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1.
Medicine (Baltimore) ; 100(2): e24099, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466177

RESUMO

BACKGROUND: To explore the ideal trajectory of lumbar cortical bone trajectory screws and provide the optimal placement scheme in clinical applications. METHODS: Lumbar computed tomography (CT) data of 40 patients in our hospital were selected, and the cortical vertebral bone contour model was reconstructed in three dimensions (3D). Depending on the different regions of the screw through the entrance and exit of the pedicle, 9 trajectories were obtained through combinational design: T-Aa, T-Ab, T-Ac, T-Ba, T-Bb, T-Bc, T-Ca, T-Cb, and T-Cc. Cortical bone trajectory (CBT) screws with appropriate diameters were selected to simulate screw placement and measure the parameters corresponding to each trajectory (screw path diameter, screw trajectory length, cephalad angle, and lateral angle), and then determine the optimal screw according to the screw parameters and screw safety. Then, 23 patients in our hospital were selected, and the navigation template was designed based on the ideal trajectory before operation, CBT screws were placed during the operation to further verify the safety and feasibility of the ideal trajectory. RESULTS: T-Bc and T-Bb are the ideal screw trajectories for L1-L2 and L3-L5, respectively. The screw placement point is located at the intersection of the inner 1/3 vertical line of the superior facet joint and the bottom 1/3 horizontal line of the outer crest of the vertebral lamina (i.e., 2-4 mm inward at the bottom 1/3 of the outer crest of the vertebral lamina). CBT screws were successfully placed based on the ideal screw trajectory in clinical practice. During the operation or the follow-up period, there were no adverse events. CONCLUSION: CBT screw placement based on the ideal screw trajectory is a safe and reliable method for achieving effective fixation and satisfactory postoperative effects.


Assuntos
Osso Cortical/lesões , Fixação de Fratura/instrumentação , Vértebras Lombares/lesões , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Simulação por Computador , Osso Cortical/diagnóstico por imagem , Osso Cortical/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Modelos Anatômicos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
2.
Rev. bras. ortop ; 55(5): 642-648, Sept.-Oct. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1144215

RESUMO

Abstract Objective To verify whether, regardless of the screw placement technique, there is a safe distance or angle in relation to the facets that can prevent violation of the facet joint when the screws are placed. Methods Retrospective, single, comparative, non-randomized center. We evaluated by axial computed tomography: the angle of the screw/rod in relation to the midline, the angle of the center of the facets in relation to the midline, the distance between the head of the screw/rod to the midline, and the distance from the center of the facets to the midline; the violation of the facet joint will be evaluated in a gradation of 0 to 2. Also will be measured the difference between the angle os the facets and the angle of the screws (Δ Angle) and, the difference between the facet distance and the screw distance (Δ Distance). Results A total of 212 patients and 397 facets were analyzed (196 on the left and 201 on the right). Of these, 303 were not violated (grade 0), corresponding to 76,32%, and 94 suffered some type of violation (grade 1 and 2), corresponding to 23,68%. The mean of Δ angle was 9.87° +/− 4.66° (grade 0), and of 3.77° +/− 4.93° in facets (grade 1 and 2) (p< 0.001), and the Δ mean distance in cases in which there was no violation was 0.94 arbitrary units (a.u.) +/− 0.39 a.u., while the Δ distance in G1 and G2 cases was 0.56 a.u. +/− 0.25 a.u. (p< 0.001). Conclusion The measurements of angle and distance between facet and screw can help in the placement of screws. These parameters can be used as safety measures with the most frequent use of surgical navigation techniques.


Resumo Objetivo Verificar se, independente da técnica de colocação do parafuso, há uma distância ou angulação segura em relação as facetas para que os parafusos sejam colocados de modo a evitar a violação da articulação facetária. Métodos Estudo retrospectivo, comparativo, não randomizado, em centro único. Foram avaliados em tomografia computadorizada axial: o ângulo do parafuso/barra em relação a linha média, o ângulo do centro das facetas em relação a linha média, a distância entre a cabeça do parafuso/barra até a linha média, e a distância do centro das facetas até a linha média; a violação da articulação facetária será avaliada em uma gradação de 0 a 2. Serão também calculados a diferença entre o ângulo do parafuso e ângulo da faceta (Δ Ångulo) e também a diferença entre a distância da faceta e a distância do parafuso (Δ Distância). Resultados Um total de 212 pacientes e 397 facetas foram analisados (196 do lado esquerdo e 201 do lado direito). Destes, 303 foram não violados (grau 0), correspondendo a 76,32%, e 94 sofreram algum tipo de violação (grau 1 e 2), correspondendo a 23,68%. A média do Δ ângulo foi de 9,87° +/− 4,66° (grau 0) e de 3,77° +/− 4,93° em facetas (grau 1 e 2) (p< 0.001), e o Δ distância médio nos casos em que não houve violação foi de 0,94 unidades aleatórias (u.a.) +/− 0,39 u.a., enquanto o Δ distância de casos G1 e G2 foi de 0,56 u.a. +/− 0,25 u.a. (p< 0.001). Conclusão As medidas de ângulo e distância entre faceta e parafuso, podem auxiliar na colocação de parafusos. Esses parâmetros podem ser utilizados como medidas de segurança com o uso mais frequentes das técnicas de navegação cirúrgica.


