in the outcomes between the preoperative and postoperative periods. PMID:24761199

Tangviriyapaiboon, Teera

2014-01-01

57

Assessment of Bioplex Interbody Fusion Device in a Sheep Lumbar Fusion Model  

PubMed Central

Objective The purpose of this study was to evaluate the bioPlex bioresorbable interbody device in a sheep lumbar fusion model and compare it to the concorde®, a standard carbon fiber interbody cage. Background Lumbar interbody fusion devices are made from a variety of materials, including titanium alloys, carbon-fiber, and PEEK. The BioPlex Continuous Phase Composite (CPC) is a unique bioresorbable material comprised of Pro Osteon 500R and 70:30 Poly (L/D, L-lactic acid). The BioPlex device is radiolucent, resorbable and due to its bulk nanoporosity of 8%, has a more consistent degradation profile as compared to a polymer alone. Methods A total of twenty five male Suffolk sheep were used in this study; nineteen of which were implanted with a bioPlex or concorde device at the L3-L4 and L5-L6 levels using a modified transforaminal/lateral approach. A discectomy was performed and each implant (filled with autologous bone) was placed within the disc space. The sheep were sacrificed at 6, 12, 24 months postimplantation. Fusion was assessed via motion, radiographic and histological data. Results The BioPlex and Concorde implanted levels had significantly less motion (p<0.05) than the normal controls in flexion/extension and lateral bending at 6, 12, and 24 months. No significant difference in motion was detected between the bioPlex and concorde implants. CT fusion scores correlated with the motion analysis in all the three cases. Conclusion In comparison to the concorde device, the bioPlex implant appears to have equivalent radiographic and biomechanical fusion success. PMID:24027458

Fredericks, Douglas C.; Gandhi, Anup A.; Grosland, Nicole M.; Smucker, Joseph D.

2013-01-01

58

A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions  

SciTech Connect

A randomized double-blind prospective study of pulsed electromagnetic fields for lumbar interbody fusions was performed on 195 subjects. There were 98 subjects in the active group and 97 subjects in the placebo group. A brace containing equipment to induce an electromagnetic field was applied to patients undergoing interbody fusion in the active group, and a sham brace was used in the control group. In the active group there was a 92% success rate, while the control group had a 65% success rate (P greater than 0.005). The effectiveness of bone graft stimulation with the device is thus established.

Mooney, V. (Univ. of California, Irvine (USA))

1990-07-01

59

Intraspinal metalloma causing lumbar stenosis after interbody fusion with cylindrical titanium cages.  

PubMed

Intraspinal metallomas are rare. The authors present a case after implantation of two titanium threaded interbody cages at the L4L5 level, without posterior instrumentation. To their knowledge this is the first case due to intervertebral cages. The lack of additional instrumentation had probably allowed the cages to make contact. Subsequently, friction generated wear debris, which led to the formation of a granuloma, responsible for compression of the dural sac. Intraspinal metallosis should be kept in mind as an infrequent cause of delayed neurological symptoms after spinal surgery with metallic instrumentation. PMID:23409582

Fernández-Baíllo, Nicomedes; Sánchez Marquez, José Miguel; Conde Gallego, Esther; Martín Esteban, Ana

2012-12-01

60

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

PubMed Central

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

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

2014-01-01

61

[Is posterior lumbar epidural space partitioned?].  

PubMed

The anatomy of the posterior lumbar epidural space (PLES) has been extensively studied. Besides the anatomists, surgeons, radiologists and anaesthetists have taken an interest in this. However, because each one has considered the PLES from his own specialist field, descriptions are not always concordant. In particular, the reality of a medial partition in the PLES has been suggested by epidurography and intraoperative observations. Lewit and Sereghy and Luyendijk opened the debate by reporting, on antero-posterior epidurographic films, a clear-cut, medial, vertical and narrow picture which partitioned the PLES. However, this was not constant. Savolaine et al. also recognized this partition on epidurographic CT scans. During laminectomies, Luyendijk has taken photographs of a medial fold of the dura mater which appeared to hold it to the posterior vertebral arch, being collapsed on either side of the midline. He named it "plica mediana dorsalis durae matris" (PMD). Several anaesthetists considered that this could explain why epidural analgesia sometimes acted on one side only. Husemeyer and White, and Harrison et al., have tried to confirm this experimentally by making casts with polymerizing resins in cadavers. They did not get very convincing results. Blomberg also tried to see this space by epiduroscopy in the cadaver. Unfortunately, for technical reasons, his photographs were of poor quality. He, however, reported having seen each time the PMD and a band of connective tissue fixing it to the vertebral arch in the midline. However, all these anatomical studies used methods which alter the natural structures. Their results are therefore questionable. The PLES is a virtual space. Histological studies have shown that it is filled with fatty tissue between the dura and the vertebral arch. It is therefore conceivable that any liquid injected into the PLES, such as contrast medium or local anaesthetic, must push back the dura, the only tissue which can move to give it any room. The fatty tissue could therefore be compressed and take any of the shapes which have been described on epidurography. On the other hand, should it be torn, it seems this fatty tissue could make up these haphazard fibrous tracts tensed between the dura and the vertebral arch, such as described in classical anatomy, as Bonica recalled. These can be clearly seen during surgical and anatomical dissections, and during endoscopies carried out on cadavers with sufficient optical means, as opposed to the medial fibrous band fixing the dura to the vertebral arch.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1443817

Morisot, P

1992-01-01

62

Novel indication for posterior dynamic stabilization: Correction of disc tilt after lumbar total disc replacement  

PubMed Central

Background The increase in total disc replacement procedures performed over the last 5 years has increased the occurrence of patients presenting with postoperative iatrogenic deformity requiring revision surgery. Proposed salvage treatments include device retrieval followed by anterior lumbar interbody fusion or posterior fusion. We propose a novel approach for the correction of disc tilt after total disc replacement using a posterior dynamic stabilization system. Methods Pedicle screws can be inserted either in an open manner or percutaneously by standard techniques under fluoroscopy. The collapsed side is expanded, and the convex side is compressed. Universal spacers are placed bilaterally, with the spacer on the collapsed side being taller by 6 mm. Cords are threaded through the spacers and pulled into place with the tensioning instrument. Extra tension is applied to the convex side, and the wound is closed by standard techniques. Results Three patients presenting with tilted total disc replacement devices underwent corrective surgery with posterior dynamic stabilization. Radiographs confirmed correction of deformity in all cases. Conclusions/Level of Evidence This technical note presents a novel indication for posterior dynamic stabilization and describes its surgical application to the correction of disc tilt after total disc replacement. This is level V evidence.

Cheng, Wayne K.; Palmer, Daniel Kyle; Jadhav, Vikram

2011-01-01

63

Clinical and radiographic outcomes after minimally invasive transforaminal lumbar interbody fusion  

PubMed Central

Objective To evaluate outcomes after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Background MI-TLIF is a relatively novel technique for treating symptomatic spondylolisthesis and degenerative disc disease of the lumbar spine. It has become a popular option for lumbar arthrodesis largely because of its potential to minimize iatrogenic trauma to the soft tissue, paraspinous muscles as well as to neural elements. Methods Literature search using PubMed database. Results Eight retrospective clinical studies and 1 prospective clinical study were identified. No randomized studies were found. The indications for surgery were low-back pain and/or radicular symptoms secondary to spondylolisthesis and/or degenerative disc disease. Analysis of radiographic outcomes demonstrated a fusion rate greater than 90% in the vast majority of patients. Patients also experienced a significant improvement in functional outcome parameters at a mean follow-up of 20 months. Comparison of functional outcomes of MI-TLIF patients to a similar matched cohort of patients who underwent conventional open TLIF did not demonstrate any statistically significant difference between both cohorts. Conclusion For carefully selected patients, MI-TLIF has a very favorable long term outcome that is comparable to conventional open TLIF, with the added benefit of decreased adjacent tissue injury.

Etame, Arnold B.; Wang, Anthony C.; Than, Khoi D.; Park, Paul

2010-01-01

64

Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion.  

PubMed

Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has become an increasingly popular method of lumbar arthrodesis. However, there are few published studies comparing the clinical outcomes between unilateral and bilateral instrumented MIS TLIF. Sixty-five patients with degenerative lumbar spine disease were enrolled in this study. Thirty-one patients were randomized to the unilateral group and 34 to the bilateral group. Recorded demographic data included sex, age, preoperative diagnosis, and degenerated segment. Operative time, blood loss, hospital stay length, complication rates, and fusion rates were also evaluated. The Oswestry Disability Index (ODI) score and Visual Analog Scale (VAS) pain score data were obtained. All patients were asked to follow-up at 3 and 6 months after surgery, and once every 6 months thereafter. The mean follow-up was 26.6 months (range 18-36 months). The two groups were similar in sex, age, preoperative diagnosis, and operated level. The unilateral group had significantly shorter operative time, lower blood loss, and shorter hospital time than the bilateral group. The average postoperative ODI and VAS scores improved significantly in each group. No significant differences were found between the two groups in relation to ODI and VAS. All patients showed evidence of fusion at 12 months postoperatively. The total fusion rate, screw failure, and general complication rate were not significantly different. Results showed that single-level MIS TLIF with unilateral pedicle screw fixation would be sufficient in the management of preoperatively stable patients with lumbar degenerative disease. It seems that MIS TLIF with unilateral pedicle screw instrumentation is a better choice for single-level degenerative lumbar spine disease. PMID:24814852

Shen, Xiaolong; Zhang, Hailong; Gu, Xin; Gu, Guangfei; Zhou, Xu; He, Shisheng

2014-09-01

65

Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases  

PubMed Central

Background: Transforaminal lumbar interbody fusion (TLIF) has been used in lumbar degenerative diseases. Some researchers have applied unilateral fixation in TLIF to reduce operational trauma without compromising the clinical outcome, but it is always suspected biomechanically unstable. The supplementary contralateral translaminar facet screw (cTLFS) seemed to be able to overcome the inherent drawbacks of unilateral pedicle screw (uPS) fixation theoretically. This study evaluates the safety, feasibility and efficacy of TLIF using uPS with cTLFS fixation in the treatment of lumbar degenerative diseases (LDD). Materials and Methods: 50 patients (29 male) underwent the aforementioned surgical technique for their LDD between December 2009 and April 2012. The results were evaluated based on visual analogue scale (VAS) of the leg and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were recorded. The radiographic examinations in form of X-ray, computed tomography (CT) or magnetic resonance imaging was done preoperatively and 1 week, 3 months, 6 months, 12 months and 24 months postoperatively. The student t-test was used for comparison between the preoperative values and postoperative counterparts. P < 0.05 was considered to be statistically significant. Results: Among 50 patients, 22 received one level fusion and 28 two level's, with corresponding operation time and estimated blood loss being approximately 90 min, 150 ml and 120 min, 200 ml, respectively. No severe complications happened perioperatively. The mean VAS (back, leg) scores dropped from (7.6, 7.5) preoperatively to (2.1, 0.6) at 12 months’ followup, ODI from 49.1 preoperatively to 5.6 and JOA score raised from 10.6 preoperatively to 28.5, all P < 0.001, suggesting of good clinical outcome. From the three-dimensional reconstructed CT, 62 out of 70 segments displayed solid fusion with fusion rate of 88.6% at 12 months postoperatively. Conclusions: TLIF using uPS fixation plus cTLFS fixation is a safe, feasible and effective technique in the treatment of one or two level lumbar degenerative diseases short termly. PMID:25143640

Liu, Fubing; Jiang, Chun; Cao, Yuanwu; Jiang, Xiaoxing; Feng, Zhenzhou

2014-01-01

66

Anterior Dislodgement of a Fusion Cage after Transforaminal Lumbar Interbody Fusion for the Treatment of Isthmic Spondylolisthesis  

PubMed Central

Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks postoperatively, imaging studies demonstrated that banana-shaped cage migrated anteriorly and anterolisthesis recurred at the index level with pseudoarthrosis. The cage was removed and exchanged by new cage through anterior approach, and screws were replaced with larger size ones and cement augmentation was added. At postoperative 2 days of revision surgery, computed tomography (CT) showed fracture on lateral pedicle and body wall of L5 vertebra. He underwent surgery again for paraspinal decompression at L4-5 and extension of instrumentation to S1 vertebra. His back and leg pains improved significantly after final revision surgery and symptom relief was maintained during follow-up period. At 6 months follow-up, CT images showed solid fusion at L4-5 level. Careful cage selection for TLIF must be done for treatment of spondylolisthesis accompanied with deformed LSTV, especially when reduction will be attempted. Banana-shaped cage should be positioned anteriorly, but anterior dislodgement of cage and reduction failure may occur in case of a highly unstable spine. Revision surgery for the treatment of an anteriorly dislodged cage may be effectively performed using an anterior approach. PMID:24175028

Oh, Hyeong Seok; Lee, Sang-Ho

2013-01-01

67

Adjuvant Posterior Stabilization in the Management of Tuberculous Spondylitis of the Dorsal and Lumbar Spine  

Microsoft Academic Search

Objective Posterior instrumentation and stabilization allowing early mobilization, shortened hospital stay and maintenance of correction after debridement and bone grafting for tuberculous spondylitis through an anterior approach. Indications Tuberculous spondylitis requiring anterior drainage, debridement and decompression, as well as interbody fusion. Significant bone loss of vertebral body. Kyphosis > 25° Concomitant posterior column disease. Contraindications Poor general health precluding such

Ravi Venkatesan; P. Narendra Babu; Alfred J. Daniel; Vernon N. Lee; Sunil Agarwal; David Sadhu; Gabriel D. Sundararaj

2001-01-01

68

Delayed perforation of posterior pharyngeal wall caused by dislodged bioresorbable interbody cage. Case report.  

PubMed

A 48-year-old man was admitted for the management of congenital anomalies: Arnold-Chiari type I malformation combined with odontoid upward migration. He also had degenerative stenosis of the spinal canal by spurs at C2/C3 and C3/C4 levels. Osseous deformities caused ischaemic changes of the brainstem as well as spinal cord compression. Authors used the Biocage - interbody cage covered by bioresorbable layer to fill the surgically created gap after removal of the right part of C3 vertebral body. Twenty-seven months after implantation, the implant was extruded through posterior pharyngeal wall. Authors describe this unusual case and discuss possible causes of Biocage extrusion. PMID:24821644

Zapa?owicz, Krzysztof; Radek, Maciej; Wojdyn, Maciej; Pietkiewicz, Piotr; Olszewski, Jurek

2014-01-01

69

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

PubMed Central

Study Design Retrospective study. Purpose This study aims to investigate the clinical and radiological results of contralateral indirect decompression through minimally invasive unilateral transforaminal lumbar interbody fusion (MI-TLIF). Overview of Literature Several studies have proposed that blood loss and operation time could be reduced through a unilateral approach, although many surgeons have forecast that satisfactory foraminal decompression is difficult to achieve through a unilateral approach. Methods The study included 30 subjects who had undergone single-level MI-TLIF. Visual analogue scale (VAS) and Oswestry disability index (ODI) were analyzed for clinical assessment. Disc height, segmental lordosis, and lumbar lordosis angle were examined for radiological assessment. The degree of contralateral indirect decompression was evaluated through a comparative analysis, with a magnetic resonance imaging (MRI) performed preoperatively and at one year postoperatively. Results Intraoperative blood loss volume was 308.75 mL in the unilateral approach group (UAP), and 575.00 mL in the bilateral approach group (BAP), showing a statistically significant difference. Operation time was 139.50 minutes in the UAP group, and 189.00 minutes in the BAP group, exhibiting a statistically significant difference (p<0.05). On the other hand, no significant difference was found in VAS, ODI, disc height, lordosis angles and the degree of nerve decompression in the vertebral foramen, using MRI, between the two groups (p>0.05). Conclusions Satisfactory results were acquired with MI-TLIF conducted through the unilateral approach of contralateral indirect decompression, in alignment with the bilateral approach. Therefore, contralateral indirect decompression is thought to be a useful procedure in reducing the operation time and volume of blood loss. PMID:25187862

Yoo, Jae-Sung; Lee, Jun-Yeul

2014-01-01

70

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

PubMed

The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered "standard of care", are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists' interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications. PMID:24906245

Bonaldi, G; Brembilla, C; Cianfoni, A

2015-05-01

71

Hybrid dynamic stabilization with posterior spinal fusion in the lumbar spine  

PubMed Central

Background Instrumented lumbar arthrodesis has been established as the gold standard in the care of patients with degenerative disc disease. However, spinal fusion results in the elimination of motion of the functional spinal unit and has been implicated in the development of adjacent-level degeneration. Motion-preserving devices such as the dynamic rod allow for stabilization of a pathologic motion segment above a fused segment and create a transitional zone (index level) that decreases the loads applied to the supra-adjacent normal segment. Methods After institutional review board approval, 28 patients were included in this prospective, consecutive, nonrandomized clinical trial. Each subject was consented for dynamic stabilization. There was no attempt at fusion at the dynamic level. The cohort underwent a posterior lateral spinal fusion with single- or 2-level transforaminal lumbar interbody fusion by use of a cage, with superior-level posterior dynamic instrumentation. Functional clinical outcomes were measured with a 100-point visual analog scale, Oswestry Disability Index, and Short Form 36 questionnaire. Radiographic measurements, fusion evaluation, complications, and screw loosening were recorded. Results A minimum of 24 months’ follow-up data included 22 patients. No device failure or screw breakage was identified. Postoperative range of motion averaged 2.5° at the index level, and the superior adjacent-level range of motion remained unchanged (P > .05). Disc height was preserved at all levels (P > .05). Of 180 screws, 6 (3%) showed radiographic loosening. Functional outcomes showed significant improvement in mean postoperative visual analog scale score by 24.7 points (P < .01) and Oswestry Disability Index by 27.6 points (P < .01), as well as the Short Form 36 physical (P < .01) and mental (P < .05) components from baseline to 2-year follow-up. Conclusions Our preliminary results at 2 years are satisfactory. Clinical Relevance Ultimately, further follow-up will assess the potential for this treatment to delay adjacent-level changes in the long term.

Hudson, William R. S.; Gee, John Eric; Billys, James B.; Castellvi, Antonio E.

2011-01-01

72

Harvesting local cylinder autograft from adjacent vertebral body for anterior lumbar interbody fusion: surgical technique, operative feasibility and preliminary clinical results  

PubMed Central

Autogenous iliac crest has long served as the gold standard for anterior lumbar arthrodesis although added morbidity results from the bone graft harvest. Therefore, femoral ring allograft, or cages, have been used to decrease the morbidity of iliac crest bone harvesting. More recently, an experimental study in the animal showed that harvesting local bone from the anterior vertebral body and replacing the void by a radio-opaque ?-tricalcium phosphate plug was a valid concept. However, such a concept precludes theoretically the use of posterior pedicle screw fixation. At one institution a consecutive series of 21 patients underwent single- or multiple-level circumferential lumbar fusion with anterior cages and posterior pedicle screws. All cages were filled with cancellous bone harvested from the adjacent vertebral body, and the vertebral body defect was filled with a ?-tricalcium phosphate plug. The indications for surgery were failed conservative treatment of a lumbar degenerative disc disease or spondylolisthesis. The purpose of this study, therefore, was to report on the surgical technique, operative feasibility, safety, benefits, and drawbacks of this technique with our primary clinical experience. An independent researcher reviewed all data that had been collected prospectively from the onset of the study. The average age of the patients was 39.9 (26–57) years. Bone grafts were successfully harvested from 28 vertebral bodies in all but one patient whose anterior procedure was aborted due to difficulty in freeing the left common iliac vein. This case was converted to a transforaminal interbody fusion (TLIF). There was no major vascular injury. Blood loss of the anterior procedure averaged 250 ml (50–350 ml). One tricalcium phosphate bone plug was broken during its insertion, and one endplate was broken because of wrong surgical technique, which did not affect the final outcome. One patient had a right lumbar plexopathy that was not related to this special technique. There was no retrograde ejaculation, infection or pseudoarthrosis. One patient experienced a deep venous thrombosis. At the last follow up (mean 28 months) all patients had a solid lumbar spine fusion. At the 6-month follow up, the pain as assessed on the visual analog scale (VAS) decreased from 6.9 to 4.5 (33% decrease), and the Oswestry disability index (ODI) reduced from 48.0 to 31.7 with a 34% reduction. However, at 2 years follow up there was a trend for increase in the ODI (35) and VAS (5). The data in this study suggest that harvesting a cylinder of autograft from the adjacent vertebral body is safe and efficient. Filling of the void defect with a ?-tricalcium phosphate plug does not preclude the use of posterior pedicle screw stabilization. PMID:16598484

Jiang, Liang; Steffen, Thomas; Ouellet, Jean; Reindl, Rudy; Aebi, Max

2006-01-01

73

Injection of Bupivacaine into Disc Space to Detect Painful Nonunion after Anterior Lumbar Interbody Fusion (ALIF) Surgery in Patients with Discogenic Low Back Pain  

PubMed Central

Purpose Bupivacaine is commonly used for the treatment of back pain and the diagnosis of its origin. Nonunion is sometimes observed after spinal fusion surgery; however, whether the nonunion causes pain is controversial. In the current study, we aimed to detect painful nonunion by injecting bupivacaine into the disc space of patients with nonunion after anterior lumbar interbody fusion (ALIF) surgery for discogenic low back pain. Materials and Methods From 52 patients with low back pain, we selected 42 who showed disc degeneration at only one level (L4-L5 or L5-S1) on magnetic resonance imaging and were diagnosed by pain provocation on discography and pain relief by discoblock (the injection of bupivacaine). They underwent ALIF surgery. If the patients showed low back pain and nonunion 2 years after surgery, we injected bupivacaine into the nonunion disc space. Patients showing pain relief after injection of bupivacaine underwent additional posterior fixation using pedicle screws. These patients were followed up 2 years after the revision surgery. Results Of the 42 patient subjects, 7 showed nonunion. Four of them did not show low back pain; whereas 3 showed moderate or severe low back pain. These 3 patients showed pain reduction after injection of bupivacaine into their nonunion disc space and underwent additional posterior fixation. They showed bony union and pain relief 2 years after the revision surgery. Conclusion Injection of bupivacaine into the nonunion disc space after ALIF surgery for discogenic low back pain is useful for diagnosis of the origin of pain. PMID:24532522

Kimura, Seiji; Orita, Sumihisa; Inoue, Gen; Eguchi, Yawara; Takaso, Masashi; Ochiai, Nobuyasu; Kuniyoshi, Kazuki; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Gou; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Yamauchi, Kazuyo; Toyone, Tomoaki; Nakamura, Junichi; Kishida, Shunji; Sato, Jun; Takahashi, Kazuhisa

2014-01-01

74

Open and Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Intermediate Results and Complications  

PubMed Central

Study Design Prospective study. Purpose To compare clinical and radiological outcomes of open vs. minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Overview of Literature MI-TLIF promises smaller incisions and less soft tissue dissection resulting in lower morbidity and faster recovery; however, it is technically challenging. Methods Twenty-five patients with MI-TLIF were compared with 25 matched open TLIF controls. A minimum 2 year follow-up and a statistical analysis of perioperative and long-term outcomes were performed. Potential complications were recorded. Results The mean ages for the open and MI-TLIF cases were 44.4 years (range, 19-69 years) and 43.6 years (range, 20-69 years), respectively. The male:female ratio was 13:12 for both groups. Average follow-up was 26.9 months for the MI-TLIF group and 29.3 months for the open group. Operative duration was significantly longer in the MI-TLIF group than that in the open group (p<0.05). No differences in estimated blood loss, duration to ambulation, or length of stay were found. Significant improvements in the Oswestry disability index and EQ-5D functional scores were observed at 6-, 12-, and 24-months in both groups, but no significant difference was detected between the groups. Fusion rates were comparable. Cage sizes were significantly smaller in the MI-TLIF group at the L5/S1 level (p<0.05). One patient had residual spinal stenosis at the MI-TLIF level, and one patient who underwent two-level MI-TLIF developed a deep vein thrombosis resulting in a pulmonary embolism. Conclusions MI-TLIF and open TLIF had comparable long-term benefits. Due to technical constraints, patients should be advised on the longer operative time and potential undersizing of cages at the L5S1 level.

Hee, Hwan Tak

2015-01-01

75

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

PubMed

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

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

2013-10-01

76

Novel Pedicle Screw and Plate System Provides Superior Stability in Unilateral Fixation for Minimally Invasive Transforaminal Lumbar Interbody Fusion: An In Vitro Biomechanical Study  

PubMed Central

Purpose This study aims to compare the biomechanical properties of the novel pedicle screw and plate system with the traditional rod system in asymmetrical posterior stabilization for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). We compared the immediate stabilizing effects of fusion segment and the strain distribution on the vertebral body. Methods Seven fresh calf lumbar spines (L3-L6) were tested. Flexion/extension, lateral bending, and axial rotation were induced by pure moments of ± 5.0 Nm and the range of motion (ROM) was recorded. Strain gauges were instrumented at L4 and L5 vertebral body to record the strain distribution under flexion and lateral bending (LB). After intact kinematic analysis, a right sided TLIF was performed at L4-L5. Then each specimen was tested for the following constructs: unilateral pedicle screw and rod (UR); unilateral pedicle screw and plate (UP); UR and transfacet pedicle screw (TFS); UP and TFS; UP and UR. Results All instrumented constructs significantly reduced ROM in all motion compared with the intact specimen, except the UR construct in axial rotation. Unilateral fixation (UR or UP) reduced ROM less compared with the bilateral fixation (UP/UR+TFS, UP+UR). The plate system resulted in more reduction in ROM compared with the rod system, especially in axial rotation. UP construct provided more stability in axial rotation compared with UR construct. The strain distribution on the left and right side of L4 vertebral body was significantly different from UR and UR+TFS construct under flexion motion. The strain distribution on L4 vertebral body was significantly influenced by different fixation constructs. Conclusions The novel plate could provide sufficient segmental stability in axial rotation. The UR construct exhibits weak stability and asymmetrical strain distribution in fusion segment, while the UP construct is a good alternative choice for unilateral posterior fixation of MI-TLIF. PMID:25807513

Zhu, Qingan; Zhou, Yue; Li, Changqing; Liu, Huan; Huang, Zhiping; Shang, Jin

2015-01-01

77

Prospective Analysis of a New Bone Graft in Lumbar Interbody Fusion: Results of a 2- Year Prospective Clinical and Radiological Study  

PubMed Central

Background This study examined the efficacy and safety of bone graft material ABM/P-15 (iFACTOR) for use in posterior lumbar interbody fusion. ABM/P-15 has been used safely for more than a decade in dental applications. Methods Forty patients underwent PLIF surgery, with each patient as control. Assessments up to 24 months included radiographs, CT scan, VAS, and ODI. Primary success criteria were fusion and safety. Results Intra-cage bridging bone occurred earlier with ABM/P-15 than autograft (97.73% vs. 59.09% at 6 months). On average pain decreased 29 points and function improved 43 points. Radio dense material outside the disk space occurred more frequently with ABM/P-15 than autograft, without clinical consequence. Conclusions This study suggests that ABM/P-15 has equal or greater efficacy at 6 and 12 months. Pain improvements exceeded success criteria at all time points. Functional improvement exceeded success criteria at all time points. Clinical Relevance This study explores the safety and efficacy of an osteobiologic peptide enhanced bone graft material as a viable alternative to autograft and its attendant risks. PMID:25709887

Raskin, Yannic

2015-01-01

78

Perioperative complications with rhBMP-2 in transforaminal lumbar interbody fusion.  

PubMed

Bone morphogenetic protein (BMP) is commonly used as an ICBG substitute for transforaminal lumbar interbody spine fusion (TLIF). However, multiple recent reports have raised concerns regarding a substantial incidence of perioperative radiculopathy. Also, given the serious complications reported with anterior cervical BMP use, risks related to swelling and edema with TLIF need to be clarified. As TLIF related complications with rhBMP-2 have generally been reported in small series or isolated cases, without a clear denominator, actual complication rates are largely unknown. The purpose this study is to characterize perioperative complications and complication rates in a large consecutive series of TLIF procedures with rhBMP-2. We reviewed inpatient and outpatient medical records for a consecutive series of 204 patients [113 females, 91 males, mean age 49.3 (22-79) years] who underwent TLIF using rhBMP-2 between 2003 and 2007. Complications observed within a 3-month perioperative interval were categorized as to etiology and severity. Wound problems were delineated as wound infection, hematoma/seroma or persistent drainage/superficial dehiscence. Neurologic deficits and radiculopathies were analyzed to determine the presence of a clear etiology (screw misplacement) and identify any potential relationship to rhBMP-2 usage. Complications were observed in 47 of 204 patients (21.6%) during the 3-month perioperative period. Major complications occurred in 13 patients (6.4%) and minor complications in 34 patients (16.7%). New or more severe postoperative neurologic complaints were noted in 13 patients (6.4%), 6 of whom required additional surgery. These cases included one malpositioned pedicle screw and one epidural hematoma. In four patients (2.0%), localized seroma/hematoma in the area of the foramen caused neural compression, and required revision. In one additional patient, vertebral osteolysis caused foraminal narrowing and radiculopathy, but resolved without further surgery. Persistent radiculopathy without clear etiology on imaging studies was seen in six patients. Wound related problems were seen in six patients (2.9%), distributed as wound infection (3), hematoma/seroma (1) and persistent drainage/dehiscence (2). Overall, this study demonstrates a modest complication rate for TLIF using rhBMP-2. While perioperative complications which appeared specific to BMP usage were noted, they occurred infrequently. It will be necessary to weigh this incidence of complications against the complication rate associated with ICBG harvest and any differential benefit in obtaining a solid arthrodesis. PMID:20582554

Owens, Kirk; Glassman, Steven D; Howard, Jennifer M; Djurasovic, Mladen; Witten, Jonathan L; Carreon, Leah Y

2011-04-01

79

Analysis of spinal lumbar interbody fusion cage subsidence using Taguchi method, finite element analysis, and artificial neural network  

NASA Astrophysics Data System (ADS)

Subsidence, when implant penetration induces failure of the vertebral body, occurs commonly after spinal reconstruction. Anterior lumbar interbody fusion (ALIF) cages may subside into the vertebral body and lead to kyphotic deformity. No previous studies have utilized an artificial neural network (ANN) for the design of a spinal interbody fusion cage. In this study, the neural network was applied after initiation from a Taguchi L 18 orthogonal design array. Three-dimensional finite element analysis (FEA) was performed to address the resistance to subsidence based on the design changes of the material and cage contact region, including design of the ridges and size of the graft area. The calculated subsidence is derived from the ANN objective function which is defined as the resulting maximum von Mises stress (VMS) on the surface of a simulated bone body after axial compressive loading. The ANN was found to have minimized the bone surface VMS, thereby optimizing the ALIF cage given the design space. Therefore, the Taguchi-FEA-ANN approach can serve as an effective procedure for designing a spinal fusion cage and improving the biomechanical properties.

Nassau, Christopher John; Litofsky, N. Scott; Lin, Yuyi

2012-09-01

80

Double-segment Wilhelm Tell technique for anterior lumbar interbody fusion in unstable isthmic spondylolisthesis and adjacent segment discopathy.  

PubMed

The Wilhelm Tell technique is a novel instrumented anterior lumbar interbody fusion (ALIF) procedure using a specially designed composite carbon fibre cage and a single short-threaded cancellous screw that obliquely passes through the upper adjacent vertebral body, the interbody cage itself and through the lower adjacent vertebral body. This single-stage fusion method, which is in principle a combination of the Louis technique and modern cage surgery, is reported to have a lower rate of pseudoarthrosis formation than stand-alone cage techniques. In addition, it eliminates both the surgical trauma of paravertebral muscle retraction and the risk of neural damage by poorly located pedicular screws. This anterior approach allows decompression of neural structures within the anterior part of the spinal canal and the foraminal region. It is the purpose of this case report, to present the successful application of this novel technique in a 32-year-old woman who concurrently suffered from severe instability-related back pain from L4/5 isthmic spondylolisthesis and marked L5/S1 degenerative disc disease. PMID:16459090

Wenger, Markus; Vogt, Emanuel; Markwalder, Thomas-Marc

2006-02-01

81

The Use of a Dehydrated Amnion/Chorion Membrane Allograft in Patients Who Subsequently Undergo Reexploration after Posterior Lumbar Instrumentation  

PubMed Central

Background Context. Products that can reduce development of epidural fibrosis may reduce risk for ongoing pain associated with development of scar tissue and make subsequent epidural reexploration easier. Purpose. To evaluate the use of dehydrated human amnion/chorion membrane (dHACM) on the formation of soft tissue scarring in the epidural space. Study Design. Case series. Patient Sample. Five patients having transforaminal lumbar interbody lumbar fusion (TLIF) with posterior instrumentation and implantation of dHACM in the epidural space and subsequent epidural reexploration. Outcome Measures. Degree of scar tissue adjacent to the epidural space at reexploration. Intraoperative and postoperative complications related to dHACM and patient reported outcomes. Methods. The degree of scar tissue adjacent to the epidural space was assessed during the reexploration surgery. Patients' outcomes were collected using standard validated questionnaires. Results. Four of 5 cases had easily detachable tissue during epidural reexploration. Angiolipoma of 10% was noted in 1 case and 5% in 2 cases. Significant improvements in patient reported outcomes were observed. No intraoperative or postoperative complications occurred. Conclusions. Our findings suggest that dHACM implant during TLIF may have favorable effects on epidural fibrosis and is well tolerated. Further studies with larger cohorts are required to prove our results. PMID:25653880

Subach, Brian R.; Copay, Anne G.

2015-01-01

82

A Systematic Review and Meta-Analysis of Unilateral versus Bilateral Pedicle Screw Fixation in Transforaminal Lumbar Interbody Fusion  

PubMed Central

Background Transforaminal lumbar interbody fusion (TLIF) has become one of the most widely used procedures for lumbar spinal disorders. However, it is still unclear whether TLIF with unilateral pedicle screw (PS) fixation is as effective as that with bilateral PS fixation. We performed a meta-analysis of the literatures and aimed to gain a better understanding of whether TLIF with unilateral PS fixation was safe and effective for lumbar diseases. Methodology/Principal Findings We systematically searched Ovid, Springer, and Medline databases for relevant randomized controlled trials (RCTs) that compared the clinical and radiological outcomes of unilateral versus bilateral PS fixation in TLIF. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. We generated pooled risk ratios or weighted mean differences across studies. According to our predefined inclusion criteria, seven RCTs with a total of 441 patients were included in this study. Baseline characteristics were similar between the unilateral and bilateral groups. Our meta-analysis showed that no significant difference was detected between the two groups in terms of postoperative clinical function, fusion status, reoperation rate, complication rate, and hospital stay (p>0.05). Pooled estimates revealed that the unilateral group was associated with significantly reduced implant cost, operative time and blood loss (p<0.05). Conclusions/Significances Our meta-analysis suggested TLIF with unilateral PS fixation was as safe and effective as that with bilateral PS fixation for lumbar diseases in selected patients. Despite these findings, our meta-analysis was based on studies with small sample size and different study characteristics that might lead to the inconsistent results such as various functional outcomes among the included studies. Therefore, high-quality randomized controlled trials with larger sample size are also needed to further clarify these issues and to provide the long-term outcomes. PMID:24489929

Hu, Xu-Qi; Wu, Xin-Lei; Xu, Cong; Zheng, Xu-Hao; Jin, Yong-Long; Wu, Li-Jun; Wang, Xiang-Yang; Xu, Hua-Zi; Tian, Nai-Feng

2014-01-01

83

Biomechanical evaluation of a spherical lumbar interbody device at varying levels of subsidence  

PubMed Central

Background Ulf Fernström implanted stainless steel ball bearings following discectomy, or for painful disc disease, and termed this procedure disc arthroplasty. Today, spherical interbody spacers are clinically available, but there is a paucity of associated biomechanical testing. The primary objective of the current study was to evaluate the biomechanics of a spherical interbody implant. It was hypothesized that implantation of a spherical interbody implant, with combined subsidence into the vertebral bodies, would result in similar ranges of motion (RoM) and facet contact forces (FCFs) when compared with an intact condition. A secondary objective of this study was to determine the effect of using a polyetheretherketone (PEEK) versus a cobalt chrome (CoCr) implant on vertebral body strains. We hypothesized that the material selection would have a negligible effect on vertebral body strains since both materials have elastic moduli substantially greater than the annulus. Methods A finite element model of L3-L4 was created and validated by use of ROM, disc pressure, and bony strain from previously published data. Virtual implantation of a spherical interbody device was performed with 0, 2, and 4 mm of subsidence. The model was exercised in compression, flexion, extension, axial rotation, and lateral bending. The ROM, vertebral body effective (von Mises) strain, and FCFs were reported. Results Implantation of a PEEK implant resulted in slightly lower strain maxima when compared with a CoCr implant. For both materials, the peak strain experienced by the underlying bone was reduced with increasing subsidence. All levels of subsidence resulted in ROM and FCFs similar to the intact model. Conclusions The results suggest that a simple spherical implant design is able to maintain segmental ROM and provide minimal differences in FCFs. Large areas of von Mises strain maxima were generated in the bone adjacent to the implant regardless of whether the implant was PEEK or CoCr.

Rundell, Steven A.; Isaza, Jorge E.; Kurtz, Steven M.

2011-01-01

84

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

PubMed

This study investigated the safety, effectiveness, and clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) for recurrent lumbar disc herniation (rLDH) following previous lumbar spine surgery. Seventy-three consecutive patients treated for rLDH between June 2005 and May 2012 were included in the study. The previous surgical procedures included percutaneous discectomy, discectomy with laminotomy, discectomy with unilateral laminectomy, and discectomy with bilateral laminectomy. The level of rLDH was L4-L5 in 51 patients, L5-S1 in 19 patients, and L3-L4 in three patients. All patients underwent reoperation using the TLIF technique. Outcomes were evaluated using the Oswestry disability index (ODI), visual analogue scale (VAS) scores for low back pain and leg pain, and the Japanese Orthopaedic Association (JOA) score, based on the results of physical examinations and questionnaires. The range of motion and disc height index of the operative segment were compared between preoperative and postoperative radiographs. The mean follow-up period was 4.1 years. The VAS scores for low back pain and leg pain, ODI, and JOA score improved significantly between the preoperative and final follow-up evaluations. The mean recovery rate of the JOA score was 89.0%. The disc space height and stability at the fused level were significantly improved after surgery. The fusion rate at the final follow-up was 93.2%. There were no major complications. These results indicate that TLIF can be considered an effective, reliable, and safe alternative procedure for the treatment of rLDH. PMID:25443080

Li, Zhonghai; Tang, Jiaguang; Hou, Shuxun; Ren, Dongfeng; Li, Li; Lu, Xiang; Hou, Tiesheng

2015-02-01

85

Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2  

PubMed Central

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

Zhou, Yue; Zhang, Zheng Feng; Li, Chang Qing; Zheng, Wen Jie; Liu, Jie

2010-01-01

86

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

PubMed Central

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

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

2013-01-01

87

Screw Placement Accuracy for Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery: A Study on 3-D Neuronavigation-Guided Surgery  

PubMed Central

Purpose?The aim of this study was to assess the impact of 3-D navigation for pedicle screw placement accuracy in minimally invasive transverse lumbar interbody fusion (MIS-TLIF). Methods?A retrospective review of 52 patients who had MIS-TLIF assisted with 3D navigation is presented. Clinical outcomes were assessed with the Oswestry Disability Index (ODI), Visual Analog Scales (VAS), and MacNab scores. Radiographic outcomes were assessed using X-rays and thin-slice computed tomography. Result?The mean age was 56.5 years, and 172 screws were implanted with 16 pedicle breaches (91.0% accuracy rate). Radiographic fusion rate at a mean follow-up of 15.6 months was 87.23%. No revision surgeries were required. The mean improvement in the VAS back pain, VAS leg pain, and ODI at 11.3 months follow-up was 4.3, 4.5, and 26.8 points, respectively. At last follow-up the mean postoperative disc height gain was 4.92?mm and the mean postoperative disc angle gain was 2.79 degrees. At L5–S1 level, there was a significant correlation between a greater disc space height gain and a lower VAS leg score. Conclusion?Our data support that application of 3-D navigation in MIS-TLIF is associated with a high level of accuracy in the pedicle screw placement. PMID:24353961

Torres, Jorge; James, Andrew R.; Alimi, Marjan; Tsiouris, Apostolos John; Geannette, Christian; Härtl, Roger

2012-01-01

88

The Combined Use of a Posterior Dynamic Transpedicular Stabilization System and a Prosthetic Disc Nucleus Device in Treating Lumbar Degenerative Disc Disease With Disc Herniations  

PubMed Central

Background Prosthetic replacement of spinal discs is emerging as a treatment option for degenerative disc disease. Posterior dynamic transpedicular stabilization (PDTS) and prosthetic disc nucleus (PDN) devices have been used sporadically in spinal surgery. Methods This was a prospective study of 13 patients averaging 40.9 years of age with degenerative disc disease who underwent posterior placement of a PDN with a PDTS. The Oswestry low-back pain disability questionnaire and visual analog scale (VAS) for pain were used to assess patient outcomes at the 3rd, 6th, and 12th postoperative months. Lumbar range of motion was evaluated using a bubble inclinometer preoperatively and at 12 months postoperatively. Radiological parameters including lumbar lordosis angle (LL), segmental lordosis angle (?), disc height at the operated level (DHo), and disc height of the adjacent level (DHu) were evaluated. A typical midline posterior approach for complete discectomy was followed by the simultaneous placement of the PDN with PDTS. Results Both the Oswestry and VAS scores showed significant improvement postoperatively (P < .05). There were no significant differences in LL, ?, DHo, and DHu parameters. We observed complications in 3 patients including 2 patients who had the PDN device embedded into the adjacent corpus; 1 had massive endplate degeneration, and the other experienced interbody space infection. In 1 patient, the PDN device migrated to one side in the vertebral space. Conclusion The use of a PDN in combination with posterior dynamic instrumentation can help to restore the physiologic motion of the anterior and posterior column and could help to establish posterior dynamic instrumentation as an important treatment of degenerative disc disease. Theoretically this concept is superior, but practically we need more advanced technology to replace disc material. Because this study examined the combination of the PDN and stabilization instrumention, the results cannot be compared with those reported in the literature for either PDN alone or dynamic screws alone. Level of Evidence Prospective cohort study with good follow-up (level 1b).

