Transdural Approach to Resection of Intraspinal Extradural Ventral Cysts in the Lumbar Spine.

BACKGROUND: Intraspinal extradural ventral cysts in the lumbar spine can cause back pain and neurological deficits of the lower extremities. For the resection of this type of space-occupying lesion, the transdural approach has not been reported in the literature. CASE DESCRIPTION: A 66-year-old man presented, suffering from progressive radiation pain of his bilateral lower extremities. Imaging examination revealed a cystic lesion in ventral side of lumbar spinal canal. We conducted the excision of the cyst with the transdural approach. The symptoms of the patient disappeared immediately after the operation and recurrence of the symptoms has not been observed in the 3-month follow-up. CONCLUSIONS: This operation approach is safe and effective. Compared with the previous surgical approach reported in the literature, by this approach surgeons could achieve less injury, shorter operation time, and the same surgical outcomes in the short term. Therefore, we would like to present this approach to provide an alternative to deal with similar lesions.

Risk factors of postoperative low back pain for low-grade isthmic spondylolisthesis: a retrospective study.

OBJECTIVE: To investigate the risk factors of postoperative low back pain (LBP) following posterior lumbar interbody fusion (PLIF) surgery for low-grade isthmic spondylolisthesis (IS). METHODS: This retrospective study enrolled patients with IS that underwent PLIF between January 2011 and January 2016. Demographic, clinical, surgical and radiological characteristics were analysed to determine associations between these characteristics and LBP as measured using a visual analogue scale (VAS) pain score. RESULTS: A total of 192 patients were enrolled in the study. The mean VAS pain score of LBP decreased significantly after surgery. The mean preoperative VAS pain score was significantly greater in patients with symptoms of ≤3 years duration compared with those with symptoms lasting >3 years. The postoperative VAS pain score was significantly lower in patients with grade 1 slippage compared with those with grade 2 slippage. There was a significant correlation between preoperative to postoperative change of VAS pain score and postoperative disc height (r = 0.99). CONCLUSION: PLIF significantly improved LBP in patients with low-grade IS, although patients still reported some postoperative LBP. The grade of slippage was a risk factor for postoperative LBP. Restoring the disc height appeared to improve LBP.

Risk Factors of Postoperative Sacroiliac Joint Pain for Posterior Lumbar Surgery: ≥2-Year Follow-up Retrospective Study.

PURPOSE: A retrospective study was conducted to clarify the risk factors of postoperative sacroiliac joint pain (SIJP) for posterior open lumbar surgery. PATIENTS AND METHODS: A total of 472 patients who underwent posterior lumbar surgery between January 2011 and December 2014 were included in this analysis. We recorded basic characteristics, surgical characteristics, and SIJP information for each patient. RESULTS: The incidence of postoperative SIJP is 13.8% in our study. Comparison of the incidence of SIJP between diskectomy and posterior lumbar interbody fusion indicated that SIJP incidence tended to be higher in posterior lumbar interbody fusion patients (P = 0.029). Compared with the single-segment group, SIJP occurred more frequently in the multiple operative segments group (P = 0.025). Comparing the incidence of SIJP among different types of lumbar diseases, SIJP incidence is significantly higher in the lumbar stenosis group (P = 0035). CONCLUSION: Lumbar fusion surgery and multiple operative segments are interdependent risk factors for the postoperative SIJP. The incidence of postoperative SIJP also increases in patients with lumbar stenosis compared with lumbar disk herniation and lumbar spondylolisthesis.

Risk Factors of Postoperative Low Back Pain for Low-Grade Degenerative Spondylolisthesis: An At Least 2-Year Follow-Up Retrospective Study.

OBJECTIVE: A retrospective study was conducted to clarify the risk factors of postoperative low back pain (LBP) for low-grade degenerative spondylolisthesis. PATIENTS AND METHODS: A total of 239 patients who underwent posterior lumbar fusion between January 2011 and January 2015 were included in this analysis. We investigated patient characteristics, surgical characteristics, and radiographic characteristics. RESULTS: The mean visual analog scale (VAS) score of LBP decreased dramatically after the operation. The mean preoperative VAS score was greater in patients with severe lumbar multifidus (LM) intramuscular adipose tissue (IMAT). The postoperative VAS score was dramatically lower in patients with shorter symptom duration. Postoperative LBP disappeared more often in patients with shorter symptom duration. LBP VAS changing showed significant differences in different symptom duration groups and LM IMAT groups. CONCLUSIONS: LM IMAT and symptom duration were risk factors for postoperative LBP. Patients with severe LM IMAT reported more severe LBP before the operation. Postoperative LBP disappeared more often in patients with shorter symptom duration.

Risk Factors of Postoperative Low Back Pain for Lumbar Spine Disease.