Assuntos
Humanos , Fusão Vertebral/métodos , Articulação Zigapofisária/cirurgia , Parafusos Pediculares , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Curva ROC , Articulação Zigapofisária/diagnóstico por imagem , Parafusos Pediculares/efeitos adversos
3.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(5): 253-258, sept.-oct. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-195158

RESUMO

Late diagnosis of cervical bilateral facet dislocation is rare and contributes to concerns in the management of these patients. We present a case of a 44-year-old woman presented 8 months after a trauma with persistent neck pain, without neurological deficits. A bilateral C5-C6 facet dislocation was identified. The patient was treated with a combined C5-C6 approach: posterior facet joints release, anterior discectomy and fusion, bilateral posterior fixation. Surgery was performed under intraoperative neurophysiological monitoring. The postoperative period was uneventful, and the patient presented functional improvement. Late surgical treatment of bilateral cervical facet dislocation is safe and feasible. Combined procedures are needed for proper reduction and stabilization of the spine. Intraoperative neurophysiological monitoring adds value to this technique contributing to good outcomes


El diagnóstico tardío de la luxación facetaria bilateral cervical es infrecuente y contribuye a crear problemas en el tratamiento de estos pacientes. Presentamos el caso de una mujer de 44 años que, 8 meses después de un traumatismo, presentaba dolor continuo en el cuello, en ausencia de deficiencias neurológicas. Se identificó una luxación facetaria bilateral en C5-C6. La paciente recibió tratamiento quirúrgico combinado en C5-C6: liberación posterior de las articulaciones facetarias, discectomía anterior y artrodesis, fijación posterior bilateral. La intervención quirúrgica se realizó con monitorización neurofisiológica intraoperatoria. La paciente presentó una evolución postoperatoria sin complicaciones y mejoría funcional. El tratamiento quirúrgico tardío de la luxación facetaria cervical bilateral es seguro y viable. Es necesario utilizar procedimientos combinados para lograr una reducción y estabilización correctas de la columna vertebral. La monitorización neurofisiológica intraoperatoria aporta valor añadido a esta técnica y contribuye a lograr buenos resultados


Assuntos
Humanos , Feminino , Adulto , Articulação Zigapofisária/lesões , Articulação Zigapofisária/cirurgia , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Vértebras Cervicais/lesões , Luxações Articulares/complicações , Discotomia/métodos , Espectroscopia de Ressonância Magnética , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/cirurgia
4.
J Clin Neurosci ; 78: 102-107, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32624368

RESUMO

PURPOSE: This study aimed to evaluate safety and effectiveness of simple anterior reduction and fusion for acute lower cervical unilateral facet dislocation without severe spinal cord injuries. MATERIALS AND METHODS: One hundred and two patients with unilateral cervical facet dislocations without severe spinal cord injuries who were surgically treated by the only anterior approach were analyzed. The treatment effects were evaluated based on the Visual Analogue Scale (VAS) scores, the Cobb angle of kyphosis, the Neck Disability Index (NDI) and Odom's criteria. Neurological recovery of patients was assessed by the Frankel grading. RESULTS: The mean duration of follow-up was 12.4 ± 4.2 years (range, 10 to 17 years). VAS scores, Kyphosis angle and NDI scores were significantly changed from preoperative values of 7.4 ± 0.8, 11.3° ± 6.8° and 29.3 ± 5.1 to last follow-up values of 1.3 ± 0.8, -6.1° ± 7.5° and 8.8 ± 3.6 (P = 0.000). Of patients, 92 (90.2%) had good to excellent outcomes, 9 (8.8%) had satisfactory outcomes, and 1 (1.0%) had poor outcomes. Patients have obtained satisfactory neurological recovery. Three patients needed additional posterior reduction. CONCLUSION: The anterior reduction and fusion is effective and safe for acute unilateral cervical facet dislocation, and can achieve good long-term clinical effects.


Assuntos
Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos da Medula Espinal , Fusão Vertebral/métodos , Articulação Zigapofisária/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem , Articulação Zigapofisária/diagnóstico por imagem
5.
J Clin Neurosci ; 78: 47-52, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616353

RESUMO

BACKGROUND: The purpose of this study was to compare the incidence of facet joint violation (FJV) after placement of percutaneous pedicle screws (PPSs) in 2 cohorts of patients who underwent surgery in a single position or dual position following lateral lumbar interbody fusion (LLIF) (extreme lateral interbody fusion [XLIF]). METHODS: We reviewed 82 patients who underwent combined XLIF surgery and PPS fixation for the treatment of degenerative lumbar spinal disorders. Patient demographics were compared between 2 groups: those who remained in the lateral decubitus position for PPS fixation (SP group) and those who were turned to the prone position (DP group). Postoperative axial computed tomography scans were evaluated independently for FJV according to the following classification: grade 0, no impingement; grade 1, screw head in contact/suspected to be in contact with the facet joint; and grade 2, screw clearly invaded the facet joint. RESULTS: A total of 349 screws were graded. Using the consensus grades, the incidence of FJV was 13.2% (46/349), but the incidence of FJV did not differ significantly according to the position of the patient during PPS insertion (SP group; 15.4%, DP group; 10.8%, P = 0.204). CONCLUSIONS: Although the incidence of FJV after PPS insertion did not differ between the prone and lateral decubitus positions, grade 2 FJV was observed only in the SP group. To avoid FJV, the surgeon should pay close attention to the facet joints when inserting PPSs with the patient in a lateral decubitus position.


