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1.
BMC Musculoskelet Disord ; 23(1): 6, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980080

RESUMO

BACKGROUND: Pedicle screw invasion of the proximal articular process will cause local articular process degeneration and acceleration, which is an important factor affecting adjacent segment degeneration. Although lumbar spondylolisthesis is a risk factor for screw invasion of the proximal joint, there is no clear conclusion regarding the two different types of spondylolisthesis. Therefore, the purpose of this study was to explore the influence of pedicle screw placement on proximal facet invasion in the treatment of degenerative spondylolisthesis and isthmic spondylolisthesis. METHODS: In total, 468 cases of lumbar spondylolisthesis treated by decompression and fusion in our hospital from January 2017 to January 2020 were included in this retrospective study. Among them, 238 cases were degenerative spondylolisthesis (group A), and 230 cases were isthmic spondylolisthesis (group B). Sex, age, body mass index, bone mineral density, preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, postoperative VAS and ODI scores at 1 month and 3 months, and angle of the proximal facet joint at the last follow-up were recorded and compared between the two groups. The degree of pedicle screw invasion of the proximal facet joint was graded and compared by the SEO grading method. RESULTS: There were no significant differences in sex, age, body mass index, bone mineral density, preoperative VAS and ODI scores, or proximal facet joint angle between the two groups (P > 0.05). There was no significant difference in VAS and ODI scores between the two groups at 1 month and 3 months after the operation (P > 0.05). The VAS score of group A at the last follow-up was 1 (1,2). The VAS score of group B at the last follow-up was 3 (1,3). The ODI score of group A at the last follow-up was 6(4,26). The ODI score of group B at the last follow-up was 15(8,36). The VAS and ODI scores of the two groups at the last follow-up were significantly different (P < 0.05). According to the SEO grading method, the invasion of the proximal articular process by pedicle screw placement in group A involved 320 cases in grade 0, 128 cases in grade I and 28 cases in grade II. In group B, there were 116 cases in grade 0, 248 cases in grade I and 96 cases in grade II, with a significant difference (P < 0.01). CONCLUSION: In summary, a certain number of cases involving screws invading the proximal facet joint occurred in the two different types of lumbar spondylolisthesis, but the number in the isthmic spondylolisthesis group was significantly higher than that in the degenerative spondylolisthesis group, which caused more trauma to the proximal facet joint and significantly affected the patient prognosis.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Espondilolistese , Humanos , Lactente , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Resultado do Tratamento
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(1): 71-78, 2022 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-35038802

RESUMO

Objective: To compare the effectiveness of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) and Wiltse-approach TLIF (W-TLIF) in the treatment of lumbar spondylolisthesis. Methods: The clinical data of 47 patients with lumbar spondylolisthesis who met the selection criteria between July 2018 and June 2019 were retrospectively analyzed, in which 21 patients were treated with PE-TLIF (PE-TLIF group) and 26 patients were treated with W-TLIF (W-TLIF group). There was no significant difference between the two groups in age, gender, disease duration, level of spondylolisthesis vertebrae, spondylolisthesis degree, spondylolisthesis type, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, lumbar Japanese Orthopaedic Association (JOA) score, and the disc height (DH), segmental lordosis (SL), and Taillard index (TI) of the operated vertebrae ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, postoperative bedridden time, and complications were compared between the two groups. The VAS score and JOA score were used to evaluate the improvement of pain and function. At last follow-up, DH, SL, and TI of operated vertebrae were measured by X-ray films, and lumbar CT was performed to evaluate the interbody fusion. Results: Compared with W-TLIF group, the operation time in PE-TLIF group was significantly longer, but the intraoperative blood loss and postoperative drainage were significantly less, and the postoperative bedridden time was significantly shorter ( P<0.05). There were 2 cases of transient lower limb radiating pain in PE-TLIF group and 1 case of superficial incision infection in W-TLIF group. There was no significant difference in the incidence of complications (9.5% vs. 3.8%) between the two groups ( χ 2=0.037, P=0.848). The patients in both groups were followed up 12-24 months, with an average of 17.3 months in PE-TLIF group and 17.7 months in W-TLIF group. The VAS scores of low back pain and leg pain, and the JOA scores of the two groups significantly improved at each time point after operation when compared with those before operation ( P<0.05). Compared with W-TLIF group, the VAS scores of low back pain in PE-TLIF group significantly lower at 3 days and 3 months after operation ( P<0.05), and the JOA score of PE-TLIF group was significantly higher at 3 months after operation ( P<0.05), and there was no significant difference in each score at any other time point between the two groups ( P>0.05). At last follow-up, the DH, SL, and TI of operated vertebrae of the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference in the differences of each parameter between the two groups ( P>0.05). According to Suk's standard, the fusion rates of PE-TLIF group and W-TLIF group were 90.5% (19/21) and 92.3% (24/26), respectively, with no significant difference ( χ 2=0.000, P=1.000). At last follow-up, there was no case of Cage sunk into the adjacent vertebral body, or dislodgement of Cage anteriorly or posteriorly in both groups. Conclusion: PE-TLIF and W-TLIF are both effective in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis. Although the operation time is prolonged, PE-TLIF has less intraoperative blood loss and postoperative drainage, shorter postoperative bedridden time, and can get more obvious short-term improvement of low back pain and function.


