Analgesic effect of buccal acupuncture on patients after lumbar spinal fusion: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of buccal acupuncture on pain after lumbar spinal fusion.@*METHODS@#Sixty patients undergoing lumbar spinal fusion were randomly divided into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 1 case was eliminated). The patients in the control group were treated with routine anesthesia. On the basis of the control group, the patients in the observation group were treated with buccal acupuncture at bilateral back point, waist point, and sacral point for 30 min per treatment. The first acupuncture was given before anesthesia induction, and then once a day postoperation for two days, totally 3 treatments. The dosage of sufentanil, the number of remedial analgesia, and the incidence of nausea and vomiting within 48 h after surgery were compared between the two groups; rest and motion visual analogue scale (VAS) scores at 2 (T1), 8 (T2), 12 (T3), 24 (T4), and 48 (T5) h after surgery were observed; the quality of recovery-15 scale (QoR-15) at 24 and 48 h after surgery were evaluated.@*RESULTS@#The dosage of sufentanil and the number of remedial analgesia within 48 h after surgery in the observation group were lower than those in the control group (P<0.01). There was no significant statistically difference in rest and motion VAS scores between the two groups in T1, T2, T3, T4 and T5 (P>0.05). The QoR-15 scores in the observation group at 24 and 48 h after surgery were higher than those in the control group (P<0.01). The incidence of nausea in the observation group was lower than that in the control group (P<0.05).@*CONCLUSION@#Buccal acupuncture could reduce the amount of postoperative analgesic drugs of patients after lumbar spinal fusion, and promote early postoperative recovery.

Three-dimensional finite element analysis of the biomechanical changes of the lumbar spine after the combination of intervertebral fusion with dynamic internal fixation of the interspinous process in the lumbosacral region / 中国组织工程研究

BACKGROUND: The Topping-off technique, which combines lumbar fusion with the dynamic internal fixation system (Coflex), can not only reduce the pressure, but also protect the adjacent segments. There is no relevant mechanical analysis performed on the rationality of the application of Topping-off technique to young patients with the need for fusion on the lumbosacral region and adjacent degenerated segments. OBJECTIVE: To establish a finite element model of Topping-off surgery on the lumbosacral junction and to analyze the biomechanical changes of the adjacent segments and the range of motion trend of the lumbar spine. METHODS: A healthy young male volunteer with no previous history of low back pain or congenital malformations was randomly selected for thin-slice CT scanning after signed the informed consent. The image information was imported into the computer and the whole lumbar spine model as the healthy group model was established by analyzing the image information through Mimics, Geomagic Studio 12.0, HyperMesh and Abaqus successively. After verifying the effectiveness of the model, the moderate degeneration model of intervertebral disc was established by changing the material properties of L4-s1 discs on the basis of the healthy model, and the fusion model and Topping-off model were respectively established on the basis of the degeneration model. After applying 400 N compressive load and 10 N-m momentum to the four groups of models, the variation trends of range of motion from L2 to L5 and the stress changes of L4/L5 intervertebral disc, nucleus pulposus and facet joints were calculated respectively. RESULTS AND CONCLUSION: (1) Compared with the degeneration model, the lumbar range of motion of Topping-off model and fusion model decreased, and the Topping-off model decreased more significantly than the fusion model. (2) The range of motion of fusion model L4-L5 increased significantly and the range of motion of L2/L3 and L3/L4 segments did not change significantly. Compared with the degeneration model, the L4-L5 range of motion of Topping-off model decreased, and range of motion of the L2/L3 and L3/L4 levels increased to some extent in the flexion and extension positions. (3) Compared with the degeneration model, the stress on the disc, nucleus pulposus and facet joint of the fusion model L4-L5 increased in four positions of flexion, extension, rotation and bending, while the fiber stress on the Topping-off model decreased significantly in all four positions. (4) These results suggest that Topping-off technology can not only reduce the stress on the upper adjacent degenerative intervertebral disc, nucleus pulposus and facet joints, but also reduce the hyperactivity of the adjacent segments and increase the range of motion of other upper segments, thereby compensating the lumbar spine mobility and delaying the degeneration of upper adjacent segments.