Assuntos
Parafusos Pediculares , Fusão Vertebral/métodos , Articulação Zigapofisária/cirurgia , Adulto , Idoso , Feminino , Humanos , Incidência , Vértebras Lombares/cirurgia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Cirurgiões , Tomografia Computadorizada por Raios X
6.
Pain Physician ; 23(4): E335-E342, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709179

RESUMO

BACKGROUND: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. OBJECTIVES: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. STUDY DESIGN: Web-based provider survey and narrative review. SETTING: Multispecialty pain clinic, academic medical center. METHODS: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. RESULTS: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. LIMITATIONS: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. CONCLUSIONS: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. KEY WORDS: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain.


Assuntos
Dor nas Costas/cirurgia , Ablação por Cateter/normas , Desfibriladores Implantáveis/normas , Médicos/normas , Guias de Prática Clínica como Assunto/normas , Inquéritos e Questionários , Anestesia por Condução/métodos , Anestesia por Condução/normas , Anestesiologia/métodos , Anestesiologia/normas , Ablação por Cateter/métodos , Dor Crônica/cirurgia , Humanos , Articulação Zigapofisária/cirurgia
7.
Medicine (Baltimore) ; 99(26): e20893, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590797

RESUMO

RATIONALE: Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve and its branches. Tarsal coalition is defined as a fibrous, cartilaginous, or osseous bridging of 2 or more tarsal bones. TTS with tarsal coalition is uncommon. Here, we present a rare example of successful surgical management of TTS with posterior facet talocalcaneal coalition. PATIENT CONCERNS: A 74-year-old woman presented with hypoesthesia, numbness, and an intermittent tingling sensation on the plantar area over the right forefoot to the middle foot area. The hypoesthesia and paresthesia of the right foot began 6 years previously and were severe along the lateral plantar aspect. The symptoms were mild at rest and increased during daily activities. Tinel sign was positive along the posteroinferior aspect of the medial malleolus. DIAGNOSIS: Lateral ankle radiography showed joint-space narrowing and sclerotic bony changes with a deformed C-sign and humpback sign. Oblique coronal and sagittal computed tomography revealed an irregular medial posterior facet, partial coalition, narrowing, and subcortical cyst formation of the posterior subtalar joint. Magnetic resonance imaging showed an abnormal posterior talocalcaneal coalition compressing the posterior tibia nerve. Electromyography and nerve conduction velocity studies were performed, and the findings indicated that there was an incomplete lesion of the right plantar nerve, especially of the lateral plantar nerve, around the ankle level. INTERVENTIONS: Surgical decompression was performed. Intraoperatively, the lateral plantar nerve exhibited fibrotic changes and tightening below the posterior facet talocalcaneal coalition. The coalition was excised, and the lateral plantar nerve was released with soft-tissue dissection. OUTCOMES: The patient's symptoms of tingling sensation and hypoesthesia were almost relieved at 4 months postoperatively, but she complained of paresthesia with an itching sensation when the skin of the plantar area was touched. The paresthesia had disappeared almost completely at 8 months after surgery. She had no recurrence of symptoms at the 1-year follow-up. LESSONS: The TTS with tarsal coalition is rare. Supportive history and physical examination are essential for diagnosis. Plain radiographs and computed tomography or magnetic resonance imaging are helpful to determine the cause of TTS and verify the tarsal coalition. After diagnosis, surgical excision of the coalition may be appropriate for management with a good outcome.


Assuntos
Coalizão Tarsal/cirurgia , Síndrome do Túnel do Tarso/complicações , Síndrome do Túnel do Tarso/cirurgia , Articulação Zigapofisária/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Eletromiografia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Parestesia/etiologia , Coalizão Tarsal/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Articulação Zigapofisária/inervação
8.
Value Health ; 23(5): 585-594, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32389224