Assuntos
Fusão Vertebral , Espondilolistese , Animais , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Espondilolistese/cirurgia , Resultado do Tratamento
3.
BMC Musculoskelet Disord ; 23(1): 39, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34991578

RESUMO

BACKGROUND: To analyze the risk factors for pedicle screw invasion of the proximal facet joint after lumbar surgery. METHODS: From January 2019 to January 2021, 1794 patients with lumbar degenerative disease, such as lumbar disc herniation, lumbar spinal stenosis and lumbar spondylolisthesis, were treated at our hospital. In all, 1221 cases were included. General data (sex, age, BMI), bone mineral density, proximal facet joint angle, degenerative lumbar spondylolisthesis, isthmic lumbar spondylolisthesis and fixed segment in the two groups were recorded. After the operation, vertebral CT of the corresponding surgical segments was performed for three-dimensional reconstruction and evaluation of whether the vertebral arch root screw interfered with the proximal facet joint. The included cases were divided into an invasion group and a noninvasion group. Univariate analysis was used to screen the risk factors for pedicle screw invasion of the proximal facet joint after lumbar surgery, and the selected risk factors were included in the logistic model for multivariate analysis. RESULTS: The single-factor analysis showed a significant difference in age, BMI, proximal facet joint angle, degenerative lumbar spondylolisthesis, and fixed segment (P < 0.1). Multifactor analysis of the logistic model showed a significant difference for age ≥ 50 years (P < 0.001, OR = 2.291), BMI > 28 kg/m2 (P < 0.001, OR = 2.548), degenerative lumbar spondylolisthesis (P < 0.001, OR = 2.187), gorge cleft lumbar relaxation (P < 0.001, OR = 2.410), proximal facet joint angle (35 ~ 45°: P < 0.001, OR = 3.151; > 45°: P < 0.001, OR = 3.578), and fixed segment (lower lumbar spine: P < 0.001, OR = 2.912). CONCLUSION: Age (≥ 50 years old), BMI (> 28 kg/m2), proximal facet joint angle (35 ~ 45°, > 45°), degenerative lumbar spondylolisthesis, isthmic lumbar spondylolisthesis and fixed segment (lower lumbar spine) are independent risk factors for pedicle screw invasion of the proximal facet joint after lumbar surgery. Compared with degenerative lumbar spondylolisthesis, facet joint intrusion is more likely in isthmic lumbar spondylolisthesis.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Espondilolistese , Articulação Zigapofisária , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Análise Multivariada , Fusão Vertebral/efeitos adversos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
4.
Zhonghua Yi Xue Za Zhi ; 102(3): 228-234, 2022 Jan 18.
Artigo em Chinês | MEDLINE | ID: mdl-35042293

