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1.
Medicine (Baltimore) ; 99(4): e18944, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977911

RESUMO

INTRODUCTION: Direct repair of the pars defect in lumbar spondylolysis is an effective surgical procedure, but it is technically challenging. We assessed the feasibility of a new robotic system for intralaminar screw fixation of spondylolysis. PATIENT CONCERNS: A 26-year-old man complained about frequent low back pain after failed conservative treatments. DIAGNOSIS: The lumbar computed tomography images demonstrated the presence of bilateral spondylolysis at the L5 level, with no spondylolisthesis. INTERVENTIONS: We performed one surgery of direct intralaminar screw fixation under the guidance of the TiRobot system. The trajectory of the screw was planned based on intraoperative 3-dimensional radiographic images. Then, the robotic arm spontaneously moved to guide the guide wires and screw insertion. OUTCOMES: Bilateral L5 intralaminar screws were safely and accurately placed. No intraoperative complications occurred. Postoperative computed tomography showed good radiological results, without cortical perforation. CONCLUSION: We report the first case of robot-assisted direct intralaminar screw fixation for spondylolysis using the TiRobot system. Robotic guidance for direct repair of spondylolysis could be feasible.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Espondilólise/cirurgia , Adulto , Parafusos Ósseos , Humanos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Espondilólise/diagnóstico por imagem
2.
Zhongguo Gu Shang ; 32(12): 1156-1159, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870078

RESUMO

OBJECTIVE: To investigate the long-term effect of posterior lumbar pedicle screw fixation combined with isthmus bone grafting and fusion in young patients with spondylolysis. METHODS: A retrospective study was carried out, consisting of 16 young patients with lumbar spondylolysis without spondylolisthesis treated by lumbar posterior pedicle screw fixation combined with isthmic bone grafting fusion from January 2006 to July 2014. There were 11 males and 5 females, aged from 18 to 21 years old, with an average age of 19.3 years old, and the course of disease ranged from 12 to 26 months, with an average of 22 months. All the patients suffered from lumbar pain and difficulty in getting out of bed. Preoperative CT confirmed 12 cases of L5 isthmus fissure and 4 cases of L4 isthmus fissure. Bone graft fusion was confirmed and internal fixation was removed after operation. Lumbar spondylolysis was evaluated by lumbago visual analogue scoring method at preoperative and postoperative time points. Lumbar isthmic fusion was evaluated by lumbar CT, and degeneration of fixed and adjacent segments of lumbar intervertebral disc was evaluated by lumbar MRI. RESULTS: Of the 16 patients, 13 patients (26 sides) were followed up, with a mean duration of 96 months. The operation time ranged from 80 to 105 minutes, with an average of 95 minutes. The intraoperative bleeding volume ranged from 150 to 300 ml, with an average of 225 ml. All the patients were successfully operated without any complications related to the operation. VAS scores at each time point after operation were improved compared with those before operation(P<0.01). Postoperative CT scans of lumbar spine showed osseous fusion at 6 to 14 months, with an average of 12 months. There were no changes of adjacent segment degeneration, fixed segment disc degeneration and protrusion on lumbar spine MRI, and no symptomatic recurrence or recurrent spondylolysis in the long term. CONCLUSIONS: The posterior lumbar pedicle screw fixation combined with isthmic bone grafting and fusion is safe and effective in the treatment of young spondylolysis. The fusion rate is high and the interference of normal physiological range is reduced. The long-term effect is satisfactory.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Espondilólise , Adolescente , Transplante Ósseo , Feminino , Humanos , Vértebras Lombares , Masculino , Estudos Retrospectivos , Espondilólise/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
World Neurosurg ; 132: 75-80, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470159

RESUMO

BACKGROUND: Incomplete ossification of the pars interarticularis will result in a pars defect, a common cause of low back pain in youth and strongly associated with participation in high-impact sports. If left untreated, it can result in spondylolisthesis, causing dynamic canal stenosis, low back pain, and radiculopathy. The treatment of pars defect was first described by Bucks in 1970, who used screws in the lamina placed through an upward and outward direction. However, because of the multiple inclusion and exclusion criteria and narrow margin of error, the Bucks pars repair technique is not commonly performed. METHODS: A 28-year-old woman had with low back pain that she had been experiencing since mid-adolescence. Computed tomography revealed a bilateral L5 pars defect without spondylolisthesis. Her L5 vertebra was reconstructed virtually. The screw trajectories, a 3-dimensional (3D) model of the vertebra, and a patient-specific drill guide (PSDG) were designed and printed using positioning guide software (MySpine MC Guides [Medacta International SA, Castel San Petro, Switzerland]). A modified Bucks procedure using cannulated compression screws and the PSDG was performed. RESULTS: Follow-up computed tomography revealed accurate placement of the compression screws, mirroring the planned trajectory. The patient was pain free at 3 months postoperatively, and early union across the defect was visualized on the 5-month radiographic imaging study. CONCLUSION: Using 3D planning software, complex surgical procedures can be planned using the patient's anatomy and computed tomography. With the aid of 3D-printed PSDGs, screw placement in narrow corridors, such as was shown in our case, is safe, efficient, and achievable.