RESUMO

OBJECTIVES: To evaluate the cost-effectiveness of radiofrequency denervation when added to a standardized exercise program for patients with chronic low back pain. METHODS: An economic evaluation was conducted alongside 3 pragmatic multicenter, nonblinded randomized clinical trials (RCTs) in The Netherlands with a follow up of 52 weeks. Eligible participants were included between January 1, 2013, and October 24, 2014, and had chronic low back pain; a positive diagnostic block at the facet joints (n = 251), sacroiliac (SI) joints (n = 228), or a combination of facet joints, SI joints, and intervertebral discs (n = 202); and were unresponsive to initial conservative care. Quality-adjusted life-years (QALYs) and societal costs were measured using self-reported questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to estimate statistical uncertainty. RESULTS: After 52 weeks, no difference in costs between groups was found in the facet joint or combination RCT. The total costs were significantly higher for the intervention group in the SI joint RCT. The maximum probability of radiofrequency denervation being cost-effective when added to a standardized exercise program ranged from 0.10 in the facet joint RCT to 0.17 in the SI joint RCT irrespective of the ceiling ratio, and 0.65 at a ceiling ratio of €30 000 per QALY in the combination RCT. CONCLUSIONS: Although equivocal among patients with symptoms in a combination of the facet joints, SI joints, and intervertebral discs, evidence suggests that radiofrequency denervation combined with a standardized exercise program cannot be considered cost-effective from a societal perspective for patients with chronic low back pain originating from either facet or SI joints in a Dutch healthcare setting.


Assuntos
Dor Crônica/cirurgia , Análise Custo-Benefício , Denervação , Dor Lombar/cirurgia , Vértebras Lombares/inervação , Terapia por Radiofrequência , Terapia por Exercício , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos , Anos de Vida Ajustados por Qualidade de Vida , Articulação Sacroilíaca/inervação , Articulação Sacroilíaca/cirurgia , Autorrelato , Inquéritos e Questionários , Articulação Zigapofisária/inervação , Articulação Zigapofisária/cirurgia
9.
J Clin Neurosci ; 77: 36-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32389542

RESUMO

Recurrent lumbar disc herniation (rLDH) is one of the major problems when surgically treating patients with LDH. Data on previous studies investigated the associations between facet joint parameters and rLDH appear only rarely in the literature. This study's objective was to evaluate the association between facet joint parameters [facet orientation (FO) and facet tropism (FT)] and rLDH. From June 2005 to January 2014, 346 patients having single-level lumbar disc herniation (LDH), who underwent surgery, were included in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group). According to 25%, 50% and 75% quantiles of FO, all the cases were divided into 4 subgroups (<42°, 42~45°, 46~49°, and >49°). Cases were divided into 3 groups according to different range of FT (<3°, 3~4° and >4°). The relationships between the facet joint parameters and rLDH were evaluated. All cases in the study were followed up for more than 5 years postoperatively. The recurrence rates of different FO groups were statistically significant (P < 0.001). With the decrease of FO, the risk of rLDH increases continuously. Also, there were statistically significant recurrence rates in different FT groups (P < 0.001), which showed the incidence of rLDH increases gradually with the increase of FT. Facet joint parameters significantly influence the biomechanics of the corresponding segment. Facet joint parameters may play a more important role in the pathogenesis of rLDH.


Assuntos
Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/epidemiologia , Vértebras Lombares/anatomia & histologia , Vigilância da População , Articulação Zigapofisária/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Vigilância da População/métodos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem , Articulação Zigapofisária/cirurgia
10.
World Neurosurg ; 139: e716-e723, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360675

RESUMO

OBJECTIVE: To investigate the incidence of superior facet joint violation (FJV) during percutaneous pedicle screw placement in minimally invasive transforaminal lumbar interbody fusion, and assess the possible risk factors for FJV. METHODS: An analysis of 91 patients with lumbar degenerative diseases treated with percutaneous pedicle screw placement via minimally invasive transforaminal lumbar interbody fusion from 2012 to 2018 was performed. Superior FJV was evaluated and graded by 3-dimensional lumbar computed tomography reconstruction. Analysis of possible risk factors included general condition of patients, anatomical characteristics of facet joint (FJ; axial, sagittal, and coronal diameters of FJ, facet angle, lumbar lordosis angle, lumbar lordosis index, and depth of lamina), and surgical factors (pedicle screw angle, screw-superior FJ distance, cranial angle, proximal rod length, and rod contouring). RESULTS: The overall violation rate of superior FJ was 34.07% (62/182), and high-grade violation rate was 16.06% (27/182). The logistic regression analysis revealed that body mass index ≥30 kg/m2 and pedicle screw placement at L5 were independent risk factors of FJV. Anatomical factors showed that the incidence of FJV was significantly increased when axial, sagittal, and coronal diameters of FJ were all ≥12 mm or FA was ≥40°. Surgical factors showed that the FJV group had a smaller pedicle screw angle and screw-superior FJ distance compared with the non-FJV group (P < 0.05). CONCLUSIONS: Body mass index ≥30 kg/m2 and pedicle screw placement at L5 were independent risk factors of superior FJV. FJV was more likely to occur in hypertrophic FJ (axial, sagittal, and coronal diameters ≥12 mm) or coronal orientation (FA ≥40°).