RESUMO

Objective: To assess the relationship between health-related quality of life (HRQOL) and spinal sagittal parameters in patients with degenerative and isthmic spondylolisthesis before and after surgery, and to provide a biomechanical basis for improving the clinical prognosis of such patients. Methods: A retrospective analysis of 63 patients with lumbar spondylolisthesis who received lumbar fusion surgery in the Department of Spine Surgery, Tianjin Union Medical Center from December 2017 to June 2020 was carried out. There were 16 males and 47 females with a mean age of (59±8) years. Subgroup analyses were conducted based on disease type (degenerative lumbar spondylolisthesis (DS) and the isthmic spondylolisthesis (IS)) and HRQOL scores. Patients were evaluated post-operatively to observe the improvement of symptoms and quality of life. The relationship between operative related factors, HRQOL scores before and after surgery, and spino-pelvic sagittal parameters (including sagittal axis of the spine, lumbar lordosis angle, pelvic incidence angle, pelvic tilt angle (PT), sacral tilt angle, matching degree of pelvic incidence angle (PI) and lumbar lordosis angle (LL), lumbar 1 vertebra plumb line, upper lumbar curve, lower lumbar curve) in the two groups were analyzed. The correlation between the improvement of HRQOL scores and spino-pelvic sagittal parameters in the DS group and the IS group was analyzed and compared. Results: There were significant differences between postoperative HRQOL scores compared with those before the operation in both the DS and IS groups at three times of follow-up after the operation (all P<0.05). There was no difference in the last HRQOL score, the number of surgical segments, operation time and intraoperative blood loss between the two groups (all P>0.05). The parameters of PT and PI-LL in DS patients with VAS back pain score>3 and ≤3 were statistically different (13.7°±6.4° vs 26.6°±7.4°, 5.1°±8.2° vs 18.2°±13.1°, respectively, both P<0.05), similar results were obtained in IS patients (14.1°±6.9° vs 16.4°±8.7°, 2.9°±9.7° vs 6.8°±9.8°, respectively, both P<0.05). In addition, the parameters of PT and PI-LL between patients with ODI>20 and ≤20 were all statistically different in the two groups at the last follow-up after surgery (all P<0.05). The improvement of VAS back pain score in DS and IS groups was significantly related to the improvement of PT value, respectively (r=0.76, 0.78, both P<0.05). The PT, LL and PI-LL were significantly correlated with the ODI in the DS group (r=0.60, 0.62, 0.50, all P<0.05). There was also a correlation between the improvement of ODI and PT, LL and PI-LL in the IS group, respectively (r=0.22, 0.41, 0.76, all P<0.05). Conclusions: Certain correlation exists between the HRQOL and spinal sagittal parameters in patients with degenerative and isthmic spondylolisthesis before and after surgery. For the treatment of lumbar spondylolisthesis and improvement of quality of life, the primary goal is to reconstruct the matching degree of the lumbar lordosis angle and PI, and to reduce the PT value to the normal range by tilting the pelvis forward.


Assuntos
Fusão Vertebral , Espondilolistese , Idoso , Animais , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Espondilolistese/cirurgia , Resultado do Tratamento
5.
Spine (Phila Pa 1976) ; 47(1): E10-E15, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32991517

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: The aim of this study was to investigate whether there is an association between revision surgery rates for adjacent segment degeneration (ASD) and Roussouly type after L4-5 transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis. SUMMARY OF BACKGROUND DATA: Revision surgery for ASD is known to occur after spinal fusion; however, it is unclear whether rates of ASD are associated with certain Roussouly types. METHODS: Patients who underwent L4-5 TLIF for spondylolisthesis at the University of California San Francisco from January 2006 to December 2016 with minimum 2-year follow-up were retrospectively analyzed by Roussouly type. Revision surgery for ASD was noted and correlated by Roussouly type. Spinopelvic parameters were also measured for correlation. A value of P < 0.05 was significant. RESULTS: There were 174 patients who met inclusion criteria, (59 males and 115 females). The average age was 62.3 (25-80) years. A total of 132 patients had grade I spondylolisthesis, and 42 had grade II. Mean follow-up was 45.2 months (24-497). A total of 22 patients (12.6%) underwent revision surgery for ASD after L4-5 TLIF. When classified by Roussouly type, revision surgery rates for ASD were: 1, 14.3%; 2, 22.6%; 3, 4.9%; and 4, 15.6% (P = 0.013). Type 3 spines with normal PI-LL (8.85°â€Š±â€Š6.83°) had the lowest revision surgery rate (4.9%), and type 2 spines with PI-LL mismatch (11.06°â€Š±â€Š8.81°) had the highest revision surgery rate (22.6%), a four-fold difference (P = 0.013). The PI-LL mismatch did not change significantly in each type postoperatively (P > 0.05). CONCLUSION: We found that there may be a correlation between Roussouly type and revision surgery for ASD after L4-5 TLIF for spondylolisthesis, with type 2 spines having the highest rate. Spinopelvic parameters may also correlate with revision surgery for ASD after L4-5 TLIF.Level of Evidence: 4.