Aydin, Ahmet Levent; Oktenoglu, Tunc; Cosar, Murat; Ataker, Yaprak; Kaner, Tuncay; Ozer, Ali Fahir

2008-01-01

89

Clinical outcomes of degenerative lumbar spinal stenosis treated with lumbar decompression and the Cosmic “semi-rigid” posterior system  

PubMed Central

Background Although some investigators believe that the rate of postoperative instability is low after lumbar spinal stenosis surgery, the majority believe that postoperative instability usually develops. Decompression alone and decompression with fusion have been widely used for years in the surgical treatment of lumbar spinal stenosis. Nevertheless, in recent years several biomechanical studies have shown that posterior dynamic transpedicular stabilization provides stabilization that is like the rigid stabilization systems of the spine. Recently, posterior transpedicular dynamic stabilization has been more commonly used as an alternative treatment option (rather than rigid stabilization with fusion) for the treatment of degenerative spines with chronic instability and for the prevention of possible instability after decompression in lumbar spinal stenosis surgery. Methods A total of 30 patients with degenerative lumbar spinal stenosis (19 women and 11 men) were included in the study group. The mean age was 67.3 years (range, 40–85 years). Along with lumbar decompression, a posterior dynamic transpedicular stabilization (dynamic transpedicular screw–rigid rod system) without fusion was performed in all patients. Clinical and radiologic results for patients were evaluated during follow-up visits at 3, 12, and 24 months postoperatively. Results The mean follow-up period was 42.93 months (range, 24–66 months). A clinical evaluation of patients showed that, compared with preoperative assessments, statistically significant improvements were observed in the Oswestry and visual analog scale scores in the last follow-up control. Compared with preoperative values, there were no statistically significant differences in radiologic evaluations, such as segmental lordosis angle (?) scores (P = .125) and intervertebral distance scores (P = .249). There were statistically significant differences between follow-up lumbar lordosis scores (P = .048). There were minor complications, including a subcutaneous wound infection in 2 cases, a dural tear in 2 cases, cerebrospinal fluid fistulas in 1 case, a urinary tract infection in 1 case, and urinary retention in 1 case. We observed L5 screw loosening in 1 of the 3-level decompression cases. No screw breakage was observed and no revision surgery was performed in any of these cases. Conclusions Posterior dynamic stabilization without fusion applied to lumbar decompression leads to better clinical and radiologic results in degenerative lumbar spinal stenosis. To avoid postoperative instability, especially in elderly patients who undergo degenerative lumbar spinal stenosis surgery with chronic instability, the application of decompression with posterior dynamic transpedicular stabilization is likely an important alternative surgical option to fusion, because it does not have fusion-related side effects, is easier to perform than fusion, requires a shorter operation time, and has low morbidity and complication rates.

Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Aydin, Ahmet Levent; Ozer, Ali Fahir

2010-01-01

90

Perioperative Surgical Complications and Learning Curve Associated with Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Single-Institute Experience  

PubMed Central

Background As surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF). Methods We performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primary outcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications, and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse events that were not specifically related to spinal surgery and did not affect recovery were also excluded. Results Perioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia, two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted bone extrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complications occurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including four reoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardware removals (one for a misplaced screw and two for infected cages). Conclusions We found perioperative complications occurred more often in the early period of a surgeon's experience with minimally invasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to this procedure. PMID:25729524

Lee, Soo Bin; Seok, Sang Ok; Jo, Byung Woo; Ha, Joong Won

2015-01-01

91

Effects of autogenous bone graft impaction and tricalcium phosphate on anterior interbody fusion in the porcine lumbar spine.  

PubMed

Background Impaction grafting can be achieved inside the spinal fusion cages, but its effect on bone graft incorporation and spinal fusion has not been studied. Animals and methods We investigated the effect of impaction grafting on the bone graft healing and fusion potential of beta-tricalcium phosphate (beta-TCP) inside the carbon fiber reinforced spinal fusion device (Brantigan cage) in 10 Danish landrace pigs. Lumbar spine interbody fusion of L2/3, L4/5 and L6/7 using carbon fiber cages was performed on each pig. Cages filled with either loosely-packed autologous iliac bone graft, rod-impacted autologous bone graft or beta-TCP were randomly distributed to the three fusion levels. Half of the animals were followed for 8 weeks, and the other half for 16 weeks. Results Radiographs and CT evaluations showed that autograft levels had significantly better results than beta-TCP levels (p<0.001 Fisher's Exact Test). However, the difference between impacted and loosely-packed levels was not significant. Histomorphometric analysis showed no difference between the loosely-packed and impacted cages with regard to bone volume, bone marrow volume, cartilage and fibrous tissue volume, while both of the autograft levels differed from the beta-TCP levels in all of the aforementioned parameters. Fluorochrome studies demonstrated that bone mineral apposition rate was significantly higher in the impacted cages than in the loosely-packed cages at 16 weeks. Interpretation Manual impaction of autologous bone graft into the carbon fiber cages resulted in a faster mineral apposition rate by 16 weeks. Bone ingrowth and spinal fusion were not influenced by impaction grafting. PMID:15370591

Li, Haisheng; Zou, Xuenong; Xue, Qingyun; Egund, Niels; Lind, Martin; Bünger, Cody

2004-08-01

92

Biomechanical Analysis of a Newly Developed Shape Memory Alloy Hook in a Transforaminal Lumbar Interbody Fusion (TLIF) In Vitro Model  

PubMed Central

Objective The objective of this biomechanical study was to evaluate the stability provided by a newly developed shape memory alloy hook (SMAH) in a cadaveric transforaminal lumbar interbody fusion (TLIF) model. Methods Six human cadaveric spines (L1-S2) were tested in an in vitro flexibility experiment by applying pure moments of ±8 Nm in flexion/extension, left/right lateral bending, and left/right axial rotation. After intact testing, a TLIF was performed at L4-5. Each specimen was tested for the following constructs: unilateral SMAH (USMAH); bilateral SMAH (BSMAH); unilateral pedicle screws and rods (UPS); and bilateral pedicle screws and rods (BPS). The L3–L4, L4–L5, and L5-S1 range of motion (ROM) were recorded by a Motion Analysis System. Results Compared to the other constructs, the BPS provided the most stability. The UPS significantly reduced the ROM in extension/flexion and lateral bending; the BSMAH significantly reduced the ROM in extension/flexion, lateral bending, and axial rotation; and the USMAH significantly reduced the ROM in flexion and left lateral bending compared with the intact spine (p<0.05). The USMAH slightly reduced the ROM in extension, right lateral bending and axial rotation (p>0.05). Stability provided by the USMAH compared with the UPS was not significantly different. ROMs of adjacent segments increased in all fixed constructs (p>0.05). Conclusions Bilateral SMAH fixation can achieve immediate stability after L4–5 TLIF in vitro. Further studies are required to determine whether the SMAH can achieve fusion in vivo and alleviate adjacent segment degeneration. PMID:25474112

Wang, Xi; Xu, Jing; Zhu, Yuexing; Li, Jiukun; Zhou, Si; Tian, Shunliang; Xiang, Yucheng; Liu, Xingmo; Zheng, Ying; Pan, Tao

2014-01-01

93

Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations  

PubMed Central

Background The observed rate of recurrent disc herniation after limited posterior lumbar discectomy is highest in patients with posterior wide annular defects, according to the Carragee classification of type II (fragment-defect) disc hernia. Although the recurrent herniation rate is lower in both type III (fragment-contained) and type IV (no fragment-contained) patients, recurrent persistent sciatica is observed in both groups. A higher rate of recurrent disc herniation and sciatica was observed in all 3 groups in comparison to patients with type I (fragment-fissure) disc hernia. Methods In total, 40 single-level lumbar disc herniation cases were treated with limited posterior lumbar microdiscectomy and posterior dynamic stabilization. The mean follow-up period was 32.75 months. Cases were selected after preoperative magnetic resonance imaging and intraoperative observation. We used the Carragee classification system in this study and excluded Carragee type I (fragment-fissure) disc herniations. Clinical results were evaluated with visual analog scale scores and Oswestry scores. Patients’ reherniation rates and clinical results were evaluated and recorded at 3, 12, and 24 months postoperatively. Results The most common herniation type in our study was type III (fragment-contained), with 45% frequency. The frequency of fragment-defects was 25%, and the frequency of no fragment-contained defects was 30%. The perioperative complications observed were as follows: 1 patient had bladder retention that required catheterization, 1 patient had a superficial wound infection, and 1 patient had a malpositioned transpedicular screw. The malpositioned screw was corrected with a second operation, performed 1 month after the first. Recurrent disc herniation was not observed during the follow-up period. Conclusions We observed that performing discectomy with posterior dynamic stabilization decreased the risk of recurrent disc herniations in Carragee type II, III, and IV groups, which had increased reherniation and persistent/continuous sciatica after limited lumbar microdiscectomy. Moreover, after 2 years’ follow-up, we obtained improved clinical results.

Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Cosar, Murat; Ozer, Ali Fahir

2010-01-01

94

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

PubMed Central

Background Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO-LIF procedure and it will assess safety and efficacy. Methods/Design Multicentric prospective study with n = 40 patients to undergo single level instrumented spinal arthrodesis of the lumbar or the lumbosacral spine, based on a diagnosis of: painful disc degeneration, painful erosive osteochondrosis, segmental instability, recurrent disc herniation, spinal canal stenosis or foraminal stenosis. The primary target criteria with regards to safety are: The number, severity and cause of intra- and perioperative complications. The number of significant penetrations of the cortical layer of the vertebral body by the implant as recognized on postoperative CT. The primary target parameters with regards to feasibility are: Performance of the procedure according to the preoperative plan. The planned follow-up is 12 months and the following scores will be evaluated as secondary target parameters with regards to clinical improvement: VAS back pain, VAS leg pain, Oswestry Disability Index, short form - 12 health questionnaire and the Swiss spinal stenosis questionnaire for patients with spinal claudication. The secondary parameters with regards to construct stability are visible fusion or lack thereof and signs of implant loosening, implant migration or pseudarthrosis on plain and functional radiographs. Discussion This trial will for the first time assess the safety and efficacy of guided oblique lumbar interbody fusion. There is no control group, but the results, the outcome and the rate of any complications will be analyzed on the background of the literature on instrumented spinal fusion. Despite its limitations, we expect that this study will serve as the key step in deciding whether a direct comparative trial with another fusion technique is warranted. Trial Registration Clinical Trials NCT00810433 PMID:20819219

2010-01-01

95

The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis  

PubMed Central

The “off label” use of rhBMP-2 in the transforaminal lumbar interbody fusion (TLIF) procedure has become increasingly popular. Although several studies have demonstrated the successful use of rhBMP-2 for this indication, uncertainties remain regarding its safety and efficacy. The purpose of this study is to evaluate the clinical and radiographic outcomes of the single-level TLIF procedure using rhBMP-2. Patients who underwent a single-level TLIF between January 2004 and May 2006 with rhBMP-2 were identified. A retrospective evaluation of these patients included operative report(s), pre- and postoperative medical records, and dynamic and static lumbar radiographs. Patient-reported clinical outcome measures were obtained from a telephone questionnaire and included a modification of the Odom’s criteria, a patient satisfaction score, and back and leg pain numeric rating scale scores. Forty-eight patients met the study criteria and were available for follow-up (avg. radiographic and clinical follow-up of 19.4 and 27.4 months, respectively). Radiographic fusion was achieved in 95.8% of patients. Good to excellent results were achieved in 71% of patients. On most recent clinical follow-up, 83% of patients reported improvement in their symptoms and 84% reported satisfaction with their surgery. Twenty-nine patients (60.4%) reported that they still had some back pain, with an average back pain numeric rating score of 2.8. Twenty patients (41.7%) reported that they still had some leg pain, with an average leg pain numeric rating score was 2.4. Thirteen patients (27.1%) had one or more complications, including transient postoperative radiculitis (8/48), vertebral osteolysis (3/48), nonunion (2/48), and symptomatic ectopic bone formation (1/48). The use of rhBMP-2 in the TLIF procedure produces a high rate of fusion, symptomatic improvement and patient satisfaction. Although its use eliminates the risk of harvesting autograft, rhBMP-2 is associated with other complications that raise concern, including a high rate of postoperative radiculitis. PMID:19475434

Makda, Junaid; Hong, Joseph; Patel, Ravi; Hilibrand, Alan S.; Anderson, David G.; Vaccaro, Alexander R.; Albert, Todd J.

2009-01-01

96

Ganglion cyst of the posterior longitudinal ligament causing lumbar radiculopathy: case report  

Microsoft Academic Search

We describe a man aged 26 years who presented with a neurological syndrome, which was found on lumbar radioculopathy to be due to a ganglion cyst originating from the posterior longitudinal ligament. Based on MRI findings, a cystic lesion was suspected, a round lesion at L4 level with no connection to the adjacent facet or to the dura matter. During

Hisatoshi Baba; Nobuaki Furusawa; Yasuhisa Maezawa; Kenzo Uchida; Yasuo Kokubo; Shinichi Imura; Sakon Noriki

1997-01-01

97

Midline lumbar fusion with cortical bone trajectory screw.  

PubMed

A novel cortical bone trajectory (CBT) screw technique provides an alternative fixation technique for lumbar spine. Trajectory of CBT screw creates a caudo-cephalad path in sagittal plane and a medio-lateral path in axial plane, and engages cortical bone in the pedicle. The theoretical advantage is that it provides enhanced screw grip and interface strength. Midline lumbar fusion (MIDLF) is composed of posterior midline approach, microsurgical laminectomy, and CBT screw fixation. We adopted the MIDLF technique for lumbar spondylolisthesis. Advantages of this technique include that decompression and fusion are available in the same field, and it minimizes approach-related damages. To determine whether MIDLF with CBT screw is as effective as traditional approach and it is minimum invasive technique, we studied the clinical and radiological outcomes of MIDLF. Our results indicate that MIDLF is effective and minimum invasive technique. Evidence of effectiveness of MIDLF is that patients had good recovery score, and that CBT screw technique was safety in clinical and stable in radiological. MIDLF with CBT screw provides the surgeon with additional options for fixation. This technique is most likely to be useful for treating lumbar spondylolisthesis in combination with midline decompression and insertion of an interbody graft, such as the transforaminal lumbar interbody fusion or posterior lumbar interbody fusion techniques. PMID:25169139

Mizuno, Masaki; Kuraishi, Keita; Umeda, Yasuyuki; Sano, Takanori; Tsuji, Masanori; Suzuki, Hidenori

2014-01-01

98

The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery  

Microsoft Academic Search

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

2007-01-01

99

Presacral retroperitoneal approach to axial lumbar interbody fusion: a new, minimally invasive technique at L5-S1: Clinical outcomes, complications, and fusion rates in 50 patients at 1-year follow-up  

PubMed Central

Background The presacral retroperitoneal approach to an axial lumbar interbody fusion (ALIF) is a percutaneous, minimally invasive technique for interbody fusion at L5-S1 that has not been extensively studied, particularly with respect to long-term outcomes. Objective The authors describe clinical and radiographic outcomes at 1-year follow-up for 50 consecutive patients who underwent the presacral ALIF. Methods Our patients included 24 males and 26 females who underwent the presacral ALIF procedure for interbody fusion at L5-S1. Indications included mechanical back pain and radiculopathy. Thirty-seven patients had disc degeneration at L5-S1, 7 had previously undergone a discectomy, and 6 had spondylolisthesis. A 2-level L4-S1 fusion was performed with a transforaminal lumbar interbody fusion at L4-5 in 15 patients. AxiaLIF was performed as a stand-alone procedure in 5 patients and supplemented with pedicle screws in 45 patients. Pre- and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were evaluated and complications were tracked. Fusion was evaluated by an independent neuro-radiologist. Results At 1-year follow-up, VAS and ODI scores had significantly improved by 49% and 50%, respectively, versus preoperative scores. By high-resolution computer tomography (CT) scans, fusion was achieved in 44 (88%) patients, developing bone occurred in 5 (10%), and 1 (2%) patient had pseudoarthrosis. One patient suffered a major operative complication–a bowel perforation with a pre-sacral abscess that resolved with treatment. Conclusion Our initial 50 patients who underwent presacral ALIF showed clinical improvement and fusion rates comparable with other interbody fusion techniques; its safety was reflected by low complication rates. Its efficacy in future patients will continue to be monitored, and will be reported in a 2-year follow-up study of fusion.

Bohinski, Robert J.; Jain, Viral V.; Tobler, William D.

2010-01-01

100

Prospective Randomized Controlled Trial of The Stabilis Stand Alone Cage (SAC) Versus Bagby and Kuslich (BAK) Implants for Anterior Lumbar Interbody Fusion  

PubMed Central

Background Degenerative disc disease is common and debilitating for many patients. If conservative extensive care fails, anterior lumbar interbody fusion has proven to be an alternative form of surgical management. The Stabilis Stand Alone Cage(SAC) was introduced as a method to obtain stability and fusion. The purpose of this study was to determine whether the Stabilis Stand Alone Cage (SAC) is comparable in safety and efficacy to the Bagby and Kuslich (BAK) device. Methods As part of a prospective, randomized, controlled FDA trial, 73 patients underwent anterior interbody fusion using either the SAC(56%) or the BAK device (44%). Results Background characteristics were similar between the two groups. There was no significant difference between the SAC and BAK groups in mean operative time or mean blood loss during surgery. Adverse event rates did not differ between the groups. Assessment of plain radiographs could not confirm solid fusion in 63% of control and 71% of study patients. Functional scores from Owestry and SF-36 improved in both groups by the two-year follow-up. There were no significant differences between the SAC and BAK patients with respect to outcome. Conclusions Both the Stabilis Stand Alone Cage and the BAK Cage provided satisfactory improvement in function and pain relief, despite less than expected radiographic fusion rates. The apparent incongruency between fusion rates and functional outcomes suggests that either radiographs underestimate the true incidence of fusion, or that patients are obtaining good pain relief and improved function despite a lower rate of fusion than previously reported. This was a Level III study. PMID:25694930

Lavelle, William; McLain, Robert F.; Rufo-Smith, Candace; Gurd, David P.

2014-01-01

101

Surgical Data and Early Postoperative Outcomes after Minimally Invasive Lumbar Interbody Fusion: Results of a Prospective, Multicenter, Observational Data-Monitored Study  

PubMed Central

Minimally invasive lumbar interbody fusion (MILIF) offers potential for reduced operative morbidity and earlier recovery compared with open procedures for patients with degenerative lumbar disorders (DLD). Firm conclusions about advantages of MILIF over open procedures cannot be made because of limited number of large studies of MILIF in a real-world setting. Clinical effectiveness of MILIF in a large, unselected real-world patient population was assessed in this Prospective, monitored, international, multicenter, observational study. Objective: To observe and document short-term recovery after minimally invasive interbody fusion for DLD. Materials and Methods: In a predefined 4-week analysis from this study, experienced surgeons (?30 MILIF surgeries pre-study) treated patients with DLD by one- or two-level MILIF. The primary study objective was to document patients’ short-term post-interventional recovery (primary objective) including back/leg pain (visual analog scale [VAS]), disability (Oswestry Disability Index [ODI]), health status (EQ-5D) and Patient satisfaction. Results: At 4 weeks, 249 of 252 patients were remaining in the study; the majority received one-level MILIF (83%) and TLIF was the preferred approach (94.8%). For one-level (and two-level) procedures, surgery duration was 128 (182) min, fluoroscopy time 115 (154) sec, and blood-loss 164 (233) mL. Time to first ambulation was 1.3 days and time to study-defined surgery recovery was 3.2 days. Patients reported significantly (P < 0.0001) reduced back pain (VAS: 2.9 vs 6.2), leg pain (VAS: 2.5 vs 5.9), and disability (ODI: 34.5% vs 45.5%), and a significantly (P < 0.0001) improved health status (EQ-5D index: 0.61 vs 0.34; EQ VAS: 65.4 vs 52.9) 4 weeks postoperatively. One adverse event was classified as related to the minimally invasive surgical approach. No deep site infections or deaths were reported. Conclusions: For experienced surgeons, MILIF for DLD demonstrated early benefits (short time to first ambulation, early recovery, high patient satisfaction and improved patient-reported outcomes) and low major perioperative morbidity at 4 weeks postoperatively. PMID:25811615

Pereira, Paulo; Buzek, David; Franke, Jörg; Senker, Wolfgang; Kosmala, Arkadiusz; Hubbe, Ulrich; Manson, Neil; Rosenberg, Wout; Assietti, Roberto; Martens, Frederic; Barbanti Brodano, Giovanni; Scheufler, Kai-Michael

2015-01-01

102

Noncontiguous lumbar vertebral hemangiomas treated by posterior decompression, intraoperative kyphoplasty, and segmental fixation.  

PubMed

Vertebral hemangiomas are benign lesions and are often asymptomatic. Most vertebral hemangiomas that cause cord compression and neurological symptoms are located in the thoracic spine and involve a single vertebra. The authors report the rare case of lumbar hemangiomas in a 60-year-old woman presenting with severe back pain and rapidly progressive neurological signs attributable to 2 noncontiguous lesions. After embolization of the feeding arteries, no improvement was noted. Thus, the authors performed open surgery using a combination of posterior decompression, intraoperative kyphoplasty, and segmental fixation. The patient experienced relief from back and leg pain immediately after surgery. At 3 months postoperatively, her symptoms and neurological deficits had improved completely. To the authors' knowledge, this is the first description of 2 noncontiguous extensive lumbar hemangiomas presenting with neurological symptoms managed by such combined treatment. The combined management seems to be an effective method for treating symptomatic vertebral hemangiomas. PMID:24236666

Yu, Bin; Wu, Desheng; Shen, Bin; Zhao, Weidong; Huang, Yufeng; Zhu, Jianguang; Qi, Dongduo

2014-01-01

103

Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion  

PubMed Central

A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an “intact” disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted. PMID:25276453

Iwatsuki, Koichi; Ohnishi, Yu-ichiro; Yoshimine, Toshiki

2014-01-01

104

Adjacent lumbar disc herniation after lumbar short spinal fusion.  

PubMed

A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3-5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an "intact" disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted. PMID:25276453

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

2014-01-01

105

The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery  

PubMed Central

A prospective observational study was conducted on patients undergoing posterior lumbar spine surgery for degenerative spinal disorders. The study purpose was to evaluate the effect of wait time to surgery on patient derived generic and disease specific functional outcome following surgery. A prolonged wait to surgery may adversely affect surgical outcome. Although there is literature on the effect of wait time to surgery in surgical fields such as oncology, cardiac, opthamologic, and total joint arthroplasty, little is known regarding the effect of wait time to surgery as it pertains to the spinal surgical population. Consecutive patients undergoing elective posterior lumbar spinal surgery for degenerative disorders were recruited. Short-Form 36 and Oswestry disability questionnaires were administered (pre-operatively, and at 6 weeks, 6 months, and 1 year post-operatively). Patients completed a questionnaire regarding their experience with the wait time to surgery. The study cohort consisted of 70 patients with follow-up in 53/70 (76%). Time intervals from the onset of patient symptoms to initial consultation by family physician through investigations, spinal surgical consultation and surgery were quantified. Time intervals were compared to patient specific improvements in reported outcome following surgery using Cox Regression analysis. The effect of patient and surgical parameters on wait time was evaluated using the median time as a reference for those patients who had either a longer or shorter wait. Significant improvements in patient derived outcome were observed comparing post-operative to pre-operative baseline scores. The greatest improvements were observed in aspects relating to physical function and pain. A longer wait to surgery was associated with less improvement in outcome following surgery (SF-36 domains of BP, GH, RP, VT). A longer wait time to surgery negatively influences the results of posterior lumbar spinal surgery for degenerative conditions as quantified by patient derived functional outcome measures. The parameters of pain severity and physical aspects of function appear to be the most significantly affected. PMID:17701060

Braybrooke, Jason; Ahn, Henry; Gallant, Aimee; Ford, Michael; Bronstein, Yigel; Finkelstein, Joel

2007-01-01

106

Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis Grades 1-2: Patient-Reported Clinical Outcomes and Cost-Utility Analysis  

PubMed Central

Background Transforaminal lumbar interbody fusion (TLIF) is the standard surgical treatment for patients with lumbar degenerative spondylolisthesis who do not respond to a 6-week course of conservative therapy. A number of morbidities are associated with the conventional open-TLIF method, so minimally invasive surgery (MIS) techniques for TLIF (MIS-TLIF) have been introduced to reduce the trauma to paraspinal muscles and hasten postoperative recovery. Because providing cost-effective medical treatment is a core initiative of healthcare reforms, a comparison of open-TLIF and MIS-TLIF must include a cost-utility analysis in addition to an analysis of clinical effectiveness. Methods We compared patient-reported clinical functional outcomes and hospital direct costs in age-matched patients treated surgically with either open-TLIF or MIS-TLIF. Patients were followed for at least 1 year, and patient scores on the Oswestry Disability Index (ODI) and visual analog scale (VAS) were analyzed at 6 weeks, 6 months, and ?1 year postoperatively in the 2 treatment groups. Results Compared to their preoperative scores, patients in both the open-TLIF and MIS-TLIF groups had significant improvements in the ODI and VAS scores at each follow-up point, but no significant difference in functional outcome occurred between the open-TLIF and MIS-TLIF groups (P=0.46). However, open-TLIF is significantly more costly compared to MIS-TLIF (P=0.0002). Conclusion MIS-TLIF is a more cost-effective treatment than open-TLIF for patients with degenerative spondylolisthesis and is equally effective as the conventional open-TLIF procedure, although further financial analysis—including an analysis of indirect costs—is needed to better understand the full benefit of MIS-TLIF. PMID:24688330

Sulaiman, Wale A. R.; Singh, Manish

2014-01-01

107

The SNAP trial: a double blind multi-center randomized controlled trial of a silicon nitride versus a PEEK cage in transforaminal lumbar interbody fusion in patients with symptomatic degenerative lumbar disc disorders: study protocol  

PubMed Central

Background Polyetheretherketone (PEEK) cages have been widely used in the treatment of lumbar degenerative disc disorders, and show good clinical results. Still, complications such as subsidence and migration of the cage are frequently seen. A lack of osteointegration and fibrous tissues surrounding PEEK cages are held responsible. Ceramic implants made of silicon nitride show better biocompatible and osteoconductive qualities, and therefore are expected to lower complication rates and allow for better fusion. Purpose of this study is to show that fusion with the silicon nitride cage produces non-inferior results in outcome of the Roland Morris Disability Questionnaire at all follow-up time points as compared to the same procedure with PEEK cages. Methods/Design This study is designed as a double blind multi-center randomized controlled trial with repeated measures analysis. 100 patients (18–75 years) presenting with symptomatic lumbar degenerative disorders unresponsive to at least 6 months of conservative treatment are included. Patients will be randomly assigned to a PEEK cage or a silicon nitride cage, and will undergo a transforaminal lumbar interbody fusion with pedicle screw fixation. Primary outcome measure is the functional improvement measured by the Roland Morris Disability Questionnaire. Secondary outcome parameters are the VAS leg, VAS back, SF-36, Likert scale, neurological outcome and radiographic assessment of fusion. After 1 year the fusion rate will be measured by radiograms and CT. Follow-up will be continued for 2 years. Patients and clinical observers who will perform the follow-up visits will be blinded for type of cage used during follow-up. Analyses of radiograms and CT will be performed independently by two experienced radiologists. Discussion In this study a PEEK cage will be compared with a silicon nitride cage in the treatment of symptomatic degenerative lumbar disc disorders. To our knowledge, this is the first randomized controlled trial in which the silicon nitride cage is compared with the PEEK cage in patients with symptomatic degenerative lumbar disc disorders. Trial registration NCT01557829 PMID:24568365

2014-01-01

108

Continuous Femoral Versus Posterior Lumbar Plexus Nerve Blocks for Analgesia After Hip Arthroplasty: A Randomized, Controlled Study  

PubMed Central

BACKGROUND Hip arthroplasty frequently requires potent postoperative analgesia, often provided with an epidural or posterior lumbar plexus local anesthetic infusion. However, American Society of Regional Anesthesia guidelines now recommend against epidural and continuous posterior lumbar plexus blocks during administration of various perioperative anticoagulants often administered after hip arthroplasty. A continuous femoral nerve block is a possible analgesic alternative, but whether it provides comparable analgesia to a continuous posterior lumbar plexus block after hip arthroplasty remains unclear. We therefore tested the hypothesis that differing the catheter insertion site (femoral versus posterior lumbar plexus) after hip arthroplasty has no impact on postoperative analgesia. METHODS Preoperatively, subjects undergoing hip arthroplasty were randomly assigned to receive either a femoral or posterior lumbar plexus stimulating catheter inserted 5 to 15 cm or 0 to 1 cm past the needletip, respectively. Postoperatively, patients received perineural ropivacaine, 0.2% (basal 6 mL/hour, bolus 4 mL, 30 min lockout) for at least two days. The primary end point was the average daily pain scores as measured with a numeric rating scale (0–10) recorded in the 24-h period beginning at 07:30 the morning after surgery, excluding twice-daily physical therapy sessions. Secondary end points included pain during physical therapy, ambulatory distance, and supplemental analgesic requirements during the same 24-h period, as well as satisfaction with analgesia during hospitalization. RESULTS The mean (SD) pain scores for subjects receiving a femoral infusion (n = 25) were 3.6 (1.8) versus 3.5 (1.8) for patients receiving a posterior lumbar plexus infusion (n = 22) resulting in a group difference of 0.1 (95% confidence interval ?0.9 to 1.2; P = 0.78). Because the confidence interval was within a prespecified ?1.6 to 1.6 range, we conclude that the effect of the two analgesic techniques on postoperative pain was equivalent. Similarly, we detected no differences between the two treatments with respect to the secondary end points, with one exception: subjects with a femoral catheter ambulated a median (10th–90th percentiles) 2 (0–17) m the morning after surgery, compared with 11 (0–31) m for subjects with a posterior lumbar plexus catheter (data nonparametric; P = 0.02). CONCLUSIONS After hip arthroplasty, a continuous femoral nerve block is an acceptable analgesic alternative to a continuous posterior lumbar plexus block when using a stimulating perineural catheter. However, early ambulatory ability suffers with a femoral infusion. PMID:21467563

Ilfeld, Brian M.; Mariano, Edward R.; Madison, Sarah J.; Loland, Vanessa J.; Sandhu, NavParkash S.; Suresh, Preetham J.; Bishop, Michael L.; Kim, T. Edward; Donohue, Michael C.; Kulidjian, Anna A.; Ball, Scott T.

2011-01-01

109

Lumbar disc herniation associated with separation of the posterior ring apophysis: analysis of five surgical cases and review of the literature  

Microsoft Academic Search

Summary¶Background. Separation of the posterior ring apophysis of an adjacent vertebral body can sometimes accompany lumbar intervertebral disc herniation. The condition can be both difficult to detect in conventional radiographs and is somewhat controversial to treat. Although there is general agreement on the frequent need for surgery, there is no consensus on the choice of operation. One procedure, posterior lumbar

T. Asazuma; M. Nobuta; M. Sato; M. Yamagishi; K. Fujikawa

2003-01-01

110

Posterior epidural migration of a lumbar disc fragment causing cauda equina syndrome: Case report and review of the relevant literature  

Microsoft Academic Search

Posterior epidural migration (PEM) of free disc fragments is rare, and reported PEM patients usually presented with radicular signs. An uncommon case involving a patient with cauda equina syndrome due to PEM of a lumbar disc fragment is reported with a review of the literature. The patient described in this report presented with an acute cauda equina syndrome resulting from

M. Döso?lu; F. Gezen; M. I. Ziyal

2001-01-01

111

Posterior Epidural Migration of an Extruded Lumbar Disc Mimicking a Facet Cyst: A Case Report  

PubMed Central

Dorsal extradural migration of extruded disc material is clinically uncommon. We report a rare case of posterior epidural migration of an extruded lumbar disc mimicking a facet cyst. A 32-year-old man was admitted to our institute with a 2-week history of severe low back pain and radiating pain in the left leg. The magnetic resonance (MR) images revealed a dorsally located, left-sided extradural cystic mass at the L2-3 level. The initial diagnosis was an epidural facet cyst because of the high signal intensity on MR images and its location adjacent to the facet joint. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was observed and excised. The pathological diagnosis was degenerated disc material. After surgery, the patient experienced complete relief from leg pain.

Yoo, Young Sun; Ju, Chang Il; Kim, Dong Min

2015-01-01

112

Conservative management of psoas haematoma following complex lumbar surgery  

PubMed Central

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

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

2014-01-01

113

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

PubMed

Platelet-rich plasma (PRP) is an autogenous source of growth factor and has been shown to enhance bone healing both in clinical and experimental studies. PRP in combination with porous hydroxyapatite has been shown to increase the bone ingrowth in a bone chamber rat model. The present study investigated whether the combination of beta tricalcium phosphate (beta-TCP) and PRP may enhance spinal fusion in a controlled animal study. Ten Danish Landrace pigs were used as a spinal fusion model. Immediately prior to the surgery, 55 ml blood was collected from each pig for processing PRP. Three-level anterior lumbar interbody fusion was performed with carbon fiber cages and staples on each pig. Autogenous bone graft, beta-TCP, and beta-TCP loaded with PRP were randomly assigned to each level. Pigs were killed at the end of the third month. Fusion was evaluated by radiographs, CT scanning, and histomorphometric analysis. All ten pigs survived the surgery. Platelet concentration increased 4.4-fold after processing. Radiograph examination showed 70% (7/10) fusion rate in the autograft level. All the levels with beta-TCP+PRP showed partial fusion, while beta-TCP alone levels had six partial fusions and four non-fusions ( P=0.08). CT evaluation of fusion rate demonstrated fusion in 50% (5/10) of the autograft levels. Only partial fusion was seen at beta-TCP levels and beta-TCP+PRP levels. Histomorphometric evaluation found no difference between beta-TCP and beta-TCP+PRP levels on new bone volume, remaining beta-TCP particles, and bone marrow and fibrous tissue volume, while the same parameters differ significantly when compared with autogenous bone graft levels. We concluded from our results in pigs that the PRP of the concentration we used did not improve the bone-forming capacity of beta-TCP biomaterial in anterior spine fusion. Both beta-TCP and beta-TCP+PRP had poorer radiological and histological outcomes than that of autograft after 3 months. PMID:14730438

Li, Haisheng; Zou, Xuenong; Xue, Qingyun; Egund, Niels; Lind, Martin; Bünger, Cody

2004-07-01

114

Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine  

PubMed Central

Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into sub-categories based on the part of the vertebral column that is addressed (anterior vs posterior). Furthermore, one has to differentiate between approaches aiming at a solid fusion in contrast to motion-sparing techniques with the proposed advantage of a reduced risk of developing adjacent disc disease. However, the field of application and long-term outcomes of these novel motion-preserving surgical techniques, including facet arthroplasty, nucleus replacement, and lumbar disc arthroplasty, need to be more precisely evaluated in long-term prospective studies. Innovative surgical treatment strategies involving minimally invasive techniques, such as lateral lumbar interbody fusion or transforaminal lumbar interbody fusion, as well as percutaneous implantation of transpedicular or transfacet screws, have been established with the reported advantages of reduced tissue invasiveness, decreased collateral damage, reduced blood loss, and decreased risk of infection. The aim of this study was to review well-established procedures for lumbar spinal fusion with the main focus on current concepts on spinal arthrodesis and motion-sparing techniques in degenerative disorders of the lumbar spine. PMID:24303453

Lykissas, Marios G; Aichmair, Alexander

2013-01-01

115

Symmetry of paraspinal muscle denervation in clinical lumbar spinal stenosis: Support for a hypothesis of posterior primary ramus stretching?  

PubMed Central

Introduction Denervation of the paraspinal muscles in spinal disorders is frequently attributed to radiculopathy. Therefore, persons with lumbar spinal stenosis causing asymmetrical symptoms should have asymmetrical paraspinal denervation. Methods 73 persons with clinical lumbar spinal stenosis, aged 55 to 85, completed a pain drawing and underwent masked electrodiagnostic testing including bilateral paraspinal mapping and testing of 6 muscles on the most symptomatic (or randomly chosen) limb. Results With the exception of 10 subjects with unilateral thigh pain (p=0.043), there was no relationship between side of pain and paraspinal mapping score for any subgroups (symmetrical pain, pain into one calf only). Among those with positive limb EMG (tested on one side), no relationship between side of pain and paraspinal EMG score was found. Discussion The evidence suggests that paraspinal denervation in spinal stenosis may not be due to radiculopathy, but rather due to stretch or damage to the posterior primary ramus. PMID:23813584

Haig, Andrew J.; London, Zachary; Sandella, Danielle E.; Yamakawa, Karen S.J.