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Incidência , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Obesidade/complicações , Fatores de Risco , Fusão Vertebral/métodos , Adulto Jovem , Articulação Zigapofisária/cirurgia
11.
World Neurosurg ; 139: e255-e264, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32294565

RESUMO

OBJECTIVE: To investigate the effect of partial facetectomy on lumbar stability using percutaneous endoscopy. METHODS: Five male adult volunteers with no history of lumbar disease participated in the study. Based on computed tomography data, a three-dimensional model of the L3-S1 segment was created using the Mimics l5.0 and Ansys 13.0 software. The use of an 8.5-mm-diameter ring saw was simulated to cut through 5 different needle insertion points (IPs) commonly used in the clinic on the left-side facet joint (FJ) of L5 to perform facetectomy. The first to third IPs were on the apex of the superior FJ, the midpoint of the ventral side of the superior FJ, and the lowest point of the ventral side of the superior FJ. The fourth and fifth IPs represented the positions of the second and third IPs (8.5 mm/2) after the radius of the ring saw was translated to the dorsal side of the superior FJ. Physiologic load was applied to the human models. The pressure on the left and right FJ of the L5 vertebra, the pressure on the L4-5 intervertebral disc, and the range of motion of the lumbar spine were recorded when normal flexion and extension and lateral flexion and rotation of the lumbar spine model after facetectomy were simulated. RESULTS: Compared with the intact group, the second IP, maximum pressure on the L4-5 intervertebral disc after facetectomy was not significantly different under any condition (P > 0.05). The maximum pressure on the left FJ of L5 showed significant differences during right rotation of the lumbar spine (P < 0.05). The pressure on the right FJ of L5 was significantly different during left rotation of the lumbar spine (P < 0.05). The range of motion of the lumbar spine was not significantly different under any condition (P > 0.05). CONCLUSIONS: The second IP at the midpoint of the ventral side of the superior FJ showed minimal effect on lumbar spine biomechanics compared with all the other IPs during percutaneous transforaminal facetectomy. Thus, it can be considered as the most suitable IP for facetectomy.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Modelos Anatômicos , Articulação Zigapofisária/cirurgia , Adulto , Fenômenos Biomecânicos , Simulação por Computador , Endoscopia/métodos , Análise de Elementos Finitos , Humanos , Imageamento Tridimensional , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Fusão Vertebral/métodos
12.
J Clin Neurosci ; 76: 214-218, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32305274

RESUMO

BACKGROUND: Percutaneous pedicle screws(PPS) have been used for decades. The difficult part of PPS placement is locating the proper entry sites on the facet joints for the Jamshidi needles. The correct positioning is usually ensured by fluoroscopy, which exposes surgeons and patients to extensive radiation exposure. OBJECTIVE: To describe a novel retractor tube technique used in the placement of PPS, which enables visualization of the anatomy of the facet joints and enables accurate placement of the Jamshidi needles. METHODS: A newly designed 15-mm-diameter retractor tube was applied during the placement of Jamshidi needles in 21 operations using PPS to treat thoracolumbar fracture. The anatomy of the entry site could be clearly visualized, and a Kirschner wire was inserted 2 mm into each of the ideal entry sites. When all the Kirschner wires were placed, the annular tubes of the Jamshidi needles were placed along the Kirschner wires into the pedicles. Fluoroscopy was used to confirm the positions of the Jamshidi needles. The rest of the procedure was conducted in the traditional PPS placement technique. RESULTS: The entrance sites were successfully accessed through the retractor tube, with only one adjustment needed at most. Only one or two fluoroscopy images were taken during the placement of the Kirschner wires, and another image was taken after all the Jamshidi needles were placed. Fluoroscopy confirmed that the positioning of the PPS was good. CONCLUSION: A retractor tube accurately exposes the entry points on the facet joints in PPS placement, and is technically easy to use.


Assuntos
Fluoroscopia , Parafusos Pediculares , Fusão Vertebral/métodos , Articulação Zigapofisária/anatomia & histologia , Articulação Zigapofisária/cirurgia , Fraturas Ósseas , Humanos , Exposição à Radiação
13.
Medicine (Baltimore) ; 99(14): e19711, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243409

RESUMO

Anatomic course of medial branches in the thoracic spine is significantly different. Cooled RFA (CRFA) is a newer technique that can create a larger spherical lesion with a potential to compensate for the anatomic variability of the medial branches in the thoracic spine. Our retrospective study aimed to investigate the efficacy and the adverse effects of the CRFA in the treatment of thoracic facet-related pain.For this retrospective study, we evaluated 40 CRFA performed on 23 patients. The patients with diagnosis of thoracic facet joint-related pain underwent CRFA. Pain scores in numeric rating scale (NRS) were recorded at pretreatment and posttreatment at different time-points. The primary outcome measure was to report descriptive NRS score and average % improvement from baseline at each time point. A significant pain relief was determined by a decrease of ≥ 50% of mean NRS. Secondary outcome measure was the time to repeat treatment with subsequent CRFA. Adverse events were also recorded.Improvement of average pain level was 20.72% in the 1st follow-up (FU) (4-8 weeks), 53% in the 2nd FU (2-6 months), and 37.58% in the 3rd FU (6-12 months). Subgroup analysis was done based on age cutoff (age in years ≤ 50 versus >50), and pretreatment NRS (≤7 versus >7). Patients with age ≤50 and NRS score >7 experienced the best pain relief in the 2nd FU period (2-6 months). The patients with age > 50 and NRS pain level ≤7 showed steadily increased benefit both in the 2nd FU (2-6 months) and 3rd FU (6-12 months).This is the first clinical study to evaluate the efficacy and adverse effects of CRFA in the thoracic spine for facet joint-related pain. Our results suggest that CRFA procedure is an effective treatment modality for thoracic facet-related pain. Our subgroup analysis demonstrated that the pain relief and duration varies with the age and the pretreatment pain levels.