Assuntos
Vértebras Lombares/cirurgia , Modelos Anatômicos , Espondilólise/cirurgia , Adulto , Parafusos Ósseos , Transplante Ósseo , Fios Ortopédicos , Feminino , Humanos , Imagem Tridimensional , Vértebras Lombares/anormalidades , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/diagnóstico por imagem , Tamanho do Órgão , Modelagem Computacional Específica para o Paciente , Impressão Tridimensional
4.
J Orthop Surg Res ; 14(1): 148, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122245

RESUMO

BACKGROUND: Contiguous double-level lumbar spondylolytic spondylolisthesis is an extremely rare condition. There is a paucity of data of lumbosacral deformity and sagittal spino-pelvic malalignment among these patients. Moreover, the effect of transforaminal lumbar interbody fusion (TLIF) on sagittal realignment still remains largely unknown. The aim of the study is to investigate the reconstruction of sagittal alignment and the improvement of clinical outcomes after posterior instrumented double-level or single-level TLIF. METHODS: From January 2010 to September 2018, the records of patients with contiguous L4/5 and L5/S1 double-level spondylolytic spondylolisthesis were retrospectively reviewed. Patients who had undergone double-level or single-level TLIF and a minimum of 2 years' follow-up were included. The slippage parameters and spino-pelvic parameters were measured preoperatively, postoperatively, and at the latest follow-up. RESULTS: A total of 58 patients (21 males and 37 females, mean age of 57.1 ± 6.9 years) were enrolled. Thirty-eight patients were treated with double-level TLIF and the remaining 20 with single-level TLIF (L4/5 in 14; L5/S1 in 6). After surgery, the spondylolisthesis was significantly reduced at both L4/5 and L5/S1 level (all P < 0.001). There was a significant reduction in pelvic tilt (P < 0.001) and a significant increase in sacral slope (P < 0.001). Significant increase in L4-S1 height (P < 0.001) and L4-S1 lordosis (P = 0.012) and decrease in L5 slope (P = 0.004) and L5 incidence (P = 0.001) were also observed. Compared to single-level TLIF, double-level TLIF increased L4-S1 height (P < 0.001) and L4-S1 lordosis (P < 0.001) and reduced L4-SVA (P = 0.007) and L5 incidence (P = 0.013) more obviously, and the sagittal balance was better corrected in double-level TLIF group (P = 0.006). Double-level TLIF group showed larger increase in VAS scores for low back pain. The incidence of implant-related complications was lower in the double-level group. CONCLUSION: Posterior short-segment instrumented TLIF can bring favorable radiographic and clinical outcomes in patients with lumbosacral contiguous double-level spondylolytic spondylolisthesis. Double-level TLIF is more efficient to improve L4-S1 height, regional lumbar lordosis, and global sagittal balance.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sacro/cirurgia , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Espondilólise/cirurgia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/normas , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Fusão Vertebral/normas , Espondilolistese/diagnóstico por imagem , Espondilólise/diagnóstico por imagem
5.
World Neurosurg ; 126: 181-188, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30876997

RESUMO

BACKGROUND: Spondylolysis is a defect in the pars interarticularis that typically presents with axial back pain. Recently, minimally invasive spine techniques have increased in popularity and have been applied to the Buck technique of direct pars repair. CASE DESCRIPTION: In our series, 2 patients underwent minimally invasive direct pars repair by the percutaneous insertion of a cannulated lag screw across the pars defect with compression against the lamina. The defect was then decorticated and packed with bone grafting material through a tubular retractor. The clinical records, including preoperative imaging characteristics and intraoperative variables, were collected. The first patient was a 22-year-old woman with bilateral pars defects, and the second was a 21-year-old woman with a left-sided pars defect. They underwent minimally invasive direct pars repair without complications and were discharged home within 24-48 hours. In the first patient, the fusion was successful; however, the second experienced screw back out and required subsequent revision. The follow-up period was 25 months for patient 1 and 21 months for patient 2. The fracture morphology differed. The successfully repaired fractures were linear with smooth cortical edges and oriented perpendicular to the screw trajectory. The failed repair involved a unilateral, curved defect with comminuted cortical edges. CONCLUSION: Minimally invasive direct pars repair can be performed safely and effectively with shortened hospital stays and reduced morbidity. Fracture morphology and orientation could be important predictors of the success of surgery.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Espondilólise/cirurgia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Reoperação , Espondilólise/diagnóstico por imagem , Falha de Tratamento , Resultado do Tratamento , Adulto Jovem
6.
World Neurosurg ; 126: e330-e341, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30822594