PURPOSE: A retrospective study was conducted to clarify the risk factors of postoperative low back pain (LBP) for lumbar spine disease. PATIENTS AND METHODS: A total of 401 patients who underwent lumbar operation between January 2011 and December 2011 were included in this analysis. We investigated patient characteristics and surgical approaches and also compared the radiographic characteristics. RESULTS: The mean visual analogue scale (VAS) score decreased dramatically after the operation. The mean preoperative VAS score was greater in patients underwent posterior lumbar interbody fusion (PLIF) with longer duration of symptoms, longer operation time, and severe lumbar multifidus (LM) intramuscular adipose tissue (IMAT). The preoperative VAS score was dramatically lower in patients with lumbar herniation. The postoperative VAS score was dramatically lower in patients who underwent PLIF with longer operation time and mild LM IMAT. Postoperative LBP disappeared more often in patients who underwent PLIF with longer operation times. The number of operative levels and type of lumbar spine disease also were associated with postoperative LBP. CONCLUSION: Type of surgery, operation time, number of operative level, and type of disease were risk factors for the postoperative LBP. Patients underwent PLIF with shorter symptom duration, longer operation time severe LM IMAT, and lumber spondylolisthesis reported more severe LBP before the operation. Patients underwent discectomy with shorter operation times.

Predictors of Surgical Outcome in Acute Spinal Cord Injury Patients with Cervical Ossification of the Posterior Longitudinal Ligament.

OBJECTIVE: A retrospective study was conducted to clarify the predictors of the operation results for ossification of the posterior longitudinal ligament (OPLL) patients with acute spinal cord injury (SCI). Detailed analyses of surgical outcomes of OPLL patients with SCI have been rare because most surveys have aimed to investigate OPLL or SCI, but not both. PATIENTS AND METHODS: A total of 36 patients who underwent operation for OPLL between January 2011 and December 2011 were included in this analysis. We investigated the patients' characteristics and surgical approaches and compared the radiographic characteristics of OPLL patients with SCI. RESULTS: The mean modified Japanese Orthopaedic Association (mJOA) score improved dramatically after operation (P = 0.006). The mean preoperative mJOA score was greater in patients with Nurick 3 than in patients with Nurick 4 and 5 (P = 0.041). The preoperative mJOA score was dramatically lower in patients caused by traffic accident and in patients with segmental OPLL lesion (P < 0.05). The postoperative mJOA score was dramatically lower in patients with continuous OPLL lesion than in the segmental OPLL lesion (P = 0.028). Changing in mJOA score was significantly different between the patients with high-intensity zone (HIZ) and without HIZ on magnetic resonance imaging. CONCLUSIONS: HIZ on magnetic resonance imaging was significantly related to the surgical outcomes, which should be highlighted in the preoperative communication with patients. Patients with lower Nirick grade and segmental OPLL would show better symptom before the operation. In addition, SCI caused by slipping or falling showed better symptoms before the operation. Patients with segmental OPLL should show better resolution of symptoms after the operation.

Predictors of surgical outcome in ossification of the posterior longitudinal ligament.

STUDY DESIGN: A retrospective study. OBJECTIVE: To clarify the predictors of the operation results for ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Detailed analyses of surgical outcomes of OPLL have been rare because most survey aimed to investigate cervical spondylotic myelopathy. METHODS: All patients who underwent cervical operation for OPLL between January 2011 and December 2011 were included in this analysis. We investigated the patients' characteristics and surgical approaches, and compared the radiographical characteristics of OPLL. RESULTS: The mean mJOA score improved from 8.312 ± 3.021 points preoperatively to 11.24 ± 3.43 points at 24 months after operation (P<0.001). The average change in mJOA score was significantly greater in patients with a higher Nirik score than in those with lower Nirik scores (P<0.0001). The average change in mJOA score was also significantly different in patients with trauma history (P<0.0001). The average recovery ratio was 42 ± 26.3% in young patients and 30 ± 31.6% in the group older than 50 years (P=0.012). The average recovery ratio in patients with acute and chronic symptoms was 48 ± 22.9% and 26 ± 33.9%, respectively. There was great difference between the two groups. CONCLUSION: OPLL patients with myelopathy would receive good result after the operation. Age and symptom duration are related to the surgical outcomes. Patients with lower Nirick grade and without trauma history would receive better results before and after the operation.

[Clinical application of a novel posterior lumbar fusion method and the short-term observation of its effect].

OBJECTIVE: To increase local blood supply of bone graft, a novel posterior lumbar spine fusion method with orthotopic paraspinal muscle-pediculated bone flaps was constructed, and the fusion rate and clinical effect.were observed. METHODS: From June 2007 to December 2010, 117 patients of lumbar spinal stenosis or lumbar destabilization treated with the novel posterior lumbar fusion method were studied, 49 males and 68 females, aged from 40 to 77 years, average 61.5 years. Clinical effect was evaluated by JOA and VAS score preoperatively and postoperatively, and the fusion result was evaluated by three-dimensional CT reconstruction postoperatively. RESULTS: Seventeen cases lost of follow up, the rest were followed up from 7 to 38 months, average 19 months. There was significant difference between pre- and postoperative JOA and VAS score (P < 0.01), the preoperative JOA score was 10.3 ± 1.9, and 25.4 ± 4.2 at the latest follow-up, the improvement rate was 81.0% ; the preoperative VAS score was 8.5 ± 0.8, and 2.3 ± 0.4 at the latest follow-up. The three-dimensional CT reconstruction showed that 126 of the 133 segments formed solid fusion in 100 patients who completed the follow-up, the fusion rate was 94.7%. CONCLUSION: The novel posterior lumbar fusion method make the bone graft position more precise, stable and increases the fusion rate, which can effectively reduce pseudarthrosis and have a promising clinical effect.