Assuntos
Artralgia/cirurgia , Dor Crônica/cirurgia , Crioterapia/métodos , Denervação/métodos , Articulação Zigapofisária/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Vértebras Torácicas/inervação , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Articulação Zigapofisária/inervação
14.
Pain Physician ; 23(2): E133-E149, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214289

RESUMO

BACKGROUND: Interventional techniques for managing spinal pain, from conservative modalities to surgical interventions, are thought to have been growing rapidly. Interventional techniques take center stage in managing chronic spinal pain. Specifically, facet joint interventions experienced explosive growth rates from 2000 to 2009, with a reversal of these growth patterns and in some settings, a trend of decline after 2009. OBJECTIVES: The objectives of this assessment of utilization patterns include providing an update of facet joint interventions in managing chronic spinal pain in the fee-for-service (FFS) Medicare population of the United States from 2000 to 2018. STUDY DESIGN: The study was designed to assess utilization patterns and variables of facet joint interventions in managing chronic spinal pain from 2000 to 2018 in the FFS Medicare population in the United States. METHODS: Data for the analysis were obtained from the master database from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2018. RESULTS: Facet joint interventions increased 1.9% annually and 18.8% total from 2009 to 2018 per 100,000 FFS Medicare population compared with an annual increase of 17% and overall increase of 309.9% from 2000 to 2009. Lumbosacral facet joint nerve block sessions or visits decreased at an annual rate of 0.2% from 2009 to 2018, with an increase of 15.2% from 2000 to 2009. In contrast, lumbosacral facet joint neurolysis sessions increased at an annual rate of 7.4% from 2009 to 2018, and the utilization rate also increased at an annual rate of 23.0% from 2000 to 2009. The proportion of lumbar facet joint blocks sessions to lumbosacral facet joint neurolysis sessions changed from 6.7 in 2000 to 1.9 in 2018. Cervical and thoracic facet joint injections increased at an annual rate of 0.5% compared with cervicothoracic facet neurolysis sessions of 8.7% from 2009 to 2018. Cervical facet joint injections increased to 4.9% from 2009 to 2018 compared with neurolysis procedures of 112%. The proportion of cervical facet joint injection sessions to neurolysis sessions changed from 8.9 in 2000 to 2.4 in 2018. LIMITATIONS: This analysis is limited by inclusion of only the FFS Medicare population, without adding utilization patterns of Medicare Advantage plans, which constitutes almost 30% of the Medicare population. The utilization data for individual states also continues to be sparse and may not be accurate. CONCLUSIONS: Utilization patterns of facet joint interventions increased 1.9% per 100,000 Medicare population from 2009 to 2018. This results from an annual decline of - 0.2% lumbar facet joint injection sessions but with an increase of facet joint radiofrequency sessions of 7.4%. KEY WORDS: Interventional techniques, facet joint interventions, facet joint nerve blocks, facet joint neurolysis.


Assuntos
Denervação/tendências , Medicare/tendências , Bloqueio Nervoso/tendências , Manejo da Dor/tendências , Doenças da Coluna Vertebral/terapia , Articulação Zigapofisária , Idoso , Idoso de 80 Anos ou mais , Anestesia por Condução/métodos , Anestesia por Condução/tendências , Raquianestesia/métodos , Raquianestesia/tendências , Dor Crônica/epidemiologia , Estudos de Coortes , Denervação/métodos , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Bloqueio Nervoso/métodos , Procedimentos Neurocirúrgicos/tendências , Dor/epidemiologia , Manejo da Dor/métodos , Estudos Retrospectivos , Doenças da Coluna Vertebral/epidemiologia , Estados Unidos/epidemiologia , Articulação Zigapofisária/cirurgia
15.
Acta Neurochir (Wien) ; 162(4): 929-936, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32086604

RESUMO

PURPOSE: Facet cysts develop due to degeneration of the zygapophyseal joints and can lead to radiculopathy and neurogenic claudication. Various surgical options are available for facet cyst excision. The aim was to facilitate surgical treatment of lumbar facet cysts based on a new classification. METHODS: We retrospectively analyzed all patients of the last 10 years in whom a facet cyst was surgically removed (ipsilateral laminotomy, contralateral laminotomy, and segmental fusion). Several radiological parameters were analyzed and correlated with the patients' outcome (residual symptoms, perioperative complications, need for re-operation, need for secondary fusion, facet cyst recurrence). RESULTS: One hundred eleven patients (55 women; median age 64 years) could be identified. Thirty-three (48%) of 69 cases, for which MRI data were available, were classified as medial facet cyst (compressing the spinal canal), 6 facet cysts were localized intraforaminal (9%) and 30 cases (43%) mediolateral (combination of both). The contralateral approach had the lowest rate for revision surgery (7.5%, p = .038) and the lowest prevalence of residual complaints (7.5%, p = .109). A spondylolisthesis and a higher/steeper angle of the facet joints were associated with poorer patient outcome. CONCLUSIONS: Lateral facet joint cysts are best resected by a contralateral approach offering the best outcome while medial cysts are suitable for removal by an ipsilateral laminotomy. The approach of mediolateral cysts can be determined by the width of the lamina and the angle of the joint. Segmental fusion should be considered in cases with detected spondylolisthesis and/or steep facet joints.