2014-01-01

116

Multilevel extreme lateral interbody fusion (XLIF) and osteotomies for 3-dimensional severe deformity: 25 consecutive cases  

PubMed Central

Background This is a retrospective review of 25 patients with severe lumbar nerve root compression undergoing multilevel anterior retroperitoneal lumbar interbody fusion and posterior instrumentation for deformity. The objective is to analyze the outcomes and clinical results from anterior interbody fusions performed through a lateral approach and compare these with traditional surgical procedures. Methods A consecutive series of 25 patients (78 extreme lateral interbody fusion [XLIF] levels) was identified to illustrate the primary advantages of XLIF in correcting the most extreme of the 3-dimensional deformities that fulfilled the following criteria: (1) a minimum of 40° of scoliosis; (2) 2 or more levels of translation, anterior spondylolisthesis, and lateral subluxation (subluxation in 2 planes), causing symptomatic neurogenic claudication and severe spinal stenosis; and (3) lumbar hypokyphosis or flat-back syndrome. In addition, the majority had trunks that were out of balance (central sacral vertical line ?2 cm from vertical plumb line) or had sagittal imbalance, defined by a distance between the sagittal vertical line and S1 of greater than 3 cm. There were 25 patients who had severe enough deformities fulfilling these criteria that required supplementation of the lateral XLIF with posterior osteotomies and pedicle screw instrumentation. Results In our database, with a mean follow-up of 24 months, 85% of patients showed evidence of solid arthrodesis and no subsidence on computed tomography and flexion/extension radiographs. The complication rate remained low, with a perioperative rate of 2.4% and postoperative rate of 12.2%. The lateral listhesis and anterior spondylolisthetic subluxation were anatomically reduced with minimally invasive XLIF. The main finding in these 25 cases was our isolation of the major indication for supplemental posterior surgery: truncal decompensation in patients who are out of balance by 2 cm or more, in whom posterior spinal osteotomies and segmental pedicle screw instrumentation were required at follow up. No patients were out of sagittal balance (sagittal vertical line <3 cm from S1) postoperatively. Segmental instrumentation with osteotomies was also more effective for restoration of physiologic lumbar lordosis compared with anterior stand-alone procedures. Conclusions This retrospective study supports the finding that clinical outcomes (coronal/sagittal alignment) improve postoperatively after minimally invasive surgery with multilevel XLIF procedures and are improved compared with larger extensile thoracoabdominal anterior scoliosis procedures. PMID:25694908

McAfee, Paul C.; Shucosky, Erin; Chotikul, Liana; Salari, Ben; Chen, Lun; Jerrems, Dan

2013-01-01

117

Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

MedlinePLUS Videos and Cool Tools

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

118

Continuous somatosensory evoked potentials monitoring is highly sensitive to intraoperative occlusion of iliac artery during anterior lumbar interbody fusion: case report.  

PubMed

We report a case of thrombotic occlusion of the left common iliac artery during an L5-S1 anterior interbody fusion exposed via a retroperitoneal approach. The loss of distal blood flow was detected by loss of cortical and peripheral somatosensory evoked potentials on the left lower extremity. Restoration of the blood flow resulted in gradual return of evoked potentials of the involved extremity. The neurophysiological and pulse oximetry monitoring of the lower extremities are extremely sensitive for an early detection of thrombotic occlusions and vascular complications. PMID:19694209

Haghighi, S S; Zhang, R; Raiszadeh, R; Chammas, J; Bench, G; Raiszadeh, K; Terramanis, T T

2009-01-01

119

100 Consecutive Cases of Degenerative Lumbar Conditions Using a Non-Threaded Locking Screw System With a 90-Degree Locking Cap  

PubMed Central

Background This prospective study analyzes the perioperative outcomes and long-term fusion success of 100 consecutive lumbar degenerative cases. The cases were managed using a non-threaded locking screw system, in conjunction with polyetheretherketone (PEEK) cages, for posterior lumbar interbody fusion (PLIF) procedures. These 100 cases were compared to another prospective study treating patients with the same inclusion and exclusion criteria using conventional plate-based pedicle screw spinal instrumentation augmented with carbon fiber interbody cages. Methods A total of 167 operative levels were treated in 100 patients (51 single-level, 39 two-level and 10 three-level cases). Eleven cases were revisions and 67 patients received interbody fusion cages. Patients had an average of 22.8 ± 4.0 months followup. Results: There was one instrumentation failure but no significant subsidence at the interbody fusion level. The disc space height was restored as part of the surgical procedure at the interbody cage levels: from 7.5 ± 2.3 mm preoperative to 9.0 ± 2.1 mm postoperative. There were 2 cases of pseudarthrosis (2 / 100 = 2%). The average operative time for 1-level cases was 111 ± 25 minutes; for 2-level cases it was 132.4 ± 21.8 minutes; and for 3-level cases it was 162.6 ± 33 minutes. Blood loss averaged 800 ± 473 cc for 1-level cases, 1055 ± 408 cc for 2 levels, and 1155 ± 714 cc for 3 levels. The length of stay was similar between the 3 groups (4.4 ± 1.2 days for single-level cases, 4.7 ± 1.1 for 2 levels, and 5.0 ± 1.1 for 3 levels; P > .05). There were 3 incidental durotomies, and 4 other patients developed infections postoperatively that required reoperation. Conclusion The disc and foraminal heights can be restored and maintained with a unilateral cage and pedicle screw construct. Unilateral transforaminal lumbar interbody fusion using a PEEK cage combined with a non-threaded locking pedicle screw and rod system results in similar fusion rates to those achieved using the bilateral Brantigan interbody fusion cage or a single BAK Vista implant. When compared to the bilateral Brantigan cages, decreased operative time (P < .001), decreased blood loss (P < .001) and reduced incidence of dural tears (P < .001) are advantages of using a non-threaded locking screw system and single PEEK interbody cage for lumbar degenerative conditions without compromising subsequent fusion rates.

Cunningham, Bryan W.; Tortolani, P. Justin; Fedder, Ira L.; Sefter, John C.; Davis, Charles

2009-01-01

120

Posterior Endoscopic Discectomy Using as Endoscopic Lumbar Discectomy System Developed in Japan  

Microsoft Academic Search

The characteristics of the endoscopic lumbar discectomy system (ELDS) developed in Japan are introduced, and the first 50 cases are clinically evaluated. The patients included four cases of double disc herniation at two levels, one of cranially and three of caudally migrated discs, three of spinal canal stenosis, one of synovial cyst, and three of persistent ring apophysis. In four

Yutaka Hiraizumi

121

Cost-utility analysis of posterior minimally invasive fusion compared with conventional open fusion for lumbar spondylolisthesis  

PubMed Central

Background The utility and cost of minimally invasive surgical (MIS) fusion remain controversial. The primary objective of this study was to compare the direct economic impact of 1- and 2-level fusion for grade I or II degenerative or isthmic spondylolisthesis via an MIS technique compared with conventional open posterior decompression and fusion. Methods A retrospective cohort study was performed by use of prospective data from 78 consecutive patients (37 with MIS technique by 1 surgeon and 41 with open technique by 3 surgeons). Independent review of demographic, intraoperative, and acute postoperative data was performed. Oswestry disability index (ODI) and Short Form 36 (SF-36) values were prospectively collected preoperatively and at 1 year postoperatively. Cost-utility analysis was performed by use of in-hospital micro-costing data (operating room, nursing, imaging, laboratories, pharmacy, and allied health cost) and change in health utility index (SF-6D) at 1 year. Results The groups were comparable in terms of age, sex, preoperative hemoglobin, comorbidities, and body mass index. Groups significantly differed (P < .01) regarding baseline ODI and SF-6D scores, as well as number of 2-level fusions (MIS, 12; open, 20) and number of interbody cages (MIS, 45; open, 14). Blood loss (200 mL vs 798 mL), transfusions (0% vs 17%), and length of stay (LOS) (6.1 days vs 8.4 days) were significantly (P < .01) lower in the MIS group. Complications were also fewer in the MIS group (4 vs 12, P < .02). The mean cost of an open fusion was 1.28 times greater than that of an MIS fusion (P = .001). Both groups had significant improvement in 1-year outcome. The changes in ODI and SF-6D scores were not statistically different between groups. Multivariate regression analysis showed that LOS and number of levels fused were independent predictors of cost. Age and MIS were the only predictors of LOS. Baseline outcomes and MIS were predictors of 1-year outcome. Conclusion MIS posterior fusion for spondylolisthesis does reduce blood loss, transfusion requirements, and LOS. Both techniques provided substantial clinical improvements at 1 year. The cost utility of the MIS technique was considered comparable to that of the open technique. Level of Evidence Level III.

Rampersaud, Y. Raja; Gray, Randolph; Lewis, Steven J.; Massicotte, Eric M.; Fehlings, Michael G.

2011-01-01

122

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

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

123

Transiliac lengthening with posterior lumbar-iliac percutaneous fusion in sacral hemiagenesis  

Microsoft Academic Search

Sacral agenesis is a term that applies to a wide range of developmental disorders of the lower portions of the spine and pelvis.\\u000a Hemisacrum patients with all sacral segments present on one side of the spine, and decompensated lumbar rotoscoliosis, whit\\u000a instability torac-pelvic that had transiliac lengthening of the lower extremity, accomplished by an innominate osteotomy with\\u000a interposition of a

Pedro Antonio Sánchez Mesa

2011-01-01

124

[Submuscular approach to the lumbar spine and extraforaminal cage implantation].  

PubMed

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

Magerl, F

2011-02-01

125

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

PubMed Central

Study Design Cross sectional study. Purpose To evaluate characteristics of back muscle strength in patients scheduled for lumbar fusion surgery. Overview of Literature Little is known regarding muscle strength in patients with symptomatic lumbar degenerative diseases who require fusion surgery. Methods Consecutive 354 patients scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases were approached for participation. 316 patients were enrolled. Before surgery, muscle strength was assessed by measuring maximal isometric extension strength at seven angular positions (0°, 12°, 24°, 36°, 48°, 60°, and 72°) and mean isometric strength was calculated. The Oswestry Disability Index (0-100) and visual analogue scale (0-100) for back pain were recorded. Muscle strength was compared according to gender, age (<60, 60-70, and ?70 years) and scheduled fusion level (short, <3; long, ?3). Results Isometric strength was significantly decreased compared with previously reported results of healthy individuals, particularly at extension positions (0°-48°, p<0.05). Mean isometric strength was significantly lower in females (p<0.001) and older patients (p<0.05). Differences of isometric strength between short and long level fusion were not significantly different (p>0.05). Isometric strengths showed significant, but weak, inverse correlations with age and Oswestry Disability Index (r<0.4, p<0.05). Conclusions In patients with symptomatic lumbar degenerative diseases, back muscle strength significantly decreased, particularly at lumbar extension positions, and in females and older patients. PMID:25346820

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

2014-01-01

126

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

PubMed

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

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

2010-12-01

127

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

PubMed

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

Staub, Blake N; Holman, Paul J

2015-02-01

128

Dissection of left iliac artery during anterior lumbar interspace fusion: Report of a case.  

PubMed

Vascular injury is an uncommon complication of spine surgery. Among the different approaches, anterior lumbar interbody fusion has increased potential for vascular injuries, since the great vessels and their branches overly the disc spaces to be operated on, and retraction of these vessels is necessary to gain adequate surgical exposure. The reported incidence for anterior lumbar interbody fusion-associated vascular injuries ranges from 0% to 18.1%, with venous laceration as the most common type. We report a case of anterior lumbar interbody fusion-associated left common iliac artery dissection leading to delayed acute limb ischemia developing in early post-operative period. PMID:24848500

Fischer, Uwe M; Davies, Mark G; Sayed, Hosam El

2015-04-01

129

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

PubMed

Biphasic calcium phosphate (BCP) has been investigated extensively as a bone substitute nowadays. However, the bone formation capacity of BCP is limited owing to lack of osteoinduction. Silk fibroin (SF) has a structure similar to type I collagen, and could be developed to a microsphere for the sustained-release of rhBMP-2. In our previous report, bioactivity of BCP could be enhanced by rhBMP-2/SF microsphere (containing 0.5 µg rhBMP-2) in vitro. However, the bone regeneration performance of the composite in vivo was not investigated. Thus, the purpose of this study was to evaluate the efficacy of BCP/rhBMP-2/SF in a sheep lumbar fusion model. A BCP and rhBMP-2/SF microsphere was developed, and then was integrated into a BCP/rhBMP-2/SF composite. BCP, BCP/rhBMP-2 and BCP/rhBMP-2/SF were implanted randomly into the disc spaces of 30 sheep at the levels of L1/2, L3/4 and L5/6. After sacrificed, the fusion segments were evaluated by manual palpation, CT scan, biomechanical testing and histology at 3 and 6 months, respectively. The composite demonstrated a burst-release of rhBMP-2 (39.1 ± 2.8 %) on the initial 4 days and a sustained-release (accumulative 81.3 ± 4.9 %) for more than 28 days. The fusion rates, semi-quantitative CT scores, fusion stiffness in bending in all directions and histologic scores of BCP/rhBMP-2/SF were significantly greater than BCP and BCP/rhBMP-2 at each time point, respectively (P < 0.05). These findings indicate that the SF microspheres containing a very low dose of rhBMP-2 improve fusion in sheep using BCP constructs. PMID:25690620

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

2015-03-01

130

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

PubMed

This prospective study aimed to compare the efficacy of epidural (EDA) versus intravenous (PCA) application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal postoperative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA. PMID:21808704

Kluba, Torsten; Hofmann, Fabian; Bredanger, Sabine; Blumenstock, Gunnar; Niemeyer, Thomas

2010-03-20

131

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

PubMed Central

This prospective study aimed to compare the efficacy of epidural (EDA) versus intravenous (PCA) application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal postoperative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA. PMID:21808704

Kluba, Torsten; Hofmann, Fabian; Bredanger, Sabine; Blumenstock, Gunnar; Niemeyer, Thomas

2010-01-01

132

Repeated microendoscopic discectomy for recurrent lumbar disk herniation  

PubMed Central

OBJECTIVES: To explore the microendoscopic discectomy technique and inclusion criteria for the treatment of recurrent lumbar disc herniation and to supply feasible criteria and technical notes to avoid complications and to increase the therapeutic effect. METHODS: A consecutive series of 25 patients who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. The inclusion criteria were as follows: no severe pain in the lumbar region, no lumbar instability observed by flexion-extension radiography and no intervertebral discitis or endplate damage observed by magnetic resonance imaging. All patients were diagnosed by clinical manifestations and imaging examinations. RESULTS: Follow-up visits were carried out in all cases. Complications, such as nerve injuries, were not observed. The follow-up outcomes were graded using the MacNab criteria. A grade of excellent was given to 12 patients, good to 12 patients and fair to 1 patient. A grade of excellent or good occurred in 96% of cases. One patient relapsed 3 months after surgery and then underwent lumbar interbody fusion and inner fixation. The numerical rating scale of preoperative leg pain was 7.4± 1.5, whereas it decreased to 2.1±0.8 at 7 days after surgery. The preoperative Oswestry disability index of lumbar function was 57.5±10.0, whereas it was 26.0±8.5 at 7 days after surgery. CONCLUSION: In these cases, microendoscopic discectomy was able to achieve satisfactory clinical results. Furthermore, it has advantages over other methods because of its smaller incision, reduced bleeding and more efficient recovery. PMID:25789521

Hou, Tianyong; Zhou, Qiang; Dai, Fei; Luo, Fei; He, Qingyi; Zhang, Jinsong; Xu, Jianzhong

2015-01-01

133

A Novel Approach to the Surgical Treatment of Lumbar Disc Herniations: Indications of Simple Discectomy and Posterior Transpedicular Dynamic Stabilization Based on Carragee Classification  

PubMed Central

Surgery of lumbar disc herniation is still a problem since Mixter and Barr. Main trouble is dissatisfaction after the operation. Today there is a debate on surgical or conservative treatment despite spending great effort to provide patients with satisfaction. The main problem is segmental instability, and the minimally invasive approach via microscope or endoscope is not necessarily appropriate solution for all cases. Microsurgery or endoscopy would be appropriate for the treatment of Carragee type I and type III herniations. On the other hand in Carragee type II and type IV herniations that are prone to develop recurrent disc herniation and segmental instability, the minimal invasive techniques might be insufficient to achieve satisfactory results. The posterior transpedicular dynamic stabilization method might be a good solution to prevent or diminish the recurrent disc herniation and development of segmental instability. In this study we present our experience in the surgical treatment of disc herniations. PMID:23653862

Ozer, A. F.; Keskin, F.; Oktenoglu, T.; Suzer, T.; Ataker, Y.; Gomleksiz, C.; Sasani, M.

2013-01-01

134

Biomechanics of Lateral Interbody Spacers: Going Wider for Going Stiffer  

PubMed Central

This study investigates the biomechanical stability of a large interbody spacer inserted by a lateral approach and compares the biomechanical differences with the more conventional transforaminal interbody fusion (TLIF), with and without supplemental pedicle screw (PS) fixation. Twenty-four L2-L3 functional spinal units (FSUs) were tested with three interbody cage options: (i) 18?mm XLIF cage, (ii) 26?mm XLIF cage, and (iii) 11?mm TLIF cage. Each spacer was tested without supplemental fixation, and with unilateral and bilateral PS fixation. Specimens were subjected to multidirectional nondestructive flexibility tests to 7.5?N·m. The range of motion (ROM) differences were first examined within the same group (per cage) using repeated-measures ANOVA, and then compared between cage groups. The 26?mm XLIF cage provided greater stability than the 18?mm XLIF cage with unilateral PS and 11?mm TLIF cage with bilateral PS. The 18?mm XLIF cage with unilateral PS provided greater stability than the 11?mm TLIF cage with bilateral PS. This study suggests that wider lateral spacers are biomechanically stable and offer the option to be used with less or even no supplemental fixation for interbody lumbar fusion. PMID:23213284

Pimenta, Luiz; Turner, Alexander W. L.; Dooley, Zachary A.; Parikh, Rachit D.; Peterson, Mark D.

2012-01-01

135

Biomechanical comparison of three stand-alone lumbar cages — a three-dimensional finite element analysis  

PubMed Central

Background For anterior lumbar interbody fusion (ALIF), stand-alone cages can be supplemented with vertebral plate, locking screws, or threaded cylinder to avoid the use of posterior fixation. Intuitively, the plate, screw, and cylinder aim to be embedded into the vertebral bodies to effectively immobilize the cage itself. The kinematic and mechanical effects of these integrated components on the lumbar construct have not been extensively studied. A nonlinearly lumbar finite-element model was developed and validated to investigate the biomechanical differences between three stand-alone (Latero, SynFix, and Stabilis) and SynCage-Open plus transpedicular fixation. All four cages were instrumented at the L3-4 level. Methods The lumbar models were subjected to the follower load along the lumbar column and the moment at the lumbar top to produce flexion (FL), extension (EX), left/right lateral bending (LLB, RLB), and left/right axial rotation (LAR, RAR). A 10 Nm moment was applied to obtain the six physiological motions in all models. The comparison indices included disc range of motion (ROM), facet contact force, and stresses of the annulus and implants. Results At the surgical level, the SynCage-open model supplemented with transpedicular fixation decreased ROM (>76%) greatly; while the SynFix model decreased ROM 56-72%, the Latero model decreased ROM 36-91%, in all motions as compared with the INT model. However, the Stabilis model decreased ROM slightly in extension (11%), lateral bending (21%), and axial rotation (34%). At the adjacent levels, there were no obvious differences in ROM and annulus stress among all instrumented models. Conclusions ALIF instrumentation with the Latero or SynFix cage provides an acceptable stability for clinical use without the requirement of additional posterior fixation. However, the Stabilis cage is not favored in extension and lateral bending because of insufficient stabilization. PMID:24088294

2013-01-01

136

A new lumbar posterior fixation system, the memory metal spinal system: an in-vitro mechanical evaluation  

PubMed Central

Background Spinal systems that are currently available for correction of spinal deformities or degeneration such as lumbar spondylolisthesis or degenerative disc disease use components manufactured from stainless steel or titanium and typically comprise two spinal rods with associated connection devices (for example: DePuy Spines Titanium Moss Miami Spinal System). The Memory Metal Spinal System of this study consists of a single square spinal rod made of a nickel titanium alloy (Nitinol) used in conjunction with connecting transverse bridges and pedicle screws made of Ti-alloy. Nitinol is best known for its shape memory effect, but is also characterized by its higher flexibility when compared to either stainless steel or titanium. A higher fusion rate with less degeneration of adjacent segments may result because of the elastic properties of the memory metal. In addition, the use of a single, unilateral rod may be of great value for a TLIF procedure. Our objective is to evaluate the mechanical properties of the new Memory Metal Spinal System compared to the Titanium Moss Miami Spinal System. Methods An in-vitro mechanical evaluation of the lumbar Memory Metal Spinal System was conducted. The test protocol followed ASTM Standard F1717-96, “Standard Test Methods for Static and Fatigue for Spinal Implant Constructs in a Corpectomy Model.” 1. Static axial testing in a load to failure mode in compression bending, 2. Static testing in a load to failure mode in torsion, 3. Cyclical testing to estimate the maximum run out load value at 5.0 x 10^6 cycles. Results In the biomechanical testing for static axial compression bending there was no statistical difference between the 2% yield strength and the stiffness of the two types of spinal constructs. In axial compression bending fatigue testing, the Memory Metal Spinal System construct showed a 50% increase in fatigue life compared to the Titanium Moss Miami Spinal System. In static torsional testing the Memory Metal Spinal System constructs showed an average 220% increase in torsional yield strength, and an average 30% increase in torsional stiffness. Conclusions The in-vitro mechanical evaluation of the lumbar Memory Metal Spinal System showed good results when compared to a currently available spinal implant system. Throughout testing, the Memory Metal Spinal System showed no failures in static and dynamic fatigue. PMID:24047109

2013-01-01

137

Posterior Dynamic Stabilization as a Salvage Procedure for Lumbar Facet Degeneration Following Total Disc Arthroplasty: Case report  

PubMed Central

Following an L5–S1 SB Charité disc III implantation, a 37-year-old female patient developed intractable radicular pain in the left L5 distribution. The patient underwent a minimally invasive foraminotomy, and her symptoms improved significantly. However, following recurrence of radicular pain, she showed signs of an L5–S1 facet degeneration and recurrent nerve root compression from hypertrophied synovium. A partial facetectomy was then performed to completely decompress the L5 root with supplemental posterior dynamic stabilization using a pedicle-based flexible titanium rod system. To date, the patient remains free of symptoms. Although posterolateral fusion would have been a viable option, the application of a posterior dynamic system permitted segmental motion preservation.

Wang, Michael Y.

2007-01-01

138

Magnetoneurographic registration of propagating magnetic fields in the lumbar spine after stimulation of the posterior tibial nerve  

NASA Astrophysics Data System (ADS)

Stimulation of the posterior tibial nerve has been associated with different somatosensory evoked potentials (SEP) recorded along the spine and thorax. The aim of this study was to register and describe the magnetic fields corresponding to different components of spinal SEP after stimulation of tibial nerves. In nine healthy subjects, right and left posterior tibial nerves were transcutaneously electrostimulated at the ankles. Neuromagnetic fields were registered over a circular 800 cm2 area of the lumbosacral spine using a 61-channel biomagnetometer. Magnetic field maps were constructed and examined visually for dipolar patterns. Equivalent current dipoles (ECD) were calculated for each somatosensory evoked field (SEF) using a least-squares fit in a spherical model. In seven subjects dipolar SEF were detected over the lower back at two separate latencies and locations and propagating ECD could be localized. Both the first and second components found agreed anatomically and functionally with respect to propagation in the underlying nerve fibers. It was possible to record and identify SEF which correspond to the SEP described in the literature. Dipole localization based on an equivalent current dipole model allowed a basic evaluation of the plausibility of the measurements with respect to the processes being examined.

Klein, Anita; van Leeuwen, Peter; Hoormann, Jörg; Grönemeyer, Dietrich

2006-06-01

139

The Extended Posterior Circumferential Decompression Technique in the Management of Tubercular Spondylitis with and without Paraplegia  

PubMed Central

Study Design Retrospective clinical series. Purpose To study the clinical, functional and radiological results of patients with tuberculous spondylitis with and without paraplegia, treated surgically using the "Extended Posterior Circumferential Decompression (EPCD)" technique. Overview of Literature With the increasing possibility of addressing all three columns by a single approach, posterior and posterolateral approaches are gaining acceptance. A single exposure for cases with neurological deficit and kyphotic deformity requiring circumferential decompression, anterior column reconstruction and posterior instrumentation is helpful. Methods Forty-one patients with dorsal/dorsolumbar/lumbar tubercular spondylitis who were operated using the EPCD approach between 2006 to 2009 were included. Postoperatively, patients were started on nine-month anti-tuberculous treatment. They were serially followed up to thirty-six months and both clinical measures (including pain, neurological status and ambulatory status) and radiological measures (including kyphotic angle correction, loss of correction and healing status) were used for assessment. Results Disease-healing with bony fusion (interbody fusion) was seen in 97.5% of cases. Average deformity (kyphosis) correction was 54.6% in dorsal spine and 207.3% in lumbar spine. Corresponding loss of correction was 3.6 degrees in dorsal spine and 1.9 degrees in the lumbar spine. Neurological recovery in Frankel B and C paraplegia was 85.7% and 62.5%, respectively. Conclusions The EPCD approach permits all the advantages of a single or dual session anterior and posterior surgery, with significant benefits in terms of decreased operative time, reduced hospital stay and better kyphotic angle correction. PMID:25558312

Rathinavelu, Barani; Krishnan, Venkatesh; Amritanand, Rohit; Sundararaj, Gabriel David

2014-01-01

140

Two-year clinical and radiographic success of minimally invasive lateral transpsoas approach for the treatment of degenerative lumbar conditions  

PubMed Central

Background The lateral transpsoas approach to interbody fusion is a less disruptive but direct-visualization approach for anterior/anterolateral fusion of the thoracolumbar spine. Several reports have detailed the technique, the safety of the approach, and the short term clinical benefits. However, no published studies to date have reported the long term clinical and radiographic success of the procedure. Materials and methods The current study is a retrospective chart review of prospectively collected clinical and radiographic outcomes in 62 patients having undergone the Anterolateral transpsoas procedure at a single institution for anterior column stabilization as treatment for degenerative conditions, including degenerative disk disease, spondylolisthesis, scoliosis, and stenosis. Only patients who were a minimum of 2 years postoperative were included in this evaluation. Clinical outcomes measured included visual analog pain scales (VAS) and Oswestry disability index (ODI). Radiographic outcomes included identification of successful arthrodesis. Results Sixty-two patients were treated with lateral interbody fusion between 2003 and December 2006. Twenty-six patients (42%) were single-level, 13 (21%) 2-level, and 23 (37%) 3- or more levels. Forty-five (73%) included supplemental posterior pedicle fixation, 4 (6%) lateral fixation, and 13 (21%) were stand-alone. Pain scores (VAS) decreased significantly from preoperative to 2 years follow-up by 37% (P < .0001). Functional scores (ODI) decreased significantly by 39% from preoperative to 2 years follow-up (P < .0001). Clinical success by ODI-change definition was achieved in 71% of patients. Radiographic success was achieved in 91% of patients, with 1 patient with pseudarthrosis requiring posterior revision. Conclusion The lateral transpsoas approach is similar to a traditional anterior lumbar interbody fusion, in that access is obtained through a retroperitoneal, direct-visualization exposure, and a large implant can be placed in the interspace to achieve disk height and alignment correction. The 2 years plus clinical and radiographic success rates are similar to or better than those reported for traditional anterior and posterior approach procedures, which, coupled with significant short-term benefits of minimal morbidity, make the lateral approach a safe and effective treatment option for anterior/anterolateral lumbar fusions.

Ozgur, Burak M.; Agarwal, Vijay; Nail, Erin; Pimenta, Luiz

2010-01-01

141

Cerebral Palsy Spasticity. Selective Posterior Rhizotomy  

Microsoft Academic Search

We have performed selective posterior rhizotomies on 60 children with cerebral palsy. The procedure involves lumbar laminectomy with stimulation of the rootlets (fascicles) of the second lumbar to the first sacral posterior roots bilaterally; those rootlets associated with an abnormal motor response, as evidenced by sustained or diffused muscular contraction, are divided leaving intact rootlets associated with a brief localized

Warwick J. Peacock; Leila J. Arens; Barbara Berman

1987-01-01

142

Laparoscopic anterior spinal arthrodesis with rhBMP-2 in a titanium interbody threaded cage.  

PubMed

Anterior lumbar interbody arthrodesis is commonly performed for conditions involving infection, deformity, and instability. The purpose of this investigation was to determine the effective dose of recombinant human bone morphogenetic protein-2 (rhBMP-2) as a bone graft substitute inside a titanium threaded interbody fusion cage using a nonhuman primate model of laparoscopic anterior lumbar interbody arthrodesis. Eight adult rhesus monkeys underwent laparoscopic exposure of the lumbosacral spine followed by insertion of a hollow titanium threaded cylindrical cage (Sofamor-Danek, Memphis, TN, U.S.A.). Before insertion, the chamber of the cage was filled with a collagen sponge delivery vehicle soaked with either 0 mg/ml (sham, buffer only), 0.75 mg/ml (low dose), or 1.5 mg/ml (high dose) of rhBMP-2 (Genetics Institute, Cambridge, MA, U.S.A.). Fusions were evaluated in a blinded fashion with plain radiographs and computed tomography (CT) scans 12 and 24 weeks after surgery, and by manual palpation and histology after euthanasia 24 weeks after surgery. All five monkeys treated with a cage filled with rhBMP-2 obtained a solid fusion as assessed by manual palpation. The two monkeys that received no growth factor did not achieve solid fusions. Plain radiographs were of limited value, with fusions best assessed on sagittally reconstructed CT scans. Scans from the two animals treated without growth factor showed ingrowth of bone only into the outer edges of the cage, but not through the center. Scans from the rhBMP-2-treated animals demonstrated arthrodesis with continuous bone growth through the cage. Histologic analysis demonstrated normal mature trabecular bone surrounding and growing through the cages, which correlated with the CT scan findings. We conclude that rhBMP-2 delivered in a threaded titanium interbody cage can serve as a bone graft substitute in a nonhuman primate model. Sagittal reconstructed CT may be a better method to assess for fusion with this device. PMID:9588464

Boden, S D; Martin, G J; Horton, W C; Truss, T L; Sandhu, H S

1998-04-01

143

Computed tomography-guided percutaneous facet screw fixation in the lumbar spine. Technical note.  

PubMed

The authors describe a new minimally invasive technique for posterior supplementation using percutaneous translaminar facet screw (TFS) fixation with computed tomography (CT) guidance. Oblique axial images were used to determine facet screw fixation sites. After the induction of local anesthesia and conscious sedation, a guide pin was inserted and guided with a laser mounted on the CT gantry. Cannulated TFSs were placed via a percutaneous approach. From December 2002 to August 2003, 18 patients underwent CT-guided TFS. In 17 of these patients this procedure was supplementary to anterior lumbar interbody fusion, which had been performed several days earlier; in the remaining patient, CT-guided TFS fixation was undertaken as the primary therapy. Twelve patients had painful degenerative disc disease or unstable degenerative spondylolisthesis, three had infections, and three had deformities. All screws were inserted accurately and there were no complications. This new minimally invasive surgical technique may offer an alternative to pedicle screw fixation as a method of posterior supplementation. PMID:17633496

Kang, Ho Yeong; Lee, Sang-Ho; Jeon, Sang Hyeop; Shin, Song-Woo

2007-07-01

144

Surgical Procedures and Clinical Results of Endoscopic Decompression for Lumbar Canal Stenosis  

Microsoft Academic Search

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

145

The First Clinical Trial of Beta-Calcium Pyrophosphate as a Novel Bone Graft Extender in Instrumented Posterolateral Lumbar Fusion  

PubMed Central

Background Porous ?-calcium pyrophosphate (?-CPP) was developed to improve the fusion success of posterolateral lumbar fusion (PLF). The possibility of accomplishing PLF using a mixture of porous ?-CPP and iliac bone was studied. This paper reports the radiologic results of PLF using the ?-CPP plus autograft for lumbar degenerative disease as a bone graft extender. Methods A prospective, case-matched, radiographic study evaluating the results of short segment lumbar fusion using a ?-CPP plus autograft was performed to compare the efficacy of ?-CPP plus autograft with that of an autograft alone for short segment lumbar fusion. Thirty one consecutive patients (46 levels) underwent posterolateral fusion with pedicle screw fixation and additional posterior lumbar interbody fusion. In all patients, 3 mL of ?-CPP plus 3 mL of autogenous bone graft was placed randomly in one side of a posterolateral gutter, and 6 mL of autogenous iliac bone graft was placed on the other. The fusion rates, volumes of fusion masses, and bone absorption percentage were evaluated postoperatively using simple radiographs and 3 dimensional computed tomography (3D-CT) scans. Results The control sides treated with an autograft showed significantly better Lenke scores than the study sides treated with ?-CPP at 3 and 6 months postoperatively, but there was no difference between the two sides at 12 months. The fusion rates (confirmed by 3D-CT) were 87.0% in the ?-CPP group and 89.1% in the autograft group, which were not significantly different. The fusion mass volumes and bone absorption percentage at 12 months postoperatively were 2.49 mL (58.4%) and 1.89 mL (69.5%) for the ?-CPP and autograft groups, respectively, and mean fusion mass volume was significantly higher in the ?-CPP group. Conclusions ?-CPP combined with an autograft is as effective as autologous bone for grafting during instrumented posterolateral spinal fusion. These findings suggest that ?-CPP bone chips can be used as a novel bone graft extender for short-segment posterolateral spinal fusion. PMID:21909472

Lee, Jae Hyup; Jeung, Ul-Oh; Park, Kun-Woo; Kim, Min-Seok; Lee, Choon-Ki

2011-01-01

146

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

Microsoft Academic Search

The current gold standard in lumbar fusion consists of transpedicular fixation in combination with an interbody interponate\\u000a of autologous bone from iliac crest. Because of the limited availability of autologous bone as well as the still relevant\\u000a donor site morbidity after iliac crest grafting the need exists for alternative grafts with a comparable outcome. Forty patients\\u000a with degenerative spinal disease

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

2009-01-01

147

ISASS Policy Statement - Cervical Interbody  

PubMed Central

Morgan Lorio, MD, FACS, Chair, ISASS Task Force on Coding & Reimbursement In 2011, CPT code 22551 was revised to combine or bundle CPT codes 63075 and 22554 when both procedures were performed at the same site/same surgical session. The add on code +22552 is used to report each additional interspace. 2014 heralded a downward pressure on this now prime target code (for non-coverage?) 22551 through an egregious insurer attempt to redefine cervical arthrodesis, effectively removing spine surgeon choice and altering best practice without clinical evidence. Currently, spine surgeons are equally split on the use of allograft versus cages for cervical arthrodesis. Structural allograft, CPT code 20931, is reported once per same surgical session, regardless of the number of allografts used. CPT code 22851 which is designated solely for cage use, has a higher reimbursement than structural allograft, and may be reported for each inner space. Hence, the rationale behind why some payers wrongly consider “spine cages NOT medically necessary for cervical fusion.” A timely consensus paper summarizing spine surgeon purview on the logical progressive evolution of cervical interbody fusion for ISASS/IASP membership was strategically identified as an advocacy focus by the ISASS Task Force. ISASS appreciates the authors’ charge with gratitude. This article has both teeth and transparent clinical real-world merit. PMID:25694945

Singh, Kern; Qureshi, Sheeraz

2014-01-01

148

ISASS Policy Statement - cervical interbody.  

PubMed

Morgan Lorio, MD, FACS, Chair, ISASS Task Force on Coding & Reimbursement In 2011, CPT code 22551 was revised to combine or bundle CPT codes 63075 and 22554 when both procedures were performed at the same site/same surgical session. The add on code +22552 is used to report each additional interspace. 2014 heralded a downward pressure on this now prime target code (for non-coverage?) 22551 through an egregious insurer attempt to redefine cervical arthrodesis, effectively removing spine surgeon choice and altering best practice without clinical evidence. Currently, spine surgeons are equally split on the use of allograft versus cages for cervical arthrodesis. Structural allograft, CPT code 20931, is reported once per same surgical session, regardless of the number of allografts used. CPT code 22851 which is designated solely for cage use, has a higher reimbursement than structural allograft, and may be reported for each inner space. Hence, the rationale behind why some payers wrongly consider "spine cages NOT medically necessary for cervical fusion." A timely consensus paper summarizing spine surgeon purview on the logical progressive evolution of cervical interbody fusion for ISASS/IASP membership was strategically identified as an advocacy focus by the ISASS Task Force. ISASS appreciates the authors' charge with gratitude. This article has both teeth and transparent clinical real-world merit. PMID:25694945

Singh, Kern; Qureshi, Sheeraz

2014-01-01

149

The LP-ESP(®) lumbar disc prosthesis with 6 degrees of freedom: development and 7 years of clinical experience.  

PubMed

The viscoelastic lumbar disk prosthesis-elastic spine pad (LP-ESP(®)) is an innovative one-piece deformable but cohesive interbody spacer providing 6 full degrees of freedom about the 3 axes, including shock absorption. A 20-year research program has demonstrated that this concept provides mechanical properties very close to those of a natural disk. Improvements in technology have made it possible to solve the problem of the bond between the elastic component and the titanium endplates and to obtain an excellent biostability. The prosthesis geometry allows limited rotation and translation with resistance to motion (elastic return property) aimed at avoiding overload of the posterior facets. The rotation center can vary freely during motion. It thus differs substantially from current prostheses, which are 2- or 3-piece devices involving 1 or 2 bearing surfaces and providing 3 or 5 degrees of freedom. This design and the adhesion-molding technology differentiate the LP-ESP prosthesis from other mono-elastomeric prostheses, for which the constraints of shearing during rotations or movement are absorbed at the endplate interface. Seven years after the first implantation, we can document in a solid and detailed fashion the course of clinical outcomes and the radiological postural and kinematic behavior of this prosthesis. PMID:23412443

Lazennec, Jean-Yves; Aaron, Alain; Brusson, Adrien; Rakover, Jean-Patrick; Rousseau, Marc-Antoine

2013-02-01

150

Construct Rigidity after Fatigue Loading in Pedicle Subtraction Osteotomy with or without Adjacent Interbody Structural Cages  

PubMed Central

Introduction?Studies document rod fracture in pedicle subtraction osteotomy (PSO) settings where disk spaces were preserved above or adjacent to the PSO. This study compares the multidirectional bending rigidity and fatigue life of PSO segments with or without interbody support. Methods?Twelve specimens received bilateral T12–S1 posterior fixation and L3 PSO. Six received extreme lateral interbody fusion (XLIF) cages in addition to PSO at L2–L3 and L3–L4; six had PSO only. Flexion-extension, lateral bending, and axial rotation (AR) tests were conducted up to 7.5 Newton-meters (Nm) for groups: (1) posterior fixation, (2) L3 PSO, (3) addition of cages (six specimens). Relative motion across the osteotomy (L2–L4) and entire fixation site (T12–S1) was measured. All specimens were then fatigue tested for 35K cycles. Results?Regardingmultiaxial bending, there was a significant 25.7% reduction in AR range of motion across L2–L4 following addition of cages. Regarding fatigue bending, dynamic stiffness, though not significant (p?=?0.095), was 22.2% greater in the PSO?+?XLIF group than in the PSO-only group. Conclusions?Results suggest that placement of interbody cages in PSO settings has a potential stabilizing effect, which is modestly evident in the acute setting. Inserting cages in a second-stage surgery remains a viable option and may benefit patients in terms of recovery but additional clinical studies are necessary to confirm this. PMID:24353970

Deviren, Vedat; Tang, Jessica A.; Scheer, Justin K.; Buckley, Jenni M.; Pekmezci, Murat; McClellan, R. Trigg; Ames, Christopher P.