RESUMO

BACKGROUND: The postoperative infection rates for transforaminal lumbar interbody fusion (TLIF) have ranged from <2% to 4%. However, no consensus has been reached on the treatment strategies. TLIF cage preservation or revision surgery for lumbar spine reconstruction are 2 possible treatments. We aimed to determine the most effective method for organ/space infection control. METHODS: The data from 4923 patients who had undergone TLIF with cage and posterior pedicle-screw instrumentation for spondylolysis or degenerative spondylolisthesis from January 2008 to December 2015 were retrospectively analyzed. Of the 4923 patients, 32 (0.65%) had developed organ/space infection of the interbody cage and were divided into 2 groups: those whose interbody cage was removed for revision (group 1) and those who interbody cage was retained (group 2). We compared the initial management of both groups in terms of age, sex, elapsed time to diagnosis, changes in spinal lordotic angle, visual analog scale score, fusion status, and Kirkaldy-Willis functional outcomes. RESULTS: The 32 patients with organ/space infection had a mean age of 66.3 years and a follow-up period of 23.8 months. Significant differences were observed in the mean elapsed time to diagnosis (P = 0.004), lordotic angle correction at the disease level (P = 0.03), and Kirkaldy-Wallis functional outcomes (P = 0.01). Of the 17 patients undergoing debridement for implant retention, 9 (52.9%) exhibited poor results. CONCLUSIONS: The most important factor contributing to TLIF cage retention failure was epidural fibrosis of the previous transforaminal route and biofilm adhesion on interbody devices affecting infection clearance. Thus, we would recommend a combined anterior and posterior approach or the transforaminal route for radical debridement with cage removal and fusion to achieve better clinical outcomes.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Região Lombossacral/cirurgia , Infecções Relacionadas à Prótese/tratamento farmacológico , Fusão Vertebral/instrumentação , Fatores Etários , Idoso , Desbridamento , Feminino , Seguimentos , Humanos , Lordose/patologia , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Estudos Retrospectivos , Fatores Sexuais , Espondilolistese/cirurgia , Espondilólise/cirurgia , Resultado do Tratamento
7.
World Neurosurg ; 123: e77-e84, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30448583

RESUMO

BACKGROUND: We have introduced a new operation for isthmic spondylolysis in adolescents and evaluated its clinical efficacy. METHODS: A total of 30 adolescent patients with isthmic spondylolysis and chronic low back pain underwent "temporary" short-segmental pedicle screw combined with transverse device fixation and isthmic bone graft repair treatment. Radiograph and computed tomography images were evaluated during regular follow-up examinations to confirm successful bone graft fusion, after which the fixation was removed. Lumbar magnetic resonance imaging was performed before and 1 year after fixation surgery and 1 year after fixation removal. Modic and Pfirrmann grading standards were used to observe the effect of "temporary" fixation on the corresponding vertebral endplate and intervertebral disc. RESULTS: All 30 patients had complete follow-up data available at 2 years postoperatively. The low back pain symptoms had disappeared completely, and radiographs and computed tomography showed that the isthmus in all patients had achieved bony fusion. With removal of the internal fixation, motion of the fixed segment recovered. "Temporary" rigid internal fixation did not increase the corresponding vertebral endplate or intervertebral disc degeneration. CONCLUSIONS: "Temporary" short-segmental pedicle screw combined with transverse device fixation is a simple and effective method for adolescent isthmic spondylolysis with rigid internal fixation and accelerated bone graft fusion.