The Efficacy and Perioperative Complications Associated with Lumbar Spinal Fusion Surgery, Focusing on Geriatric Patients in the Republic of Korea

OBJECTIVE: The purpose of this study was to examine the efficacy and perioperative complications associated with lumbar spinal fusion surgery, focusing on geriatric patients in the Republic of Korea. METHODS: We retrospectively investigated 485 patients with degenerative spinal diseases who had lumbar spinal fusion surgeries between March 2006 and December 2010 at our institution. Age, sex, comorbidity, American Society of Anesthesiologists (ASA) class, fusion segments, perioperative complications, and outcomes were analyzed in this study. Risk factors for complications and their association with age were analyzed. RESULTS: In this study, 81 patients presented complications (16.7%). The rate of perioperative complications was significantly higher in patients 70 years or older than in other age groups (univariate analysis, p=0.015; multivariate analysis, p=0.024). The perioperative complications were not significantly associated with the other factors tested (sex, comorbidity, ASA class, and fusion segments). Post-operative outcomes of lumbar spinal fusion surgeries for the patients were determined on the basis of MacNab's criteria (average follow up period : 19.7 months), and 412 patients (85.0%) were classified as having "excellent" or "good" results. CONCLUSION: Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery, whereas other factors were not significant. However, patients' satisfaction or return to daily activities when compared with younger patients did not show much difference. We recommend good clinical judgment as well as careful selection of geriatric patients for lumbar spinal fusion surgery.

Clinical Results of Lumbar Spinal Fusion in Degenerative Spine Disease in Patients over 75 Years Old: Comparative Study of Patients over 65 Years Old and Patients less than 75 Years Old / 대한정형외과학회잡지

PURPOSE: The elderly patients have been known for high incidence of postoperative complications following a lumbar fusion surgery. This study was conducted to determine the results of clinical outcomes after a lumbar fusion surgery in patients older than 75 years and to compare with those in patients between 65 and 74 years old. MATERIALS AND METHODS: One hundred twenty-five patients who underwent lumbar fusion were enrolled. The mean follow-up was 22.5+/-15.7 months. Preoperative diagnosis was spinal stenosis in 113 patients and degenerative spondylolisthesis in 12 patients. Revision surgery or multi-level spinal fusion (>4 segments) was excluded. There were 27 patients in group A (>75 years) and 98 patients in group B (65-74 years). Preoperative American Society of Anesthesiologists (ASA) scores, visual analog scale (VAS), Oswestry disability index (ODI), postoperative complications, and bone union rate were compared. RESULTS: The mean age was 78.6 years and 68.8 years in Group A and Group B, respectively. The mean preoperative ASA score was statistically different between group A and group B (p=0.025). The mean bone mineral density T score in group A was higher than that in group B (p=0.002). The mean VAS did not show a difference between the groups (p=0.171). There was no difference in the mean ODI between the groups in the improvement of VAS and ODI. The major and minor complications of early complications and late complications were observed without any statistical difference. CONCLUSION: Although preoperative ASA score was higher and osteoporosis was severe in the elderly patients (>75 years old), the improvement of clinical outcome was satisfactory as much as younger patients (65-74 years old) following a lumbar fusion surgery for degenerative spinal disease.

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

OBJECTIVE: Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complications and assess risk factors associated with lumbar spinal fusion, focusing on geriatric patients at least 70 years of age in the Republic of Korea. METHODS: We retrospectively investigated 489 patients with various lumbar spinal diseases who underwent lumbar spinal fusion surgery between 2003 and 2007 at our institution. Three fusion procedures and the number of fused segments were analyzed in this study. Chronic diseases were also evaluated. Risk factors for complications and their association with age were analyzed. RESULTS: In this study, 74 patients experienced complications (15%). The rate of perioperative complications was significantly higher in patients 70 years of age or older than in other age groups (univariate analysis, p=0.001; multivariate analysis, p=0.004). However, perioperative complications were not significantly associated with the other factors tested (sex, comorbidities, operation procedures, fusion segments involved). CONCLUSION: Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery whereas other factors were not significant. We recommend good clinical judgment and careful selection of geriatric patients undergoing lumbar spinal fusion surgery.

Modified posterior lumbar interbody fusion using unilateral pedicle screw fixation in lumbar spinal fusion / 第二军医大学学报

Objective: To compare the clinical efficacies and complications between the posterior lumbar interbody fusion (PLIF) using bilateral pedicle screw fixation and modified PLIF using unilateral pedicle screw fixation. Methods: A total of 96 patients who underwent lumbar spinal fusion operation during Feb. 2007 to May 2009 were divided into 2 groups. Group A included 40 patients (14 males and 26 female, average age being [52.23±9.75] years) receiving unilateral modified PLIF; Group B included 56 patients (22 males and 34 female, average age being [56.02±10.25] years) receiving bilateral PLIF. Oswestry disability index (ODI), visual analog scale (VAS), operating time, blood loss, length of hospital stay, hospitalization cost, fusion rates, complication rates, intervertebral height and medical expenses were all compared between the two groups. Results: The short-term ODI, VAS indices showed no significant difference between the two groups. Blood loss, operating time, and hospitalization cost of group A were significantly less than those in group B (P<0.05). Fusion rate was 100% in both groups 12 months after the operation. Conclusion: Modified PLIF using unilateral pedicle screw fixation is effective for lumbar spinal fusion, and it has the less trauma, risk and hospitalization cost compared with PLIF using bilateral pedicle screw fixation; but its long-term efficacy still needs to be further observed.