2012-01-01

151

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

PubMed

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

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

2013-02-01

152

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

PubMed

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

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

2014-12-01

153

Stimulation of the Human Lumbar Spinal Cord With Implanted and Surface Electrodes: A Computer Simulation Study  

Microsoft Academic Search

Human lumbar spinal cord networks controlling stepping and standing can be activated through posterior root stimulation using implanted electrodes. A new stimulation method utilizing surface electrodes has been shown to excite lumbar posterior root fibers similarly as with implants, an unexpected finding considering the distance to these target neurons. In the present study we apply computer modeling to compare the

Josef Ladenbauer; Karen Minassian; Ursula S. Hofstoetter; Milan R. Dimitrijevic; Frank Rattay

2010-01-01

154

LUMBAR STRAIN: Back to the Basics  

Microsoft Academic Search

3. Muscles- the large thoracolumbar fascia represents a grouping of fascia and several muscles. Paraspinal muscle group and abdominal musculature are other important anatomical support for the back. Remember that muscle groups for the anterior and posterior legs are instrumental in lumbar biomechanics. III. History æ Location- consider if dermatomal Vs nondermatomal pattern æ ? Radiation- radiation into the leg

Gaetano P. Monteleone

155

Update review and clinical presentation on chronic low back pain treated by AxiaLIF  

Microsoft Academic Search

Paracoccygeal approach to the L5–S1 junction with transsacral instrumentation was described recently as an alternative method\\u000a to transforaminal lumbar interbody fusion or posterior lumbar interbody fusion. A percutaneous L5–S1 discectomy, interbody\\u000a distraction, and fixation could be achieved while preserving the integrity of the muscles, ligaments, and disc anulus. Retroperitoneal\\u000a viscera and dorsal neural elements are avoided via the presacral safe

Samo K. Fokter

2011-01-01

156

Navigation-assisted fluoroscopy in minimally invasive direct lateral interbody fusion: a cadaveric study  

PubMed Central

Background Minimally invasive surgery (MIS) is dependent on intraoperative fluoroscopic imaging for visualization, which significantly increases exposure to radiation. Navigation-assisted fluoroscopy (NAV) can potentially decrease radiation exposure and improve the operating room environment by reducing the need for real-time fluoroscopy. The direct lateral interbody fusion (DLIF) procedure is a technique for MIS intervertebral lumbar and thoracic interbody fusions. This study assesses the use of navigation for the DLIF procedure in comparison to standard fluoroscopy (FLUORO), as well as the accuracy of the NAV MIS DLIF procedure. Methods Three fresh whole-body cadavers underwent multiple DLIF procedures at the T10-L5 levels via either NAV or FLUORO. Radiation exposure and surgical times were recorded and compared between groups. An additional cadaver was used to evaluate the accuracy of the NAV system for the DLIF procedure by measuring the deviation error as the surgeon worked further from the anterior superior iliac spine tracker. Results Approach, discectomy, and total fluoroscopy times for FLUORO were longer than NAV (P < .05). In contrast, the setup time was longer in NAV (P = .005). Cage insertion and total operating times were similar for both. Radiation exposure to the surgeon for NAV was significantly less than FLUORO (P < .05). Accuracy of the NAV system was within 1 mm for L2-5. Conclusion Navigation for the DLIF procedure is feasible. Accuracy for this procedure over the most common levels (L2-5) is likely sufficient for safe clinical application. Although initial setup times were longer with NAV, simultaneous anteroposterior and lateral imaging with the NAV system resulted in overall surgery times similar to FLUORO. Navigation minimizes fluoroscopic radiation exposure. Clinical significance Navigation for the DLIF procedure is accurate and decreases radiation exposure without increasing the overall surgical time.

Webb, Jonathan E.; Regev, Gilad J.; Garfin, Steven R.; Kim, Choll W.

2010-01-01

157

Fractures of the Thoracic and Lumbar Spine  

Microsoft Academic Search

\\u000a Injuries of the thoracic and lumbar spine in children are rare. The potential for continued growth, the presence of healthy\\u000a disc tissue, the elasticity of the soft tissues, and well-mineralized bone distinguish these injuries from those in the adult.\\u000a The immature spine has the capacity to remodel the vertebral body, but not the posterior elements. Restoration of height of\\u000a a

Robert N. Hensinger; Clifford L. Craig

158

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

PubMed Central

Background and purpose Instrumented and non-instrumented methods of fusion have been compared in several studies, but the results are often inconsistent and conflicting. We compared the 2-year results of 3 methods of lumbar fusion when used in degenerative disc disease (DDD), using the Swedish Spine Register (SWESPINE). Methods All patients registered in SWESPINE for surgical treatment of DDD between January 1, 2000 and October 1, 2007 were eligible for the study. Patients who had completed the 2-year follow-up were included in the analysis. The outcomes of 3 methods of surgical fusion were assessed. Results Of 1,310 patients enrolled, 115 had undergone uninstrumented fusion, 620 instrumented posterolateral fusion, and 575 instrumented interbody fusion. Irrespective of the surgical procedure, quality of life (QoL) improved and back pain diminished. Change in QoL and functional disability and return to work was similar in the 3 groups. Patients who had undergone uninstrumented fusion had more back pain than the patients with instrumented interbody fusion at the 2-year follow-up (p = 0.02), although the difference was only 7 visual analog scale (VAS) units (95% CI: 1–13) on a 100-point scale. Moreover, 83% of the patients with uninstrumented fusion used analgesics at the end of follow-up as compared to 68% of the patients who had undergone surgery with one of the 2 instrumented fusion techniques. Interpretation In comparison with instrumented interbody fusion, uninstrumented fusion was associated with higher levels of back pain 2 years after surgery. We found no evidence for differences in QoL between uninstrumented fusion and instrumented interbody fusion. PMID:23368746

2013-01-01

159

Current and Future Approaches to Lumbar Disc Surgery (A Literature Review)  

Microsoft Academic Search

Herniation may occur anywhere along the spine but most commonly in the lumbar region, usually between the fifth lumbar and first sacral vertebrae (L5-S1). The usual cause is degeneration of the posterior longitudinal ligaments and the annulus fibrosis, frequently occurring in adults 35 years and older. Surgical interventions to treat degenerative disc disease range from the widely accepted microdiscectomy to

Cargill H. Alleyne Jr; Gerald E. Rodts Jr.

160

Spectrum of magnetic resonance imaging findings in congenital lumbar spinal stenosis  

PubMed Central

AIM: To investigate whether congenital lumbar spinal stenosis (CLSS) is associated with a specific degenerative changes of the lumbar spine. METHODS: The lumbar spine magnetic resonance imaging studies of 52 subjects with CLSS and 48 control subjects were retrospectively evaluated. In each examination, the five lumbar levels were assessed for the presence or absence of circumferential or shallow annular bulges, annular tears, anterior or posterior disc herniations, epidural lipomatosis, Schmorl’s nodes, spondylolisthesis, pars defects, and stress reactions of the posterior vertebral elements. RESULTS: Compared to control individuals, subjects with CLSS exhibited increased incidence of circumferential and shallow annular bulges, annular tears, disc herniations and spondylolisthesis (P < 0.05). CONCLUSION: CLSS is associated with increased incidence of degenerative changes in specific osseous and soft-tissue elements of the lumbar spine. PMID:25516864

Soldatos, Theodoros; Chalian, Majid; Thawait, Shrey; Belzberg, Alan J; Eng, John; Carrino, John A; Chhabra, Avneesh

2014-01-01

161

Lumbar Spinal Canal Stenosis  

MedlinePLUS

... pain caused by a ruptured disk in the lumbar spine is usually easy to diagnose and is known ... the pressure off the nerves in your lower spine. This surgery works well for many people. Questions to Ask Your Doctor My father had lumbar spinal canal stenosis. Am I at risk of ...

162

Comparison of Sagittal Spinopelvic Alignment between Lumbar Degenerative Spondylolisthesis and Degenerative Spinal Stenosis  

PubMed Central

Objective The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS). Methods Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value (<50 mm and ?50 mm). Spinopelvic parameters/PI ratios were assessed and compared between the groups. Results The PI of DSPL was significantly greater than that of DSS (p=0.000). The SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (p<0.05) in the DSPL group. In sub-group analysis between the positive (12.5%) and normal SVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group. Conclusion Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis. PMID:25237428

Lim, Jae Kwan

2014-01-01

163

Morphological structure and variations of lumbar plexus in human fetuses.  

PubMed

The objective of this study is to study the anatomy of lumbar plexus on human fetuses and to establish its morphometric characteristics and differences compared with adults. Twenty lumbar plexus of 10 human fetal cadavers in different gestational ages and genders were dissected. Lumbar spinal nerves, ganglions, and peripheral nerves were exposed. Normal anatomical structure and variations of lumbar plexus were investigated and morphometric analyses were performed. The diameters of lumbar spinal nerves increased from L1 to L4. The thickest nerve forming the plexus was femoral nerve, the thinnest was ilioinguinal nerve, the longest nerve through posterior abdominal wall was iliohypogastric nerve, and the shortest nerve was femoral nerve. Each plexus had a single furcal nerve and this arose from L4 nerve in all fetuses. No prefix or postfix plexus variation was observed. In two plexuses, L1 nerve was in the form of a single branch. Also, in two plexuses, genitofemoral nerve arose only from L2 nerve. Accessory obturator nerve was observed in four plexuses. According to these findings, the morphological pattern of the lumbar plexus in the fetus was found to be very similar to the lumbar plexus in adults. PMID:22696243

Yasar, Soner; Kaya, Serdar; Temiz, Ca?lar; Tehli, Ozkan; Kural, Cahit; Izci, Yusuf

2014-04-01

164

Footprint mismatch in lumbar total disc arthroplasty  

PubMed Central

Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening and biomechanical failure due to an incorrect center of rotation. The aim of the present study was to measure the dimensions of lumbar vertebrae based on CT scans and assess the accuracy of match in currently available lumbar disc prostheses. A total of 240 endplates of 120 vertebrae were included in the study. The sagittal and mediolateral diameter of the upper and lower endplates were measured using a digital measuring system. For the levels L4/L5 and L5/S1, an inappropriate size match was noted in 98.8% (Prodisc L) and 97.6% (Charite) with regard to the anteroposterior diameter. Mismatch in the anterior mediolateral diameter was noted in 79.3% (Prodisc L) and 51.2% (Charite) while mismatch in the posterior mediolateral diameter was observed in 91.5% (Prodisc L) and 78% (Charite) of the endplates. Surgeons and manufacturers should be aware of the size mismatch of currently available lumbar disc prostheses, which may endanger the safety and efficacy of the procedure. Larger footprints of currently available total disc arthroplasties are required. PMID:18791748

Michaela, Gstoettner; Denise, Heider; Liebensteiner, Michael

2008-01-01

165

Complication with Removal of a Lumbar Spinal Locking Plate  

PubMed Central

Introduction. The use of locking plate technology for anterior lumbar spinal fusion has increased stability of the vertebral fusion mass over traditional nonconstrained screw and plate systems. This case report outlines a complication due to the use of this construct. Case. A patient with a history of L2 corpectomy and anterior spinal fusion presented with discitis at the L4/5 level and underwent an anterior lumbar interbody fusion (ALIF) supplemented with a locking plate placed anterolaterally for stability. Fifteen months after the ALIF procedure, he returned with a hardware infection. He underwent debridement of the infection site and removal of hardware. Results. Once hardware was exposed, removal of the locking plate screws was only successful in one out of four screws using a reverse thread screw removal device. Three of the reverse thread screw removal devices broke in attempt to remove the subsequent screws. A metal cutting drill was then used to break hoop stresses associated with the locking device and the plate was removed. Conclusion. Anterior locking plates add significant stability to an anterior spinal fusion mass. However, removal of this hardware can be complicated by the inherent properties of the design with significant risk of major vascular injury. PMID:25838956

Crawford, Brooke; Lenarz, Christopher; Watson, J. Tracy; Alander, Dirk

2015-01-01

166

Complication with removal of a lumbar spinal locking plate.  

PubMed

Introduction. The use of locking plate technology for anterior lumbar spinal fusion has increased stability of the vertebral fusion mass over traditional nonconstrained screw and plate systems. This case report outlines a complication due to the use of this construct. Case. A patient with a history of L2 corpectomy and anterior spinal fusion presented with discitis at the L4/5 level and underwent an anterior lumbar interbody fusion (ALIF) supplemented with a locking plate placed anterolaterally for stability. Fifteen months after the ALIF procedure, he returned with a hardware infection. He underwent debridement of the infection site and removal of hardware. Results. Once hardware was exposed, removal of the locking plate screws was only successful in one out of four screws using a reverse thread screw removal device. Three of the reverse thread screw removal devices broke in attempt to remove the subsequent screws. A metal cutting drill was then used to break hoop stresses associated with the locking device and the plate was removed. Conclusion. Anterior locking plates add significant stability to an anterior spinal fusion mass. However, removal of this hardware can be complicated by the inherent properties of the design with significant risk of major vascular injury. PMID:25838956

Crawford, Brooke; Lenarz, Christopher; Watson, J Tracy; Alander, Dirk

2015-01-01

167

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

Microsoft Academic Search

BACKGROUND: The number of surgical techniques for decompression and solid interbody fusion as treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques remains unclear. OBJECTIVES: To determine which technique of anterior interbody fusion gives the best clinical and radiological outcomes in patients with single- or double-level degenerative disc disease of the cervical spine.

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

2011-01-01

168

Verification of the position of pedicle screws in lumbar spinal fusion  

Microsoft Academic Search

Medial or lateral pedicle screw penetration with the potential to affect neural structures in a well-known and frequent problem associated with posterior spinal fusion. We evaluated the placement of pedicle screws (n = 141) in 36 patients following posterior lumbar spinal fusion with Socon or Kluger instrumentation via a lateral transpedicular approach. The examination was based on CT and MR

R. G. Haaker; U. Eickhoff; E. Schopphoff; R. Steffen; M. Jergas; J. Krämer

1997-01-01

169

Finite element biomechanics of cervical spine interbody fusion  

Microsoft Academic Search

The biomechanical responses of cervical discectomy coupled with fusion using five types of interbody fusion materials were determined. Titanium core, titanium cage, tricortical iliac crest, tantalum core, and tantalum cage fusion materials were used. Smith-Robinson and Bailey-Badgley procedures were analyzed. A validated three-dimensional anatomically accurate three-segment C4-C5-C6 finite element model of the spine was developed using close-up computed tomography images

Srirangak Kumaresan; Narayan Yoganandan; Frank A. Pintar

1997-01-01

170

Transforaminal Lumbar Interbody Fusion Using a Modified Distractor Handle: A Midterm Clinicoradiological Follow-Up Study  

PubMed Central

In current TLIF practice, the choice of the cage size is empirical and primarily depends on the case volume and experience of the surgeon. We used a self-made modified distractor handle in TLIF procedure with the goal of standardizing the intervertebral space tension and determining the proper cage size. PMID:24089692

Rewuti, Abuduaini; Chen, Zixian; Feng, Zhenzhou; Cao, Yuanwu; Jiang, Xiaoxing; Jiang, Chun

2013-01-01

171

A prospective study of Autologous Growth Factors (AGF) in lumbar interbody fusion  

Microsoft Academic Search

BackgroundNumerous preclinical and clinical studies have reported on the use of platelet concentrates to promote tissue healing. The results in spinal fusion applications are limited and controversial.

Louis G. Jenis; Robert J. Banco; Brian Kwon

2006-01-01

172

Retroperitoneal lymphocele after lumbar total disc replacement: a case report and review of literature  

PubMed Central

Background Retroperitoneal lymphoceles (RPLs) caused by injury to the lymphatics are commonly seen after pelvic lymphadenectomy, renal transplantation, and gynecologic tumor resection surgeries. Degenerative disc disease still remains the major cause of low-back pain. Anterior lumbar spinal procedures, such as anterior lumbar interbody fusion and anterior lumbar arthroplasty, have been increasingly performed for treatment of axial back pain. RPLs, as an approach-related complication, though infrequent, have been reported after anterior lumbar spinal surgery. We report a case of RPL after total disc replacement of the lumbar spine. To our knowledge, there has been no prior report of RPL after total disc replacement managed by percutaneous aspiration only. Methods A 49-year-old woman who underwent total disc replacement at the L4-5 level presented with a postoperative complication of RPL. The imaging findings, clinical course, and treatment are discussed, and a review of literature is presented. Results The patient presented with significant abdominal swelling and discomfort at 4 weeks after surgery without any signs or symptoms of infection. Investigations showed an RPL. She was treated by multiple aspirations under ultrasound guidance. At 12 months’ follow-up, the patient had no further abdominal symptoms and had gone back to her routine activities and work with significant improvement in back pain. Conclusions RPL is an uncommon complication after anterior lumbar surgery and can be managed effectively if detected and diagnosed early. Although repeated aspiration is associated with high recurrence and infection, it is a safe and minimally invasive procedure to manage RPL.

Mohapatra, Bibhudendu; Kishen, Thomas; Loi, Ken W. K.; Diwan, Ashish D.

2010-01-01

173

Lumbar spinal epidural angiolipoma  

Microsoft Academic Search

Spinal angiolipomas are rare benign tumours most commonly found in the thoracic spine. A case of an extradural lumbar angiolipoma in a 47-year-old female is described. She had a recent history of lower back pain accompanied by sciatica. Lumbar MRI revealed a dorsal epidural mass at the L2–L3 level. The patient underwent a bilateral laminectomy, in which the tumour was

Kimon Nanassis; Parmenion Tsitsopoulos; Dimitrios Marinopoulos; Apostolos Mintelis; Philippos Tsitsopoulos

2008-01-01

174

The cortical and cerebellar representation of the lumbar spine.  

PubMed

Eight decades after Penfield's discovery of the homunculus only sparse evidence exists on the cortical representation of the lumbar spine. The aim of our investigation was the description of the lumbar spine's cortical representation in healthy subjects during the application of measured manual pressure. Twenty participants in the prone position were investigated during functional magnetic resonance imaging (fMRI). An experienced manual therapist applied non-painful, posterior-to-anterior (PA) pressure on three lumbar spinous processes (L1, L3, and L5). The pressure (30 N) was monitored and controlled by sensors. The randomized stimulation protocol consisted of 68 pressure stimuli of 5 s duration. Blood oxygenation level dependent (BOLD) responses were analyzed in relation to the lumbar stimulations. The results demonstrate that controlled PA pressure on the lumbar spine induced significant activation patterns. The major new finding was a strong and consistent activation bilaterally in the somatosensory cortices (S1 and S2). In addition, bilateral activation was located medially in the anterior cerebellum. The activation pattern also included other cortical areas probably related to anticipatory postural adjustments. These revealed stable somatosensory maps of the lumbar spine in healthy subjects can subsequently be used as a baseline to investigate cortical and subcortical reorganization in low back pain patients. PMID:24464423

Boendermaker, Bart; Meier, Michael L; Luechinger, Roger; Humphreys, B Kim; Hotz-Boendermaker, Sabina

2014-08-01

175

Lumbar disk herniation with contralateral symptoms.  

PubMed

The aim of the study is to determine if leg pain can be caused by contralateral lumbar disk herniation and if intervention from only the herniation side would suffice in these patients. Five patients who had lumbar disk herniations with predominantly contralateral symptoms were operated from the side of disk herniation without exploring or decompressing the symptomatic side. Patients were evaluated pre- and postoperatively. To our knowledge, this is the first reported series of such patients who were operated only from the herniation side. The possible mechanisms of how contralateral symptoms predominate in these patients are also discussed. In all patients, the shape of disk herniations on imaging studies were quite similar: a broad-based posterior central-paracentral herniated disk with the apex deviated away from the side of the symptoms. The symptoms and signs resolved in the immediate postoperative period. Our data clears that sciatica can be caused by contralateral lumbar disk herniation. When operation is considered, intervention only from the herniation side is sufficient. It is probable that traction rather than direct compression is responsible from the emergence of contralateral symptoms. PMID:16231173

Sucu, Hasan Kamil; Gelal, Fazil

2006-05-01

176

Lumbar spinal surgery - series (image)  

MedlinePLUS

... spinal column around the spinal cord. Symptoms of lumbar spine problems include: pain that extends (radiates) from the ... require physical therapy to optimize spinal mobility after lumbar spine surgery. Results are variable depending on the disease ...

177

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

PubMed

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

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

2007-11-01

178

Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy  

Microsoft Academic Search

Existing studies on micro-endoscopic lumbar discectomy report similar outcomes to those of open and microdiscectomy and conflicting\\u000a results on complications. We designed a randomised controlled trial to investigate the hypothesis of different outcomes and\\u000a complications obtainable with the three techniques. 240 patients aged 18–65 years affected by posterior lumbar disc herniation\\u000a and symptoms lasting over 6 weeks of conservative management were randomised

Marco Teli; Alessio Lovi; Marco Brayda-Bruno; Antonino Zagra; Andrea Corriero; Fabrizio Giudici; Leone Minoia

2010-01-01

179

Lumbar Disc Herniation in Adolescence  

Microsoft Academic Search

Lumbar disc herniation very rarely occurs in adolescence. The aim of this study was to assess the radiological, clinical and surgical features and case outcomes for adolescents with lumbar disc herniation, and to compare with adult cases. The cases of 17 adolescents (7 girls and 10 boys, age range 13–17 years) who were surgically treated for lumbar disc herniation in

Serdar Ozgen; Deniz Konya; O. Zafer Toktas; Adnan Dagcinar; M. Memet Ozek

2007-01-01

180

Current strategies for the restoration of adequate lordosis during lumbar fusion  

PubMed Central

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

Barrey, Cédric; Darnis, Alice

2015-01-01

181

Septic arthritis of a lumbar facet joint: Detection with bone SPECT imaging  

SciTech Connect

We present a rare case of septic arthritis of a lumbar facet joint with an associated epidural abscess resulting from Staphylococcus aureus. The infection was initially detected with planar bone scintigraphy and precisely localized with single photon emission computed tomography bone scintigraphy, despite an initially negative radiologic evaluation that included radiographs of the lumbar spine, lumbar myelography, and a postmyelography x-ray computed tomography scan. In the appropriate clinical setting, a bone scan demonstrating unilateral increased activity within the spine should raise the suspicion of inflammatory involvement of the posterior elements.

Swayne, L.C.; Dorsky, S.; Caruana, V.; Kaplan, I.L. (Morristown Memorial Hospital, NJ (USA))

1989-08-01

182

Retrolisthesis as a Compensatory Mechanism in Degenerative Lumbar Spine  

PubMed Central

Objective Posterior vertebral translation as a type of spondylolisthesis, retrolisthesis is observed commonly in patients with degenerative spinal problems. Nevertheless, there is insufficient literature on retrolisthesis compared to anterolisthesis. The purpose of this study is to clarify the clinical features of retrolisthesis, and its developmental mechanism associated with a compensatory role in sagittal imbalance of the lumbar spine. Methods From 2003 to 2012, 230 Korean patients who underwent spinal surgery in our department under the impression of degenerative lumbar spinal disease were enrolled. All participants were divided into four groups : 35 patients with retrolisthesis (group R), 32 patients with simultaneous retrolisthesis and anterolisthesis (group R+A), 76 patients with anterolisthesis (group A), and 87 patients with non-translation (group N). The clinical features and the sagittal parameters related to retrolisthesis were retrospectively analyzed based on the patients' medical records. Results There were different clinical features and developmental mechanisms between retrolisthesis and anterolisthesis. The location of retrolisthesis was affected by the presence of simultaneous anterolisthesis, even though it predominantly manifest in L3. The relative lower pelvic incidence, pelvic tilt, and lumbar lordosis compared to anterolisthesis were related to the generation of retrolisthesis, with the opposite observations of patients with anterolisthesis. Conclusion Retrolisthesis acts as a compensatory mechanism for moving the gravity axis posteriorly for sagittal imbalance in the lumbar spine under low pelvic incidence and insufficient intra-spinal compensation. PMID:25810857

Jeon, Ikchan

2015-01-01

183

The Effects of Lumbar Facet Dowels on Joint Stiffness: A Biomechanical Study  

PubMed Central

Background Facet joint arthrosis may play a significant role in low back pain generation. The placement of facet dowels is a percutaneous treatment that aims to fuse the facets and increase joint stiffness. In this cadaveric study, we evaluated spine stiffness after facet dowel insertion in combination with several surgical procedures and determined which motions promote dowel migration. Methods Six fresh frozen lumbar spines were tested in flexion-extension, lateral bending, and axial rotation. Spine stiffness was determined for the intact specimens, after L4 laminectomy, and after bilateral L4-L5 facet dowel placement, respectively. One specimen underwent a unilateral transforaminal lumbar interbody fusion (TLIF) construct and another underwent extreme lateral interbody fusion (XLIF) graft (22 mm) placement, followed by placement of facet dowels. Afterwards, the specimens were subjected to 10,000 cycles of fatigue testing in flexion-extension or axial rotation. Results The overall decrease in stiffness after laminectomy was 4.6%. Facet dowel placement increased overall stiffness by 7.2%. The greatest increase was seen with axial rotation (13%), compared to flexion, extension, and lateral bending (9.5%, 2.3%, and 5.6%, respectively). The TLIF and XLIF plus dowel construct increased specimen stiffness to 266% and 163% of baseline, respectively. After fatigue testing, dowel migration was detected by computed tomography in the 2 uninstrumented specimens undergoing axial rotation cycling. Conclusion Facet dowels increase the stiffness of the motion segment to which they are applied and can be used in conjunction with laminectomy procedures to increase the stiffness of the joint. However, dowel migration can occur after axial rotation movements. Hybrid TLIF or XLIF plus facet dowel constructs have significantly higher stiffness than noninstrumented ones and may prevent dowel migration. PMID:24688332

Trahan, Jayme; Morales, Eric; Richter, Erich O.; Tender, Gabriel C.

2014-01-01

184

The lateral transpsoas approach to the lumbar and thoracic spine: A review  

PubMed Central

Background: In the last several years, the lateral transpsoas approach to the thoracic and lumbar spine, also known as extreme lateral interbody fusion (XLIF) or direct lateral interbody fusion (DLIF), has become an increasingly common method to achieve fusion. Several recent large series describe several advantages to this approach, including less tissue dissection, smaller incisions, decreased operative time, blood loss, shorter hospital stay, reduced postoperative pain, enhanced fusion rates, and the ability to place instrumentation through the same incision. Indications for this approach have expanded and now include degenerative disease, tumor, deformity, and infection. Methods: A lateral X-ray confirms that the patient is in a truly lateral position. Next, a series of tubes and dilators are used, along with fluoroscopy, to identify the mid-position of the disk to be incised. After continued dilation, the optimal site to enter the disk space is the midpoint of the disk, or a position slightly anterior to the midpoint of the disk. XLIF typically allows for a larger implant to be inserted compared to TLIF or PLIF, and, if necessary, instrumentation can be inserted percutaneously, which would allow for an overall minimally invasive procedure. Results: Fixation techniques appear to be equal between XLIF and more traditional approaches. Some caution should be exercised because common fusion levels of the lumbar spine, including L4-5 and L4-S1, are often inaccessible. In addition, XLIF has a unique set of complications, including neural injuries, psoas weakness, and thigh numbness. Conclusion: Additional studies are required to further evaluate and monitor the short and long-term safety, efficacy, outcomes, and complications of XLIF procedures. PMID:22905326

Arnold, Paul M.; Anderson, Karen K.; McGuire, Robert A.

2012-01-01

185

Lumbar disc replacement: update.  

PubMed

Over the last decades, fusion of lumbar spinal motion segments has represented the mainstay of treatment of lumbar degenerative conditions which failed to respond adequately to conservative therapy. Increasing demands and expectations from patients as well as the necessity to avoid fusion related negative side effects such as adjacent level disc degeneration, considerable complication and reoperation rates, cranial facet joint violations, pseudarthrosis and others led to the development of motion preserving technologies such as total lumbar disc replacement (TDR). The first and rudimentary attempts to preserve motion of lumbar motion segments can be dated back to the early 1950s. Over the past two to three decades, a variety of new implants with different motion characteristics have been developed and introduced into the market. Despite of the extensive knowledge which has been gained in this field of research, insurers in the United States have refused to reimburse surgeons due to fear of late complications and reoperations as well as unknown secondary costs, which led to a global decline in the numbers of TDR procedures. The current literature review intends to provide a concise summary of the adequate indications for TDR as well as outcome determining factors and delineate the role of TDR in the currently available armamentarium for the treatment of low back pain (LBP) resulting from degenerative disc disease (DDD) without instabilities or deformities. PMID:25649068

Heider, F C; Mayer, H M; Siepe, C J

2015-06-01

186

Finite element analysis of anterior cervical spine interbody fusion.  

PubMed

The present study investigated the external and the internal biomechanical responses of anterior cervical discectomy coupled with fusion. Five different types of interbody fusion materials were used: titanium core, titanium cage, tricortical iliac crest, tantalum core, and tantalum cage. Two different types of surgical procedures were analyzed: Smith-Robinson and Bailey-Badgley. A validated three-dimensional anatomically accurate finite element model of the human cervical spine was used in the study. The finite element model was exercised in compression, flexion, extension, and lateral bending for the intact case and for the two surgical procedures with five implant materials. The external response in terms of the stiffness and angular rotation, and the internal response in terms of the disc and the vertebral stresses were determined. The Smith-Robinson technique resulted in the highest increase in external response under all modes of loading for all implant materials. In contrast, the Bailey-Badgley technique produced a higher increase in the disc and the vertebral body stresses than the Smith-Robinson technique. As experimental human cadaver tests can only determine the external response of the non-fused spine simulating immediate post-operative structure, the present finite element studies assist in the understanding of biomechanics of interbody fusion by delineating the changes in the extrinsic and intrinsic characteristics of the cervical spine components due to surgery. PMID:9408574

Kumaresan, S; Yoganandan, N; Pintar, F A

1997-01-01

187

Lumbar Corsets Can Decrease Lumbar Motion in Golf Swing  

PubMed Central

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 points Rotational and extension forces on the lumbar spine may cause golf-related low back pain Wearing 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

2013-01-01

188

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

PubMed

Bone morphogenetic protein (BMP)-2 induces bone and cartilage tissue formation. Large amounts of BMP-2 are difficult to purify or to produce in vitro using eukaryotic cells. The goal of the present study was to assess the clinical use of Escherichia coli-derived recombinant human BMP-2 (ErhBMP-2) on bone fusion after cervical and lumbar spine surgery in a goat model, compared with the standard autogenous iliac bone grafting. Thirty-six goats were randomized to 3 groups: (A) autogenous iliac bone grafting, (B) cervical interbody fusion cage containing ß-tricalcium phosphate (ß-TCP), or (C) cervical interbody fusion cage containing ß-TCP+ErhBMP-2 (2.5 mg). Cervical bone repair was evaluated using radiographs and computed tomography scans at 0, 3, and 6 months. Histological analyses were performed on cervical samples. Two goats died from infection. The differences in intervertebral height among the groups were not significant 3 months postoperatively but became significant after 6 months between groups A vs B and C (P=.04); there was no difference between groups B and C at 6 months. Adding ErhBMP-2 significantly increased cervical fusion at 6 months (P=.04). Histological examinations showed that ß-TCP+ErhBMP-2 increased new bone area, material degradation rate, and depth of tissue penetration and decreased residual material area, all in a time-dependent manner. Escherichia coli-derived rhBMP-2 combined with an enhanced fusion cage containing ß-TCP induced bone formation in a goat model. Furthermore, its ability to promote bone fusion was similar to autogenous iliac bone grafting. PMID:24679197

Wang, Hongli; Zhang, Fan; Lv, Feizhou; Jiang, Jianyuan; Liu, Dayong; Xia, Xinlei

2014-02-01

189

Posterior fossa tumor  

MedlinePLUS

Posterior fossa tumor is a type of brain tumor located in or near the bottom of the ... The posterior fossa is a small space in the skull, found near the brainstem and cerebellum. The cerebellum is ...

190

Lumbar spinal stenosis.  

PubMed Central

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 PMID:8434469

Ciricillo, S F; Weinstein, P R

1993-01-01

191

Lumbar spondylolysis: a review  

Microsoft Academic Search

Spondylolysis is an osseous defect of the pars interarticularis, thought to be a developmental or acquired stress fracture\\u000a secondary to chronic low-grade trauma. It is encountered most frequently in adolescents, most commonly involving the lower\\u000a lumbar spine, with particularly high prevalence among athletes involved in certain sports or activities. Spondylolysis can\\u000a be asymptomatic or can be a cause of spine

Antonio Leone; Alessandro Cianfoni; Alfonso Cerase; Nicola Magarelli; Lorenzo Bonomo

2011-01-01

192

Electrodiagnosis of lumbar radiculopathy.  

PubMed

The evaluation of patients with suspected lumbar radiculopathy is one of the most common reasons patients are referred for electrodiagnostic testing. The utility of this study depends on the expertise of the physician who plans, performs, and completes the study. This article reviews the strengths and weaknesses of electrodiagnosis to make this diagnosis, as well as the clinical reasoning of appropriate study planning. The current use of electrodiagnostic testing to determine prognosis and treatment outcomes is also discussed. PMID:23177032

Barr, Karen

2013-02-01

193

Pedicle screw-based posterior dynamic stabilization: literature review.  

PubMed

Posterior dynamic stabilization (PDS) indicates motion preservation devices that are aimed for surgical treatment of activity related mechanical low back pain. A large number of such devices have been introduced during the last 2 decades, without biomechanical design rationale, or clinical evidence of efficacy to address back pain. Implant failure is the commonest complication, which has resulted in withdrawal of some of the PDS devices from the market. In this paper the authors presented the current understanding of clinical instability of lumbar motions segment, proposed a classification, and described the clinical experience of the pedicle screw-based posterior dynamic stabilization devices. PMID:23227349

Sengupta, Dilip K; Herkowitz, Harry N

2012-01-01

194

Effects on inadvertent endplate fracture following lateral cage placement on range of motion and indirect spine decompression in lumbar spine fusion constructs: A cadaveric study  

PubMed Central

Background The lateral transpsoas approach to interbody fusion is gaining popularity. Existing literature suggests that perioperative vertebra-related complications include endplate breach owing to aggressive enedplate preparation and poor bone quality. The acute effects of cage subsidence on stabilization and indirect decompression at the affected level are unknown. The purpose of this study was to compare the kinematics and radiographic metrics of indirect decompression in lumbar spines instrumented with laterally placed cages in the presence of inadvertent endplate fracture, which was determined radiographically, to specimens instrumented with lateral cages with intact endplates. Methods Five levels in 5 specimens sustained endplate fracture during lateral cage implantation followed by supplementary fixation (pedicle screw/rod [PSR]: n = 1; anterolateral plate [ALP]: n = 4), as part of a larger laboratory-based study. Range of motion (ROM) in these specimens was compared with 13 instrumented specimens with intact endplates. All specimens were scanned using computed tomography (CT) in the intact, noninstrumented condition and after 2-level cage placement with internal fixation under a 400-N follower load. Changes in disc height, foraminal area, and canal area were measured and compared between specimens with intact endplates and fractured endplates. Results Subsidence in the single PSR specimen and 4 ALP specimens was 6.5 mm and 4.3 ± 2.7 mm (range: 2.2–8.3 mm), respectively. ROM was increased in the PSR and ALP specimens with endplate fracture when compared with instrumented specimens with intact endplates. In 3 ALP specimens with endplate fracture, ROM in some motion planes increased relative to the intact, noninstrumented spine. These increases in ROM were paralleled by increase in cage translations during cyclic loading (up to 3.3 mm) and an unpredictable radiographic outcome with increases or decreases in posterior disc height, foraminal area, and canal area when compared with instrumented specimens with intact endplates. Conclusions Endplate fracture and cage subsidence noted radiographically intraoperatively or in the early postoperative period may be indicative of biomechanical instability at the affected level concomitant with a lack of neurologic decompression, which may require revision surgery. PMID:25694896

Santoni, Brandon G.; Alexander, Gerald E.; Nayak, Aniruddh; Cabezas, Andres; Marulanda, German A.; Murtagh, Ryan; Castellvi, Antonio E.

2013-01-01

195

A ganglion cyst causing lumbar radiculopathy in a baseball pitcher: A case report  

Microsoft Academic Search

This report describes a case of a professional baseball pitcher who developed acute left lumbar radicular symptoms after a baseball game and was subsequently sidelined for the rest of the season. Physical examination revealed depressed reflexes in the left posterior tibialis and left medial hamstring muscles, mild weakness in the left extensor hallucis longus, and positive dural tension signs. Magnetic

Joe Lee; Ronald J. Wisneski; Gregory E. Lutz

2000-01-01

196

In vivo morphological features of human lumbar discs.  

PubMed

Recent biomechanics studies have revealed distinct kinematic behavior of different lumbar segments. The mechanisms behind these segment-specific biomechanical features are unknown. This study investigated the in vivo geometric characteristics of human lumbar intervertebral discs. Magnetic resonance images of the lumbar spine of 41 young Chinese individuals were acquired. Disc geometry in the sagittal plane was measured for each subject, including the dimensions of the discs, nucleus pulposus (NP), and annulus fibrosus (AF). Segmental lordosis was also measured using the Cobb method.In general, the disc length increased from upper to lower lumbar levels, except that the L4/5 and L5/S1 discs had similar lengths. The L4/5 NP had a height of 8.6±1.3?mm, which was significantly higher than all other levels (P<0.05). The L5/S1 NP had a length of 21.6±3.1?mm, which was significantly longer than all other levels (P<0.05). At L4/5, the NP occupied 64.0% of the disc length, which was significantly less than the NP of the L5/S1 segment (72.4%) (P<0.05). The anterior AF occupied 20.5% of the L4/5 disc length, which was significantly greater than that of the posterior AF (15.6%) (P<0.05). At the L5/S1 segment, the anterior and posterior AFs were similar in length (14.1% and 13.6% of the disc, respectively). The height to length (H/L) ratio of the L4/5 NP was 0.45±0.06, which was significantly greater than all other segments (P<0.05). There was no correlation between the NP H/L ratio and lordosis. Although the lengths of the lower lumbar discs were similar, the geometry of the AF and NP showed segment-dependent properties. These data may provide insight into the understanding of segment-specific biomechanics in the lower lumbar spine. The data could also provide baseline knowledge for the development of segment-specific surgical treatments of lumbar diseases. PMID:25526494

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

2014-12-01

197

Lumbar Extension during Stoop Lifting is Delayed by the Load and Hamstring Tightness  

PubMed Central

[Purpose] This study investigated the relationship between lumbar pelvic rhythm and the physical characteristics of stoop lifting. [Subjects and Methods] Participants performed a stoop lifting task under two conditions: with and without load. We assessed the lumbar kyphosis and sacral inclination angles using the SpinalMouse® system, as well as hamstring flexibility. During stoop lifting, surface electromyograms and the lumbar and sacral motions were recorded using a multi-channel telemetry system and flexible electrogoniometers. [Results] In the initial phase of lifting, lumbar extension was delayed by load; the delay showed a negative correlation with sacral inclination angle at trunk flexion, whereas a positive correlation was observed with electromyogram activity of the lumbar multifidus. Additionally, a positive correlation was observed between sacral inclination angle and hip flexion range of motion during the straight leg raise test. [Conclusion] We found that a disorder of the lumbar pelvic rhythm can be caused by both load and hamstring tightness. In the initial phase of stoop lifting, delayed lumbar extension is likely to lead to an increase in spinal instability and stress on the posterior ligamentous system. This mechanism shows that stoop lifting of a load may be harmful to the lower back of people with hamstring tightness. PMID:24567676

Iwasaki, Risa; Yokoyama, Ginga; Kawabata, Satoshi; Suzuki, Tomotaka

2014-01-01

198

Lumbar spine stenosis: a common cause of back and leg pain.  

PubMed

Lumbar spine stenosis most commonly affects the middle-aged and elderly population. Entrapment of the cauda equina roots by hypertrophy of the osseous and soft tissue structures surrounding the lumbar spinal canal is often associated with incapacitating pain in the back and lower extremities, difficulty ambulating, leg paresthesias and weakness and, in severe cases, bowel or bladder disturbances. The characteristic syndrome associated with lumbar stenosis is termed neurogenic intermittent claudication. This condition must be differentiated from true claudication, which is caused by atherosclerosis of the pelvofemoral vessels. Although many conditions may be associated with lumbar canal stenosis, most cases are idiopathic. Imaging of the lumbar spine performed with computed tomography or magnetic resonance imaging often demonstrates narrowing of the lumbar canal with compression of the cauda equina nerve roots by thickened posterior vertebral elements, facet joints, marginal osteophytes or soft tissue structures such as the ligamentum flavum or herniated discs. Treatment for symptomatic lumbar stenosis is usually surgical decompression. Medical treatment alternatives, such as bed rest, pain management and physical therapy, should be reserved for use in debilitated patients or patients whose surgical risk is prohibitive as a result of concomitant medical conditions. PMID:9575322

Alvarez, J A; Hardy, R H

1998-04-15

199

Surgical outcomes of modified lumbar spinous process-splitting laminectomy for lumbar spinal stenosis.  