Assuntos
Fusão Vertebral , Espondilolistese , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Resultado do Tratamento
6.
BMC Musculoskelet Disord ; 22(1): 920, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34724945

RESUMO

OBJECTIVE: This paper was a anatomical radiographic study of distance between lumbar bi-cortical pedicle screws (BPSs) and anterior large vessels (ALVs) in patients with lumbar spondylolisthesis, and to provide clinical basis for evaluating the safety of bi-cortical pedicle screw implantation during lumbar spondylolisthesis. METHODS: Complete Computed tomography (CT) data of 104 patients with grade I lumbar spondylolisthesis (L4 52 and L5 52) and 107 non-spondylolisthesis patients (control group) were collected in this study. The distances between lumbar 4,5(L4,5) and sacrum 1(S1) BPSs and ALVs (abdominal aorta, inferior vena cava, left and right common iliac artery, internal and external iliac artery) were respectively measured at different transverse screw angles (TSAs) (L4:5°,10°; L5:10°,15°; S1:0°,5°,10°) and analyzed by SPSS (v25.0). There were three types of distances from the anterior vertebral cortex (AVC) to the ALVs (DAVC-ALV): DAVC-ALV N, DAVC-ALV ≥ 0.50 cm, and DAVC-ALV < 0.50 cm; these different distances represented non-contact, distant and close ALV respectively. RESULTS: We calculated the incidences of screw tip contacting large vessels at different TSAs and provided the appropriate angle of screw implantation. In non-spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 4.62%. In S1, the appropriate left TSA was 0° and the incidence of the close ALV was 22.4%, while the appropriate right TSA was 10° and the incidence of the close ALV was 17.8%. In L4 spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 3.8%. In L5 spondylolisthesis group, in S1, the appropriate left TSA was 0° and the incidence of the close ALV was 19.2%, while the appropriate right TSA was 10° and the incidence of the close ALV was 21.2%. The use of BPS was not appropriate on the right side of L4 or on the either side of L5 both in spondylolisthesis and control group. In patients with lumbar 4 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in both L4 and 5. In patients with lumbar 5 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in L5, while there were no significant difference in S1. CONCLUSION: It is very important that considering the anatomical relationship between the AVC and the ALVs while planning BPSs. The use of BPS does not apply to every lumbar vertebra. In patients with lumbar spondylolisthesis and non-spondylolisthesis patients, the incidences of screw tip contacting large vessels are different.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Fusão Vertebral/efeitos adversos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
7.
Neurol India ; 69(5): 1196-1199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747783

RESUMO

Background: : MITLIF is popular among minimally invasive lumbar interbody fusion procedures. The common indications of MITLIF are Grade I and selected cases of Grade II spondylolisthesis, Failed Back Surgery Syndrome, spondylodiscitis and deformity correction. Objective: : To describe the technical nuances of MITLIF along with an operative video of a case of L4-L5 Grade I Spondylolisthesis. Surgical Procedure: : Two incisions of 2.5 cm length are made on either side, at the level to be operated and further access is created by muscle splitting. Screws, rods and cage(s) are placed through this corridor under fluoroscopic guidance. Results: : This procedure has the advantages of minimal blood loss, less muscular trauma, retention of intact posterior ligamentous anatomy, shorter hospital stay, lesser CSF leak and infection rates when compared to the open approaches. Conclusions: MITLIF has emerged as the standard procedure replacing open approaches. Mastery of this approach is strongly recommended to spine surgeons.