Assuntos
Transplante Ósseo , Fixadores Internos , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/métodos , Espondilólise/cirurgia , Adolescente , Feminino , Seguimentos , Humanos , Ílio/transplante , Dor Lombar/diagnóstico por imagem , Dor Lombar/etiologia , Dor Lombar/cirurgia , Imagem por Ressonância Magnética , Masculino , Duração da Cirurgia , Espondilólise/complicações , Espondilólise/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
World Neurosurg ; 115: 79-84, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29654954

RESUMO

BACKGROUND: Posterior arch defect of C2 with an unstable spondylolysis is a rare condition mostly occurring within children. Its management is still controversial. CASE DESCRIPTION: We report in this article the first minimally invasive surgery (MIS) technique for this condition in an 8-year-old boy. A primary unstable C2 spondylolysis was diagnosed on the exploration of episodic paresthesia of upper limbs associated with headache lasting for several months. The surgical technique consisted in a direct pars repair through an MIS approach: METRx tubular retractor system (Medtronic Sofamor Danek, Memphis, Tennessee, USA), intraoperative C-arm fluoroscopy, surgical microscope, endoscopic spine instrument, and high-speed drill were required. Muscles were split and retracted. One-year postoperative course was excellent. CONCLUSIONS: After reviewing the past literature of this pathology, we discuss the minimally invasive posterior approach of the upper cervical spine. It is the first case, to our knowledge, describing direct minimally invasive repair for bilateral primary C2 pars defect in a child. Image guidance and surgical microscope help safe and effective screw placement.


Assuntos
Parafusos Ósseos , Instabilidade Articular/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Espondilólise/cirurgia , Criança , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Espondilólise/diagnóstico , Resultado do Tratamento
9.
J Orthop Surg Res ; 13(1): 55, 2018 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-29548343

RESUMO

BACKGROUND: Lumbar spondylolysis and isthmic spondylolisthesis are common conditions. However, double-level lumbar spondylolysis and spondylolisthesis are rare. We report 24 cases of it along with a review of literature and a briefly description of the clinical and radiological features and integrated management of patients with this condition. METHODS: Of 1700 inpatients diagnosed with lumbar spondylolisthesis at our hospital between January 2008 and September 2015, we selected those with a diagnosis of double-level spondylolisthesis who underwent surgery. We analyzed the data regarding age, sex, and heavy physical labour. Japanese Orthopaedic Association (JOA) and Visual Analog Scale (VAS) scores were used to evaluate preoperative and postoperative neurological function and back pain. All patients underwent decompression, reduction, and posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with a cage. After the operation, we were followed up for more than 2 years to observe the effect of the operation. In the meantime, the height of the intervertebral discs was measured at follow-up, and all data are analyzed in SPSS stastic. RESULTS: Double-level spondylolisthesis occurred at the L2/L3 and L3/L4 levels in one patient, L3/4 and L4/L5 levels in 11 patients, and L4/L5 and L5/S1 levels in 12 patients. Nine patients also had spondylolysis. Twenty patients underwent posterior lumbar interbody fusion and internal fixation with autologous bone chip, and 4 of them underwent cage and autogenous bone graft fixation. Postoperatively, the major symptoms (neurological dysfunction and low-back pain) improved significantly. Comparison of JOA and VAS scores indicated effective recovery of neurological function (p < 0.05). Postoperative follow-up demonstrated satisfactory interbody fusion and pars interarticularis healing. CONCLUSIONS: Double-level lumbar spondylolysis and spondylolisthesis occurred more often in women. Most common site of double lumbar spondylolisthesis was L3-L5. The treatment principle was the same as that for single-level spondylolisthesis, but the reset order is questionable. Both, posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with cage can relieve discomfort in most patients. In our follow-up, we found that there was a high degree of loss in disk height when autogenous bone was used. Therefore, we suggest the use of a cage.


Assuntos
Vértebras Lombares/cirurgia , Espondilolistese/cirurgia , Espondilólise/cirurgia , Adulto , Idoso , Transplante Ósseo/métodos , Feminino , Humanos , Fixadores Internos , Dor Lombar/cirurgia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fusão Vertebral/métodos , Espondilolistese/complicações , Espondilolistese/diagnóstico por imagem , Espondilólise/complicações , Espondilólise/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Orthop Clin North Am ; 49(2): 191-194, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29499820

RESUMO

Evidence-based medicine (EBM) is a process of decision-making aimed at making the best clinical decisions as they relate to patients' health. The current use of EBM in pediatric spine surgery is varied, based mainly on the availability of high-quality data. The use of EBM is limited in idiopathic scoliosis, whereas EBM has been used to investigate the treatment of pediatric spondylolysis. Studies on early onset scoliosis are of low quality, making EBM difficult in this condition. Future focus and commitment to study quality in pediatric spinal surgery will likely increase the role of EBM in these conditions.