PubMed

The lumbar spinous process-splitting laminectomy (LSPSL) procedure was developed as an alternative to lumbar laminectomy. In the LSPSL procedure, the spinous process is evenly split longitudinally and then divided at its base from the posterior arch, leaving the bilateral paravertebral muscle attached to the lateral aspects. This procedure allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional laminectomy while minimizing damage to posterior supporting structures. In this study, the authors make some modifications to the original LSPSL procedure (modified LSPSL), in which laminoplasty is performed instead of laminectomy. The purpose of this study was to compare postoperative outcomes in modified LSPSL with those in conventional laminectomy (CL) and to evaluate bone unions between the split spinous process and residual laminae following modified LSPSL. Forty-seven patients with lumbar spinal stenosis were enrolled in this study. Twenty-six patients underwent modified LSPSL and 21 patients underwent CL. Intraoperative blood loss and surgical duration were evaluated. The Japanese Orthopaedic Association (JOA) scale scores were used to assess parameters before surgery and 12 months after surgery. The recovery rates were also evaluated. Postoperative paravertebral muscle atrophy was assessed using MRI. Bone union rates between the split spinous process and residual laminae were also examined. The mean surgical time and intraoperative blood loss were 25.7 minutes and 42.4 ml per 1 level in modified LSPSL, respectively, and 22.7 minutes and 29.5 ml in CL, respectively. The recovery rate of the JOA score was 64.2% in modified LSPSL and 68.7% in CL. The degree of paravertebral muscle atrophy was 7.8% in modified LSPSL and 22.2% in CL at 12 months after surgery (p < 0.05). The fusion rates of the spinous process with the arcus vertebrae at 6 and 12 months in modified LSPSL were 56.3% and 81.3%, respectively. The modified LSPSL procedure was less invasive to the paravertebral muscles and could be a laminoplasty; therefore, the modified LSPSL procedure presents an effective alternative to lumbar laminectomy. PMID:25594729

Kanbara, Shunsuke; Yukawa, Yasutsugu; Ito, Keigo; Machino, Masaaki; Kato, Fumihiko

2015-04-01

200

Posterior Ischemic Optic Neuropathy  

Microsoft Academic Search

14 cases of posterior ischemic optic neuropathy (PION) were clinically analyzed, in whom we excluded known etiologies of optic nerve disturbances and confirmed the decreased blood supply to the posterior portion of the optic nerve. On the basis of our clinical findings, we have proposed the following criteria for the diagnosis of idiopathic PION: (1) sudden onset of unilateral visual

Y. Isayama; T. Takahashi; M. Inoue; T. Jimura

1983-01-01

201

Endoscopic endonasal posterior clinoidectomy  

PubMed Central

Background: Posterior clinoidectomy is a useful procedure for maximizing exposure to the interpeduncular cistern via transcranial approaches for basilar tip aneurysms and select intracranial tumors. The value of posterior clinoidectomy during endonasal endoscopic transclival surgery is not well described. Methods: We performed endoscopic endonasal transsphenoidal extradural bilateral posterior clinoidectomy and dorsum sella removal on five silicon-injected cadaveric heads. The dorsum sella was split in the midline and removed from medial to lateral until the posterior clinoids were encountered. The posterior clinoid was dissected from the medial wall of the cavernous sinus and mobilized medially in order to detach it from the ligaments and carefully fractured it from the bony attachment to the petrous apex and carotid canal. Following this, the clival and dorsum sella dura was opened to expose the interpeduncular cistern and its contents. Results: The technical feasibility of endoscopic endonasal extradural posterior clinoidectomy was reproduced in all five cadaveric specimens. This technique was performed without damaging the vital structures, including preservation of the pituitary gland. After performing bilateral posterior clinoidectomy, the retrosellar dura was opened, allowing good visualization of the contents of the prepontine and interpeduncular cistern. Conclusion: We describe the technique of endoscopic endonasal extradural posterior clinoidectomy. We believe this approach is best suited for retrosellar pathology located in the interpeduncular cistern and is a useful adjunct to the transclival approach to increase the field of view and maximize the extent of resection. PMID:22754729

Silva, Danilo; Attia, Moshe; Kandasamy, Jothy; Alimi, Marjan; Anand, Vijay K.; Schwartz, Theodore H.

2012-01-01

202

Repair of a large thoracolumbar myelomeningocele with associated lumbar kyphosis.  

PubMed

This report describes a novel method of repair for a large thoracolumbar myelomeningocele with an associated lumbar kyphosis in the neonate. A Caucasian male child was born at term with an antenatal diagnosis of hydrocephalus and spina bifida. Lumbar spine X-ray showed a significant kyphosis at L2-L3 level. Kyphectomy was performed and a cervical plate was used to reduce the gibbus deformity and maintain a rigid construct. Local rotation flaps were elevated and advanced to cover the defect. Wound was well healed at 3-month follow-up and the patient remained shunt-free at 1 year. To our knowledge, this is the first description of myelomeningocele repair with kyphectomy and posterior fixation in a neonate. PMID:23828714

Duddy, John C; Caird, John; Connolly, Paul

2013-10-01

203

Use of autologous growth factors in lumbar spinal fusion.  

PubMed

The results of spinal fusion, especially posteriorly above the lumbosacral junction, have been mixed. Autologous growth factor concentrate (AGF) prepared by ultraconcentration of platelets contains multiple growth factors having a chemotactic and mitogenic effect on mesenchymal stem cells and osteoblasts and may play a role in initiating bone healing. The purpose of this retrospective study is to review our results with AGF in lumbar spinal fusions. To date, AGF has been used in 39 patients having lumbar spinal fusion. The study group consisted of the first 19 consecutive cases to allow at least 6 months follow-up. The average follow-up was 13 months (range 6 to 18 months). Follow-up compliance was 91%. There were 7 men and 12 women. Average age was 52 years (range 30-72 years). Nine patients had prior back surgery. There were 8 smokers. AGF was used in posterior (n = 15) or anterior intradiscal (n = 4) fusions. AGF was used with autograft and coraline hydroxyapatite in all posterior fusions, and autograft, coral, and intradiscal spacer (carbon fiber spinal fusion cages or Synthes femoral ring) in intradiscal fusions. Posterior stabilization was used in all cases. Eight cases were single-level fusions, 6 were two-level, and 1 was a three-level fusion. Autologous iliac crest bone graft was taken in 14 cases and local autograft used in 5 cases. Posteriorly, a total of 23 levels were fused; of these, nine were at L5-S1, eight at L4-L5, five at L3-L4, and one at L2-L3. No impending pseudoarthroses were noted on plain radiographic examination at last follow-up visit. Solid fusion was confirmed in 3 patients having routine hardware removal, and in 2 patients who had surgery at an adjacent level. There was one posterior wound infection, which was managed without sequelae. When used as an adjunct to autograft, AGF offers theoretical advantages that need to be examined in controlled studies. Further study is necessary to determine whether coralline hydroxyapatite used as a bone graft extender in lumbar spinal fusion may help to obviate the need for secondary site graft harvesting. PMID:10458274

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

1999-08-01

204

Fracture models in the lumbar sheep spine: a biomechanical investigation.  

PubMed

The purpose of this study was to find out if a limited resection of the cranial vertebral body leaving the posterior wall intact is a sufficient model for AO type 3 fractures, or if additional resection of the posterior wall is necessary. In six, fresh-frozen, lumbar sheep spine specimens, the segmental stability was tested in three motion planes in a spine tester. First, the intact specimens were tested. Then, partial resection of the intervertebral disc L3/4 and resection of the cranial vertebral body of L4 was performed, leaving the posterior wall intact. This defect was tested without instrumentation and with a ventral monosegmental interlocking plate mounted. Then, the defect was extended to a total cranial resection, including the posterior wall, and the tests were subsequently repeated. The stability of both types of defects under the different conditions was compared. Without instrumentation, the total cranial resection showed significantly more ROM in flexion/extension and axial rotation than partial cranial resection. With the ventral interlocking plate mounted, the instability in total cranial resection was significantly higher in flexion/extension, with the relative relation even being increased. In axial rotation and lateral bending, the differences were equalized by the mounted plate. From a biomechanical point of view, total cranial resection including the posterior wall should be preferred as a sheep spine fracture model for AO type 3 fractures. PMID:20058270

Heineck, Jan; Haupt, Cornelius; Werner, Karin; Rammelt, Stefan; Zwipp, Hans; Wilke, Hans-Joachim

2010-06-01

205

Pars Stress Fracture (Lumbar Spondylolysis)  

MedlinePLUS

... Neck and Back) > Pars Stress Fracture Pars Stress Fracture Page Content Pars stress fractures occur in young athletes involved in repetitive bending ... an episode of low back pain Pars stress fracture, also called lumbar spondylolysis, is one of the ...

206

Posterior approach to ventrally located spinal meningiomas  

PubMed Central

For the resection of anteriorly located meningiomas, various approaches have been used. Posterior approach is less invasive and demanding; however, it has been associated with increased risk of spinal cord injury. We evaluated ten consecutive patients that underwent surgery for spinal meningiomas. All patients were preoperative assessed by neurological examination, computed tomography and magnetic resonance imaging. All tumors were ventrally located and removed via a posterior approach. Transcranial motor-evoked potentials (TcMEPs), somatosensory-evoked potential (SSEP) and free running electromyography (EMG) were monitored intraoperative. Postoperative all patients had regular follow-up examinations. There were four males and six females. The mean age was 68.2 years (range 39–82 years). In nine out of ten cases, the tumor was located in the thoracic spine. A case of a lumbar meningioma was recorded. The most common presenting symptom was motor and sensory deficits and unsteady gait, whereas no patient presented with paraplegia. All meningiomas were operated using a microsurgical technique via a posterior approach. During the operation, free running EMG monitoring prompted a surgical alert in case of irritation, whereas TcMEP and SSEP amplitudes remained unchanged. Histopathology revealed the presence of typical (World Health Organisation grade I) meningiomas. The mean Ki-67/MIB-1 index was 2.75% (range 0.5–7). None of our patients sustained a transient or permanent motor deficit. After a mean follow-up period of 26 months (range 56–16 months), no tumor recurrence and no instability were found. Posterior approach for anteriorly located meningiomas is a safe procedure with the use of intraoperative monitoring, less invasive and well-tolerated especially in older patients. Complete tumor excision can be performed with satisfactory results. PMID:20127494

Voulgaris, Spyridon; Mihos, Evaggelos; Karagiorgiadis, Dimitrios; Zigouris, Andreas; Fotakopoulos, George; Drosos, Dimitrios; Pahaturidis, Dimitrios

2010-01-01

207

Bilateral implantation of low-profile interbody fusion cages: subsidence, lordosis, and fusion analysis  

Microsoft Academic Search

BACKGROUND CONTEXT: The use of interbody fusion cages as a treatment for degenerative disc disease has become widespread. Low-profile cages have been developed to allow a closer fit when implanting bilateral cages in patients with smaller vertebral bodies. Some surgeons feel the open design also allows better bone contact and visualization. This is particularly true when two low-profile cages are

Michael Schiffman; Salvador A Brau; Robin Henderson; Gwen Gimmestad

2003-01-01

208

Surgical Management for Thoracic Spinal Tuberculosis Posterior Only versus Anterior Video-Assisted Thoracoscopic Surgery  

PubMed Central

Study Design A comparable retrospective study. Object To compare the clinical outcomes of surgical treatment by posterior only and anterior video-assisted thoracoscopic surgery for thoracic spinal tuberculosis (TSTB). Method 145 patients with TSTB treated by two different surgical procedures in our institution from June 2001 to June 2014 were studied. All cases were retrospectively analyzed and divided into two groups according to the given treatments: 75 cases (32F/43M) in group A performed single-stage posterior debridement, transforaminal thoracic interbody fusion and instrumentation, and 70 cases (30F/40M) in group B underwent anterior video-assisted thoracoscopic surgery (VATS). Clinical and radiographic results in the two groups were analyzed and compared. Results Patients in group A and B were followed up for an average of 4.6±1.8, 4.4±1.2 years, respectively. There was no statistically significant difference between groups in terms of the operation time, blood loss, bony fusion, neurological recovery and the correction angle of kyphotic deformity (P>0.05). Fewer pulmonary complications were observed in group A. Good clinical outcomes were achieved in both groups. Conclusions Both the anterior VATS and posterior approaches can effectively treat thoracic tuberculosis. Nevertheless, the posterior approach procedure obtained less morbidity and complications than the other. PMID:25781165

Zhong, Weiye; Xiong, Guangzhong; Wang, Bing; Dai, Zhihui

2015-01-01

209

STABILITY AND INFINITESIMAL ROBUSTNESS OF POSTERIOR DISTRIBUTIONS AND POSTERIOR QUANTITIES  

E-print Network

STABILITY AND INFINITESIMAL ROBUSTNESS OF POSTERIOR DISTRIBUTIONS AND POSTERIOR QUANTITIES revision February, 1998 Abstract Infinitesimal sensitivities of the posterior distribution P (\\DeltajX ) and posterior quantities ae(P ) w.r.t. the choice of the prior P are considered. In a very general setting

Basu, Sanjib

210

Lumbar Spinal Stenosis Minimally Invasive Treatment with Bilateral Transpedicular Facet Augmentation System  

SciTech Connect

Purpose. The purpose of this study was to evaluate the effectiveness of a new pedicle screw-based posterior dynamic stabilization device PDS Percudyn System Trade-Mark-Sign Anchor and Stabilizer (Interventional Spine Inc., Irvine, CA) as alternative minimally invasive treatment for patients with lumbar spine stenosis. Methods. Twenty-four consecutive patients (8 women, 16 men; mean age 61.8 yr) with lumbar spinal stenosis underwent implantation of the minimally invasive pedicle screw-based device for posterior dynamic stabilization. Inclusion criteria were lumbar stenosis without signs of instability, resistant to conservative treatment, and eligible to traditional surgical posterior decompression. Results. Twenty patients (83 %) progressively improved during the 1-year follow-up. Four (17 %) patients did not show any improvement and opted for surgical posterior decompression. For both responder and nonresponder patients, no device-related complications were reported. Conclusions. Minimally invasive PDS Percudyn System Trade-Mark-Sign has effectively improved the clinical setting of 83 % of highly selected patients treated, delaying the need for traditional surgical therapy.

Masala, Salvatore, E-mail: salva.masala@tiscali.it [Interventional Radiology and Radiotherapy, University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging (Italy); Tarantino, Umberto [University of Rome 'Tor Vergata', Department of Orthopaedics and Traumatology (Italy); Nano, Giovanni, E-mail: gionano@gmail.com [Interventional Radiology and Radiotherapy, University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging (Italy); Iundusi, Riccardo [University of Rome 'Tor Vergata', Department of Orthopaedics and Traumatology (Italy); Fiori, Roberto, E-mail: fiori.r@libero.it; Da Ros, Valerio, E-mail: valeriodaros@hotmail.com; Simonetti, Giovanni [Interventional Radiology and Radiotherapy, University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging (Italy)

2013-06-15

211

Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in posterolateral lumbar spine fusion: complications in the elderly  

PubMed Central

Study design Retrospective cohort study of 1430 patients undergoing lumbar spinal fusion from 2002 - 2009. Objective: The goal of this study was to compare and evaluate the number of complications requiring reoperation in elderly versus younger patients. Summary of background data rhBMP-2 has been utilized off label for instrumented lumbar posterolateral fusions for many years. Many series have demonstrated predictable healing rates and reoperations. Varying complication rates in elderly patients have been reported. Materials and methods All patients undergoing instrumented lumbar posterolateral fusion of ??3 levels consenting to utilization of rhBMP-2 were retrospectively evaluated. Patient demographics, body mass index, comorbidities, number of levels, associated interbody fusion, and types of bone void filler were analyzed. The age of patients were divided into less than 65 and greater than or equal to 65 years. Complications related to the performed procedure were recorded. Results After exclusions, 482 consecutive patients were evaluated with 42.1% males and 57.9% females. Average age was 62 years with 250 (51.9%) < 65 and 232 (48.1%) ??65 years. Patients ??65 years of age stayed longer (5.0 days) in the hospital than younger patients (4.5 days) (p=0.005). Complications requiring reoperation were: acute seroma formation requiring decompression 15/482, 3.1%, bone overgrowth 4/482, 0.8%, infection requiring debridement 11/482, 2.3%, and revision fusion for symptomatic nonunion 18/482, 3.7%. No significant differences in complications were diagnosed between the two age groups. Statistical differences were noted between the age groups for medical comorbidities and surgical procedures. Patients older than 65 years underwent longer fusions (2.1 versus 1.7 levels, p=0.001). Discussion Despite being older and having more comorbidities, elderly patients have similar complication and reoperation rates compared to younger healthier patients undergoing instrumented lumbar decompression fusions with rhBMP-2. PMID:23317417

2013-01-01

212

Posterior Predictive Inference Sudipto Banerjee  

E-print Network

Posterior Predictive Inference Sudipto Banerjee sudiptob@biostat.umn.edu University of Minnesota Posterior Predictive Inference ­ p. 1/ #12;Posterior Predictive Checks Assume modelling data as y = (y1(T(yrep, ) > T(y, ) | y) = 1 M M t=1 1[T(yt rep, t) > T(y, t)]. Posterior Predictive Inference ­ p. 2/ #12;Model

Carlin, Bradley P.

213

Spinal epidural lipomatosis in lumbar magnetic resonance imaging scans.  

PubMed

The goal of this study was to quantify the frequency of advanced spinal epidural lipomatosis (SEL) detected on lumbar magnetic resonance imaging (MRI) scans performed at the authors' hospital and to compare the frequency, cause, and progression of SEL in these cases with that reported in the literature. The total number of MRI examinations of the lumbar spine performed at this hospital over 45 months was 1498 (705 men and 793 women; mean age, 60.3 years). After the MRI data were reduced (T1- and T2-weighted sagittal and axial images) on the basis of the exclusion criteria, the anterior and posterior diameters of the dural sac and spinal canal were measured, as well as the thickness of the epidural fat. On the basis of these parameters, the severity of SEL was classified as grade 0 to grade III. Five cases of grade III SEL were diagnosed. The frequency of grade III SEL noted in this study was 0.33% (5/1498). Obesity (body mass index greater than 27.5) was noted in 3 cases, and the use of exogenous corticosteroids was noted in 3 cases. Exogenous steroid usage associated with advanced SEL in this study was greater than that reported in the literature. Most symptoms of SEL progress slowly, and early diagnosis allows for a dose reduction of the prescribed steroids. Thus, lumbar MRI examinations should be conducted aggressively in patients with exogenous steroid use and presenting with low back pain or buttock pain. PMID:24762841

Sugaya, Hisashi; Tanaka, Toshikazu; Ogawa, Takeshi; Mishima, Hajime

2014-04-01

214

The transverse placement laminoplasty using titanium miniplates for the reconstruction of the laminae in thoracic and lumbar lesion  

Microsoft Academic Search

Laminoplasty for thoracic and lumbar spine surgery enables surgeons to preserve the posterior arch of the spine while preventing invasion of hematoma and scar tissue, postoperative instability, subluxation, and kyphotic deformities. The authors have developed a new surgical technique: namely, transverse placement laminoplasty (TPL) using titanium miniplates. Eight patients and 18 laminae underwent TPL using a titanium mini-plate. The preoperative

Shinichi Hida; Masatoshi Naito; Jun Arimizu; Yuichiro Morishita; Atsuhiko Nakamura

2006-01-01

215

Spondylolisthesis and posterior instability.  

PubMed

We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI. PMID:19253068

Niggemann, P; Simons, P; Kuchta, J; Beyer, H K; Frey, H; Grosskurth, D

2009-04-01

216

Percutaneous endoscopic decompression for lumbar spinal stenosis.  

PubMed

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

Ahn, Yong

2014-11-01

217

Changes in Neuroforaminal Height with 2 Level Axial Presacral Lumbar Interbody Fusion at L4-S1  

PubMed Central

Background The objective was to examine the changes in neuroforaminal height at L4-L5 and L5-S1 after insertion and graduated foraminal distraction using the 2 level transsacral implant in a cadaveric model. Methods Discectomy and transsacral instrumentation was performed in six fresh human cadavers at L4-S1. The neuroforaminal height was measured at L4-L5 and L5-S1 before and after insertion of the implant and then at each stage of manual distraction. Results Mean L4-5 neuroforaminal height increased from 18.2 ± 3.1mm to 20.3± 2.9mm (11%) on the left and from 18.8±2.8mm to 20.6± 2.3mm (12%) on the right (P<0.05). Mean L5-S1 neuroforaminal height increased from 15.7±3.0mm to 18.4 ±2.8mm (17%) on the left and from 15.6 ±2.1mm to 18.3 ±1.8mm (17%) on the right (P<0.05). When the neuroforaminal height was plotted against amount of rotation of the screw driver it was found that the neuroforaminal height at L5-S1 increased by 1mm on average for every complete revolution of the screw driver. At least 2 full rotations of the screw driver were achieved in all cadavers. Conclusions The transsacral screw construct distracted the disc space and neuroforaminal height in a cadaveric spine model without soft tissue envelope. During the initial process, manual control of disc space distraction predictably correlated with the increase in the neuroforaminal height to a maximum. However, further research is needed to look at variables affecting disc space pliability, implant subsidence, in vivo application, and clinical benefit of this procedure. PMID:25694937

Marawar, Satyajit; Jung, Jin; Sun, Mike

2014-01-01

218

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

PubMed

Pedicle screw and rod instrumentation has become the preferred technique for performing stabilization and fusion in the surgical treatment of lumbar spine degenerative disease. Rigid fixation leads to high fusion rates but may also contribute to stress shielding and adjacent segment degeneration. Thus, the use of semirigid rods made of polyetheretherketone (PEEK) has been proposed. Although the PEEK rods biomechanical properties, such as anterior load sharing properties, have been shown, there are few clinical studies evaluating their application in the lumbar spine surgical treatment. This study examined a retrospective cohort of patients who underwent posterior lumbar fusion for degenerative disease using PEEK rods, in order to evaluate the clinical and radiological outcomes and the incidence of complications. PMID:25751575

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

2015-06-01

219

49 CFR 572.187 - Lumbar spine.  

Code of Federal Regulations, 2013 CFR

...7 2013-10-01 2013-10-01 false Lumbar spine. 572.187 Section 572.187 Transportation...Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in...

2013-10-01

220

49 CFR 572.187 - Lumbar spine.  

Code of Federal Regulations, 2012 CFR

...7 2012-10-01 2012-10-01 false Lumbar spine. 572.187 Section 572.187 Transportation...Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in...

2012-10-01

221

49 CFR 572.187 - Lumbar spine.  

Code of Federal Regulations, 2014 CFR

...7 2014-10-01 2014-10-01 false Lumbar spine. 572.187 Section 572.187 Transportation...Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in...

2014-10-01

222

Endoscopic lumbar foraminotomy.  

PubMed

Foraminal stenosis frequently causes radiculopathy in lumbar degenerative spondylosis. Endoscopic transforaminal techniques allow for foraminal access with minimal tissue disruption. However, the effectiveness of foraminal decompression by endoscopic techniques has yet to be studied. We evaluate radiographic outcome of endoscopic transforaminal foraminotomies performed at L3-L4, L4-L5, and L5-S1 on cadaveric specimens. Before and after the procedures, three dimensional CT scans were obtained to measure foraminal height and area. Following the foraminotomies, complete laminectomies and facetectomies were performed to assess for dural tears or nerve root damage. L3-L4 preoperative foraminal height increased by 8.9%, from 2.12±0.13cm to 2.27±0.14cm (p<0.01), and foraminal area increased by 24.8% from 2.21±0.18cm(2) to 2.72±0.19cm(2) (p<0.01). At L4-L5, preoperative foraminal height was 1.87±0.17cm and area was 1.78±0.18cm(2). Endoscopic foraminotomies resulted in a 15.3% increase of foraminal height (2.11±0.15cm, p<0.05) and 44.8% increase in area of (2.51±0.21cm(2), p<0.01). At L5-S1, spondylitic changes caused diminished foraminal height (1.26±0.14cm) and foraminal area (1.17±0.18cm(2)). Postoperatively, foraminal height increased by 41.6% (1.74±0.09cm, p<0.05) and area increased by 98.7% (2.08±0.17cm(2), p<0.01). Subsequent inspection via a standard midline approach revealed one dural tear of an S1 nerve root. Endoscopic foraminotomies allow for effective foraminal decompression, though clinical studies are necessary to further evaluate complications and efficacy. PMID:25744073

Evins, Alexander I; Banu, Matei A; Njoku, Innocent; Elowitz, Eric H; Härtl, Roger; Bernado, Antonio; Hofstetter, Christoph P

2015-04-01

223

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

PubMed Central

Dynamic systems in the lumbar spine are believed to reduce main fusion drawbacks such as pseudarthrosis, bone rarefaction, and mechanical failure. Compared to fusion achieved with rigid constructs, biomechanical studies underlined some advantages of dynamic instrumentation including increased load sharing between the instrumentation and interbody bone graft and stresses reduction at bone-to-screw interface. These advantages may result in increased fusion rates, limitation of bone rarefaction, and reduction of mechanical complications with the ultimate objective to reduce reoperations rates. However published clinical evidence for dynamic systems remains limited. In addition to providing biomechanical evaluation of a pedicle-screw-based dynamic system, the present study offers a long-term (average 10.2 years) insight view of the clinical outcomes of 18 patients treated by fusion with dynamic systems for degenerative lumbar spine diseases. The findings outline significant and stable symptoms relief, absence of implant-related complications, no revision surgery, and few adjacent segment degenerative changes. In spite of sample limitations, this is the first long-term report of outcomes of dynamic fusion that opens an interesting perspective for clinical outcomes of dynamic systems that need to be explored at larger scale. PMID:25031874

Barrey, Cédric; Perrin, Gilles; Champain, Sabina

2013-01-01

224

Posterior sagittal proctectomy.  

PubMed Central

Rectal excision for non-malignant conditions using a posterior sagittal approach is described in three patients. The technique allows excellent exposure of the rectum, meticulous haemostasis, minimal risk of pelvic nerve injury and accurate reconstruction of the pelvic floor without the need for drainage. Images Figure 2 PMID:9623381

Stringer, M. D.; Crabbe, D. C.

1998-01-01

225

Posterior distribution Andrew Gelman  

E-print Network

Posterior distribution Andrew Gelman Volume 3, pp 1627­1628 in Encyclopedia of Environmetrics (ISBN of the vector of uncertain quantities w1, . . . , wJ, as illustrated in the following matrix: l w1 w2 Ð Ð Ð wJ 1

Gelman, Andrew

226

Posterior Cranial Fossa Meningiomas*  

PubMed Central

This study evaluated the outcomes, complications, and recurrence rates of posterior cranial fossa meningiomas. We retrospectively reviewed our surgical experience with 64 posterior cranial fossa meningiomas. Mean age was 56 years with a female preponderance (67.2%). Headache was the most common symptom. Retrosigmoid approach was the commonest surgical procedure (23.4%). The incidence of cranial nerve related complications was 28%. Postoperatively facial nerve weakness was observed in 11%. The incidence of cerebrospinal fluid leak was 4.6%. Gross total resection was achieved in 37 patients (58%). Sixteen patients (25%) with residual tumors underwent Gamma knife radiosurgery. Recurrence or tumor progression was observed in 12 patients (18.7%). Operative mortality was 3.1%. At their last follow-up, 93% of the cases achieved Glasgow Outcome Scale scores 4 or 5. Total excision is the ideal goal which can be achieved with meningiomas located in certain location, such as lateral convexity, but for other posterior fossa meningiomas the close proximity of critical structures is a major obstacle in achieving this goal. In practicality, a balance between good functional outcome and extent of resection is important for posterior cranial fossa meningiomas in proximity to critical structures. PMID:23372989

Javalkar, Vijayakumar; Banerjee, Anirban Deep; Nanda, Anil

2012-01-01

227

The Effects on the Pain Index and Lumbar Flexibility of Obese Patients with Low Back Pain after PNF Scapular and PNF Pelvic Patterns  

PubMed Central

[Purpose] The purpose of this study was to determine whether exercises using proprioceptive neuromuscular facilitation (PNF) scapular and pelvic patterns might decrease the pain index and increase the lumbar flexibility of obese patients with low back pain. [Subjects and Methods] Thirty obese patients with low back pain were randomly assigned to an experimetal group (n=15) and a control group (n=15). The exercise program of the experimental group consisted of scapular patterns (anterior depression ? posterior elevation) and pelvic patterns (anterior elevation ? posterior depression). The control group performed neutral back muscle strengthening exercises. Over the course of four weeks, the groups participated in PNF or performed strengthening exercises for 30 minutes, three times per week. Subjects were assessed a pre-test and post-test using measurements of pain and lumbar flexibility. [Results] The results show that lumbar flexion and lumbar extension significantly improved in the experimental group, had significant improvement and that the Oswestry Disability index (ODI) significantly decreased. However, there were no significant changes in the control group. The experimental group also showed significant differences in the pain index and lumbar flexibility from the control group. [Conclusion] This study showed that PNF can be used to improve pain index rating and lumbar flexibility. The findings indicate that the experimental group experienced greater improvement than the control group by participating in the PNF lumbar stabilization program. PMID:25364115

Park, KwangYong; Seo, KyoChul

2014-01-01

228

The Effects on the Pain Index and Lumbar Flexibility of Obese Patients with Low Back Pain after PNF Scapular and PNF Pelvic Patterns.  

PubMed

[Purpose] The purpose of this study was to determine whether exercises using proprioceptive neuromuscular facilitation (PNF) scapular and pelvic patterns might decrease the pain index and increase the lumbar flexibility of obese patients with low back pain. [Subjects and Methods] Thirty obese patients with low back pain were randomly assigned to an experimetal group (n=15) and a control group (n=15). The exercise program of the experimental group consisted of scapular patterns (anterior depression - posterior elevation) and pelvic patterns (anterior elevation - posterior depression). The control group performed neutral back muscle strengthening exercises. Over the course of four weeks, the groups participated in PNF or performed strengthening exercises for 30 minutes, three times per week. Subjects were assessed a pre-test and post-test using measurements of pain and lumbar flexibility. [Results] The results show that lumbar flexion and lumbar extension significantly improved in the experimental group, had significant improvement and that the Oswestry Disability index (ODI) significantly decreased. However, there were no significant changes in the control group. The experimental group also showed significant differences in the pain index and lumbar flexibility from the control group. [Conclusion] This study showed that PNF can be used to improve pain index rating and lumbar flexibility. The findings indicate that the experimental group experienced greater improvement than the control group by participating in the PNF lumbar stabilization program. PMID:25364115

Park, KwangYong; Seo, KyoChul

2014-10-01

229

Measuring lumbar motion in industry, utilizing the lumbar motion monitor  

E-print Network

measure and document the E3-dimensional trunk motions of high frequency MMH jobs in industry using the Lumbar Motion Monitor (LMM) from Chattanooga Group, loc. Five jobs were analyzed with five different workers in each job. The range of motion observed...

Bryan, Rex Wade

1999-01-01

230

Effects of aging and spinal degeneration on mechanical properties of lumbar supraspinous and interspinous ligaments  

Microsoft Academic Search

Background context: The effects of aging and spinal degeneration on the mechanical properties of spinal ligaments are still unknown, although there have been several studies demonstrating those of normal spinal ligaments.Purpose: To investigate the mechanical properties of the human posterior spinal ligaments in human lumbar spine, and their relation to age and spinal degeneration parameters.Study design\\/setting: Destructive uniaxial tensile tests

Takahiro Iida; Kuniyoshi Abumi; Yoshihisa Kotani; Kiyoshi Kaneda

2002-01-01

231

Lumbar spine disc heights and curvature: upright posture vs. supine compression harness  

NASA Technical Reports Server (NTRS)

INTRODUCTION: Spinal lengthening in microgravity is thought to cause back pain in astronauts. A spinal compression harness can compress the spine to eliminate lengthening but the loading condition with harness is different than physiologic conditions. Our purpose was to compare the effect of spine compression with a harness in supine position on disk height and spinal curvature in the lumbar spine to that of upright position as measured using a vertically open magnetic resonance imaging system. METHODS: Fifteen healthy subjects volunteered. On day 1, each subject lay supine for an hour and a baseline scan of the lumbar spine was performed. After applying a load of fifty percent of body weight with the harness for thirty minutes, the lumbar spine was scanned again. On day 2, after a baseline scan, a follow up scan was performed after kneeling for thirty minutes within the gap between two vertically oriented magnetic coils. Anterior and posterior disk heights, posterior disk bulging, and spinal curvature were measured from the baseline and follow up scans. RESULTS: Anterior disk heights increased and posterior disk heights decreased compared with baseline scans both after spinal compression with harness and upright posture. The spinal curvature increased by both loading conditions of the spine. DISCUSSION: The spinal compression with specially designed harness has the same effect as the physiologic loading of the spine in the kneeling upright position. The harness shows some promise as a tool to increase the diagnostic capabilities of a conventional MR system.

Lee, Shi-Uk; Hargens, Alan R.; Fredericson, Michael; Lang, Philipp K.

2003-01-01

232

Hyperlipidaemia diagnosed at lumbar puncture.  

PubMed Central

A patient presenting with subarachnoid haemorrhage and high lipid concentrations in the cerebrospinal fluid (taken at lumbar puncture), who has later shown to have type V hyperlipidaemia is described. This case, so far as can be ascertained by the authors, is the first report of hyperlipidaemia being diagnosed from CSF examination. Images Fig. 1 PMID:7267506

Burke, B. J.; McKee, J. I.; Hargreaves, T.

1981-01-01

233

Activity of thoracic and lumbar epaxial extensors during postural responses in the cat  

NASA Technical Reports Server (NTRS)

This study examined the role of trunk extensor muscles in the thoracic and lumbar regions during postural adjustments in the freely standing cat. The epaxial extensor muscles participate in the rapid postural responses evoked by horizontal translation of the support surface. The muscles segregate into two regional groups separated by a short transition zone, according to the spatial pattern of the electromyographic (EMG) responses. The upper thoracic muscles (T5-9) respond best to posteriorly directed translations, whereas the lumbar muscles (T13 to L7) respond best to anterior translations. The transition group muscles (T10-12) respond to almost all translations. Muscles group according to vertebral level rather than muscle species. The upper thoracic muscles change little in their response with changes in stance distance (fore-hindpaw separation) and may act to stabilize the intervertebral angles of the thoracic curvature. Activity in the lumbar muscles increases along with upward rotation of the pelvis (iliac crest) as stance distance decreases. Lumbar muscles appear to stabilize the pelvis with respect to the lumbar vertebrae (L7-sacral joint). The transition zone muscles display a change in spatial tuning with stance distance, responding to many directions of translation at short distances and focusing to respond best to contralateral translations at the long stance distance.

Macpherson, J. M.; Fung, J.; Peterson, B. W. (Principal Investigator)

1998-01-01

234

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

PubMed Central

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

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

2012-01-01

235

Persistent occiput posterior.  

PubMed

Persistent occiput posterior (OP) is associated with increased rates of maternal and newborn morbidity. Its diagnosis by physical examination is challenging but is improved with bedside ultrasonography. Occiput posterior discovered in the active phase or early second stage of labor usually resolves spontaneously. When it does not, prophylactic manual rotation may decrease persistent OP and its associated complications. When delivery is indicated for arrest of descent in the setting of persistent OP, a pragmatic approach is suggested. Suspected fetal macrosomia, a biparietal diameter above the pelvic inlet or a maternal pelvis with android features should prompt cesarean delivery. Nonrotational operative vaginal delivery is appropriate when the maternal pelvis has a narrow anterior segment but ample room posteriorly, like with anthropoid features. When all other conditions are met and the fetal head arrests in an OP position in a patient with gynecoid pelvic features and ample room anteriorly, options include cesarean delivery, nonrotational operative vaginal delivery, and rotational procedures, either manual or with the use of rotational forceps. Recent literature suggests that maternal and fetal outcomes with rotational forceps are better than those reported in older series. Although not without significant challenges, a role remains for teaching and practicing selected rotational forceps operations in contemporary obstetrics. PMID:25730235

Barth, William H

2015-03-01

236

Effect of Lumbar Stabilization and Dynamic Lumbar Strengthening Exercises in Patients With Chronic Low Back Pain  

PubMed Central

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. PMID:23525973

Moon, Hye Jin; Kim, Dae Ha; Kim, Ha Jeong; Cho, Young Ki; Lee, Kwang Hee; Kim, Jung Hoo; Choi, Yoo Jung

2013-01-01

237

The effect of anterior-posterior shear on the wear of Charité TDR  

PubMed Central

Study Design An in-vitro study of the wear rates of the Charité lumbar total disc replacement. Objective To investigate the effect of anterior-posterior shear on the in-vitro wear rates of the Charité lumbar total disc replacement. Summary of Background Data Current standards prescribe only 4 degree of freedom (DOF) inputs for evaluating the in-vitro wear of total disc replacements, despite the functional spinal unit incorporating 6DOF. Anterior-posterior shear has been highlighted as a significant load, particularly in the lumbar spine. A previous study investigated the effect of an anterior-posterior shear on the ProDisc-L, finding that wear rates were not significantly different from 4DOF wear tests. Methods 6 Charité lumbar discs were mounted in a 5 active DOF spine wear simulator and tested under 4DOF (ISO18192) conditions. 6 further Charité lumbar discs were tested under 5DOF conditions, consisting of 4DOF conditions plus an anterior-posterior shear displacement of +2/-1.5mm. The displacement was decreased and then increased by a factor of 2, to investigate the effect of the magnitude of displacement. µCT scans were taken of the discs before and after wear testing, and the height loss of the discs calculated. These were compared to the same measurements taken from explanted Charite discs, µCT scanned at another institution. Results 4DOF wear rates (12.2±1.0mg/MC) were not significantly different from 4DOF tests on the ProDisc-L. Wear rates were significantly increased (p<0.01) for ‘standard’ 5DOF conditions (22.3±2.0 mg/MC), decreased 5DOF (24.3±4.9 mg/MC) and increased 5DOF (29.1±7.6mg/MC). The height loss of the explants and in-vitro tested discs were not significantly different (p>0.05). Conclusion The addition of anterior-posterior shear to wear testing inputs of the Charité lumbar total disc replacement increases the wear rate significantly, which is in direct contrast to the previous 5DOF testing on the ProDisc. This study highlights the importance of clinically relevant testing regimens, and that test inputs may be different for dissimilar design philosophies. PMID:22037530

Vicars, R; Prokopovich, P; Brown, T D; Tipper, JL; Ingham, E; Fisher, J; Hall, RM

2011-01-01

238

Spontaneous Posterior Iliac Crest Regeneration Enabling Second Bone Graft Harvest; A Case Report  

Microsoft Academic Search

We present a case of a revision spinal fusion in which successful bone graft reharvesting was performed from the posterior\\u000a iliac crest 4 years after initial intracortical harvesting. To date, only anterior iliac crest regeneration has been reported\\u000a in orthopedic trauma patients. A 70-year-old man with a history of two prior instrumented lumbar fusion operations developed\\u000a thoracolumbar kyphosis junctional to the

Elias C. Papadopoulos; Patrick F. O’Leary; Ioannis P. Pappou; Federico P. Girardi

2009-01-01

239

Work-related outcomes after lumbar fusion  

Microsoft Academic Search

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

2002-01-01

240

Case report and review of lumbar hernia  

PubMed Central

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

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

2014-01-01

241

What is a lumbar puncture? Lumbar puncture (LP), also called a spinal  

E-print Network

What is a lumbar puncture? Lumbar puncture (LP), also called a spinal tap, is the procedure doctors through) the bones of the spine until the spinal fluid is found. For testing, approxi- mately 2 to anticipate potential problems and minimize these risks. Lumbar Puncture Fact Sheet Memory & Aging Project

Baloh, Bob

242

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

PubMed Central

In the treatment of multilevel degenerative disorders of the lumbar spine, spondylodesis plays a controversial role. Most patients can be treated conservatively with success. Multilevel lumbar fusion with instrumentation is associated with severe complications like failed back surgery syndrome, implant failure, and adjacent segment disease (ASD). This retrospective study examines the records of 70 elderly patients with degenerative changes or instability of the lumbar spine treated between 2002 and 2007 with spondylodesis of more than two segments. Sixty-four patients were included; 5 patients had died and one patient was lost to follow-up. We evaluated complications, clinical/radiological outcomes, and success of fusion. Flexion-extension and standing X-rays in two planes, MRI, and/or CT scans were obtained pre-operatively. Patients were assessed clinically using the Oswestry disability index (ODI) and a Visual Analogue Scale (VAS). Surgery performed was dorsolateral fusion (46.9%) or dorsal fusion with anterior lumbar interbody fusion (ALIF; 53.1%). Additional decompression was carried out in 37.5% of patients. Mean follow-up was 29.4±5.4 months. Average patient age was 64.7±4.3 years. Clinical outcomes were not satisfactory for all patients. VAS scores improved from 8.6±1.3 to 5.6±3.0 pre- to post-operatively, without statistical significance. ODI was also not significantly improved (56.1±22.3 pre- and 45.1±26.4 post-operatively). Successful fusion, defined as adequate bone mass with trabeculation at the facets and transverse processes or in the intervertebral segments, did not correlate with good clinical outcomes. Thirty-five of 64 patients (54%) showed signs of pedicle screw loosening, especially of the screws at S1. However, only 7 of these 35 (20%) complained of corresponding back pain. Revision surgery was required in 24 of 64 patients (38%). Of these, indications were adjacent segment disease (16 cases), pedicle screw loosening (7 cases), and infection (one case). At follow-up of 29.4 months, patients with radiographic ASD had worse ODI scores than patients without (54.7 vs. 36.6; P<0.001). Multilevel fusion for degenerative disease still has a high rate of complications, up to 50%. The problem of adjacent segment disease after fusion surgery has not yet been solved. This study underscores the need for strict indication guidelines to perform lumbar spine fusion of more than two levels. PMID:21808698

Röllinghoff, Marc; Schlüter-Brust, Klaus; Groos, Daniel; Sobottke, Rolf; Michael, Joern William-Patrick; Eysel, Peer; Delank, Karl Stefan

2010-01-01

243

Corneal topography of posterior keratoconus.  