Assuntos
Laminectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Cisto Sinovial/classificação , Articulação Zigapofisária/cirurgia , Adulto , Idoso , Feminino , Humanos , Laminectomia/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Cisto Sinovial/diagnóstico por imagem , Cisto Sinovial/patologia , Cisto Sinovial/cirurgia
16.
World Neurosurg ; 137: e321-e327, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32018050

RESUMO

OBJECTIVE: To investigate the noninferiority of facet joint- and nuchal ligament-sparing laminectomy (FNL) compared with conventional open-door laminoplasty. METHODS: This retrospective study analyzed 31 patients who underwent FNL (7 women; median age, 71 years) and 29 patients who underwent laminoplasty (9 women; median age, 61 years) with cervical myelopathy due to degenerative cervical spine diseases. The surgical concept in laminectomy was to spare the facet joints and nuchal ligament, providing laminectomy with deviation to the side of dominant symptoms. In both groups, recovery rate of Japanese Orthopaedic Association (JOA) score, mean decompression ratio (decompressed width/distance between outermost edges of the lateral mass on computed tomography ×100) at decompressed laminas, and pre- and postoperative final cervical Cobb angle and cervical sagittal vertical axis were mainly examined. RESULTS: Clinical and radiologic median data with interquartile range for patients who underwent FNL and laminoplasty were as follows: postoperative follow-up, 783.0 days (535.0-1128.0 days) and 731.0 days (524.0-1213.5 days); preoperative JOA score (full score 17), 13.0 (9.5-15.0) and 13.0 (10.0-14.0); recovery rate of JOA score, 72.2% (33.3-100.0%) and 50.0% (31.0-75.0%); and mean decompression ratio, 41.9% (40.0-43.6%) and 51.6% (48.9-55.4%), respectively. The FNL group showed a comparable recovery rate of JOA score to the laminoplasty group, despite the significantly smaller mean decompression ratio (P < 0.001). Furthermore, no significant differences in pre- or postoperative median cervical Cobb angle or sagittal vertical axis were observed between groups. CONCLUSIONS: FNL was not inferior to conventional open-door laminoplasty in terms of clinical or radiologic outcomes, reducing the detachment of muscle from each lamina.


Assuntos
Laminectomia/métodos , Laminoplastia/métodos , Ligamentos Articulares/cirurgia , Articulação Zigapofisária/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia
17.
Anesthesiology ; 132(5): 1165-1174, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32011343

RESUMO

BACKGROUND: Zygapophyseal (facet) joint interventions are the second most common interventional procedure in pain medicine. Opioid exposure after surgery is a significant risk factor for chronic opioid use. The aim of this study was to determine the incidence of new persistent use of opioids after lumbar facet radiofrequency ablation and to assess the effect of postprocedural opioid prescribing on the development of new persistent opioid use. METHODS: The authors conducted a retrospective cohort study using claims from the Clinformatics Data Mart Database (OptumInsight, USA) to identify opioid-naïve patients between 18 and 64 yr old who had lumbar radiofrequency ablation. Patients who had either subsequent radiofrequency ablation 15 to 180 days or subsequent surgery within 180 days after the primary procedure were excluded from the analysis. The primary outcome was new persistent opioid use, defined as opioid prescription fulfillment within the 8 to 90 and 91 to 180 day periods after radiofrequency ablation. The authors then assessed patient-level risk factors for new persistent opioid use. RESULTS: A total of 2,887 patients met the inclusion criteria. Of those patients, 2,277 (78.9%) had radiofrequency ablation without a perioperative opioid fill, and 610 (21.1%) patients had the procedure with a perioperative opioid fill. The unadjusted rate of new persistent opioid use was 5.6% (34 patients) in the group with a perioperative opioid fill versus 2.8% (63 patients) for those without an opioid fill. Periprocedural opioid prescription fill was independently associated with increased odds of new persistent use (adjusted odds ratio, 2.35; 95% CI, 1.51 to 3.66; P < 0.001). CONCLUSIONS: Periprocedural opioid use after lumbar radiofrequency ablation was associated with new persistent use in previously opioid-naïve patients, suggesting that new exposure to opioids is an independent risk factor for persistent use in patients having radiofrequency ablation for chronic back pain. Opioid prescribing after radiofrequency ablation should be reevaluated and likely discontinued in this population.