Assuntos
Medicina Baseada em Evidências , Procedimentos Ortopédicos/métodos , Escoliose/cirurgia , Espondilólise/cirurgia , Adolescente , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Seguimentos , Humanos , Masculino , Seleção de Pacientes , Qualidade de Vida , Escoliose/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Espondilólise/diagnóstico por imagem , Resultado do Tratamento
11.
Neurosurg Focus ; 44(1): E10, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29290131

RESUMO

OBJECTIVE Spondylosis with or without spondylolisthesis that does not respond to conservative management has an excellent outcome with direct pars interarticularis repair. Direct repair preserves the segmental spinal motion. A number of operative techniques for direct repair are practiced; however, the procedure of choice is not clearly defined. The present study aims to clarify the advantages and disadvantages of the different operative techniques and their outcomes. METHODS A meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following databases were searched: PubMed, Cochrane Library, Web of Science, and CINAHL ( Cumulative Index to Nursing and Allied Health Literature). Studies of patients with spondylolysis with or without low-grade spondylolisthesis who underwent direct repair were included. The patients were divided into 4 groups based on the operative technique used: the Buck repair group, Scott repair group, Morscher repair group, and pedicle screw-based repair group. The pooled data were analyzed using the DerSimonian and Laird random-effects model. Tests for bias and heterogeneity were performed. The I2 statistic was calculated, and the results were analyzed. Statistical analysis was performed using StatsDirect version 2. RESULTS Forty-six studies consisting of 900 patients were included in the study. The majority of the patients were in their 2nd decade of life. The Buck group included 19 studies with 305 patients; the Scott group had 8 studies with 162 patients. The Morscher method included 5 studies with 193 patients, and the pedicle group included 14 studies with 240 patients. The overall pooled fusion, complication, and outcome rates were calculated. The pooled rates for fusion for the Buck, Scott, Morscher, and pedicle screw groups were 83.53%, 81.57%, 77.72%, and 90.21%, respectively. The pooled complication rates for the Buck, Scott, Morscher, and pedicle screw groups were 13.41%, 22.35%, 27.42%, and 12.8%, respectively, and the pooled positive outcome rates for the Buck, Scott, Morscher, and pedicle screw groups were 84.33%, 82.49%, 80.30%, and 80.1%, respectively. The pedicle group had the best fusion rate and lowest complication rate. CONCLUSIONS The pedicle screw-based direct pars repair for spondylolysis and low-grade spondylolisthesis is the best choice of procedure, with the highest fusion and lowest complication rates, followed by the Buck repair. The Morscher and Scott repairs were associated with a high rate of complication and lower rates of fusion.


Assuntos
Vértebras Lombares/cirurgia , Parafusos Pediculares , Espondilolistese/cirurgia , Espondilólise/cirurgia , Fenômenos Biomecânicos/fisiologia , Feminino , Humanos , Masculino , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
Bull Hosp Jt Dis (2013) ; 76(4): 246-251, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31513509

RESUMO

INTRODUCTION: Spondylolysis is an increasingly common diagnoses for young individuals and presents with a wide range of pathological and clinical findings. Most patients are treated conservatively, and surgery is reserved for severe cases. This is a populations study defining the incidence of spondylolysis in the Kids' Inpatient Database (KID) and assess trends in diagnoses, causes, and treatments. METHODS: Retrospective analysis of the prospectively collected information in KID was performed for the years 2003 through 2012. Patients with a diagnosis of spondylolysis (ICD-9-CM 756.11) between the ages of 0 and 20 years in the KID were identified. Incidence of spondylolysis was established using KID-supplied hospital- and year-adjusted trend weights. Demographics including age, race, gender, and Charlson Comorbidity Index were assessed for all spondylolysis patients. Primary outcome measures were yearadjusted and hospital-adjusted incidence of spondylolysis. Secondary outcome measures were concurrent diagnoses and surgical details. RESULTS: Six hundred and sixteen patients with a diagnosis of spondylolysis (329 with primary diagnosis) were identified (female: 53.8%; age: 15.27 ± 3.32 years). The incidence of spondylolysis is 7 per 100,000 patients nationally. Spondylolysis incidence has increased over time (p < 0.001) though the operative rate for spondylolysis has remained the same in the last decade (70% average, p = 0.52). The average CCI is 0.234, the average length of stay is 3.76 days and 92.4% of patients were discharged home. The etiology of the spondylolysis was trauma in 8.6% of patients (3.2% car crash, 1.9% pedestrian, 1.3% fall, 1.3% assault, 1.1% other transport, 1.0% sports, 0.3% motorcycle, 0.2% firearm, 0.2% bicycle; 1.9% reported multiple trauma etiologies). The most common concurrent diagnoses for all spondylolysis patients were spondylolisthesis (28%), idiopathic scoliosis (4.4%), cerebral palsy (1.9%), and spina bifida (1.8%). Four hundred and thirty patients with spondylolysis underwent surgical treatment and 40% of the surgically treated patients had spondylolisthesis. The rate of fusions was 54.9% fusions and 21% decompression, though the rate of fusions or decompressions being performed for spondylolysis has remained the same in the last decade (average fusion rate: 55%; average decompression rate: 18%; both p > 0.05). Levels fused and complications did not differ depending on whether or not decompression was performed (p > 0.05). The posterior-only approach was used in 62.2% of surgeries and were mostly 2 to 3 level procedures (63.5%). Perioperative complications occurred in 8.1% of patients, with the most common complications being device-related (2.3%), respiratory (1.5%), and digestive (1.5%). CONCLUSIONS: The national incidence of spondylolysis has increased over time, and the surgical rate and treatment techniques have remained constant. The most common concurrent diagnoses were idiopathic scoliosis, cerebral palsy, and spina bifida. Further work is required to determine the significance of these trends and associations.


