The Correlation Between Restoration of Lumbar Lordosis and Surgical Outcome in the Treatment of Low-grade Lumbar Degenerative Spondylolisthesis With Spinal Fusion.

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To investigate the relationship between the restoration of the lumbar lordosis (LL) and the surgical outcome of patients undergoing spinal fusion for low-grade lumbar degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA: Correlation between low back pain and the loss of LL in the treatment of low-grade lumbar degenerative spondylolisthesis has seldom been reported. METHODS: Between May 2005 and July 2011, 59 patients with low back pain and neurogenic claudication due to low-grade lumbar degenerative spondylolisthesis underwent spinal decompression and fusion by a senior surgeon. Ten patients were lost to follow-up. The mean age of the remaining 49 patients (10 men and 39 women) was 64.0 years (range, 47-88 y). Patients were categorized on the basis of the spino-pelvic posture: type 1 [pelvic incidence (PI)<45 degrees] (n=12), type 2 (45 degrees≤PI≤60 degrees) (n=24), and type 3 (PI>60 degrees) (n=13). The LL restoration ratio was calculated by the actual LL divided by the predicted LL. The clinical results were evaluated using a visual analogue scale and the Oswestry Disability Index. Postoperative 36-inch spinal films were used to assess the sagittal balance. RESULTS: The mean follow-up period was 43.2 months (range, 28-62 mo). Forty-eight patients showed significant improvement with respect to visual analogue scale and Oswestry Disability Index regardless of whether the LL was restored higher or lower. Postoperative 36-inch spinal films showed the C7 plumb line to be within an average of 4.4 cm (range, 0.6-5.6 cm) from the posterior-superior corner of the S1 vertebrae. CONCLUSIONS: Patients with smaller PI tended to be restored higher, and those patients with a larger PI were more likely to be restored lower. For patients with normal sagittal balance, the surgical outcomes in the treatment of low-grade lumbar degenerative spondylolisthesis with spinal fusion are not correlated with restoration of the LL.

Human adipose-derived stem cells for the treatment of intracerebral hemorrhage in rats via femoral intravenous injection.

Human adipose-derived stem cells (huADSC) were generated from fat tissue of a 65-year-old male donor. Flow cytometry and reverse transcription polymerase chain reaction (RT-PCR) analyses indicated that the huADSC express neural cell proteins (MAP2, GFAP, nestin and ß-III tubulin), neurotrophic growth factors (BDNF and GDNF), and the chemotactic factor CXCR4 and its corresponding ligand CXCL12. In addition, huADSC expressed the characteristic mesenchymal stem cell (MSC) markers CD29, CD44, CD73, CD90, CD105 and HLA class I. The huADSC were employed, via a right femoral vein injection, to treat rats inflicted with experimental intracerebral hemorrhage (ICH). Behavioral measurement on the experimental animals, seven days after the huADSC therapy, showed a significant functional improvement in the rats with stem cell therapy in comparison with rats of the control group without the stem cell therapy. The injected huADSC were detectable in the brains of the huADSC treated rats as determined by histochemistry analysis, suggesting a role of the infused huADSC in facilitating functional recovery of the experimental animals with ICH induced stroke.

Surgical experience with symptomatic thoracic ossification of the ligamentum flavum.

OBJECT: Symptomatic thoracic ossification of the ligamentum flavum (OLF) is rare, and its prognostic factors remain unclear. The authors retrospectively studied 24 patients with surgically treated thoracic OLF to delineate its prognostic factor. METHODS: The clinical manifestations, radiological studies, surgical records, and pathological findings were reviewed. Preoperative and postoperative neurological data were reappraised using the American Spinal Injury Association and modified Japanese Orthopaedic Association (JOA) scoring systems. Spearman rank-correlation coefficients and nonparametric tests were used to analyze the correlations between the variables of patient characteristics, preoperative duration of symptoms, preoperative neurological status, associated spinal disorder(s) other than thoracic OLF, and the final functional outcome. CONCLUSIONS: Decompressive surgery is indicated in patients in whom symptomatic thoracic spinal cord compression is caused by intruding OLF. Magnetic resonance imaging can provide sufficient clues for the diagnosis of thoracic OLF. Higher preoperative modified JOA scores of 3 and 4 are positively correlated with better postoperatiVe functional recovery than lower scores. Surgery should be performed as soon as possible before independent ambulatory function is impaired.

Clinical results of a single central interbody fusion cage and transpedicle screws fixation for recurrent herniated lumbar disc and low-grade spondylolisthesis.

BACKGROUND: The posterior lumbar interbody fusion (PLIF) procedure allows restoration of the weight-bearing capacity to a more physiological ventral position and maintenance of disc space height. However, the procedure can be technically difficult and may cause complications. It has always been performed bilaterally with paired cages; a single central cage has not been commonly used. METHODS: Twenty-eight patients who met the interbody fusion criteria from March 1999 through November 2001 were included in the study. Surgery was performed from the posterior with a single central cage supplemented with transpedicle screws. The follow-up period ranged from 8 to 39 months with a mean of 14.4 months. Clinical outcomes were assessed. Dynamic radiography for fusion mass was interpreted by an independent radiologist. RESULTS: Overall, 92.86% of the patients were satisfied with their conditions after surgery. Radiography study showed the rate of bony fusion being 82.14%. Fibrous union was noted in five patients. No migration of the cage was observed. One patient experienced laceration of the dura without clinical sequelae. One patient had transient paresthesia and recovered within 2 weeks. One patient had transient bladder atony and recovered within 3 days. Overall, the complications were negligible and none of the patients sustained a motor deficit and permanent complication. CONCLUSIONS: The PLIF procedure using a single, central cage combined with bilateral pedicle screws fixation obtained satisfactory outcome within a short-term or long-term follow-up period. Since the implant-related complications have seldom been observed, it may be used as an alternative option for recurrent lumbar disc herniation or low grade spondylolisthesis with apparent degenerative disc disease.

Efficacy of topical microfibrillar collagen mixed with steroid hormone and morphine for postoperative pain control during lumbar laminectomy: a preliminary report.

BACKGROUND: Current inpatient management of postoperative pain in lumbar surgery includes the use of intramuscular opioid analgesics, nonsteroidal anti-inflammatory drugs, or patient-controlled analgesia; however, all types of medications are associated with side effects that can limit their usefulness in the inpatient setting. METHODS: In a well-conducted non-randomized prospective trial, 80 consecutive patients who underwent elective multilevel lumbar laminectomy surgery were identified. Two types of trials with different doses of steroids were used. Patients' preoperative medical records, pain scores, narcotics consumption, costs for the regimen, hospital stay, unwanted complications, and walking ability were evaluated postoperatively. RESULTS: Pain in patients after lumbar surgery can be dramatically controlled postoperatively. Seventy-eight patients (97.5%) were able to walk without support on the first postoperative day. Major side effects were found in 5 patients (6.2%). CONCLUSIONS: This experience indicates that pain-control agents with epidural sustained-released preparation seem to be beneficial in early mobilization, are cost effective, and require lower analgesic consumption by patients. Similar pain control can be obtained with lower doses of methylprednisolone. In spite of its clinical attractiveness, improvements in the side effects of complications from epidural morphine and the combination of steroids and microfibrillar collagen have yet to be realized.