Pelvic Bone Stress Fracture after Lumbar Spinal Fusion: Two Cases Report / 대한정형외과학회잡지

Fractures of the pelvic ring after long fusions to the lumbosacral spine is a heretofore rarely reported complication. Stress fractures of the pelvic ring are a potential source of late pain after fusions of the lumbosacral spine. We report two cases of stress fracture of the pelvic bone after lumbar spinal fusion.

Experimental study on posterolateral lumbar spinal fusion with allograft and rhBMP-2 in a rabbit model / 中华创伤骨科杂志

Objective To evaluate the effects of allografi and rhBMP-2 in posterolateral lumbar spinal fusion in a rabbit model.Methods Thirty rabbits were randomly divided into three groups:autogenous lilac crest bone graft group,rhBMP-2/allograft composite group,and allograft group.The animals were killed and sampled six weeks after the surgery.The lumbar intertransverse process fusion for the animals was assessed by manual palpation,biomechanical testing,radiography,histology and quantitative histology of spine fusion mass in a 6-week observation.Results The ratio of fusion in rhBMP-2/allograft composite group(90%)was significantly higher than that in autogenous lilac crest bone graft group(40%)and allograft group(20%)(P＜0.05).The autogenous lilac crest bone graft group and rhBMP-2/allograft composite group showed significantly higher uniaxial tensile strength than allograft group.The au- togenous lilac crest bone graft group and rhBMP-2/allograft composite group also showed significantly more new bone formation than allograft group,but there was no significant difference between the former two grnups.Conclusion rhBMP-2/allograft composite may be an ideal substitute for autograft in lumbar spinal fusion.

Surgical Treatment of Adjacent Segment Degeneration after Spinal Fusion in Degenerative Lumbar Disc Disease

OBJECTIVE: We experienced some cases of adjacent segment degeneration after spinal fusion and treated them by various reoperation methods. The authors report an evaluation of causes of adjacent segment degeneration after spinal fusion and treatment methods. METHODS: Sixteen patients was admitted to our hospital due to adjacent segment degeneration after spinal fusion from November 1997 to May 2001 and we operated 11 patients among 16 patients with various surgical methods. We analyzed clinical diagnosea, surgical methods, and disc degeneration status of adjacent segment following spinal fusion on 1st operation and 2nd operation, and also evaluated the clinical symptoms, type of adjacent segment degeneration, and time interval between the 1st operation and the 2nd operation. RESULTS: Clinical diagnoses on 1st operation were degenerative spondylolisthesis of four cases, chronic degenerative disc disease with spinal stenosis of six cases, and recurred herniated lumbar disc disease of one case. We treated eight cases by posterior lumbar interbody fusion, one case by 360degrees fusion, and two cases by pedicle screw fixation only. Disc degeneration on adjacent segment to spinal fusion existed already in nine among 11 patients before spinal fusion. Types of adjacent segment degeneration after spinal fusion were disc degeneration of two cases, lumbar instability of three cases, lumbar stenosis of four cases, and lumbar instability and stenosis of two cases. Most patients complained of low back pain due to disc degeneration and instability, and some patients complained of leg and buttock pain due to stenosis. Time interval from 1st operation to reoperation was 20 months through 99 months, mean time interval was 57 months. CONCLUSION: Inevitable compensatory mechanism occurs at adjacent segment after fusion, because of stress concentration and alteration of biomechanics after fusion. But, we achieve excellent or good results of reoperation surgical treatment for adjacent segment degeneration after spinal fusion.

Local Bone versus Autogenous Iliac Bone Graft for Posterolateral Lumbar Fusion in the Same Patient / 대한척추외과학회지

STUDY DESIGN: A prospective study. OBJECTIVES: To determine the usefulness of local bone obtained from laminectomy and decortication as graft bone instead of autogenous iliac bone in posterolateral lumbar spinal fusion. MATERIALS AND METHODS: Thirty-one patients underwent posterolateral lumbar spinal fusion with pedicle screw instrumentation. Local bone was inserted in the right side of intertransverse space and autogenous iliac bone was in the left side. We compared fusion rate in the radiographs at postoperative 6 week, 3 month, 6 month and 1 year. RESULTS: Radiographic fusion grading of local bone was 20 cases of grade 1, 8 cases of grade 2, 2 cases of grade 3 and 1 case of grade 4. Fusion grading of autogenous iliac bone was 24 cases of grade 1, 4 cases of grade 2 and 3 cases of grade 3. Bone fusion was complete after 9.1 months in local bone and 7.2 months in autogenous iliac bone. No significant differences was found between the two groups. CONCLUSION: The local bone in posterolateral lumbar fusion is appropriate for satisfactory fusion instead of autogenous iliac bone if the amount of local bone is sufficient and decortication of the fusion bed is proper.