PubMed

Posterior keratoconus is an unusual abnormality of the cornea generally classified as one of the anterior chamber cleavage anomalies. It is characterized clinically by the presence of a circumscribed or generalized corneal thinning with posterior depression of the cornea and is considered distinct from keratoconus. Although patients with posterior keratoconus may have visual complaints clearly related to their abnormal corneas, the surface topography of these corneas has not been studied in detail. Keratometry and photokeratoscopy provide an incomplete picture of the surface geometry of posterior keratoconus. We utilized computer assisted topographic analysis to study the cornea of a patient with posterior keratoconus. The Topographic Modeling System demonstrated that the patient's cornea showed a central steepened "cone" coincident with the area of circumscribed posterior keratoconus as well as paracentral flattening. This report documents the topographic abnormality in this rare disorder. PMID:1424657

Mannis, M J; Lightman, J; Plotnik, R D

1992-07-01

244

Automated quantification of lumbar vertebral kinematics from dynamic fluoroscopic sequences  

NASA Astrophysics Data System (ADS)

We hypothesize that the vertebra-to-vertebra patterns of spinal flexion and extension motion of persons with lower back pain will differ from those of persons who are pain-free. Thus, it is our goal to measure the motion of individual lumbar vertebrae noninvasively from dynamic fluoroscopic sequences. Two-dimensional normalized mutual information-based image registration was used to track frame-to-frame motion. Software was developed that required the operator to identify each vertebra on the first frame of the sequence using a four-point "caliper" placed at the posterior and anterior edges of the inferior and superior end plates of the target vertebrae. The program then resolved the individual motions of each vertebra independently throughout the entire sequence. To validate the technique, 6 cadaveric lumbar spine specimens were potted in polymethylmethacrylate and instrumented with optoelectric sensors. The specimens were then placed in a custom dynamic spine simulator and moved through flexion-extension cycles while kinematic data and fluoroscopic sequences were simultaneously acquired. We found strong correlation between the absolute flexionextension range of motion of each vertebra as recorded by the optoelectric system and as determined from the fluoroscopic sequence via registration. We conclude that this method is a viable way of noninvasively assessing twodimensional vertebral motion.

Camp, Jon; Zhao, Kristin; Morel, Etienne; White, Dan; Magnuson, Dixon; Gay, Ralph; An, Kai-Nan; Robb, Richard

2009-02-01

245

Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease  

Microsoft Academic Search

There are very few studies with more than 20 years' follow-up of lumbar spine fusions for disc degeneration. Currently, there is a lot of interest in the subject of degenerative changes above the level of fusion; this study is concerned with such changes in the very long term (30 years). Twenty-eight patients showing sound fusion on radiographs following posterior midline

Malhar N. Kumar; Frederic Jacquot

2001-01-01

246

Novel posterior fixation keratoprosthesis  

NASA Astrophysics Data System (ADS)

The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.

Lacombe, Emmanuel

1992-08-01

247

The Effects of Single-Level Instrumented Lumbar Laminectomy on Adjacent Spinal Biomechanics  

PubMed Central

Study Design?Biomechanical study. Objective?Posterior instrumentation is used to stabilize the spine after a lumbar laminectomy. However, the effects on the adjacent segmental stability are unknown. Therefore, we studied the range of motion (ROM) and stiffness of treated lumbar spinal segments and cranial segments after a laminectomy and after posterior instrumentation in flexion and extension (FE), lateral bending (LB), and axial rotation (AR). These outcomes might help to better understand adjacent segment disease (ASD), which is reported cranial to the level on which posterior instrumentation is applied. Methods?We obtained 12 cadaveric human lumbar spines. Spines were axially loaded with 250?N for 1 hour. Thereafter, 10 consecutive load cycles (4 Nm) were applied in FE, LB, and AR. Subsequently, a laminectomy was performed either at L2 or at L4. Thereafter, load-deformation tests were repeated, after similar preloading. Finally, posterior instrumentation was added to the level treated with a laminectomy before testing was repeated. The ROM and stiffness of the treated, the cranial adjacent, and the control segments were calculated from the load-displacement data. Repeated-measures analyses of variance used the spinal level as the between-subject factor and a laminectomy or instrumentation as the within-subject factors. Results?After the laminectomy, the ROM increased (+19.4%) and the stiffness decreased (?18.0%) in AR. The ROM in AR of the adjacent segments also increased (+11.0%). The ROM of treated segments after instrumentation decreased in FE (?74.3%), LB (?71.6%), and AR (?59.8%). In the adjacent segments after instrumentation, only the ROM in LB was changed (?12.9%). Conclusions?The present findings do not substantiate a biomechanical pathway toward or explanation for ASD. PMID:25649753

Bisschop, Arno; Holewijn, Roderick M.; Kingma, Idsart; Stadhouder, Agnita; Vergroesen, Pieter-Paul A.; van der Veen, Albert J.; van Dieën, Jaap H.; van Royen, Barend J.

2014-01-01

248

Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature  

PubMed Central

The objective of this study is to evaluate the effectiveness and safety of total disc replacement surgery compared with spinal fusion in patients with symptomatic lumbar disc degeneration. Low back pain (LBP), a major health problem in Western countries, can be caused by a variety of pathologies, one of which is degenerative disc disease (DDD). When conservative treatment fails, surgery might be considered. For a long time, lumbar fusion has been the “gold standard” of surgical treatment for DDD. Total disc replacement (TDR) has increased in popularity as an alternative for lumbar fusion. A comprehensive systematic literature search was performed up to October 2008. Two reviewers independently checked all retrieved titles and abstracts, and relevant full text articles for inclusion. Two reviewers independently assessed the risk of bias of included studies and extracted relevant data and outcomes. Three randomized controlled trials and 16 prospective cohort studies were identified. In all three trials, the total disc replacement was compared with lumbar fusion techniques. The Charité trial (designed as a non-inferiority trail) was considered to have a low risk of bias for the 2-year follow up, but a high risk of bias for the 5-year follow up. The Charité artificial disc was non-inferior to the BAK® Interbody Fusion System on a composite outcome of “clinical success” (57.1 vs. 46.5%, for the 2-year follow up; 57.8 vs. 51.2% for the 5-year follow up). There were no statistically significant differences in mean pain and physical function scores. The Prodisc artificial disc (also designed as a non-inferiority trail) was found to be statistically significant more effective when compared with the lumbar circumferential fusion on the composite outcome of “clinical success” (53.4 vs. 40.8%), but the risk of bias of this study was high. Moreover, there were no statistically significant differences in mean pain and physical function scores. The Flexicore trial, with a high risk of bias, found no clinical relevant differences on pain and physical function when compared with circumferential spinal fusion at 2-year follow up. Because these are preliminary results, in addition to the high risk of bias, no conclusions can be drawn based on this study. In general, these results suggest that no clinical relevant differences between the total disc replacement and fusion techniques. The overall success rates in both treatment groups were small. Complications related to the surgical approach ranged from 2.1 to 18.7%, prosthesis related complications from 2.0 to 39.3%, treatment related complications from 1.9 to 62.0% and general complications from 1.0 to 14.0%. Reoperation at the index level was reported in 1.0 to 28.6% of the patients. In the three trials published, overall complication rates ranged from 7.3 to 29.1% in the TDR group and from 6.3 to 50.2% in the fusion group. The overall reoperation rate at index-level ranged from 3.7 to 11.4% in the TDR group and from 5.4 to 26.1% in the fusion group. In conclusion, there is low quality evidence that the Charité is non-inferior to the BAK cage at the 2-year follow up on the primary outcome measures. For the 5-year follow up, the same conclusion is supported only by very low quality evidence. For the ProDisc, there is very low quality evidence for contradictory results on the primary outcome measures when compared with anterior lumbar circumferential fusion. High quality randomized controlled trials with relevant control group and long-term follow-up is needed to evaluate the effectiveness and safety of TDR. PMID:20508954

van den Eerenbeemt, Karin D.; van Royen, Barend J.; Peul, Wilco C.; van Tulder, Maurits W.

2010-01-01

249

Lumbar Intervertebral Disc Puncture under C-arm Fluoroscopy: a New Rat Model of Lumbar Intervertebral Disc Degeneration  

PubMed Central

To establish a minimally invasive rat model of lumbar intervertebral disc degeneration (IDD) to better understand the pathophysiology of the human condition. The annulus fibrosus of lumbar level 4–5 (L4-5) and L5-6 discs were punctured by 27-gauge needles using the posterior approach under C-arm fluoroscopic guidance. Magnetic resonance imaging (MRI), histological examination by hematoxylin and eosin (H&E) staining, and reverse transcription polymerase chain reaction (RT-PCR) were performed at baseline and 2, 4, and 8 weeks after disc puncture surgery to determine the degree of degeneration. All sixty discs (thirty rats) were punctured successfully. Only two of thirty rats subjected to the procedure exhibited immediate neurological symptoms. The MRI results indicated a gradual increase in Pfirrmann grade from 4 to 8 weeks post-surgery (P<0.05), and H&E staining demonstrated a parallel increase in histological grade (P<0.05). Expression levels of aggrecan, type II collagen (Col2), and Sox9 mRNAs, which encode disc components, decreased gradually post-surgery. In contrast, mRNA expression of type I collagen (Col1), an indicator of fibrosis, increased (P<0.05). The procedure of annular puncture using a 27-gauge needle under C-arm fluoroscopic guidance had a high success rate. Histological, MRI, and RT-PCR results revealed that the rat model of disc degeneration is a progressive pathological process that is similar to human IDD. PMID:24770648

Li, Dapeng; Yang, Huilin; Huang, Yonghui; Wu, Yan; Sun, Taicun; Li, Xuefeng

2014-01-01

250

Lumbar laminectomy with segmental continuous epidural anesthesia  

PubMed Central

Lumbar laminectomies are usually performed under general anesthesia in the prone position. We report a case of lumbar laminectomy done under segmental continuous epidural anesthesia, so that direct visual intra-operative monitoring of the motor and sensory component of the lower extremities was possible.

Kiran, Lakkam Vamsee; Radhika, Kusuma Srividhya; Parthasarathy, S.

2014-01-01

251

PEEK Versus Ti Interbody Fusion Devices: Resultant Fusion, Bone Apposition, Initial and 26 Week Biomechanics.  

PubMed

STUDY DESIGN:: Comparative evaluation of in vitro and in vivo biomechanics, resulting fusion and histomorphometric aspects of Polyetheretherketone (PEEK) versus Titanium (Ti) interbody fusion devices in an animal model with similar volumes of bone graft. OBJECTIVE:: Identify differences in the characteristics of fusion and biomechanics immediately following implantation (time zero) and at 26 weeks with each interbody implant. SUMMARY OF BACKGROUND DATA:: PEEK has been well accepted in spinal surgery, it provides a closer match to the mechanical properties of bone than metallic implants such as titanium. This is thought to reduce graft stress shielding and subsidence of interbody fusion devices. There remains controversy as to the overall influence of this as a factor influencing resultant fusion and initial stability. While material modulus is one factor of importance, other design factors are likely to play a large role determining overall performance of an interbody implant. METHODS:: A Ti and PEEK device of similar size with a central void to accommodate graft material were compared. The PEEK device had a ridged surface on the caudal and cephalad surfaces, while Ti device allowed axial compliance and had bone ingrowth endplates and polished internal surfaces. A two level ALIF was performed in 9 sheep and fusion, biomechanics, and bone apposition were evaluated at 26 weeks. Time zero in vitro biomechanical tests were performed to establish initial stability immediately following implantation. RESULTS:: No differences were detected in the biomechanical measures of each of the devices in in vitro time zero tests. All levels were fused by 26 weeks with considerably lower Range of Motion (ROM) when compared to in vitro tests. ROM in all modes of bending was reduced by over 70% when compared to intact values for Axial Rotation (Ti-74%, PEEK-71%), Lateral Bending (Ti-90%, PEEK-88%) and Flexion/Extension (Ti-92%, PEEK-91%). Mechanical properties of fusions formed with each implant did not differ, however bone apposition was variable with polished internal Ti surfaces being lower than PEEK and treated Ti endplates showing the greatest levels. Graft material displayed axial trabecular alignment with both implants. CONCLUSIONS:: Although material properties and surface characteristics resulted in differing amounts of biological integration from the host, both implants were capable of producing excellent fusion results using similar volumes of bone graft. PMID:22801456

Pelletier, Matthew; Cordaro, Nicholas; Lau, Abe; Walsh, William R

2012-07-13

252

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

Microsoft Academic Search

BACKGROUND: Lumbosacral fusion is a relatively common procedure that is used in the management of an unstable spine. The anterior interbody cage has been involved to enhance the stability of a pedicle screw construct used at the lumbosacral junction. Biomechanical differences between polyaxial and monoaxial pedicle screws linked with various rod contours were investigated to analyze the respective effects on

Shih-Hao Chen; Ruey Mo Lin; Hsiang-Ho Chen; Kai-Jow Tsai

2007-01-01

253

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

Microsoft Academic Search

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine which technique of anterior cervical interbody fusion (ACIF) gives the best outcome in patients with cervical degenerative disc disease. SUMMARY OF BACKGROUND DATA: The number of surgical techniques for decompression and ACIF as treatment for cervical degenerative disc disease has increased rapidly, but the rationale for the choice

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

2011-01-01

254

Recidive of renal cell carcinoma tumor thrombus in inferior vena cava via lumbar vein.  

PubMed

Renal cell carcinoma (RCC) develops tumor thrombus in the renal vein and inferior vena cava (IVC) in 10% of cases. Surgical treatment is radical nephrectomy and thrombectomy of the IVC. Local recidive can develop in the lumbar fossa, lymph nodes, and the IVC. We report a 58-year-old patient admitted to the Clinic for Urology at the Military Medical Academy, Belgrade, Serbia, in February 2009 with RCC of the left kidney and tumor thrombus in the IVC. After ultrasonography exam and multislice computed tomography scan, we performed radical nephrectomy and thrombectomy of the IVC (level II). Four months after the operation, ultrasound exam and cavography showed intracaval and paracaval recidive tumor masses in the renal part of the IVC. On operation we removed intraluminal IVC thrombus, which arises from the lumbar vein on the IVC posterior wall, with paracaval thrombus in the lumbar vein. We conclude that RCC tumor thrombus can spread from the kidney to the IVC through the lumbar vein. PMID:21309423

Tomi?, Aleksandar; Milovi?, Novak

2010-01-01

255

Lumbar spine surgery in athletes:: outcomes and return-to-play criteria.  

PubMed

Surgical treatment of lumbar spine conditions in athletes can produce excellent outcomes. Professional and competitive athletes participating in both noncontact and contact sports can return to their preinjury level of performance and have successful careers after lumbar discectomy for LDH. NFL players, especially offensive and defensive linemen, may experience greater improvement with lumbar discectomy than nonoperative treatment. Athletes who undergo direct pars repair for spondylolysis or grade I spondylolisthesis may be able to return to sports but their participation level may vary. Athletes and military personnel who undergo lumbar TDR are capable of returning to rigorous activities, including contact and extreme sports and unrestricted full-service military duty. Distal fusion level may be an independent negative predictor of successful RTP after posterior spinal fusion for adolescent idiopathic scoliosis. There is great variability in published RTP criteria, which are based primarily on authors’ opinions and experience. Athletes must demonstrate resolution of preoperative symptoms, full range of motion, and successful completion of a structured rehabilitation program before returning to play. Physicians must ultimately base their decision to release an athlete back to sport on each individual’s condition and on the chosen sport. PMID:22657997

Li, Ying; Hresko, M Timothy

2012-07-01

256

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

PubMed

A comprehensive economic analysis generally involves the calculation of indirect and direct health costs from a societal perspective as opposed to simply reporting costs from a hospital or payer perspective. Hospital charges for a surgical procedure must be converted to cost data when performing a cost-effectiveness analysis. Once cost data has been calculated, quality-adjusted life year data from a surgical treatment are calculated by using a preference-based health-related quality-of-life instrument such as the EQ-5D. A recent cost-utility analysis from a single study has demonstrated the long-term (over an 8-year time period) benefits of circumferential fusions over stand-alone posterolateral fusions. In addition, economic analysis from a single study has found that lumbar fusion for selected patients with low-back pain can be recommended from an economic perspective. Recent economic analysis, from a single study, finds that femoral ring allograft might be more cost-effective compared with a specific titanium cage when performing an anterior lumbar interbody fusion plus posterolateral fusion. PMID:24980580

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

2014-07-01

257

Posterior cortical atrophy: Unique features  

Microsoft Academic Search

Posterior cortical atrophy (PCA) is a visual-cognitive syndrome caused by Creutzfeldt-Jakob disease (CJD), Alzheimer's disease (AD), or subcortical gliosis. We report a case of posterior cortical atrophy unique in (1) comprehensive documentation of clinical, radiologic, electroencephalograph, metabolic and histopathologic findings, (2) repeated clinical and laboratory assessment, and (3) establishment of unique occipital subcortical gliosis in a patient with AD. Clinical

T. Tom; J. L. Cummings; J. Pollak

1998-01-01

258

Does Vertebral Endplate Morphology Influence Outcomes in Lumbar Disc Arthroplasty? Part I: An Initial Assessment of a Novel Classification System of Lumbar Endplate Morphology  

PubMed Central

Background The influence of lumbar endplate morphology on the clinical and radiographic outcomes of lumbar disc arthroplasty has not been evaluated to the best of our knowledge. Study Design and Objective In this observational study of 80 patients, the objective was to formulate a reproducible and valid lumbar endplate classification system to be used in evaluating lumbar total disc replacement patients. Methods A novel vertebral endplate morphology classification system was formulated after review of data related to 80 patients enrolled in a prospective, randomized clinical trial in conjunction with an application for a US Food and Drug Administration investigational device exemption. Intraobserver and interobserver analyses of the classification system were performed on the same 80 patients utilizing the classification system. Results The initial review of the radiographs revealed 5 types of endplates: Type I (n = 82) flat endplates; Type II (n = 26) posterior lip; Type III (n = 5) central concavity; Type IV (n = 4) anterior sloping endplate; and Type V (n = 2) combination of Types I—IV. The intraobserver kappa was 0.66 and the interobserver kappa was 0.51. These kappa values indicate “substantial” to “moderate” reproducibility, respectively. Conclusions In this study, we propose a lumbar endplate classification system to be used in the preoperative assessment of patients undergoing lumbar disc arthroplasty. The classification can function as a basis for comparison and discussion among arthroplasty clinicians, and serve as a possible exclusionary screening tool for disc arthroplasty. Special consideration should be given to Type II endplates to optimize proper positioning and functioning of a total disc replacement (TDR) implant. Further outcome studies are warranted to assess the clinical significance of this classification system. The key points of our study are: (1) We present a novel lumbar vertebral endplate classification system; (2) Five types of endplates were identified and classified; (3) Intraobserver and interobserver reliability were classified as substantial and moderate, respectively; and (4) The classification system used may assist in the preoperative evaluation of patients for total disc replacement. Level of Evidence A systematic review of cohort studies (level 2a).

Yue, James J.; Oetgen, Matthew E.; la Torre, Jorge J. Jaramillo-de; Bertagnoli, Rudolf

2008-01-01

259

Finite Element Study of Matched Paired Posterior Disc Implant and Dynamic Stabilizer (360° Motion Preservation System)  

PubMed Central

Background Anterior lumbar disc replacements are used to restore spinal alignment and kinematics of a degenerated segment. Compared to fusion of the segment, disc replacements may prevent adjacent segment degeneration. To resolve some of the deficiencies of anterior lumbar arthroplasty, such as the approach itself, difficulty of revision, and postoperative facet pain, 360° motion preservation systems based on posterior disc and posterior dynamic system (PDS) designs are being pursued. These systems are easier to revise and address all the pain generators in a motion segment, including the nerves, facets, and disc. However, biomechanics of the 360° posterior motion preservation system, including the contributions of the 2 subsystems (disc and PDS), are sparsely reported in the literature.nds. Methods An experimentally validated 3-dimensional finite element model of the ligamentous L3-S1 segment was used to investigate the differences in biomechanical behavior of the lumbar spine. A single-level 360° posterior motion preservation system and its individual components in various orientations were simulated and compared with an intact model. Appropriate posterior surgical procedures were simulated. The PDS, a curved device with male and female components, was attached to the pedicle screws. The finite element models were subjected to 400 N of follower load plus 10Nm moment in extension and flexion. Results The PDS restored flexion/extension motion to normal. The artificial disc led to increases in range of motion (ROM) compared with the intact model. ROM for the 360° system at the implanted and adjacent levels were similar to those of the respective intact levels. ROM was similar whether the discs were placed (a) both parallel to the midsagittal plane, (b) both angled 20° to the midsagittal plane, and (c) one at 20° and one parallel to the midsagittal plane. However, the stresses were slightly higher in the nonparallel disc configuration than in the parallel disc configuration, both in flexion and extension modes. Conclusions Posterior disc replacement with PDS restored the kinematics of the spine at all levels to near normal. In addition, placing the discs in a nonparallel configuration with respect to the midsagittal plane does not affect the functionality of the discs compared with parallel placement. Posterior disc replacement alone is not sufficient to restore the segment biomechanics to normal levels. Clinical Relevance Finite element analysis results show that, unlike implants for fusion, PDS and posterior discs together (360° motion preservation system) are needed to preserve ROM. Such systems will prevent adjacent level degeneration and address pain from various spinal components, including facets.

Kiapour, Ali; Faizan, Ahmed; Krishna, Manoj; Friesem, Tai

2007-01-01

260

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

PubMed Central

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. PMID:23662211

Kaner, Tuncay; Ozer, Ali Fahir

2013-01-01

261

Computed tomography of thoracic and lumbar spine fractures that have been treated with Harrington instrumentation  

SciTech Connect

Twenty patients with fractures of the thoracic and lumbar spine underwent computed tomography (CT) following Harrington distraction instrumentation and a spinal fusion. CT was done to search for a cause of persistent cord or nerve root compression in those patients who failed to improve and completely recover their partial neurologic deficit (14 cases). The most common abnormality was the presence of residual bone fragments originating in the burst fracture of a vertebral body displaced posteriorly, into the spinal canal. In patients with complications in the late recovery period, CT found exuberant callus indenting the canal or lack of fusion of the bone grafts placed in the anterolateral aspect of the vertebral bodies. This experience indicates that CT is the modality of choice for spinal canal evaluation in those patients who fail to have an optimal clinical course following fractures of the thoracic and lumbar spine treated with Harrington rods.

Golimbu, C.; Firooznia, H.; Rafii, M.; Engler, G.; Delman, A.

1984-06-01

262

A posterior approach for inspection of reduction of sacroiliac joint disruption.  

PubMed

This anatomic study was undertaken to describe a new posterior approach enabling direct inspection of reduction of sacroiliac joint disruption (SIJD), and guidance of iliosacral screw placement. The reduction of SIJD is usually monitored by inspection of the opposing sacrum and ilium at the posterior margin of the greater sciatic notch and there is a relative lack of information concerning inspection of reduction of SIJD from the posterosuperior aspect of the sacroiliac joint surface. Ten cadavers were dissected to determine the possibility of inspecting reduction of SIJD from the posterosuperior aspect of the sacroiliac joint by means of a posterior approach which passed immediately lateral to the deep back muscles and the fifth lumbar transverse process. The results indicated that the posterosuperior aspect of the sacroiliac joint surface and sacral ala can be directly palpated or visualised. This approach facilitates improved access for inspection of reduction of SIJD and guidance of iliosacral screw placement. PMID:10635092

Ebraheim, N A; Lu, J; Heck, B E; Yeasting, R A

1999-01-01

263

Radiation therapy: posterior segment complications.  

PubMed

Therapeutic radiation to the posterior segment of the eye is a common option for posterior segment tumors. Such tumors are often malignant, but sometimes, benign neoplasms are treated with ionizing radiation. Also, non-neoplastic intraocular lesions like wet age-related macular degeneration may be treated with radiotherapy. Orbital disease, both neoplastic lesions like optic nerve sheath meningioma and non-neoplastic entities like Graves' ophthalmopathy may be treated with radiotherapy and this may include radiation of the optic nerve and posterior segment of the eye. Occasionally, radiotherapy of extraocular malignant disease, involving, e.g. the paranasal sinuses, may cause significant radiation damage to the eye. Complications after radiation to the posterior segment of the eye are largely related to the radiation dose to the posterior segment. The amount of irradiated volume of normal tissue and fractionation are also important for the development of radiation complications to the posterior segment. Radiation retinopathy is the most common complication of the posterior segment, but radiation optic neuropathy also occurs frequently. Radiation scleral necrosis is less frequent probably due to the radioresistance of the scleral collagen. These complications have the potential to cause blindness (radiation retinopathy and optic neuropathy) or enucleation of the eye (scleral necrosis). Although numerous treatments have been advocated, management of radiation-induced damage remains controversial. Efficacy for any treatment still needs to be proven and, if possible, the best option by far is to minimize radiation changes to normal tissue. PMID:23989132

Seregard, Stefan; Pelayes, David E; Singh, Arun D

2013-01-01

264

Prevalence and Distribution of Thoracic and Lumbar Compressive Lesions in Cervical Spondylotic Myelopathy  

PubMed Central

Study Design Retrospective cross-sectional study. Purpose This study analyzed the prevalence and distribution of horacic and lumbar compressive lesions in cervical spondylotic myelopathy as well as their relationships with cervical developmental spinal canal stenosis (DCS) by using whole-spine postmyelographic computed tomography. Overview of Literature There are few studies on missed compressive lesions of the spinal cord or cauda equina at the thoracolumbar level in cervical spondylotic myelopathy. Furthermore, the relationships between DCS, and the prevalence and distribution of thoracic and lumbar compressive lesions are unknown. Methods Eighty patients with symptomatic cervical spondylotic myelopathy were evaluated. Preoperative image data were obtained. Patients were classified as DCS or non-DCS (n=40 each) if their spinal canal longitudinal diameter was <12 mm at any level or ?12 mm at all levels, respectively. Compressive lesions in the anterior and anteroposterior parts, ligamentum flavum ossification, posterior longitudinal ligament ossification, and spinal cord tumors at the thoracolumbar levels were analyzed. Results Compressive lesions in the anterior and anteroposterior parts were observed in 13 (16.3%) and 45 (56.3%) patients, respectively. Ligamentum flavum and posterior longitudinal ligament ossification were observed in 19 (23.8%) and 3 (3.8%) patients, respectively. No spinal cord tumors were observed. Thoracic and lumbar compressive lesions of various causes tended to be more common in DCS patients than non-DCS patients, although the difference was statistically insignificant. Conclusions Surveying compressive lesions and considering the thoracic and lumbar level in cervical spondylotic myelopathy in DCS patients are important for preventing unexpected neurological deterioration and predicting accurate neurological condition after cervical surgery.

Kodera, Ryuzo; Yoshiiwa, Toyomi; Kawano, Masanori; Kaku, Nobuhiro; Tsumura, Hiroshi

2015-01-01

265

Posterior sampling with improved efficiency  

SciTech Connect

The Markov Chain Monte Carlo (MCMC) technique provides a means to generate a random sequence of model realizations that sample the posterior probability distribution of a Bayesian analysis. That sequence may be used to make inferences about the model uncertainties that derive from measurement uncertainties. This paper presents an approach to improving the efficiency of the Metropolis approach to MCMC by incorporating an approximation to the covariance matrix of the posterior distribution. The covariance matrix is approximated using the update formula from the BFGS quasi-Newton optimization algorithm. Examples are given for uncorrelated and correlated multidimensional Gaussian posterior distributions.

Hanson, K.M.; Cunningham, G.S.

1998-12-01

266

ISASS Policy Statement – Lumbar Artificial Disc  

PubMed Central

Purpose The primary goal of this Policy Statement is to educate patients, physicians, medical providers, reviewers, adjustors, case managers, insurers, and all others involved or affected by insurance coverage decisions regarding lumbar disc replacement surgery. Procedures This Policy Statement was developed by a panel of physicians selected by the Board of Directors of ISASS for their expertise and experience with lumbar TDR. The panel's recommendation was entirely based on the best evidence-based scientific research available regarding the safety and effectiveness of lumbar TDR. PMID:25785243

Garcia, Rolando

2015-01-01

267

[Microsurgical decompression of lumbar spinal stenosis].  

PubMed

Lumbar spinal stenosis in most cases is due to progressive degeneration of the spine, resulting in thickening of facet joints and flaval ligament. Thus the diameter of the lumbar spinal canal is reduced to less than 12 mm in the AP direction. Typically complaints consist in neurogenic claudication. Patients usually experience improvement of pain when bending their back or walking up a hill. Diagnosis of lumbar spinal stenosis is confirmed by MRI. CT myelography may help detect where compression is most pronounced. Surgical treatment should be based on the clinical symptoms of the mostly elderly people and should be performed as microsurgical decompression or in cases of clinical instability as TLIF. PMID:20480133

Drumm, J; Branea, I; Pitzen, T

2010-06-01

268

Gonadal dose reduction in lumbar spine radiography  

SciTech Connect

Different ways to minimize the gonadal dose in lumbar spine radiography have been studied. Two hundred and fifty lumbar spine radiographs were reviewed to assess the clinical need for lateral L5/S1 projection. Modern film/screen combinations and gonadal shielding of externally scattered radiation play a major role in the reduction of the genetic dose. The number of exposures should be minimized. Our results show that two projections, anteroposterior (AP) and lateral, appear to be sufficient in routine radiography of the lumbar spine.

Moilanen, A.; Kokko, M.L.; Pitkaenen, M.

1983-02-01

269

Interspinous posterior devices: What is the real surgical indication?  

PubMed Central

Interspinous posterior device (IPD) is a term used to identify a relatively recent group of implants used to treat lumbar spinal degenerative disease. This kind of device is classified as part of the group of the dynamic stabilization systems of the spine. The concept of dynamic stabilization has been replaced by that of dynamic neutralization of hypermobility, with the intention of clarifying that the primary aim of this kind of system is not the preservation of the movement, but the dynamic neutralization of the segmental hypermobility which is at the root of the pathological condition. The indications for the implantation of an IPD are spinal stenosis and neurogenic claudication, assuming that its function is the enlargement of the neural foramen and the decompression of the roots forming the cauda equina in the central part of the vertebral canal. In the last 10 years, use of these implants has been very common but to date, no long-term clinical follow-up regarding clinical and radiological aspects are available. The high rate of reoperation, recurrence of symptoms and progression of degenerative changes is evident in the literature. If these devices are effectively a miracle cure for lumbar spinal stenosis, why do the utilization and implantation of IPD remain extremely controversial and should they be investigated further? Excluding the problems related to the high cost of the device, the main problem remains the pathological substrate on which the device is explicit in its action: the degenerative pathology of the spine. PMID:25232541

Landi, Alessandro

2014-01-01

270

Interspinous spacer decompression (X-STOP) for lumbar spinal stenosis and degenerative disk disease: a multicenter study with a minimum 3-year follow-up.  

PubMed

Interspinous distraction devices provide an effective treatment for patients suffering from lumbar spinal stenosis and/or degenerative disk disease. The aim of this multicenter study was the prospective evaluation of patients treated for symptomatic lumbar spinal stenosis with interspinous process decompression (IPD) implants compared with a population of patients managed with conservative treatment. 542 patients affected by symptomatic lumbar spine degenerative disease were enrolled in a controlled trial. 422 patients underwent surgical treatment consisting of X-STOP device implantation, whereas 120 control cases were managed conservatively. Both patient groups underwent follow-up evaluations at 6, 12, 24, and 36 months using the Zurich Claudication Questionnaire, the Visual Analog Scale score and spinal lumbar X-rays, CT scans and MR imaging. One-year follow-up evaluation revealed positive good results in the 83.5% of patients treated with IPD with respect to 50% of the nonoperative group cases. During the first three years, in 38 out of the 120 control cases, a posterior decompression and/or spinal fixation was performed because of unsatisfactory results of the conservative therapy. In 24 of 422 patients, the IPD device had to be removed, and a decompression and/or pedicle screw fixation was performed because of the worsening of neurological symptoms. Our results support the effectiveness of surgery in patients with stenosis. IPD may offer an effective and less invasive alternative to classical microsurgical posterior decompression in selected patients with spinal stenosis and lumbar degenerative disk diseases. PMID:25064150

Puzzilli, Fabrizio; Gazzeri, Roberto; Galarza, Marcelo; Neroni, Massimiliano; Panagiotopoulos, Konstantinos; Bolognini, Andrea; Callovini, Giorgio; Agrillo, Umberto; Alfieri, Alex

2014-09-01

271

Posterior Tibial Tendon Dysfunction (PTTD)  

MedlinePLUS

... ACFAS | Información en Español Advanced Search Home » Foot & Ankle Conditions » Posterior Tibial Tendon Dysfunction (PTTD) Text Size ... the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. ...

272

[Occupation and lumbar disk prolapse].  

PubMed

All Danish occupational groups were screened for an increased risk of hospitalization due to a prolapsed lumbar intervertebral disc (PLID) (ICD-8: 725.11). A cohort of all gainfully employed Danes aged 20 to 59 years in 1981 was followed-up for 10 years for first hospitalization with PLID. A Standardized Hospitalization Ratio was calculated using all economically active persons as the reference group. Male groups with an elevated risk were found in building and construction, the iron and metal industry, in the food and nutrition sector and in occupational driving. Almost all groups of professional drivers had an elevated risk. Female groups with an elevated risk were mainly found in the same industries, but home helps, service workers in the private sector and sewing machine operators also had an elevated risk. We conclude that there are significant and systematic differences between occupational groups as concerns the risk of hospital admission due to PLID. PMID:7725550

Jensen, M V; Tüchsen, F

1995-03-13

273

Posterior skull surgery in craniosynostosis  

Microsoft Academic Search

In 1984, two young infants with unusual “clover-leaf” patterns of skull deformity were treated by posterior skull-releasing surgery that dramatically improved their overall skull shape, to the extent that further operative intervention was not required. This focused our attention on the posterior skull and its role in craniosynostosis. In cases of multi-suture craniosynostosis and craniofacial syndromes severely raised intracranial pressure

S. Sgouros; J. H. Goldin; A. D. Hockley; M. J. C. Wake

1996-01-01

274

Lumbar plexopathy as a complication of percutaneous nephrolithotomy in a horseshoe kidney  

PubMed Central

Treatment of nephrolithiasis in horseshoe kidneys can be challenging due to anomalies in renal position, collecting system anatomy and vascular supply. We report on a patient who was referred after a failed percutaneous nephrolithotomy for a left moiety staghorn calculus in a horseshoe kidney. Two punctures had been performed involving upper and middle posterior calyces. Both were very medially placed and inadvertently traversed the psoas muscle, resulting in lumbar plexopathy with permanent deficit. This complication presented postoperatively with left leg weakness, paresthesia, and pain which impaired independent ambulation. The patient went on to be successfully treated for her stone disease with robotic-assisted laparoscopic pyelolithotomy. PMID:25737767

Lantz, Andrea G.; Honey, R. John D’A

2015-01-01

275

Fractures of the Thoracic and Lumbar Spine  

MedlinePLUS

... thoracic and lumbar spine. At the accident scene, EMS rescue workers will ? rst check vital signs, ... of Orthopaedic Surgeons. Before moving the patient, the EMS team must immobilize the patient in a cervical ( ...

276

Posteroanterior versus anteroposterior lumbar spine radiology  

SciTech Connect

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

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

1990-03-01

277

Design concepts in lumbar total disc arthroplasty  

Microsoft Academic Search

The implantation of lumbar disc prostheses based on different design concepts is widely accepted. This paper reviews currently\\u000a available literature studies on the biomechanics of TDA in the lumbar spine, and is targeted at the evaluation of possible\\u000a relationships between the aims of TDA and the geometrical, mechanical and material properties of the various available disc\\u000a prostheses. Both theoretical and

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

2008-01-01

278

STIR Sequence for Depiction of Degenerative Changes in Posterior Stabilizing Elements in Patients with Lower Back Pain  

Microsoft Academic Search

OBJECTIVE. The aims of this study were to investigate whether degenerative posterior paraspinal changes are a cause of lower back pain and to determine the age- and sex-related distribution of these changes on MR images acquired with a STIR sequence. SuBJECTS AND METHODS. The lumbar MRI findings of 372 patients (141 men, 231 women; mean age, 51.2 years) with nonradicular

Hatice Lakadamyali; Nefise Cagla Tarhan; Tarkan Ergun; Banu Cakir; Ahmet Muhtesem Agildere

2008-01-01

279

The effect of complex training on the children with all of the deformities including forward head, rounded shoulder posture, and lumbar lordosis.  

PubMed

The purpose of this study is to investigate the effect of complex training on children with the deformities including forward head, rounded shoulder posture, and lumbar lordosis. The complex training program was performed for 6 month three times per week. The complex training improved posture as measured by forward head angle (FHA), forward shoulder angle (FSA), and angle between anterior superior iliac spine and posterior superior iliac spine (APA). In the present results, complex training might overcome vertebral deformity through decreasing forward head, rounded shoulder posture, and lumbar lordosis and increasing flexibility in the children. PMID:25061597

Park, Hae-Chan; Kim, Yang-Soo; Seok, Sang-Hun; Lee, Soo-Kyung

2014-06-01

280

The Importance of Proximal Fusion Level Selection for Outcomes of Multi-Level Lumbar Posterolateral Fusion  

PubMed Central

Background There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes. Methods We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors. Results Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203). Conclusions The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered. PMID:25729522

Nam, Woo Dong

2015-01-01

281

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

NASA Astrophysics Data System (ADS)

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

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

2010-03-01

282

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

NASA Astrophysics Data System (ADS)

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

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

2009-12-01

283

The Comprehensive Biomechanics and Load-Sharing of Semirigid PEEK and Semirigid Posterior Dynamic Stabilization Systems  

PubMed Central

Alternatives to conventional rigid fusion have been proposed for several conditions related to degenerative disc disease when nonoperative treatment has failed. Semirigid fixation, in the form of dynamic stabilization or PEEK rods, is expected to provide compression under loading as well as an intermediate level of stabilization. This study systematically examines both the load-sharing characteristics and kinematics of these two devices compared to the standard of internal rigid fixators. Load-sharing was studied by using digital pressure films inserted between an artificially machined disc and two loading fixtures. Rigid rods, PEEK rods, and the dynamic stabilization system were inserted posteriorly for stabilization. The kinematics were quantified on ten, human, cadaver lumbosacral spines (L3-S1) which were tested under a pure bending moment, in flexion-extension, lateral bending, and axial rotation. The magnitude of load transmission through the anterior column was significantly greater with the dynamic device compared to PEEK rods and rigid rods. The contact pressures were distributed more uniformly, throughout the disc with the dynamic stabilization devices, and had smaller maximum point-loading (pressures) on any particular point within the disc. Kinematically, the motion was reduced by both semirigid devices similarly in all directions, with slight rigidity imparted by a lateral interbody device. PMID:23984077

Sengupta, D. K.; Bucklen, Brandon; McAfee, Paul C.; Nichols, Jeff; Angara, Raghavendra; Khalil, Saif

2013-01-01

284

A biomechanical analysis of the self-retaining pedicle hook device in posterior spinal fixation.  