Assuntos
Analgésicos Opioides/administração & dosagem , Prescrições de Medicamentos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Ablação por Radiofrequência/tendências , Articulação Zigapofisária/cirurgia , Adolescente , Adulto , Analgésicos Opioides/efeitos adversos , Estudos de Coortes , Prescrições de Medicamentos/normas , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Pós-Operatória/epidemiologia , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Adulto Jovem
18.
Spine (Phila Pa 1976) ; 45(11): E624-E630, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31972745

RESUMO

STUDY DESIGN: This is an in vitro biomechanical study. OBJECTIVES: The aim of this study was to investigate the biomechanical variations of lumbar spine motor units and that under different moments after screw heads blocking superior-adjacent bilateral facets through the cadaver specimen biomechanical experiment. SUMMARY OF BACKGROUND DATA: Facet joint violation by pedicle screws is not a rare adverse event in instrumented lumbar fusion surgery, and one of the most common types is the screw head blocking the superior-adjacent facet. However, its contribution to biomechanical instability at the supradjacent level is unknown. METHODS: The range of motion (ROM) of 12 lumbar spines (L4-S1) were measured in flexion-extension, lateral bending, and axial rotation for L4/5. All specimens were randomly divided into two groups: the control group and the blocking group, each with 6 specimens. Spine were tested on intact and instrumented specimens, respectively. The relative ROM changes were compared between the blocking and control groups. RESULTS: In the blocking group, the supradjacent-level flexion-extension ROM significantly decreased under all moments (7.5, 6.0, 4.5 Nm) relative to the intact spine and a significant decrease in the lateral bending relative ROM was found at 4.5 Nm. In the control group, no significant change of supradjacent-level ROM was found relative to the intact noninstrumented spine at each moment. When performing flexion-extension, the relative ROM change between the 2 groups was significantly different at 4.5 Nm. When performing lateral bending, the relative ROM change between the 2 groups was significantly different at moments of 6.0 and 4.5 Nm. CONCLUSION: When screw heads blocked superior-adjacent bilateral facets, the supradjacent-level flexion-extension ROM and lateral bending ROM decreased. In the long run, this may be a risk of persistent low-back pain due to frequent impingement. LEVEL OF EVIDENCE: N/A.


Assuntos
Fenômenos Biomecânicos/fisiologia , Vértebras Lombares/fisiologia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Articulação Zigapofisária/fisiologia , Articulação Zigapofisária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Amplitude de Movimento Articular/fisiologia , Rotação
19.
BMC Musculoskelet Disord ; 21(1): 56, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996194

RESUMO

BACKGROUND: This study was performed to investigate the association between lumbar disc herniation (LDH) and facet joint osteoarthritis (FJOA) using magnetic resonance imaging (MRI). METHODS: Between March 2012 and September 2018, a total of 441 segments from 394 patients with LDH were included in the study. LDH was classified according to the Michigan State University (MSU) classification, in which the degree of LDH is divided into 3 levels (expressed as 1, 2, and 3) and the location of LDH is divided into 4 zones (described as A, AB, B, and C). Bilateral FJOA was graded from 0 to 3 using the criteria introduced by Weishaupt et al., and bilateral facet orientations were measured on axial MRI slices. A mixed-effects ordinal logistic regression model was utilized to determine the potential factors that may be associated with FJOA, including sex, age, body mass index (BMI), segment, facet orientation and tropism, and the degree and location of LDH. RESULTS: In general, the prevalence of FJOA (grade ≥ 2) was 66.2% in LDH segments. For both the left and right sides, the degree of LDH was associated with the severity of FJOA (p < 0.01). Age and BMI were also associated with the severity of left and right FJOA (p = 0.002 and p < 0.001 for age, p < 0.001 and p = 0.003 for BMI, respectively), while segment, facet orientation, and facet tropism were not (p > 0.05 for all). Notably, MSU-B LDH was associated with greater odds of having more severe FJOA on the herniation side (left: p < 0.001, odds ratio (OR) = 2.714, 95% confidence interval (CI) = 1.583~4.650; right: p = 0.003, OR = 2.615, 95% CI = 1.405~4.870). However, other locations of LDH were not associated with the severity of FJOA (p > 0.05 for all). CONCLUSIONS: Both the degree of LDH and MSU-B LDH are associated with the severity of FJOA. The association between LDH and FJOA highlights the complexity of the etiology of FJOA.


Assuntos
Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Adulto , Estudos Transversais , Feminino , Humanos , Deslocamento do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Osteoartrite/epidemiologia , Osteoartrite/cirurgia , Estudos Retrospectivos , Articulação Zigapofisária/cirurgia
20.
J Orthop Surg Res ; 15(1): 4, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900227

RESUMO

BACKGROUND: Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis. METHODS: This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months. RESULTS: There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05). CONCLUSIONS: ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.


Assuntos
Artralgia/cirurgia , Dor Crônica/cirurgia , Dor Lombar/cirurgia , Neuroendoscopia/métodos , Rizotomia/métodos , Articulação Zigapofisária/cirurgia , Idoso , Artralgia/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Articulação Zigapofisária/diagnóstico por imagem
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