Surgical Treatment of Adjacent Degenerative Segment after Lumbar Fusion: Preliminary report / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To demonstrate the early experience of operative treatment about adjacent segments degeneration after lumbar fusion. SUMMARY OF LITERATURE REVIEW: The treatment of degenerative changes at adjacent segment after lumbar spinal fusion have not been well described in literature. MATERIALS AND METHODS: A retrospective reviews of radiographs, medical records and follow up study were undertaken in eight patients who had been treated surgically due to degenerative changes at adjacent segment after lumbar fusion. Average follow up duration was 25 months. Causes of secondary operation were 3 cases of segmental instability, 2 cases of degenerative spondylolisthesis, 2 cases of degenerative spinal stenosis, 2 cases of cauda equina syndrome, 1 case of disc degeneration. Clinical results were evaluated by using of author's criteria. For the radiographic evaluation, plain roentgenogram(AP, Lat. flextion/extension Lat.), CT, MRI were checked. RESULTS: The mean time interval to secondary operation from first operation was seven years nine months. At the preoperative CT or MRI film review, there were initial adjacent segment degenerative changes in half of the cases preoperatively. The level developing degenerative changes were upper segment in 5 cases, lower segment in 2 cases and both segment in 1 case. Most common segment was L3,4 in 5 cases. The second operations were mainly PLIF in 7 cases and PL fusion in 1 case. All cases showed solid fusion. Clinical results were excellent in 3 cases, good in 4 cases, fair in 1 case and poor in no case. CONCLUSION: The early clinical and radiographic results of surgical treatment was satisfactory. If the degenerative changes of adjacent segments are detected preoperatively, there are some needs to consider the extension of surgery according to the severity of the lesions. We think that the results of secondary operation was better in case of PLIF than posterolateral fusion because PLIF provided more rigid stability which enabled early walking stability and better corrective power. But long term results of that should be followed up.

Lumbar Spinal Fusion with Pedicle Screw Fixation in the Elderly Patients / 대한척추외과학회지

STUDY DESIGN: A retrospective study was performed in elderly patients undergoing lumbar spinal fusion using pedicle screw fixation. OBJECTIVES: To investigate perioperative complications and surgical outcomes in elderly patients who underwent lumbar spinal fusion with pedicle screw fixation. SUMMARY OF LITERATURE REVIEW: There have been few reports regarding the lumbar spinal fusion using pedicle screws in the elderly, especially in the Korean literature. MATERIALS AND METHODS: Thirty-three patients over 60 years of age who underwent decompression and instrumented fusion with pedicle screws were retrospectively evaluated. Minimum follow-up was 2 years. We reviewed medical records and radiological films. We studied age, sex, lesion site, duration of hospital stay, operating time, amount of transfusion, clinical outcomes, complications, preoperative co-morbidity, fusion level, time at which fusion was complete, and fusion rate. RESULTS: The 33 patients consisted of 13 male and 20 female patients. Mean age was 63.8 (60-74) years. Preoperative diagnoses were spinal stenosis, 23, degenerative spondylolisthesis, 8, and spondylolytic spondylolisthesis, 2. Twenty-one cases nvolved single level and 12 cases involved multiple levels. Sixteen patients had 12 co-morbidities. The mean fusion segments ere 1.5 (1-3) segments. The mean operating time was 204.7 (115-330) minutes. The mean amount of transfusion was 2.5 (0-6) ints. The mean duration of hospital stay was 17.8 (13-29) days. Satisfactory clinical outcomes were found in 27 patients (81.8%). usion rate was 93.8%. The time at which fusion was complete was 5.6 (3-12) months. Complication rate was 21.2%. Mortality ate was 3.0%. There was a high postoperative complication rate in patients who had had medical problems before the operation, hich was statistically significant. CONCLUSIONS: Pedicle screw fixation in patients over 60 years was a useful method for the treatment of degenerative spinal disorders. However, patients with preoperative co-morbidity showed a very high medical complication rate. Therefore, careful erioperative management was recommended in high-risk elderly patients with preexisting medical problems.