PubMed

Regular hooks lack initial fixation to the spine during spinal deformity surgery. This runs the risk of posterior hook dislodgement during manipulation and correction of the spinal deformity, that may lead to loss of correction, hook migration, and post-operative junctional kyphosis. To prevent hook dislodgement during surgery, a self-retaining pedicle hook device (SPHD) is available that is made up of two counter-positioned hooks forming a monoblock posterior claw device. The initial segmental posterior fixation strength of a SPHD, however, is unknown. A biomechanical pull-out study of posterior segmental spinal fixation in a cadaver vertebral model was designed to investigate the axial pull-out strength for a SPHD, and compared to the pull-out strength of a pedicle screw. Ten porcine lumbar vertebral bodies were instrumented in pairs with two different instrumentation constructs after measuring the bone mineral density of each individual vertebra. The instrumentation constructs were extracted employing a material testing system using axial forces. The maximum pull-out forces were recorded at the time of the construct failure. Failure of the SPHD appeared in rotation and lateral displacement, without fracturing of the posterior structures. The average pull-out strength of the SPHD was 236 N versus 1,047 N in the pedicle screws (P < 0.001). The pull-out strength of the pedicle screws showed greater correlation with the BMC compared to the SPHD (P < 0.005). The SPHD showed to provide a significant inferior segmental fixation to the posterior spine in comparison to pedicle screw fixation. Despite the beneficial characteristics of the monoblock claw construct in a SPHD, that decreases the risk of posterior hook dislodgement during surgery compared to regular hooks, the SPHD does not improve the pull-out strength in such a way that it may provide a biomechanically solid alternative to pedicle screw fixation in the posterior spine. PMID:17203270

van Laar, Wilbert; Meester, Rinse J; Smit, Theo H; van Royen, Barend J

2007-08-01

285

Posterior crossbite - treatment and stability  

PubMed Central

Posterior crossbite is defined as an inadequate transversal relationship of maxillary and mandibular teeth. Even when eliminating the etiologic factors, this malocclusion does not have a spontaneous correction, and should be treated with maxillary expansion as early as possible. This treatment aims at providing a better tooth/skeletal relationship, thereby improving masticatory function, and establishing a symmetrical condyle/fossa relationship. Should posterior crossbite not be treated early, it may result in skeletal changes, demanding a more complex approach. Additionally, an overcorrection expansion protocol should be applied in order to improve the treatment stability. Although the literature has reported a high rate of relapse after maxillary expansion, the goal of this study was to demonstrate excellent stability of the posterior crossbite correction 21 years post treatment. PMID:22666850

de ALMEIDA, Renato Rodrigues; de ALMEIDA, Marcio Rodrigues; OLTRAMARI-NAVARRO, Paula Vanessa Pedron; CONTI, Ana Cláudia de Castro Ferreira; NAVARRO, Ricardo de Lima; MARQUES, Henry Victor Alves

2012-01-01

286

Continuous posterior lumbar plexus and continuous parasacral and intubation with lighted stylet for ankylosing spondylitis  

PubMed Central

Ankylosing spondylitis is characterized by progressive ossification of the spinal column with resultant stiffness. Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway and performing neuraxial blockade. We describe a case of intubation with lighted stylet, and use of the continuous lumbosacral plexus for THA and postoperative analgesia with an elastomeric pump. Key words: Airways difficult anticipated, anesthesia, ankoylosing spondylitis, arthroplasty, conduction, continuous lumbosacral plexus, hip, infusion pumps, intubation awake, replacement

Imbelloni, Luiz Eduardo; Lucena, Neli

2015-01-01

287

Continuous posterior lumbar plexus and continuous parasacral and intubation with lighted stylet for ankylosing spondylitis.  

PubMed

Ankylosing spondylitis is characterized by progressive ossification of the spinal column with resultant stiffness. Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway and performing neuraxial blockade. We describe a case of intubation with lighted stylet, and use of the continuous lumbosacral plexus for THA and postoperative analgesia with an elastomeric pump. Key words: Airways difficult anticipated, anesthesia, ankoylosing spondylitis, arthroplasty, conduction, continuous lumbosacral plexus, hip, infusion pumps, intubation awake, replacement. PMID:25886430

Imbelloni, Luiz Eduardo; Lucena, Neli

2015-01-01

288

Primary myelolipoma in posterior mediastinum  

PubMed Central

Myelolipoma in posterior mediastinum is indeed rare. As a benign tumor, it consists of mature fat with scattered foci of haematopoietic elements resembling bone marrow. The computed tomography (CT) and magnetic resonance imaging (MRI) are effective methods to detect them, while the definite diagnosis still depends on pathological diagnosis. Up to now, there is no standard treatment for this disease. Surgery is thought to be the best choice in some literatures reports. In this paper, two patients with primary posterior mediastinal tumor are reported, both of whom were underwent Video-assisted thoracoscopic surgery (VATS). Postoperative pathological diagnosis was myelolipoma. PMID:25276393

Xiong, Yan; Wang, Yong

2014-01-01

289

Lumbar-pelvic range and coordination during lifting tasks  

E-print Network

, the passive musculature can contribute to further limiting the functional neutral range of lumbar motion. Movement out of this functional neutral range could potentially put greater loads on these structures. In this study, the range of lumbar curvature...

Maduri, Anupama; Pearson, Bethany L.; Wilson, Sara E.

2008-01-01

290

Economic impact of minimally invasive lumbar surgery  

PubMed Central

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

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

2015-01-01

291

Minimally invasive procedures on the lumbar spine  

PubMed Central

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

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

2015-01-01

292

Minimally invasive procedures on the lumbar spine.  

PubMed

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

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

2015-01-16

293

Children's Understanding of Posterior Probability  

ERIC Educational Resources Information Center

Do young children have a basic intuition of posterior probability? Do they update their decisions and judgments in the light of new evidence? We hypothesized that they can do so extensionally, by considering and counting the various ways in which an event may or may not occur. The results reported in this paper showed that from the age of five,…

Girotto, Vittorio; Gonzalez, Michael

2008-01-01

294

Unilateral posterior crossbite and mastication  

Microsoft Academic Search

ObjectiveThis study was designed to characterize masticatory-cycle morphology, and distance of the contact glide in the closing masticatory stroke, in adult subjects with uncorrected unilateral posterior crossbite (UPXB), comparing the results obtained with those obtained in a parallel group of normal subjects.

Benito Rilo; José Luis da Silva; María Jesús Mora; Carmen Cadarso-Suárez; Urbano Santana

2007-01-01

295

49 CFR 572.19 - Lumbar spine, abdomen and pelvis.  

Code of Federal Regulations, 2012 CFR

... 2012-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19...3-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the part of...

2012-10-01

296

49 CFR 572.19 - Lumbar spine, abdomen and pelvis.  

Code of Federal Regulations, 2014 CFR

... 2014-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19...3-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the part of...

2014-10-01

297

49 CFR 572.19 - Lumbar spine, abdomen and pelvis.  

Code of Federal Regulations, 2011 CFR

... 2011-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19...3-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the part of...

2011-10-01

298

49 CFR 572.19 - Lumbar spine, abdomen and pelvis.  

Code of Federal Regulations, 2013 CFR

... 2013-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19...3-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the part of...

2013-10-01

299

49 CFR 572.85 - Lumbar spine flexure.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Lumbar spine flexure. 572.85 Section 572.85...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected to continuously...paragraph (b) of this section, the lumbar spine assembly shall flex by an amount that...

2010-10-01

300

49 CFR 572.115 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Lumbar spine and pelvis. 572.115 Section 572...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to those for...

2010-10-01

301

Therapeutic Options in Lithiasis of the Lumbar Ureter  

Microsoft Academic Search

Introduction: In the past 25 years, the treatment of lithiasis of the lumbar ureter has evolved from ureterolithotomy to extracorporeal shockwave lithotripsy and\\/or endoscopic lithotripsy. Our objective has been to analyse the results of extracorporeal lithotripsy and endoscopic surgery in lithiasis of the lumbar ureter.Materials and Methods: We have analysed 734 single calculi of the lumbar ureter treated during the

Miguel Arrabal-Mart??n; Manuel Pareja-Vilches; Francisco Gutiérrez-Tejero; José Luis Miján-Ortiz; Francisco Palao-Yago; Armando Zuluaga-Gómez

2003-01-01

302

Lumbar Spine Disc Herniation Diagnosis with a Joint Shape Model  

E-print Network

Lumbar Spine Disc Herniation Diagnosis with a Joint Shape Model Raja S Alomari1 , Jason J Corso1 diagnosis of the DDD for lumbar spine. We design a classifier to automatically detect degenerated disc (also. Keywords: Lumbar Spine Diagnosis, MRI, Disc Degenerative Disease 1 Introduction Low Back Pain has a major

Corso, Jason J.

303

49 CFR 572.115 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Lumbar spine and pelvis. 572.115 Section...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to...

2011-10-01

304

49 CFR 572.115 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2014 CFR

...2014-10-01 2014-10-01 false Lumbar spine and pelvis. 572.115 Section...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to...

2014-10-01

305

Introduction Functional in vivo studies of the lumbar spine using  

E-print Network

Introduction Functional in vivo studies of the lumbar spine using open MRI systems are described in the locomotor system of the lumbar spine and their effects on CSF space and relevant nerve roots has not been-Definition 3D Studies of the Lumbar Spine Using Magnetic Resonance Imaging K. E. W. Eberhardt1 , B. F. Tomandl1

Blanz, Volker

306

49 CFR 572.85 - Lumbar spine flexure.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Lumbar spine flexure. 572.85 Section...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected...paragraph (b) of this section, the lumbar spine assembly shall flex by an...

2011-10-01

307

49 CFR 572.85 - Lumbar spine flexure.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Lumbar spine flexure. 572.85 Section...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected...paragraph (b) of this section, the lumbar spine assembly shall flex by an...

2012-10-01

308

49 CFR 572.115 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Lumbar spine and pelvis. 572.115 Section...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to...

2012-10-01

309

The Robotic Lumbar Spine (RLS): Dynamics and Feedback Linearization Control  

E-print Network

The Robotic Lumbar Spine (RLS): Dynamics and Feedback Linearization Control Ernur Karadogan. Karadogan and R.L. Williams II, 2013, "The Robotic Lumbar Spine (RLS): Dynamics and Feedback Linearization.edu Abstract The Robotic Lumbar Spine (RLS) is a 15 degreeoffreedom, fully cableactuated robotic

Williams II, Robert L.

310

49 CFR 572.85 - Lumbar spine flexure.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Lumbar spine flexure. 572.85 Section...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected...paragraph (b) of this section, the lumbar spine assembly shall flex by an...

2013-10-01

311

49 CFR 572.85 - Lumbar spine flexure.  

Code of Federal Regulations, 2014 CFR

...2014-10-01 2014-10-01 false Lumbar spine flexure. 572.85 Section...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected...paragraph (b) of this section, the lumbar spine assembly shall flex by an...

2014-10-01

312

49 CFR 572.115 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Lumbar spine and pelvis. 572.115 Section...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to...

2013-10-01

313

Successful operative management of an upper lumbar spinal canal stenosis resulting in multilevel lower nerve root radiculopathy  

PubMed Central

Lumbar stenosis is a common disorder, usually characterized clinically by neurogenic claudication with or without lumbar/sacral radiculopathy corresponding to the level of stenosis. We present a case of lumbar stenosis manifesting as a multilevel radiculopathy inferior to the nerve roots at the level of the stenosis. A 55-year-old gentleman presented with bilateral lower extremity pain with neurogenic claudication in an L5/S1 distribution (posterior thigh, calf, into the foot) concomitant with dorsiflexion and plantarflexion weakness. Imaging revealed grade I spondylolisthesis of L3 on L4 with severe spinal canal stenosis at L3-L4, mild left L4-L5 disc herniation, no stenosis at L5-S1, and no instability. EMG revealed active and chronic L5 and S1 radiculopathy. The patient underwent bilateral L3-L4 hemilaminotomy with left L4-L5 microdiscectomy for treatment of his L3-L4 stenosis. Postoperatively, he exhibited significant improvement in dorsiflexion and plantarflexion. The L5-S1 level was not involved in the operative decompression. Patients with radiculopathy and normal imaging at the level corresponding to the radiculopathy should not be ruled out for operative intervention should they have imaging evidence of lumbar stenosis superior to the expected affected level. PMID:25552866

McClelland, Shearwood; Kim, Stefan S.

2015-01-01

314

Traumatic lumbar hernia: report of a case.  

PubMed

Traumatic lumbar hernias are very rare. Here, we present a case of secondary lumbar hernia. A 44-year-old man sustained a crushing injury. On admission, ecchymotic, fluctuating swelling was present on his left flank with normal vital signs. Subcutaneous intestinal segments were revealed at his left flank on abdominal CT. Emergency laparotomy revealed a 10-cm defect on the left postero-lateral abdominal wall. The splenic flexure was herniated through the defect. Herniated segments was reduced, the defect was repaired with a polypropylene mesh graft. There was also a serosal tear and an ischemic area 3mm wide on the splenic flexure and was repaired primarily. The patient had an uneventful recovery. Most traumatic lumbar hernias are caused by blunt trauma. Trauma that causes abdominal wall disruption also may cause intraabdominal organ injury. Abdominal CT is useful in the diagnosis and allows for diagnosis of coexisting organ injury. Emergency laparotomy should be performed to repair possible coexisting injuries. PMID:19059139

Torer, Nurkan; Yildirim, Sedat; Tarim, Akin; Colakoglu, Tamer; Moray, Gokhan

2008-12-01

315

Degenerative lumbar spinal stenosis: evaluation and management.  

PubMed

Degenerative lumbar spinal stenosis is caused by mechanical factors and/or biochemical alterations within the intervertebral disk that lead to disk space collapse, facet joint hypertrophy, soft-tissue infolding, and osteophyte formation, which narrows the space available for the thecal sac and exiting nerve roots. The clinical consequence of this compression is neurogenic claudication and varying degrees of leg and back pain. Degenerative lumbar spinal stenosis is a major cause of pain and impaired quality of life in the elderly. The natural history of this condition varies; however, it has not been shown to worsen progressively. Nonsurgical management consists of nonsteroidal anti-inflammatory drugs, physical therapy, and epidural steroid injections. If nonsurgical management is unsuccessful and neurologic decline persists or progresses, surgical treatment, most commonly laminectomy, is indicated. Recent prospective randomized studies have demonstrated that surgery is superior to nonsurgical management in terms of controlling pain and improving function in patients with lumbar spinal stenosis. PMID:22855855

Issack, Paul S; Cunningham, Matthew E; Pumberger, Matthias; Hughes, Alexander P; Cammisa, Frank P

2012-08-01

316

Iatrogenic lumbar meningocoele: report of three cases  

PubMed Central

We have reported three cases of iatrogenic lumbar meningocoeles after surgery for herniated lumbar intervertebral discs. We reject the term spurious, pseudo, or false as given by earlier writers. We feel that, in reality, these sacs are true meningocoeles, with complete arachnoidal lining and freely communicating with the intraspinal subarachnoid space. We have also given a brief outline of the clinical features, elucidated the mechanisms operative in the production of symptoms, and suggested the cardinal features of radiographic diagnosis. Prevention is, of course, the best way to avoid this complication. If a dural tear does occur, every effort should be made to suture it in a watertight manner. Images PMID:4918460

Rinaldi, Italo; Hodges, Thomas O.

1970-01-01

317

Computed tomography of the postoperative lumbar spine  

SciTech Connect

In the postoperative patient ordinary radiographs of the spine generally add very little information, revealing the usual postoperative bone changes and often postoperative narrowing of the intervertebral space. Myelography may sometimes be informative, showing evidence of focal arachnoiditis or a focal defect at the surgical site. However, the latter finding is difficult to interpret. As experience with high-resolution CT scanning of the lumbar spine has been increasing, it is becoming apparent that this noninvasive and easily performed study can give considerably more information about the postoperative spine than any of the other current imaging methods. About 750 patients with previous lumbar laminectomies had CT scanning within a 28 month period.

Teplick, J.G.; Haskin, M.E.

1983-11-01

318

Lumbar vertebral pedicles: radiologic anatomy and pathology  

SciTech Connect

With the advancement of high-resolution computed tomography (CT) scanning the spine has added new knowledge to the various conditions affecting the pedicles. We wish to review the entire spectrum of pedicular lesions: the embryology, normal anatomy, normal variants, pitfalls, congenital anomalies, and pathological conditions are discussed. Different imaging modalities involving CT, isotope bone scanning, and Magnetic Resonance Imaging (MRI) are used to complement plain films of the lumbar spine. This subject review is an excellent source for future reference to lumbar pedicular lesions. 27 references.

Patel, N.P.; Kumar, R.; Kinkhabwala, M.; Wengrover, S.I.

1988-01-01

319

Diagnostic value of the lumbar extension-loading test in patients with lumbar spinal stenosis: a cross-sectional study  

PubMed Central

Background The gait-loading test is a well known, important test with which to assess the involved spinal level in patients with lumbar spinal stenosis. The lumbar extension-loading test also functions as a diagnostic loading test in patients with lumbar spinal stenosis; however, its efficacy remains uncertain. The purpose of this study was to compare the diagnostic value of the lumbar extension-loading test with that of the gait-loading test in patients with lumbar spinal stenosis. Methods A total of 116 consecutive patients (62 men and 54 women) diagnosed with lumbar spinal stenosis were included in this cross-sectional study of the lumbar extension-loading test. Subjective symptoms and objective neurological findings (motor, sensory, and reflex) were examined before and after the lumbar extension-loading and gait-loading tests. The efficacy of the lumbar extension-loading test for establishment of a correct diagnosis of the involved spinal level was assessed and compared with that of the gait-loading test. Results There were no significant differences between the lumbar extension-loading test and the gait-loading test in terms of subjective symptoms, objective neurological findings, or changes in the involved spinal level before and after each loading test. Conclusions The lumbar extension-loading test is useful for assessment of lumbar spinal stenosis pathology and is capable of accurately determining the involved spinal level. PMID:25080292

2014-01-01

320

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

PubMed

Lumbar stenosis patients typically present with neurogenic claudication or radiculopathy. Studies have shown the benefit of surgical management of lumbar stenosis for patients who fail medical management. Surgical management traditionally involved an open laminectomy and foramenotomies. The emergence of minimally invasive spinal surgery has allowed for comparable clinical outcomes to open laminectomies, with the potential additional benefits of decreased blood loss, shorter hospital stay, decreased postoperative narcotic requirement, decreased rate of infection, and the potential benefit of decreasing the risk of postoperative instability. A shorter length of stay and faster return to work after minimally invasive lumbar decompression may result in the minimally invasive approach being more cost effective than an open approach. A literature review was performed to evaluate the clinical outcomes and cost effectiveness associated with minimally invasive decompression of lumbar stenosis. PMID:25370820

Johans, S J; Amin, B Y; Mummaneni, P V

2015-03-01

321

Electrophysiological and cognitive effects of lumbar myelography with iopamidol: comparison with diagnostic lumbar puncture.  

PubMed

To assess the influence of contrast medium on cortical function, we studied 20 patients undergoing lumbar myelography with iopamidol and 10 patients undergoing diagnostic lumbar puncture (controls). The examinations performed before and 6 and 24 h after myelography (or lumbar puncture) included a neuropsychological battery and an electrophysiological evaluation. In the patients cranial CT was performed thrice to assess passage of contrast medium from the cerebrospinal fluid into the brain. Neither patients nor controls had significantly different scores on neuropsychological testing after the diagnostic examinations. A transient slowing of basal EEG activity could be detected in 2 patients and 3 controls 6 h after the lumbar puncture. In 3 patients CT showed a transient increase in density of the brain. None of the parameters studied was significantly affected by myelography with iopamidol. CT findings support the hypothesis of early clearance of iopamidol from brain tissue, explaining its low neurotoxicity. PMID:8232868

Provinciali, L; Ceravolo, M G; Signorino, M; Baroni, M; Pasquini, U; Cerrutti, R; Salvolini, U

1993-01-01

322

Posterior cruciate ligament (PCL) injury - aftercare  

MedlinePLUS

... of tissue that connects bone to bone. The posterior cruciate ligament (PCL) is located inside your knee ... Curtis C, Bienkowski P, Micheli LJ. Posterior cruciate ligament ... of Physical Medicine and Rehabilitation. 2nd ed. St. Louis, ...

323

Nanotherapy for posterior eye diseases.  

PubMed

It is assumed that more than 50% of the most enfeebling ocular diseases have their origin in the posterior segment. Furthermore, most of these diseases lead to partial or complete blindness, if left untreated. After cancer, blindness is the second most dreaded disease world over. However, treatment of posterior eye diseases is more challenging than the anterior segment ailments due to a series of anatomical barriers and physiological constraints confronted for delivery to this segment. In this regard, nanostructured drug delivery systems are proposed to defy ocular barriers, target retina, and act as permeation enhancers in addition to providing a controlled release. Since an important step towards developing effective treatment strategies is to understand the course or a route a drug molecule needs to follow to reach the target site, the first part of the present review discusses various pathways available for effective delivery to and clearance from the posterior eye. Promise held by nanocarrier systems, viz. liposomes, nanoparticles, and nanoemulsion, for effective delivery and selective targeting is also discussed with illustrative examples, tables, and flowcharts. However, the applicability of these nanocarrier systems as self-administration ocular drops is still an unrealized dream which is in itself a huge technological challenge. PMID:24862316

Kaur, Indu Pal; Kakkar, Shilpa

2014-11-10

324

Tadpole system as new lumbar spinal instrumentation  

Microsoft Academic Search

BACKGROUND: There have been reports of serious complications associated with pedicle screw fixation, including nerve root injuries caused by accidental screw insertion. We have developed a new system of lumbar spinal instrumentation that we call Tadpole system®. The purposes of this report were to show the results of a biomechanical study and the short-term outcome of a clinical study, as

Yuichi Kasai; Tadashi Inaba; Koji Akeda; Atsumasa Uchida

2008-01-01

325

Ontogeny of Androgen Receptor Immunoreactivity in Lumbar  

E-print Network

Ontogeny of Androgen Receptor Immunoreactivity in Lumbar Motoneurons and in the Sexually Dimorphic, University of California, Los Angeles, California 90095-1527 ABSTRACT We documented the ontogeny of androgen retrodorsolat- eral nucleus (RDLN). We also assessed the ontogeny of AR immunoreactivity in the rat sexually

Breedlove, Marc

326

49 CFR 572.187 - Lumbar spine.  

Code of Federal Regulations, 2011 CFR

...CONTINUED) ANTHROPOMORPHIC TEST DEVICES 2re Side Impact Crash Test Dummy, 50th Percentile Adult Male § 572.187 Lumbar...The maximum rotation in the lateral direction of the reference plane of the headform (175-9000) as shown in Figure...

2011-10-01

327

Acute Sciatic Neuritis following Lumbar Laminectomy  

PubMed Central

It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciatica might be associated with inflammation. We report a case of acute sciatic neuritis presented with significant persistent pain shortly after a successful disc surgery. The patient is a 59-year-old female with complaint of newly onset sciatica after complete pain resolution following a successful lumbar laminectomy for acute disc extrusion. In order to manage the patient's newly onset pain, the patient had multiple pain management visits which provided minimum relief. Persistent sciatica and consistent physical examination findings urged us to perform a pelvic MRI to visualize suspected pathology, which revealed right side sciatic neuritis. She responded to the electrical neuromodulation. Review of the literature on sciatic neuritis shows this is the first case report of sciatic neuritis subsequent to lumbar laminectomy. PMID:25024708

Hitchon, Patrick; Reddy, Chandan G.

2014-01-01

328

Lumbar Extradural Hemangiomas: Report of Three Cases  

Microsoft Academic Search

Summary: The CT, MR, and histologic findings of three patients with surgically proved lumbar extradural cavern- ous and arteriovenous hemangiomas are reported. All three patients suffered from radicular and low back pain that disappeared completely or nearly so after total surgical ex- cision. In each case, neuroimaging studies showed a well- defined ventrally located extradural mass with no bone in-

Antoni Rovira; Alex Rovira; Jaume Capellades; Martin Zauner; Rosa Bell; Mariana Rovira

329

Isolated posterior cruciate ligament injuries in athletes  

Microsoft Academic Search

The literature is divided as to the necessity of an intact posterior cruciate ligament for functional stability. Pre sented here is a prospective study of isolated posterior cruciate injuries seen in the acute stage in 13 patients, 6 males and 7 females. The diagnosis of posterior cruciate ligament tear was made clinically and con firmed by arthroscopy. The average age

P. J. Fowler; S. S. Messieh

1987-01-01

330

Posterior Integration in Dynamic Models Peter Mueller  

E-print Network

Posterior Integration in Dynamic Models Peter Mueller Institute of Statistics & Decision Sciences of posterior distributions corresponding to the subsequent stages of the dynamic model. In the absence of these posterior distri­ butions. This paper reviews some previously suggested Monte Carlo based algorithms

West, Mike

331

Posterior Implementation vs Ex-Post Implementation  

E-print Network

Posterior Implementation vs Ex-Post Implementation by Philippe Jehiel, Moritz Meyer-ter-Vehn, Benny Moldovanu and William R. Zame1 This version: 1.9.2006 In this short note we discuss how posterior, posterior implemen- tation is de...ned with respect to the information released by the mechanism

Franz, Sven Oliver

332

Visualizing highdimensional posterior distributions in Bayesian modeling  

E-print Network

Visualizing high­dimensional posterior distributions in Bayesian modeling Jarkko Venna and Samuel on the posterior distribution of the model parameters. The closed­form solution is seldom known and samples of the posterior have to be computed with Markov Chain Monte Carlo (MCMC) methods. The problem is that for large

Kaski, Samuel

333

UNIFORM STABILITY OF POSTERIORS Sanjib Basu  

E-print Network

UNIFORM STABILITY OF POSTERIORS by Sanjib Basu Northern Illinois University DeKalb, IL 60115, USA E­mail: basu@niu.edu Abstract Infinitesimal sensitivities of the posterior distribution P (\\DeltajX ) and posterior quantities ae(P ) w.r.t. the choice of the prior P are considered. In a very general setting

Basu, Sanjib

334

Posterior Probabilistic Clustering using NMF CSE Department  

E-print Network

Posterior Probabilistic Clustering using NMF Chris Ding CSE Department University of Texas of Computer Science Florida International University wpeng002@cs.fiu.edu ABSTRACT We introduce the posterior probabilistic clustering (PPC), which provides a rigorous posterior probability interpretation for Non- negative

Li, Tao

335

Consistency of Posterior Distributions for Neural Networks  

E-print Network

Consistency of Posterior Distributions for Neural Networks Herbert Lee \\Lambda May 21, 1998 Abstract In this paper we show that the posterior distribution for feedforward neural networks is asymp problem, then uses bounds on the bracketing entropy to show that the posterior is consistent over

336

Introduction In normal eyes, the posterior corneal  

E-print Network

Introduction In normal eyes, the posterior corneal aberration has a relatively small impact. However, in keratoconic eyes, contribution of the posterior corneal aberration to the total ocular aberration can also be compensated by the posterior corneal aberration. The goal of this study

Yoon, Geunyoung

337

CONCENTRATION OF POSTERIOR DISTRIBUTIONS WITH MISSPECIFIED MODELS  

E-print Network

CONCENTRATION OF POSTERIOR DISTRIBUTIONS WITH MISSPECIFIED MODELS Christophe ABRAHAMa and Benoît investigate the asymptotic properties of posterior distributions when the model is misspecified, i the asymptotic of the posterior distribution when the model is correctly specified i.e. q is equal to h for some

Boyer, Edmond

338

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

Microsoft Academic Search

Platelet-rich plasma (PRP) is an autogenous source of growth factor and has been shown to enhance bone healing both in clinical and experimental studies. PRP in combination with porous hydroxyapatite has been shown to increase the bone ingrowth in a bone chamber rat model. The present study investigated whether the combination of beta tricalcium phosphate (?-TCP) and PRP may enhance

Haisheng Li; Xuenong Zou; Qingyun Xue; Niels Egund; Martin Lind; Cody Bünger

2004-01-01

339

Anterolateral radical debridement and interbody bone grafting combined with transpedicle fixation in the treatment of thoracolumbar spinal tuberculosis.  

PubMed

This retrospective cohort study was conducted to evaluate the clinical outcomes of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting with transpedicle fixation for the treatment of thoracolumbar tuberculosis.Spinal tuberculosis operation aims to remove the lesions and necrotic tissues, remove spinal cord compression, and reconstruct spinal stability. However, traditional operation methods cannot effectively correct cyrtosis or stabilize the spine. In addition, the patient needs to stay in bed for a long time and may have many complications. So far, the best surgical method and fixation method for spinal tuberculosis remain controversial.There were a total of 43 patients, 16 involving spinal cord injury, from January 2004 to January 2011. The patients were surgically treated for radical anterolateral debridement via posterolateral incision and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation. All the patients were followed up to determine the stages of intervertebral bone fusion and the corrections of spinal kyphosis with the restoration of neurological deficit.The erythrocyte sedimentation rate (ESR) of these patients decreased to normal levels for a mean of 2.8 months. The function of feeling, motion, and sphincter in 16 paraplegia cases gradually recovered after 1 week to 3 months postoperatively, and the American Spinal Injury Association scores significantly increased at the final follow-up. Intervertebral bone fusions were all achieved postoperatively. No internal fixation devices were loose, extracted, or broken. There was no correction degree loss during the follow-up.The method of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation was effective for the treatment of thoracolumbar tuberculosis, correcting kyphotic deformity, and reconstructing spinal stability, obtaining successful intervertebral bony fusion and promoting the recovery of paraplegia. These results showed satisfactory clinical outcomes. PMID:25860219

Cheng, Zhaohui; Wang, Jian; Zheng, Qixin; Wu, Yongchao; Guo, Xiaodong

2015-04-01

340

[Diagnosis and treatment of lumbar spinal canal stenosis].  

PubMed

Lumbar spinal canal stenosis (LSCS) was first described in 1954 by Verbiest, followed by the currently accepted international classification of LSCS in 1976 by Arnoldi. Briefly, LSCS is a nervous system syndrome that is characterized by neural symptoms in the lower extremities due to tightened cauda equina and spinal nerve root involvement. LSCS international classification consists of: (1) degenerative, (2) congenital developmental, (3) combined, (4) spondylolytic spondylolisthesis, (5) iatrogenic and (6) post traumatic stenosis. Degenerative stenosis-the most common type of LSCS-is caused by disc degeneration, osteoarthritis of the facet joint and hypertrophy of the ligamentum flavum. LSCS may also be the result of intervertebral disc degeneration, protruded intervertebral disc and/or bony spur compress cauda equina and spinal nerve root anteriorally, while degenerated facet joint and hypertrophied the ligamentum flavum compress cauda equina and spinal nerve root posteriorally? Most often, spondylolytic spondylolisthesis occurs at the fourth lumbar vertebrae in middle-aged women. As a result of a slipping forward of the vertebra, cauda equina and spinal nerve roots can be tightened between the edge behind the top of lower vertebra and frontal edge of the lower part of upper lamina. Typical clinical symptoms of LSCS are low back pain, leg pain and intermittent claudication. Low back pain is chronic with secondary radiating pain in the buttock. The leg pain is called "sciatica", which tends to appear on the back of thigh, in the lateral aspect of lower leg and calf muscles, and which intensifies when the patient is fatigued. Intermittent claudication is a symptom associated with this syndrome. Often, patients with LSCS find it impossible to walk because of increased numbness and pain in their leg. Many patients report that after squatting for a few minutes they are able to resume walking. LSCS patients may also report dysaesthesia in the perineum area, and may also report urinary dysfunction ranging from extreme urgency to urinary delay. Patients who present with symptoms of LSCS should be seen by an orthopedic surgeon. Correct diagnosis by imaging and clinical examination, with appropriate conservative or operative treatment in a timely fashion should be encouraged in order to prevent irreversible nerve damage. PMID:12646992

Miyamoto, Masabumi; Genbum, Yoshikazu; Ito, Hiromoto

2002-12-01

341

Complications of Lumbar Artificial Disc Replacement Compared to Fusion: Results From the Prospective, Randomized, Multicenter US Food and Drug Administration Investigational Device Exemption Study of the Charité Artificial Disc  

PubMed Central

Background Previous reports of lumbar total disc replacement (TDR) have described significant complications. The US Food and Drug Administration (FDA) investigational device exemption (IDE) study of the Charité artificial disc represents the first level I data comparison of TDR to fusion. Methods In the prospective, randomized, multicenter IDE study, patients were randomized in a 2:1 ratio, with 205 patients in the Charité group and 99 patients in the control group (anterior lumbar interbody fusion [ALIF] with BAK cages). Inclusion criteria included confirmed single-level degenerative disc disease at L4-5 or L5-S1 and failure of nonoperative treatment for at least 6 months. Complications were reported throughout the study. Results The rate of approach-related complications was 9.8% in the investigational group and 10.1% in the control group. The rate of major neurological complications was similar between the 2 groups (investigational = 4.4%, control = 4.0%). There was a higher rate of superficial wound infection in the investigational group but no deep wound infections in either group. Pseudarthrosis occurred in 9.1% of control group patients. The rate of subsidence in the investigational group was 3.4%. The reoperation rate was 5.4% in the investigational group and 9.1% in the control group. Conclusions The incidence of perioperative and postoperative complications for lumbar TDR was similar to that of ALIF. Vigilance is necessary with respect to patient indications, training, and correct surgical technique to maintain TDR complications at the levels experienced in the IDE study.

Majd, Mohammed E.; Isaza, Jorge E.; Blumenthal, Scott L.; McAfee, Paul C.; Guyer, Richard D.; Hochschuler, Stephen H.; Geisler, Fred H.; Garcia, Rolando; Regan, John J.

2007-01-01

342

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate.  

PubMed

Graft subsidence following anterior cervical reconstruction can result in the loss of sagittal balance and recurring foraminal stenosis. This study examined the implant-endplate interface using a cyclic fatigue loading protocol in an attempt to model the subsidence seen in vivo. The superior endplate from 30 cervical vertebrae (C3 to T1) were harvested and biomechanically tested in axial compression with one of three implants: Fibular allograft; titanium mesh cage packed with cancellous chips; and trabecular metal. Each construct was cyclically loaded from 50 to 250?N for 10,000 cycles. Nondestructive cyclic loading of the cervical endplate-implant construct resulted in a stiffer construct independent of the type of the interbody implant tested. The trabecular metal construct demonstrated significantly more axial stability and significantly less subsidence in comparison to the titanium mesh construct. Although the allograft construct resulted in more subsidence than the trabecular metal construct, the difference was not significant and no difference was found when comparing axial stability. For all constructs, the majority of the subsidence during the cyclic testing occurred during the first 500 cycles and was followed by a more gradual settling in the remaining 9,500 cycles. PMID:22002745

Ordway, Nathaniel R; Rim, Byeong Cheol; Tan, Rong; Hickman, Rebecca; Fayyazi, Amir H

2012-04-01

343

USING MORE INFORMATIVE POSTERIOR PROBABILITIES FOR SPEECH RECOGNITION  

E-print Network

USING MORE INFORMATIVE POSTERIOR PROBABILITIES FOR SPEECH RECOGNITION Hamed Ketabdar, Jithendra speech recognition systems by estimating more informative posteriors taking into account acoustic context knowledge). These posteriors are esti- mated based on HMM state posterior probability definition (typically

344

Hemophilic pseudotumor of the first lumbar vertebra  

PubMed Central

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

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

2014-01-01

345

49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 false Lumbar spine, abdomen, and pelvis assembly and test procedure...Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The...

2013-10-01

346

49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Lumbar spine, abdomen, and pelvis assembly and test procedure...Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The...

2011-10-01

347

49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.  

Code of Federal Regulations, 2014 CFR

...2014-10-01 false Lumbar spine, abdomen, and pelvis assembly and test procedure...Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The...

2014-10-01

348

49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Lumbar spine, abdomen, and pelvis assembly and test procedure...Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The...

2012-10-01

349

Tuina therapy for prolapsed lumbar intervertebral disc  

Microsoft Academic Search

Recurrent low back pain and reflex sciatica of lower limbs are the two leading symptoms of prolapsed lumbar intervertebral\\u000a disc, which can be confirmed in the history, symptoms, signs and imaging examination such as CT scan and MRI. It should be\\u000a differentiated from those conditions characterized by lumbago and\\/or possible sciatica. Tuina was performed mostly on the\\u000a Bladder Meridian, Gallbladder

Zhang Bi-meng; Wu Huan-gan; Shen Jian

2004-01-01

350

[Renal actinomycosis with fistulized lumbar abscess].  

PubMed

The authors report a case of renal actinomycosis in an adolescent presenting with two fistulized lumbar abscesses. This rare disease, which generally has a good prognosis, is difficult to diagnose, both clinically and radiologically. The positive diagnosis is based on histological examination, more frequently of the nephrectomy operative specimen, than ultrasound-guided fine needle aspiration biopsy of an atypical renal tumour. Conservative treatment with high-dose penicillin gives excellent results. PMID:11064902

Mallick, S; Klein, J F

2000-09-01

351

Herniation of the upper lumbar discs  

Microsoft Academic Search

Summary On the basis of investigations involving 134 patients operated on at the National Institute of Neurosurgery, Budapest, the authors point out that herniations of the intervertebral discs at L 1\\/2, L 2\\/3, L 3\\/4 levels are characterized by more severe neurological changes. Paresis and autonomic disorders occur much more frequently than in lower lumbar disc herniations: paresis was found

E. Pásztor; I. Szarvas

1981-01-01

352

Footprint mismatch in lumbar total disc arthroplasty  

Microsoft Academic Search

Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the\\u000a implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The\\u000a fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening\\u000a and biomechanical failure

Gstoettner Michaela; Heider Denise; Michael Liebensteiner; Bach Christian Michael

2008-01-01

353

Complications of fluoroscopically guided transforaminal lumbar epidural injections  

Microsoft Academic Search

Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil 2000;81:1045-50. Objectives: To assess the incidence of complications of fluoroscopically guided lumbar transforaminal epidural injections. Design: A retrospective cohort design study. Patients presenting with radiculopathy, caused by either lumbar spinal stenosis or herniated nucleus pulposus confirmed

Kenneth P. Botwin; Robert D. Gruber; Constantine G. Bouchlas; Francisco M. Torres-Ramos; Ted L. Freeman; Warren K. Slaten

2000-01-01

354

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

PubMed

The goal of this review is to discuss the mechanisms of postural degeneration, particularly the loss of lumbar lordosis commonly observed in the elderly in the context of evolution, mechanical, and biological studies of the human spine and to synthesize recent research findings to clinical management of postural malalignment. Lumbar lordosis is unique to the human spine and is necessary to facilitate our upright posture. However, decreased lumbar lordosis and increased thoracic kyphosis are hallmarks of an aging human spinal column. The unique upright posture and lordotic lumbar curvature of the human spine suggest that an understanding of the evolution of the human spinal column, and the unique anatomical features that support lumbar lordosis may provide insight into spine health and degeneration. Considering evolution of the skeleton in isolation from other scientific studies provides a limited picture for clinicians. The evolution and development of human lumbar lordosis highlight the interdependence of pelvic structure and lumbar lordosis. Studies of fossils of human lineage demonstrate a convergence on the degree of lumbar lordosis and the number of lumbar vertebrae in modern Homo sapiens. Evolution and spine mechanics research show that lumbar lordosis is dictated by pelvic incidence, spinal musculature, vertebral wedging, and disc health. The evolution, mechanics, and biology research all point to the importance of spinal posture and flexibility in supporting optimal health. However, surgical management of postural deformity has focused on restoring posture at the expense of flexibility. It is possible that the need for complex and costly spinal fixation can be eliminated by developing tools for early identification of patients at risk for postural deformities through patient history (genetics, mechanics, and environmental exposure) and tracking postural changes over time. PMID:24785474

Sparrey, Carolyn J; Bailey, Jeannie F; Safaee, Michael; Clark, Aaron J; Lafage, Virginie; Schwab, Frank; Smith, Justin S; Ames, Christopher P

2014-05-01

355

Risk Factors for Recurrent Lumbar Disc Herniations  

PubMed Central

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

2014-01-01

356

Augmentation of intertransverse process lumbar fusion.  