Assuntos
Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Espondilolistese/cirurgia , Resultado do Tratamento
10.
Medicina (Kaunas) ; 57(11)2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34833488

RESUMO

Background and Objectives: In recent literature, the routine addition of arthrodesis to decompression for lumbar spinal stenosis (LSS) with concomitant stable low-grade degenerative spondylolisthesis remains controversial. The purpose of this study is to compare the clinical outcome, complication and re-operation rates following minimally invasive (MIS) tubular decompression without arthrodesis in patients suffering from LSS with or without concomitant stable low-grade degenerative spondylolisthesis. Materials and Methods: This study is a retrospective review of prospectively collected data. Ninety-six consecutive patients who underwent elective MIS lumbar decompression with a mean follow-up of 27.5 months were included in the study. The spondylolisthesis (S) group comprised 53 patients who suffered from LSS with stable degenerative spondylolisthesis, and the control (N) group included 43 patients suffering from LSS without spondylolisthesis. Outcome measures included complications and revision surgery rates. Pre- and post-operative visual analog scale (VAS) for both back and leg pain was analyzed, and the Oswestry Disability Index (ODI) was used to evaluate functional outcome. Results: The two groups were comparable in most demographic and preoperative variables. VAS for back and leg pain improved significantly following surgery in both groups. Both groups showed significant improvement in their ODI scores, at one and two years postoperatively. The average length of hospital stay was significantly higher in patients with spondylolisthesis (p-value< 0.01). There was no significant difference between the groups in terms of post-operative complications rates or re-operation rates. Conclusions: Our results indicate that MIS tubular decompression may be an effective and safe procedure for patients suffering from LSS, with or without degenerative stable spondylolisthesis.


Assuntos
Estenose Espinal , Espondilolistese , Descompressão , Humanos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Resultado do Tratamento
11.
Ann Palliat Med ; 10(9): 9848-9858, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628911

RESUMO

BACKGROUND: Minimally invasive transforaminal interbody fusion (MI-TLIF) can minimize surgical incision, tissue damage, and intraoperative blood loss in the treatment of spondylolisthesis. However, there is a lack of evidence-based research to confirm its clinical efficacy. METHODS: Chinese and English databases were searched with "open", "minimally invasive transforaminal interbody fusion", "MIS-TLIF", "spondylolisthesis", and "open transforaminal interbody fusion" as search terms. Rev Man 5.3 provided by the Cochrane system was used to assess the quality of the literature. RESULTS: Of the 12 randomized controlled trials (RCTs), 7 references were level A (58.34%), 4 were B level (33.33%), and 1 reference was C level (8.33%). There was a statistically significant difference in intraoperative blood loss between MI-TLIF and open transforaminal interbody fusion (O-TLIF) in the treatment of spondylolisthesis [mean difference (MD) =-349.35, 95% confidence interval (CI): (-410.66, -288.03), P<0.00001]. There was also a statistically significant difference in visual analogue scale (VAS) scores before and after MI-TLIF at the last follow-up [MD =5.72, 95% CI: (4.83, 6.62), P<0.00001], and in the complication rate between MI-TLIF and O-TLIF [odds ratio (OR) =0.48, 95% CI: (0.30, 0.76), P<0.00001]. DISCUSSION: This meta-analysis confirmed that MI-TLIF could significantly reduce intraoperative blood loss, mitigate patient pain, and reduce the incidence of complications without increasing the operation time in the treatment of spondylolisthesis.


Assuntos
Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Espondilolistese/cirurgia , Resultado do Tratamento
12.
Orthop Surg ; 13(7): 2093-2101, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34596342