Assuntos
Descompressão Cirúrgica , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral , Espondilólise , Adolescente , Paralisia Cerebral/epidemiologia , Criança , Comorbidade , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Incidência , Classificação Internacional de Doenças , Masculino , Escoliose/epidemiologia , Disrafismo Espinal/epidemiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Espondilólise/diagnóstico , Espondilólise/epidemiologia , Espondilólise/cirurgia , Estados Unidos/epidemiologia
13.
Spine (Phila Pa 1976) ; 43(2): E111-E117, 2018 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-28591074

RESUMO

STUDY DESIGN: Retrospective cohort study OBJECTIVE.: The aim of this study was to compare perioperative adverse events for patients with lumbar spondylolysis treated with transforaminal lumbar interbody fusion (TLIF), posterior spinal fusion (PSF), combined anterior and posterior fusion (AP fusion), or anterior lumbar interbody fusion (ALIF). SUMMARY OF BACKGROUND DATA: Previous cohort studies have shown similar long-term outcomes for different surgical approaches for this indication, but potential differences in 30-day perioperative adverse events have not been well characterized. METHODS: The present study uses data extracted from the American College of Surgeons National Surgical Quality Improvement Database. Patients undergoing fusion with different approaches for lumbar spondylolysis were identified. Propensity score matching was utilized to account for potential differences in demographic and comorbidity factors. Comparisons among perioperative outcomes were then made among the propensity score-matched study groups. RESULTS: Of 1077 cases of spondylolysis identified, 556 underwent TLIF, 327 underwent PSF, 108 underwent AP fusion, and 86 underwent ALIF. After propensity score matching, there were no differences in the rates of any of the 30-day individual adverse events studied and no differences in the aggregated groupings of any adverse event, serious adverse event, or minor adverse event. There was a significantly increased operative time in the AP fusion group, but there were no differences in hospital length of stay or readmission rates. CONCLUSION: Because perioperative adverse event rates were similar, even with a slightly longer operative time in the AP fusion group, these findings suggest that surgeon preference and long-term outcomes are better used to determine the recommendation of one surgical approach over another for single level fusions for lumbar spondylolysis. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Espondilólise/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
14.
World Neurosurg ; 109: e609-e614, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29054782

RESUMO

BACKGROUND/OBJECTIVE: Multilevel spondylolysis is a rare cause of progressive lower back pain, and patients who fail conservative management are treated surgically. Direct repair methods can maintain mobility and lead to decreased morbidity compared with spinal fusion in single-level spondylolysis. In this paper, we present a patient with nonadjacent multilevel spondylolysis who underwent the "smiley face" technique of direct multilevel repair without fusion using 3-dimensional intraoperative spinal navigation. METHODS: Bilateral spondylolysis at L3 and L5 with associated spondylolisthesis in a 50-year-old male was repaired using the "smiley face" technique. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and visual analog scale scores for back and leg pain, were assessed preoperatively along with 6 weeks and 4 months postoperatively. RESULTS: Postoperative computed tomography imaging showed precise screw insertion and rod placement along with stable hardware alignment in follow-up imaging. The patient's ODI and lower back visual analog scale scores decreased from 25 to 8 and 7.5 to 4, respectively, correlating to an excellent outcome on ODI. CONCLUSION: Direct repair and avoidance of fusion is possible and can provide good functional outcomes in patients with nonadjacent multilevel spondylolysis and associated spondylolisthesis.