PubMed

Spinal fusion surgery for alleviation of intractable lower back pain in humans is currently a primary therapeutic technique, with failure rates averaging between 5 to 35%. Implanted and external source-based electrical stimulation devices have been investigated in an attempt to increase osteogenesis at the fusion site in an attempt to reduce spinal fusion failure rates. The purpose of our study was to evaluate the efficacy of two co-processor systems and an additional system with an SIS generation field at 15.8 mA (rms) using biomechanical, dual-energy X-ray absorptiometry (DXA), and histomorphometric analyses, in rabbits following dorsolateral (= posteriolateral [in humans]) spinal fusion. Fifty-six male New Zealand White underwent bilateral lumbar spinal fusion by performing decortication of the transverse processes of lumbar vertebrae four and five with placement of autogenic cancellous bone graft harvested from the ilial wings. Four study groups were designated based on the type of IES device used for stimulation or as a control. Eight weeks after surgery all subjects were sacrificed and the quality and strength of the fusion masses were compared using radiographic, biomechanical, histomorphometry, and qualitative histological evaluation. While some variation existed within and between groups, Group 2 showed a significant improvement in all parameters measured as compared to the control group (P < 0.05). The use of adjunct non-invasive surface IES for improving bony fusion rates for patients undergoing lumbar spinal fusion is supported by this study. PMID:16810348

Nawrocki, Michael A; Martinez, Steven A; Hughes, Joanne; Lincoln, James D; Shih, Mei-Shu; Zheng, Hellen; Carroll, William J

2006-01-01

357

Excision of The Posterior Longitudinal Ligament During Anterior Cervical Corpectomy: A Biomechanical Study.  

PubMed

STUDY DESIGN:: An in vitro biomechanical study of the cervical spine. OBJECTIVE:: To evaluate the biomechanical significance of the posterior longitudinal ligament (PLL) following anterior cervical corpectomy and reconstruction with a strut graft and anterior plate. SUMMARY OF BACKGROUND DATA:: Routine excision of the PLL during anterior cervical corpectomy is controversial. Many surgeons believe that maintaining the PLL following cervical corpectomy adds stability to the reconstruction, while others believe it can be excised without sequelae. There are no biomechanical studies to our knowledge evaluating the biomechanical significance of excising the PLL during corpectomy and whether this affects the stability of a reconstruction consisting of a strut graft and anterior plate. The purpose of this study was to evaluate the biomechanical effects of PLL excision during a complete anterior cervical corpectomy reconstructed with a strut graft and anterior plate. METHODS:: Seven human cadaveric fresh-frozen cervical spines C2-T1 were tested for range of motion before surgery and reconstruction. A complete C6 corpectomy was performed and an interbody strut spacer with load cell was placed along with an anterior plate. Range of motion was measured with ±2.5 Nm of torque in flexion-extension, lateral bending, and axial rotation. Load-sharing data were recorded with incremental axial loads. The PLL was excised and range of motion and load sharing testing was repeated. RESULTS:: There were no significant differences in range of motion or load sharing with an anterior corpectomy and reconstruction following PLL excision. CONCLUSIONS:: Excision of the PLL during anterior cervical corpectomy reconstructed with a strut graft and anterior plate does not significantly affect the construct stability or load-sharing of the graft. PMID:23059704

Daubs, Michael D; Patel, Alpesh A; Lawrence, Brandon D; Brodke, Darrel S

2012-10-10

358

Posterior subcapsular cataract in Degos disease  

Microsoft Academic Search

PURPOSE: To report an association of posterior subcapsular cataract with Degos disease.METHOD: Case report of a 42-year-old man.RESULTS: A posterior subcapsular cataract developed in the patient’s left eye at age 43 years, 1 year before his death. The diagnosis of Degos disease was confirmed pathologically by skin biopsy and at necropsy.CONCLUSION: Posterior subcapsular cataract may be associated with Degos disease

Robert Egan; Simmons Lessell

2000-01-01

359

Minimally Invasive Posterior Hamstring Harvest  

PubMed Central

Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient. The deep fascia is bluntly penetrated, and the tendon or tendons are identified. Adhesions are dissected. Then, an open tendon stripper is used to release the tendon or tendons proximally; a closed, sharp tendon stripper is used to release the tendon or tendons from the pes. Layered, absorbable skin closure is performed, and the skin is covered with a skin sealant, bolster dressing, and plastic adhesive bandage for 2 weeks. PMID:24266003

Wilson, Trent J.; Lubowitz, James H.

2013-01-01

360

Posterior Lamellar Keratoplasty in Perspective  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Posterior lamellar keratoplasty (PLK) offers many substantial benefits compared to penetrating keratoplasty (PK) including:\\u000a closed eye surgery elimination of both regular and irregular postoperative astigmatism leading to full visual rehabilitation\\u000a with spectacles within 3–6 months, elimination of postoperative corneal anaesthesia, and a reduced risk of postoperative globe\\u000a rupture.\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Disadvantages of PLK compared to PK include: corneal stromal scarring

F Arnalich-Montiel; JKG Dart

361

Biomechanical Evaluation of Pedicle Screw-Based Dynamic Stabilization Devices for the Lumbar Spine: A Systematic Review  

PubMed Central

Study Design This study is a systematic review of published biomechanical studies involving pedicle screw-based posterior dynamic stabilization devices (PDS) with a special focus on kinematics and load transmission through the functional spine unit (FSU). Methods A literature search was performed via the PubMed online database from 1990 to 2008 using the following key words: “biomechanics,” “lumbar dynamic stabilization,” “Graf system,” “Dynesys,” and “posterior dynamic implant.” Citations were limited to papers describing biomechanics of pedicle screw-based PDS devices currently available for clinical use. Studies describing clinical experience, radiology, and in vivo testing were excluded from the review. Parameters measured included kinematics of the FSU (range of motion (ROM), neutral zone (NZ), and location of the center of rotation) and load transmission through the disk, facets, and instrumentation. Results A total of 27 publications were found that concerned the biomechanical evaluation of lumbar pedicle screw-based dynamic stabilization instrumentation. Nine in vitro experimental studies and 4 finite element analyses satisfied the inclusion criteria. The Dynesys implant was the most investigated pedicle screw-based PDS system. In vitro cadaveric studies mainly focused on kinematics comparing ROM of intact versus instrumented spines whereas finite element analyses allowed analysis of load transmission at the instrumented and adjacent levels. Conclusion Biomechanical studies demonstrate that pedicle screw-based PDS devices limit intervertebral motion while unloading the intervertebral disk. The implant design and the surgical technique have a significant impact on the biomechanical behavior of the instrumented spinal segment. The posterior placement of such devices results in non-physiologic intervertebral kinematics with a posterior shift of the axis of rotation. Biomechanical studies suggest that the difference at the adjacent level between investigated dynamic devices and rigid stabilization systems may not be as high as reported. Finally, additional investigations of semirigid devices are needed to further evaluate their biomechanical properties compared to soft stabilization PDS systems.

Ponnappan, Ravi K.; Song, Jason; Vaccaro, Alexander R.

2008-01-01

362

Lumbar Disk Herniation Surgery: Outcome and Predictors  

PubMed Central

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

Sedighi, Mahsa; Haghnegahdar, Ali

2014-01-01

363

Lumbar disk herniation surgery: outcome and predictors.  

PubMed

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

Sedighi, Mahsa; Haghnegahdar, Ali

2014-12-01

364

Endovascular treatment of posterior circulation aneurysms.  

PubMed

Endovascular techniques are well suited for the treatment of posterior circulation aneurysms. This review describes the endovascular management of these aneurysms and discusses relevant technical advances. PMID:24617934

Eller, Jorge L; Dumont, Travis M; Mokin, Maxim; Sorkin, Grant C; Levy, Elad I; Snyder, Kenneth V; Nelson Hopkins, L; Siddiqui, Adnan H

2014-04-01

365

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

PubMed Central

Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar surgery for patients with adjacent segment degeneration (ASD) and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients) or repeated open lumbar surgery (25 patients), due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and ?0.56 in the open lumbar surgery group (P < 0.0001). Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort. PMID:25861474

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

2015-01-01

366

Chronic spontaneous lumbar epidural hematoma simulating extradural spinal tumor: a case report.  

PubMed

Spinal epidural hematoma (SEH) is an uncommon disorder, and chronic SEHs are rarer than acute SEHs. However, there is few reported involving the bone change of the vertebral body in chronic SEHs. We present a case report of lumbar epidural hematoma that required differentiation from extramedullary spinal tumors by a long process because the CT scan revealed scalloping of the vertebral body and review the relevant literature. A 78-year-old man had experienced a gradual onset of low back pain and excruciating pain in both legs. Lumbar MRI on T1-weighted images revealed a space-occupying lesion with a hyperintense signal relative to the spinal cord with no enhancement on gadolinium adminisration. Meanwhile, T2-weighted images revealed a heterogeneous intensity change, accompanying a central area of hyperintense signals with a hypointense peripheral border at the L4 vertebra. Moreover, the CT scan demonstrated scalloping of the posterior wall of the L4 vertebral body which is generally suspected as the CT finding of spainal tumor. During the epidural space exploration, we found a dark red-colored mass surrounded by a capsular layer, which was fibrous and adhered to the flavum and dura mater. Microscopic histological examination of the resected mass revealed a mixture of the relatively new hematoma and the hematoma that was moving into the connective tissue. Accordingly, the hematoma was diagnosed as chronic SEH. The particular MRI findings of chronic SEHs are helpful for making accurate preoperative diagnoses of this pathology. PMID:25130006

Matsui, Hiroki; Imagama, Shiro; Ito, Zenya; Ando, Kei; Hirano, Kenichi; Tauchi, Ryoji; Muramoto, Akio; Matsumoto, Tomohiro; Ishiguro, Naoki

2014-02-01

367

Motion-preserving technologies for degenerative lumbar spine: The past, present, and future horizons  

PubMed Central

Over the past few decades, remarkable advancements in the understanding of the origin of low-back pain and lumbar spinal disorders have been achieved. Spinal fusion is generally considered the “gold standard” in the treatment of low-back pain; however, fusion is also associated with accelerated degeneration of adjacent levels. Spinal arthroplasty and dynamic stabilization technologies, as well as the continuous improvement in diagnosis and surgical interventions, have opened a new era of treatment options. Recent advancements in nonfusion technologies such as motion-preservation devices and posterior dynamic stabilization may change the gold standard. These devices are designed with the intent to provide stabilization and eliminate pain while preserving motion of the functional spinal unit. The adaption of nonfusion technologies by the surgical community and payers for the treatment of degenerative spinal conditions will depend on the long-term clinical outcome of controlled randomized clinical studies. Although the development of nonfusion technology has just started and the adoption is very slow, it may be considered a viable option for motion preservation in coming years. This review article provides technical and surgical views from the past and from the present, as well as a glance at the future endeavors and challenges in instrumentation development for lumbar spinal disorders. © 2011 SAS - The International Society for the Advancement of Spine Surgery. Published by Elsevier Inc. All rights reserved.

Serhan, Hassan; Mhatre, Devdatt; Defossez, Henri; Bono, Christopher M.

2011-01-01

368

Transpedicular screw fixation in the thoracic and lumbar spine with a novel cannulated polyaxial screw system  

PubMed Central

Objective: Transpedicular screws are commonly and successfully used for posterior fixation in spinal instability, but their insertion remains challenging. Even using navigation techniques, there is a misplacement rate of up to 11%. The aim of this study was to assess the accuracy of a novel pedicle screw system. Methods: Thoracic and lumbar fusions were performed on 67 consecutive patients for tumor, trauma, degenerative disease or infection. A total of 326 pedicular screws were placed using a novel wire-guided, cannulated, polyaxial screw system (XIA Precision®, Stryker). The accuracy of placement was assessed postoperatively by CT scan, and the patients were followed-up clinically for a mean of 16 months. Results: The total medio-caudal pedicle wall perforation rate was 9.2% (30/326). In 19 of these 30 cases a cortical breakthrough of less than 2 mm occurred. The misplacement rate (defined as a perforation of 2 mm or more) was 3.37% (11/326). Three of these 11 screws needed surgical revision due to neurological symptoms or CSF leakage. There have been no screw breakages or dislocations over the follow up-period. Conclusion: We conclude that the use of this cannulated screw system for the placement of pedicle screws in the thoracic and lumbar spine is accurate and safe. The advantages of this technique include easy handling without a time-consuming set up. Considering the incidence of long-term screw breakage, further investigation with a longer follow-up period is necessary. PMID:22915906

Weise, Lutz; Suess, Olaf; Picht, Thomas; Kombos, Theodoros

2008-01-01

369

Functional Assessment of Children with Cerebral Palsy Following Limited (L4-S1) Selective Posterior Rhizotomy – A Preliminary Report  

Microsoft Academic Search

Summary.\\u000a Summary.  \\u000a \\u000a \\u000a Objective:   Selective Posterior Rhizotomy (SPR) is effective for reducing spasticity in children with cerebral palsy (CP). Nonetheless,\\u000a extensive sensory deafferentation associated with this procedure can lead to prolonged postoperative hypotonia that delays\\u000a the functional recovery of the patient. As lumbar rhizotomy provokes suprasegmental hypotonia, we hypothesized that reducing\\u000a the extent of the deafferentation to the roots of L4-S1

M. Galarza; E. G. Fowler; L. Chipps; T. M. Padden; J. A. Lazareff

2001-01-01

370

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

PubMed

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

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

2014-11-01

371

Twelve-month results of a multicenter, blinded, pilot study of a novel peptide (B2A) in promoting lumbar spine fusion.  

PubMed

OBJECT Failure of fusion after a transforaminal lumbar interbody fusion (TLIF) procedure is a challenging problem that can lead to ongoing low-back pain, dependence on pain medication, and inability to return to work. B2A is a synthetic peptide that has proven efficacy in achieving fusion in animal models and may have a better safety profile than bone morphogenetic protein. The authors undertook this study to evaluate the safety and efficacy of B2A peptide-enhanced ceramic granules (Prefix) in comparison with autogenous iliac crest bone graft (ICBG, control) in patients undergoing single-level TLIF. METHODS Twenty-four patients with single-level degenerative disorders of the lumbar spine at L2-S1 requiring TLIF were enrolled between 2009 and 2010. They were randomly assigned to 3 groups: a control group (treated with ICBG, n = 9), a Prefix 150 group (treated with Prefix 150 ?g/cm(3) granules, n = 8), and a Prefix 750 group (treated with Prefix 750 ?g/cm(3) granules, n = 7). Outcome measures included the Oswestry Disability Index (ODI), visual analog pain scale, and radiographic fusion as assessed by CT and dynamic flexion/extension lumbar plain radiographs. RESULTS At 12 months after surgery, the radiographic fusion rate was 100% in the Prefix 750 group, 78% in the control group, and 50% in the Prefix 150 group, although the difference was not statistically significant (p = 0.08). At 6 weeks the mean ODI score was 41.0 for the control group, 27.7 for the Prefix 750 group, and 32.2 for the Prefix 150 group, whereas at 12 months the mean ODI was 24.4 for control, 31.1 for Prefix 750, and 29.7 for Prefix 150 groups. Complications were evenly distributed among the groups. CONCLUSIONS Prefix appears to provide a safe alternative to autogenous ICBG. Prefix 750 appears to show superior radiographic fusion when compared with autograft at 12 months after TLIF, although no statistically significant difference was demonstrated in this small study. Prefix and control groups both appeared to demonstrate comparable improvements to ODI at 12 months. PMID:25615629

Sardar, Zeeshan; Alexander, David; Oxner, William; Plessis, Stephan du; Yee, Albert; Wai, Eugene K; Anderson, D Greg; Jarzem, Peter

2015-04-01

372

Posterior Cruciate Ligament Removal Contributes to Abnormal Knee Motion during Posterior Stabilized Total Knee Arthroplasty  

E-print Network

Posterior Cruciate Ligament Removal Contributes to Abnormal Knee Motion during Posterior Stabilized Total Knee Arthroplasty Melinda J. Cromie,1,2 Robert A. Siston,1,2,3,4 Nicholas J. Giori,2,5 Scott L (20­608) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes

Delp, Scott

373

Giant cell tumour of the sacrum: function-preserving surgery with extended curettage and ilio-lumbar fusion.  

PubMed

Giant cell tumours of the sacrum pose a unique therapeutic challenge due to the inaccessibility of the tumour, significant intra-operative blood loss from extensive vascularity, high rate of local recurrence with conservative surgery, and loss of neurological function and mechanical instability with en-bloc excision. We present a case where successful outcome was achieved by tailoring treatment in consideration of the above issues. A 28 year old male diagnosed on biopsy to have giant cell tumour of the sacrum presented to us with low-back pain, left-sided S1 radiculopathy, ankle weakness and urinary incontinence. MRI showed a tumour involving the S1 and S2 vertebral segments, breaching the posterior cortex and compressing the neural elements. An angiographic tumour embolization was performed followed by surgery through a posterior approach whereby an extended curettage was done, carefully freeing the sacral nerve roots and abrading the bone using high-speed burr. An ilio-sacro-lumbar fusion was done employing iliolumbar instrumentation and bone grafting. Post-operatively, within a week the patient was ambulated with a lumbar corset. At 9 months follow-up, the patient was completely pain free, had no ankle weakness, and had normal continence. This treatment approach resulted in preservation of neurologic function and maintenance of spinal stability, thus the patient returned to full function. PMID:25226752

Lakdawala, Riaz H; Ahmad, Tashfeen; Enam, Syed A

2013-01-01

374

Nonoperatively treated isolated posterior cruciate ligament injuries  

Microsoft Academic Search

To evaluate the theory that isolated posterior cruciate ligament injuries do well when treated nonoperatively, we reviewed 40 patients (mean age, 33 years at fol lowup ; average interval from injury, 6 years) who com pleted a modified Noyes knee questionnaire and were reevaluated by physical examination, radiographs, and isokinetic testing. Thirty of the injuries to the posterior cruciate ligament

Paul M. Keller; K. Donald Shelbourne; John R. McCarroll; Arthur C. Rettig

1993-01-01

375

Visualizing the emergence of posterior cortical atrophy  

Microsoft Academic Search

Posterior cortical atrophy (PCA) is a neurodegenerative condition characterized by a progressive loss of visual processing skills and other posterior functions. Diagnosis is often delayed in PCA as symptoms can be difficult for the patient to articulate and for the clinician to detect. Diagnosis is particularly challenging in the earliest stages of the disease since visual symptoms are often mistaken

Jonathan Kennedy; Manja Lehmann; Magdalena J. Sokolska; Hilary Archer; Elizabeth K. Warrington; Nick C. Fox; Sebastian J. Crutch

2012-01-01

376

Visualizing the emergence of posterior cortical atrophy  

Microsoft Academic Search

Posterior cortical atrophy (PCA) is a neurodegenerative condition characterized by a progressive loss of visual processing skills and other posterior functions. Diagnosis is often delayed in PCA as symptoms can be difficult for the patient to articulate and for the clinician to detect. Diagnosis is particularly challenging in the earliest stages of the disease since visual symptoms are often mistaken

Jonathan Kennedy; Manja Lehmann; Magdalena J. Sokolska; Hilary Archer; Elizabeth K. Warrington; Nick C. Fox; Sebastian J. Crutch

2011-01-01

377

[Posterior epispadias with unknown complete duplicated urethra].  

PubMed

The authors report a case of posterior epispadias associated with complete ventral urethra only discovered during the urethroplasty phase of the operation. This malformation is a rare form of urethral duplication and should be considered in any case of apparently isolated posterior epispadias. PMID:1302070

Aubert, D; Rigaud, P; Destuynder, O; Zoupanos, G

1992-04-01

378

Lumbar disc nucleoplasty using coblation technology: clinical outcome  

Microsoft Academic Search

Background and purposeAlthough the standard treatment for lumbar disc herniation is lumbar microdiscectomy, nucleoplasty offers a new technique with encouraging results in well selected cases. Nucleoplasty is a minimally invasive technique that manages intradiscal herniation through energy based removal of part of the nucleus pulposus. The purpose of this study was to assess the safety and clinical outcome of the

Alaa Azzazi; Sherif AlMekawi; Mostafa Zein

2010-01-01

379

Circumferential cells of the developing Rana catesbeiana lumbar spinal cord  

Microsoft Academic Search

Neural elements in the lumbar enlargement of the developing Rana catesbeiana spinal cord were labelled by placing chips of dessicated horseradish peroxidase (HRP) into various lesions of the spinal cord. Of the elements labelled in the lumbar enlargement, a population of cells circumjacent to the gray matter was seen to be distinct from all others on the basis of their

H. Lee Campbell; Michael S. Beattie; Jacqueline C. Bresnahan

1987-01-01

380

The Clinical Syndrome Associated with Lumbar Spinal Stenosis  

Microsoft Academic Search

Lumbar spinal stenosis is well defined in patho-anatomical terms but its clinical features are heterogeneous. We carried out a comprehensive retrospective review of the clinical features, radiological changes and outcome of 75 patients with radiologically diagnosed lumbar spinal stenosis in order to define its clinical spectrum. The presenting complaints were of weakness, numbness\\/tingling, radicular pain and neurogenic claudication in almost

Khean Jin Goh; Waël Khalifa; Philip Anslow; Tom Cadoux-Hudson; Michael Donaghy

2004-01-01

381

49 CFR 572.43 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2010 CFR

...Transportation 7 2010-10-01 2010-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a fully...

2010-10-01

382

Mechanical differences between lumbar and tail discs in the mouse  

Microsoft Academic Search

The mouse lumbar and tail discs are both used as models to study disc degeneration; however, the mechanical behavior of these two levels has not been compared. The objective of this study was to compare the elastic and viscoelastic mechanical properties of lumbar and tail discs of the mouse under axial compression–tension loading. We hypothesized that tail discs would have

Joseph J. Sarver; Dawn M. Elliott

2005-01-01

383

The Robotic Lumbar Spine: Dynamics and Feedback Linearization Control  

PubMed Central

The robotic lumbar spine (RLS) is a 15 degree-of-freedom, fully cable-actuated robotic lumbar spine which can mimic in vivo human lumbar spine movements to provide better hands-on training for medical students. The design incorporates five active lumbar vertebrae and the sacrum, with dimensions of an average adult human spine. It is actuated by 20 cables connected to electric motors. Every vertebra is connected to the neighboring vertebrae by spherical joints. Medical schools can benefit from a tool, system, or method that will help instructors train students and assess their tactile proficiency throughout their education. The robotic lumbar spine has the potential to satisfy these needs in palpatory diagnosis. Medical students will be given the opportunity to examine their own patient that can be programmed with many dysfunctions related to the lumbar spine before they start their professional lives as doctors. The robotic lumbar spine can be used to teach and test medical students in their capacity to be able to recognize normal and abnormal movement patterns of the human lumbar spine under flexion-extension, lateral bending, and axial torsion. This paper presents the dynamics and nonlinear control of the RLS. A new approach to solve for positive and nonzero cable tensions that are also continuous in time is introduced. PMID:24151527

Karadogan, Ernur; Williams, Robert L.

2013-01-01

384

Low-Back Pain Following Surgery for Lumbar Disc Herniation  

Microsoft Academic Search

Background: Lumbar disc herniation often causes sciatica. Although surgery may provide relief of sciatic pain, it is uncertain how surgery affects the relief of low-back pain. The purpose of the present prospective study was to assess the efficacy of discectomy in the treatment of low-back pain associated with lumbar disc herniation. Methods: Between 1998 and 2001, forty consecutive patients with

TOMOAKI TOYONE; TADASHI TANAKA; DAISUKE KATO; RYUTAKU KANEYAMA

385

49 CFR 572.43 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2013 CFR

...Transportation 7 2013-10-01 2013-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a...

2013-10-01

386

49 CFR 572.43 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2014 CFR

...Transportation 7 2014-10-01 2014-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a...

2014-10-01

387

49 CFR 572.43 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2011 CFR

...Transportation 7 2011-10-01 2011-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a...

2011-10-01

388

49 CFR 572.43 - Lumbar spine and pelvis.  

Code of Federal Regulations, 2012 CFR

...Transportation 7 2012-10-01 2012-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a...

2012-10-01

389

Effects of external trunk loads on lumbar spine stability  

Microsoft Academic Search

Stability of the lumbar spine is an important factor in determining spinal response to sudden loading. Using two different methods, this study evaluated how various trunk load magnitudes and directions affect lumbar spine stability. The first method was a quick release procedure in which effective trunk stiffness and stability were calculated from trunk kinematic response to a resisted-force release. The

Jacek Cholewicki; Adam P. D Simons; Andrea Radebold

2000-01-01

390

Chronic inflammatory demyelinating polyneuropathy mimicking a lumbar spinal stenosis syndrome  

Microsoft Academic Search

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

L Ginsberg; A D Platts; P K Thomas

1995-01-01

391

Early clinical effects of the Dynesys system plus transfacet decompression through the Wiltse approach for the treatment of lumbar degenerative diseases  

PubMed Central

Background This study investigated early clinical effects of Dynesys system plus transfacet decompression through the Wiltse approach in treating lumbar degenerative diseases. Material/Methods 37 patients with lumbar degenerative disease were treated with the Dynesys system plus transfacet decompression through the Wiltse approach. Results Results showed that all patients healed from surgery without severe complications. The average follow-up time was 20 months (9–36 months). Visual Analogue Scale and Oswestry Disability Index scores decreased significantly after surgery and at the final follow-up. There was a significant difference in the height of the intervertebral space and intervertebral range of motion (ROM) at the stabilized segment, but no significant changes were seen at the adjacent segments. X-ray scans showed no instability, internal fixation loosening, breakage, or distortion in the follow-up. Conclusions The Dynesys system plus transfacet decompression through the Wiltse approach is a therapeutic option for mild lumbar degenerative disease. This method can retain the structure of the lumbar posterior complex and the motion of the fixed segment, reduce the incidence of low back pain, and decompress the nerve root. PMID:24859831

Liu, Chao; Wang, Lei; Tian, Ji-wei

2014-01-01

392

High posterior density ellipsoids of quantum states  

E-print Network

Regions of quantum states generalize the classical notion of error bars. High posterior density (HPD) credible regions are the most powerful of region estimators. However, they are intractably hard to construct in general. This paper reports on a numerical approximation to HPD regions for the purpose of testing a much more computationally and conceptually convenient class of regions: posterior covariance ellipsoids (PCEs). The PCEs are defined via the covariance matrix of the posterior probability distribution of states. Here it is shown that PCEs are near optimal for the example of Pauli measurements on multiple qubits. Moreover, the algorithm is capable of producing accurate PCE regions even when there is uncertainty in the model.

Christopher Ferrie

2013-10-07

393

Alien hand syndrome in left posterior stroke.  

PubMed

Alien hand syndrome is a rare neurological disorder characterized by involuntary and uncontrollable motor behaviour, usually of an arm or hand. The patient perceives the affected limb as alien, and may personify it. The case of a 61-year-old right-handed woman who developed right posterior AHS after ischaemic stroke in the left posterior cerebral artery territory is reported. Neuroimaging studies disclosed no frontal or parietal involvement, while a posterior thalamic lesion was detected. A possible role of the thalamus in the genesis of AHS is discussed. PMID:21327399

Bartolo, Michelangelo; Zucchella, C; Pichiecchio, A; Pucci, E; Sandrini, G; Sinforiani, E

2011-06-01

394

Microcirculation of human fetal posterior root ganglia: a scanning electron microscopic study of corrosion casts.  

PubMed

The vasculature of lumbar posterior root ganglia was investigated in human fetuses aged 17-24 weeks; using the corrosion casting technique and scanning electron microscopy. The arterial supply consisted of one main artery and occasional arterioles entering the ganglion at its pole and running axially, while the venous drainage was located at the periphery of the ganglion, thus indicating a centrifugal pattern of blood flow. The dense capillary network of the ganglion showed the roughly parallel course of the vessels in the central zone and an irregular arrangement in the peripheral zone where capillaries formed "nests", probably surrounding individual perikaryons of ganglionic cells. The capillaries had a sinusoidal character with numerous dilatations about twice the normal capillary size, as well as occasional larger vascular spaces resulting from capillary interconnections and suggesting the intussusceptive type of angiogenesis. PMID:9488902

Gorczyca, J; Skawina, A; Litwin, J A; Miodo?ski, A J

1998-02-01

395

POSTERIOR CONSISTENCY IN NONPARAMETRIC REGRESSION PROBLEMS UNDER GAUSSIAN PROCESS PRIORS  

E-print Network

POSTERIOR CONSISTENCY IN NONPARAMETRIC REGRESSION PROBLEMS UNDER GAUSSIAN PROCESS PRIORS By Taeryon Choi and Mark J. Schervish Carnegie Mellon University Posterior consistency can be thought processes. In this paper, we study posterior consistency in nonparametric regression problems using Gaussian

396

A Posterior Approach for Microphone Array Based Speech Recognition   

E-print Network

posterior-based approach for array-based speech recognition. The main idea is, instead of enhancing speech signals, we try to enhance the posterior probabilities that frames belonging to recognition units, e.g., phones. These enhanced posteriors...

Wang, Dong; Himawan, Ivan; Frankel, Joe; King, Simon

2008-01-01

397

Shining a light on posterior cortical atrophy Sebastian J. Crutcha  

E-print Network

Shining a light on posterior cortical atrophy Sebastian J. Crutcha , Jonathan M. Schotta , Gil D Posterior cortical atrophy (PCA) is a clinicoradiologic syndrome characterized by progressive de- cline; Posterior cortical atrophy; Atypical dementia; Simultanagnosia; Visual disturbances; Differential diagnosis

Dickerson, Brad

398

COMBINED POSTERIOR-ANTERIOR SURGERY FOR OSTEOPOROTIC DELAYED VERTEBRAL FRACTURE WITH NEUROLOGIC DEFICIT  

PubMed Central

ABSTRACT With the aging of society, osteoporotic thoracolumbar compression fracture is a concern. This fracture occurs occasionally; however, some cases progress to neural compromise due to delayed vertebral body collapse requiring surgery. Surgical treatment and postoperative care are difficult because of patients’ serious comorbidities and poor bone quality, and hence, optimum treatment is not clear, even though some surgical approaches have been reported. There were 35 consecutive patients (5 males and 30 females) with osteoporotic delayed vertebral fractures and associated neurological deficit. Mean age at surgery was 70.7 years (range 60–84 years). Average postoperative follow-up was 3.8 years (range 0.6–11.3 years). All patients experienced a single vertebra collapse, except for 1 with a 2-level collapse of lumbar vertebrae. One thoracic (Th7), 19 thoracolumbar (Th12-L1), and 16 lumbar (L2-5) fractures were treated with combined posterior-anterior surgery. The American Spinal Injury Association (ASIA) impairment scale, activities of daily living (ADL) status, and local sagittal angle were evaluated both before and after surgery. Forty-six percent of all patients showed an improvement of more than 1 grade postoperatively on the ASIA impairment scale, and 74% demonstrated an improvement in ADL status. No deterioration was observed in neurological or ADL status after surgery. With regard to sagittal alignment, preoperative kyphosis of 18.4 degrees was corrected to 2.4 degrees of kyphosis postoperatively. However, 11.5 degrees loss of correction was observed at final follow-up observation. Combined posterior-anterior surgery could provide reliable improvement in both neurological and ADL status, although maintenance of postoperative alignment was difficult to achieve in some cases. PMID:25741039

NAKASHIMA, HIROAKI; YUKAWA, YASUTSUGU; ITO, KEIGO; MACHINO, MASAAKI; ISHIGURO, NAOKI; KATO, FUMIHIKO

2014-01-01

399

Retrolisthesis and lumbar disc herniation: a postoperative assessment of patient function  

PubMed Central

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. PMID:23201024

Kang, Kevin K.; Shen, Michael S.; Zhao, Wenyan; Lurie, Jon D.; Razi, Afshin E.

2013-01-01

400

Echocardiographic examination of the posterior atrioventricular groove.  

PubMed

Abnormalities of the posterior atrioventricular (AV) groove may be mischaracterized or overlooked in the course of routine echocardiographic imaging. Vascular abnormalities in this location include plethora of the coronary sinus and ectasia of the circumflex coronary artery. Excess accumulation of calcium (mitral annular calcification) and of fat (lipomatosis of the posterior AV groove) may also occur in this region. Masses (tumors or thrombus) arising from the floor of the left atrium or extrinsic to it (hiatal hernia, lymph nodes) may occupy the posterior AV groove. Abnormalities of the left ventricle, including aneurysms and pseudoaneurysms may present as masses in the posterior AV groove. This article discusses the echocardiographic features, differential diagnosis, and clinical significance of these abnormalities. PMID:24495083

Silbiger, Jeffrey J

2014-02-01

401

Efficient search using posterior phone probability estimates.   

E-print Network

In this paper we present a novel, efficient search strategy for large vocabulary continuous speech recognition (LVCSR). The search algorithm, based on stack decoding, uses posterior phone probability estimates to substantially increase its...

Renals, Steve; Hochberg, Mike

1995-01-01

402

[Pathogenesis of posterior capsule opacification in pseudophakia].  

PubMed

The lens epithelial cells of A and E type are involved in pathogenesis of posterior capsule opacification (PCO). They undergo metaplasia into microfibroblasts, then migrate towards posterior capsule where they proliferate and form opacification. These processes are stimulated by cytokines and interleukines. The extracellular matrix which constitutes a scaffold for migration and attachment of epithelial cells plays an important role in PCO formation. Integrines intercede in this process. PMID:20169899

?ukaszewska-Smyk, Agnieszka; Ka?uzny, Józef

2009-01-01

403

Cognitive rehabilitation in posterior cortical atrophy  

Microsoft Academic Search

Posterior cortical atrophy (PCA) is a rare early-onset dementing syndrome presenting with visuo-perceptual deficits. Clinicopathologically, it is most commonly considered a form of Alzheimer's disease. We present the case of a 64-year-old male patient with posterior cortical atrophy who took part in a cognitive rehabilitation programme that included psychoeducation, compensatory strategies, and cognitive exercises. After the cognitive rehabilitation programme, subtle

María Roca; Ezequiel Gleichgerrcht; Teresa Torralva; Facundo Manes

2010-01-01

404

Posterior atlantoaxial dislocation without associated fracture.  

PubMed

We report on a 38-year-old man with post-traumatic posterior displacement of the atlas with respect to the axis without any associated fracture or neurological deficit caused by the displacement. Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) revealed posterior displacement of the atlas with the odontoid peg lying anterior and to the right of the anterior arch of the atlas. PMID:12195506

Sud, S; Chaturvedi, S; Buxi, T B S; Singh, S

2002-09-01

405

Posterior odds ratios for selected regression hypotheses  

Microsoft Academic Search

Summary  Bayesian posterior odds ratios for frequently encountered hypotheses about parameters of the normal linear multiple regression\\u000a model are derived and discussed. For the particular prior distributions utilized, it is found that the posterior odds ratios\\u000a can be well approximated by functions that are monotonic in usual sampling theoryF statistics. Some implications of this finding and the relation of our work

A. Zellner; A. Siow

1980-01-01

406

Optimal Intervertebral Sealant Properties for the Lumbar Spinal Disc: A Finite-Element Study  

PubMed Central

Background In the lumbar spinal column, an annular disruption may be sealed after annulotomy to prevent further prolapse and instability. We investigated the biomechanical effects of various material properties of an injectable sealant Methods We used a 3-dimensional, nonlinear, osteoligamentous, experimentally validated finite-element model of the L3–L5 spine segment to study annulotomies of varying sizes and locations in the L3–L4 annulus followed by replacement with isotropic sealants (plugs) with a Young's modulus of 0.4, 2.0, 4.0, 6.0, and 40.0 MPa. Annulotomies in the region of the posterior longitudinal ligament were studied with and without the ligament in place. Intact, destabilized, and repaired models were subjected to 400 N compression and 12.7 Nm moment in all loading modes to compute plug forces, plug stresses, motion characteristics, and annulus bulge. Results Changes in sealant stiffness minimally affected the overall motion characteristics of the segment. Increases in shear stress and von Mises stress were proportional to the stiffness of the sealant. The von Mises stress was inversely proportional to plug size. Removal of portions of the posterior longitudinal ligament did not significantly alter motion between spinal segments or stress in the annulus fibrosus. Removal of portions of the ligament increased the disc bulge when plugs were less stiff. Intradiscal pressure decreased when an annulotomy was created. The sealant generally restored nucleus pressure to a degree proportionate to sealant stiffness. Conclusions Minimizing sealant stresses as well as expulsion and separation forces should lead to a minimal Young's modulus. Sealant materials with a Young's modulus close to 6 MPa are most appropriate. The allowable variation in material properties is reduced with increased annulotomy size. Removal of posterior longitudinal ligament only allows increased sealant bulge when the sealant's modulus of elasticity is very low. This removal does not affect spinal unit biomechanics or annulus stress in annulotomy or annulotomy with sealant repair.

Holekamp, Scott; Kuroki, Hiroshi; Huntzinger, Janet; Ebraheim, Nabil

2007-01-01

407

[Lumbar disc herniation--diagnosis and treatment].  

PubMed

A lumbar disc herniation (LDH) is a condition frequently encountered in primary care medicine. It may give rise to a compression of one or more nerve roots, which can lead to a nerve root irritation, a so-called radiculopathy, with or without a sensorimotor deficit. The majority of LDHs can be supported by means of a conservative treatment consisting of physical therapy, ergotherapy, analgetics, anti-inflammatory therapy or corticosteroids, which may be eventually administered by infiltrations. If a clinico-radiological correlation is present and moderate neurological deficit appears suddenly, if it is progressive under conservative treatment or if pain is poorly controlled by well-conducted conservative treatment performed during four to six months, surgery is then recommended. PMID:25632633

Corniola, M-V; Tessitore, E; Schaller, K; Gautschi, O P

2014-12-10

408

Traumatic subdural hematoma in the lumbar spine.  

PubMed

Traumatic spinal subdural hematoma is rare and its mechanism remains unclear. This intervention describes a patient with mental retardation who was suffering from back pain and progressive weakness of the lower limbs following a traffic accident. Magnetic resonance imaging of the spine revealed a lumbar subdural lesion. Hematoma was identified in the spinal subdural space during an operation. The muscle power of both lower limbs recovered to normal after surgery. The isolated traumatic spinal subdural hematoma was not associated with intracranial subdural hemorrhage. A spinal subdural hematoma should be considered in the differential diagnosis of spinal cord compression, especially for patients who have sustained spinal trauma. Emergency surgical decompression is usually the optimal treatment for a spinal subdural hematoma with acute deterioration and severe neurological deficits. PMID:21943822

Song, Jenn-Yeu; Chen, Yu-Hao; Hung, Kuang-Chen; Chang, Ti-Sheng

2011-10-01

409

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

PubMed

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

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

2014-03-01

410

Tracking Lumbar Vertebrae in Digital Videofluoroscopic Video Automatically  

E-print Network

Tracking Lumbar Vertebrae in Digital Videofluoroscopic Video Automatically Shu-Fai WONG1 , Kwan) shows typical videofluoroscopic image of spine. Thus, a wide range of researches on automatic extraction

Wong, Kenneth K.Y.

411

Sense in the lumbar spine Is diminished with flexion  

E-print Network

Proprioception plays an important role in appropriate sensation of spine position, movement and stability. Previous research has demonstrated that position sense error in the lumbar spine is increased in flexed postures. This study investigated...

Gade, Venkata; Wilson, Sara E.

2007-01