Aggrecan variable number of tandem repeat polymorphism and lumbar disc degeneration: a meta-analysis.

STUDY DESIGN: Data on the association between the ACAN (encoded for aggrecan core protein) variable number of tandem repeat (VNTR) polymorphism and lumbar disc degeneration are conflicting, so we performed a meta-analysis. OBJECTIVE: Aggrecan is involved in the shock absorbing function of the lumbar disc; we performed a meta-analysis to assess the association between ACAN VNTR and lumbar degeneration. SUMMARY OF BACKGROUND DATA: To perform a meta-analysis, we searched for studies published until September 2012, using electronic databases (PubMed, EMBASE, and China National Knowledge Infrastructure). Eight studies involving 965 cases of lumbar disc degeneration and 982 control subjects were identified. METHODS: Assessment for eligibility and extraction of data were performed by 2 independent investigators. We extracted allele frequency for each study. We calculated the pooled odds ratios (ORs) and 95% confidence intervals (CI) to assess the strength of the association between the ACAN VNTR polymorphism and lumbar disc degeneration risk. RESULTS: Results from the allele model suggested an increased risk of lumbar disc degeneration for the shorter alleles carriers compared with the normal alleles and longer alleles (OR = 1.54, 95% CI: 1.04-2.30, P = 0.03). In subgroup analysis by ethnicity, significant increased risks were found among Asians with shorter alleles (OR=1.65, 95% CI: 1.17-2.33, P = 0.004). CONCLUSION: Our results suggest an increased risk of shorter alleles compared with normal alleles and longer alleles against lumbar disc degeneration among populations especially among Asian descent. Such association may not be statistically significant in European populations.

Association of ADAMTS5 gene polymorphisms with osteoarthritis in Chinese Han population: a community-based case-control study.

Aggrecanase-2 (ADAMTS5) is reported to play essential roles in the pathophysiology of osteoarthritis (OA). To explore the relationship between ADAMTS5 gene polymorphisms and primary OA, we conducted a community-based case-control study. A total of 732 community residents aged 40-84 years participated in the community-based study in Northeast China. After taking physical examination and radiographic examination, 420 persons of the residents were diagnosed OA (216 women and 204 men). The other 312 individuals without any symptoms of osteoarthritis or signs in the radiographs (156 women and 156 men) were considered as healthy controls. After obtaining the DNA of patients and control group, genotypes of the ADAMTS5 gene polymorphisms were determined by polymerase chain reaction (PCR) followed by restriction enzyme digestion (HAEIII for P692L in exon 7 and BSRBI for R614H in exon 5). The numbers of patients with different OA subtypes were also calculated. The genotype and allele frequency of for the exon 5C/T BSRBI polymorphism was significantly different between OA patients and control individuals (P = 0.001, OR = 0.701, 95% CI = 0.569-0.863). This difference was more obvious in cervical OA patients (P = 0.001, OR = 0.664, 95% CI = 0.521-0.847). The mutation type of exon 5C/T BSRBI polymorphism would be a protective factor for OA especially for cervical OA. Our results suggest that the ADAMTS5 gene polymorphisms may contribute to the susceptibility of osteoarthritis in the Chinese Han population.

MATN3 gene polymorphism is associated with osteoarthritis in Chinese Han population: a community-based case-control study.

BACKGROUND: The matrilin, especially matrilin-3 (MATN3), are reported to play important roles in the pathophysiology of osteoarthritis (OA). To explore the relationship between MATN3 SNP6 (rs8176070) and primary OA, we conducted a community-based case-control study. METHODS: A total of 732 community residents aged 40-84 years participated in the community-based study in Northeast China. After taking physical and radiographic examinations, 420 of the residents were diagnosed OA (216 women and 204 men). The other 312 individuals without any symptoms of osteoarthritis or signs in the radiographs (156 women and 156 men) were considered as healthy controls. After obtaining the DNA of case and control groups, genotypes of the MATN3 SNP6 were determined by polymerase chain reaction followed by restriction enzyme digestion. The numbers of patients with different OA subtypes were also calculated. RESULTS: The distribution of genotypes and alleles of the MATN3 SNP6 between OA patients and controls was different significantly. The BB carrier tends to be associated with the increased osteoarthritis (P = 0.025, OR = 1.724, 95% CI = 1.071-2.77), especially the knee osteoarthritis (P = 0.021, OR = 2.402, 95% CI = 1.141-5.060) and lumber osteoarthritis (P = 0.020, OR = 1.880, 95% CI = 1.103-3.204). Bb carrier increased hand osteoarthritis risk (P = 0.002, OR = 5.380, 95% CI = 1.828-15.835). The B allele might have an effect on the increased knee osteoarthritis (P = 0.000, OR = 3.143, 95% CI = 2.283-4.328). CONCLUSION: These findings suggest that the MATN3 gene polymorphism might be associated with osteoarthritis in the Chinese Han population.