Assuntos
Neuronavegação/métodos , Procedimentos Neurocirúrgicos/métodos , Parafusos Pediculares , Espondilólise/cirurgia , Humanos , Imagem Tridimensional , Cuidados Intraoperatórios/métodos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem , Espondilolistese/complicações , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Espondilólise/complicações , Espondilólise/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
Neurocirugia (Astur) ; 29(3): 122-130, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28988667

RESUMO

Since 1968, many surgical techniques used in repairing the pars defect of the vertebra have been reported. Technological advances are giving rise to new ways of obtaining the best outcome using less invasive methods, which are more accurate, simple and effective. To treat cases of spondylolysis such as pseudarthrosis, we used neuro-navigation and microscopy through a 2.5-cm skin incision to approach the pars defect, freshen the fracture and place a type of screw that, until now, has never been used for this purpose. This is a novel technique, which guarantees prolonged compression and sufficient stability to facilitate the prompt healing of the vertebra. We present 2 cases of L5 spondylolysis treated with our technique, a modification of Buck's technique. A detailed description of the screw selection, surgical technical details, follow-up and outcome are discussed.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Microcirurgia/métodos , Neuronavegação , Espondilólise/cirurgia , Desenho de Equipamento , Seguimentos , Fraturas Espontâneas/cirurgia , Humanos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Dor Intratável/etiologia , Fraturas da Coluna Vertebral/cirurgia , Espondilólise/complicações , Espondilólise/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Acta Orthop Belg ; 84(3): 359-365, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30840580

RESUMO

The initial treatment of acute spondylolysis in young elite athletes is conservative. Excellent clinical results are seen when there is osseous healing of the defect. When there is no osseous healing, repetitive and maximal loading of the lumbar spine often remain painful. Osseous healing is more likely when lesions are diagnosed and treated early. When no signs of healing are present at computed tomography (CT-scan) after 4 months of conservative treatment and when pain persists, percutaneous surgical treatment can be considered in elite athletes. We present a new percutaneous bone grafting technique for young elite athletes with acute spondylolysis. Osseous healing was achieved and the patient was able to resume competitive sport activities within 6 months after surgery. This technique can improve fracture biology without muscle damage and without affecting the normal mobility of the spine, eventually leading to osseous healing.


Assuntos
Atletas , Transplante Ósseo/métodos , Vértebras Lombares/cirurgia , Espondilólise/cirurgia , Doença Aguda , Tratamento Conservador , Humanos , Tomografia Computadorizada por Raios X , Transplante Autólogo , Falha de Tratamento
17.
Neurosurg Focus ; 43(2): E6, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28760031

RESUMO

OBJECTIVE The objective of this study was to describe the use of a minimally invasive surgical treatment of lumbar spondylolysis in athletes by a fluoroscopically guided direct pars screw placement with recombinant human bone morphogenetic protein-2 (rhBMP-2) and to report on clinical and radiographic outcomes. METHODS A retrospective review was conducted of all patients treated surgically for lumbar spondylolysis via a minimally invasive direct pars repair with cannulated screws. Demographic information, clinical features of presentation, perioperative and intraoperative radiographic imaging, and postoperative data were collected. A 1-cm midline incision was performed for the placement of bilateral pars screws utilizing biplanar fluoroscopy, followed by placement of a fully threaded 4.0-mm-diameter titanium cannulated screw. A tubular table-mounted retractor was utilized for direct pars fracture visualization and debridement through a separate incision. The now-visualized pars fracture could then be decorticated, with care taken not to damage the titanium screw when using a high-speed drill. Local bone obtained from the curettage was then placed in the defect with 1.05 mg rhBMP-2 divided equally between the bilateral pars defects. RESULTS Nine patients were identified (mean age 17.7 ± 3.42 years, range 14-25 years; 6 male and 3 female). All patients had bilateral pars fractures of L-4 (n = 4) or L-5 (n = 5). The mean duration of preoperative symptoms was 17.22 ± 13.2 months (range 9-48 months). The mean operative duration was 189 ± 29 minutes (range 151-228 minutes). The mean intraoperative blood loss was 17.5 ± 10 ml (range 10-30 ml). Radiographic follow-up was available in all cases; the mean length of time from surgery to the most recent imaging study was 30.8 ± 23.3 months (range 3-59 months). The mean hospital length of stay was 1.13 ± 0.35 days (range 1-2 days). There were no intraoperative complications. CONCLUSIONS Lumbar spondylolysis treatment with a minimally invasive direct pars repair is a safe and technically feasible option that minimizes muscle and soft-tissue dissection, which may particularly benefit adolescent patients with a desire to return to a high level of physical activity.


Assuntos
Proteína Morfogenética Óssea 2/administração & dosagem , Parafusos Ósseos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Espondilólise/cirurgia , Fator de Crescimento Transformador beta/administração & dosagem , Adolescente , Parafusos Ósseos/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Vértebras Lombares/diagnóstico por imagem , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Proteínas Recombinantes/administração & dosagem , Estudos Retrospectivos , Espondilólise/diagnóstico por imagem , Adulto Jovem
18.
Childs Nerv Syst ; 33(9): 1563-1570, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28643037

RESUMO

PURPOSE: The purpose of this study is to describe national trends in spinal decompression without fusion and discectomy procedures in the US pediatric inpatient population. METHODS: The Kids' Inpatient Database (KID) was queried for pediatric patients with primary diagnoses of spinal spondylolysis/stenosis or disc herniation and having undergone spinal decompression without fusion or discectomy over more than a decade (2000 to 2012). The primary (indirect) outcomes of interest were in-hospital complication rates, length of stay (LOS), total costs, and discharge dispositions. RESULTS: A total of 7315 patients, comprised of pediatric spinal spondylolysis/stenosis (n = 287, 3.92%) and pediatric disc herniation (n = 7028, 96.1%) patients, were included in the study. During the years 2000 to 2012, diagnoses of pediatric spondylolysis/spinal stenosis increased from 61 to 90 diagnoses per 3-year period, while diagnoses of pediatric disc herniation decreased from 2133 to 1335 diagnoses per 3-year period. Spinal decompression was associated with higher in-hospital complication rates (18.1 vs 5.3%, p < 0.0001), longer hospital stays (5 vs 1.69 days, p < 0.0001), higher mean total charges ($49,186 vs $19,057, p < 0.0001), and higher non-routine discharge rates (12.3 vs 2.5%, p < 0.0001) versus discectomy. CONCLUSIONS: Spinal decompression is associated with longer hospital stays, more complications, higher costs, and more non-routine discharges when compared to discectomy. The data supports the disparate nature of these disease processes and elucidates basic clinical trends in uncommon spinal disorders affecting children.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Discotomia/efeitos adversos , Deslocamento do Disco Intervertebral/cirurgia , Estenose Espinal/cirurgia , Espondilólise/cirurgia , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
19.
Instr Course Lect ; 66: 403-408, 2017 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-28594516

RESUMO

Low back pain is the most common complaint expressed by adult patients in the primary care setting, and the incidence of low back pain in adolescents is rising. Adolescents who are involved in athletics most commonly suffer from spondylolysis, spondylolisthesis, mechanical low back pain, and herniated disks, whereas adult athletes most commonly suffer from lumbosacral strain and herniated or degenerative disks. Initial nonsurgical management aims to reduce inflammation and noninvasively strengthen damaged tissues. Although most patients who have low back pain will return to sports after nonsurgical treatment, surgery may be required in patients who have persistent or progressive neurologic symptoms.


Assuntos
Traumatismos em Atletas , Deslocamento do Disco Intervertebral , Espondilolistese , Espondilólise , Adolescente , Adulto , Atletas , Traumatismos em Atletas/cirurgia , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Espondilolistese/cirurgia , Espondilólise/cirurgia
20.
Instr Course Lect ; 66: 409-413, 2017 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-28594517

RESUMO

The most common causes of low back pain in adolescents are spondylolysis and spondylolisthesis. Mechanical factors combined with rapid growth during adolescence place stress on the spine and can result in a stress fracture. Sports that require athletes to repeatedly place the spine in hyperextension may exacerbate both spondylolysis and spondylolisthesis. Many adolescent athletes with spondylolysis or low-grade spondylolisthesis have minimal symptoms and require no treatment or alteration in activity, including sports activity. For adolescents with spondylolysis or low-grade spondylolisthesis who have symptoms, nonsurgical treatment with activity restrictions and a structured rehabilitation program can help in return to most sports. Surgical treatment may be required for patients who have symptoms that are unresponsive to nonsurgical treatment and patients who have grade III or grade IV spondylolisthesis. Treatment and return to competitive sports must be individualized based on the severity and symptoms of the disease in each patient.


Assuntos
Fraturas de Estresse , Espondilolistese , Espondilólise , Adolescente , Atletas , Fraturas de Estresse/cirurgia , Humanos , Vértebras Lombares , Volta ao Esporte , Coluna Vertebral , Espondilolistese/cirurgia , Espondilólise/cirurgia
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