RESUMO

OBJECTIVE: To compare the safety and effectiveness of robot-assisted minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) and oblique lumbar interbody fusion (OLIF) for the treatment of single-level lumbar degenerative spondylolisthesis (LDS). METHODS: This is a retrospective study. Between April 2018 and April 2020, a total of 61 patients with single-level lumbar degenerative spondylolisthesis and treated with robot-assisted OLIF (28 cases, 16 females, 12 males, mean age 50.4 years) or robot-assisted Mis-TLIF (33 cases, 18 females, 15 males, mean age 53.6 years) were enrolled and evaluated. All the pedicle screws were implanted percutaneously assisted by the TiRobot system. Surgical data included the operation time, blood loss, and length of postoperative hospital stay. The clinical and functional outcomes included Oswestry Disability Index (ODI), Visual Analog scores (VAS) for back and leg pain, complication, and patient's satisfaction. Radiographic outcomes include pedicle screw accuracy, fusion status, and disc height. These data were collected before surgery, at 1 week, 3 months, 6 months, and 12 months postoperatively. RESULTS: There were no significantly different results in preoperative measurement between the two groups. There was significantly less blood loss (142.4 ± 89.4 vs 291.5 ± 72.3 mL, P < 0.01), shorter hospital stays (3.2 ± 1.8 vs 4.2 ± 2.5 days, P < 0.01), and longer operative time (164.9 ± 56.0 vs 121.5 ± 48.2 min, P < 0.01) in OLIF group compared with Mis-TLIF group. The postoperative VAS scores and ODI scores in both groups were significantly improved compared with preoperative data (P < 0.05). VAS scores for back pain were significantly lower in OLIF group than Mis-TLIF group at 1 week (2.8 ± 1.2 vs 3.5 ± 1.6, P < 0.05) and 3 months postoperatively (1.6 ± 1.0 vs 2.1 ± 1.1, P < 0.05), but there was no significant difference at further follow-ups. ODI score was also significantly lower in OLIF group than Mis-TLIF group at 3 months postoperatively (22.3 ± 10.0 vs 26.1 ± 12.8, P < 0.05). There was no significant difference in the proportion of clinically acceptable screws between the two groups (97.3% vs 96.2%, P = 0.90). At 1 year, the OLIF group had a higher interbody fusion rate compared with Mis-TLIF group (96.0% vs 87%, P < 0.01). Disc height was significantly higher in the OLIF group than Mis-TLIF group (12.4 ± 3.2 vs 11.2 ± 1.3 mm, P < 0.01). Satisfaction rates at 1 year exceeded 90% in both groups and there was no significant difference (92.6% for OLIF vs 91.2% for Mis-TLIF, P = 0.263). CONCLUSION: Robot-assisted OLIF and Mis-TLIF both have similar good clinical outcomes, but OLIF has the additional benefits of less blood loss, less postoperative hospital stays, higher disc height, and higher fusion rates. Robots are an effective tool for minimally invasive spine surgery.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Parafusos Pediculares , Estudos Retrospectivos
13.
BMC Musculoskelet Disord ; 22(1): 879, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34649557

RESUMO

BACKGROUND: Reduction of lumbar spondylolisthesis during spinal fusion surgery is important for improving the fusion rate and restoring the sagittal alignment. Despite the variety of reduction methods, the fundamental mechanics of lumbar spondylolisthesis reduction remain unclear. This study aimed to investigate the biomechanical behavior while performing spondylolisthesis reduction with the anterior and posterior lever reduction method. METHODS: We developed an L4-L5 spondylolisthesis model using sawbones. Two spine surgeons performed the simulated reduction with a customized Cobb elevator. The following data were collected: the torque and angular motion of Cobb, displacement of vertebral bodies, change of lordotic angle between L4 and L5, total axial force and torque applied on the model, and force received by adjacent disc. RESULTS: Less torque value (116 N-cm vs. 155 N-cm) and greater angular motion (53o vs. 38o) of Cobb elevator were observed in anterior lever reduction. Moreover, the total axial force received by the entire model was greater in the posterior lever method than that in the anterior lever method (40.8 N vs. 16.38 N). Besides, the displacement of both vertebral bodies was greater in the anterior lever method. CONCLUSIONS: The anterior lever reduction is a more effort-saving method than the posterior lever reduction method. The existing evidence supports the biomechanical advantage of the anterior reduction method, which might be one of the contributing factors to successfully treating high-grade lumbar spondylolisthesis with short-segment instrumentation.


Assuntos
Lordose , Procedimentos Cirúrgicos Reconstrutivos , Fusão Vertebral , Espondilolistese , Fenômenos Biomecânicos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
14.
BMC Musculoskelet Disord ; 22(1): 850, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34615516

RESUMO

BACKGROUND: Few reports to date have evaluated the effects of different pedicle screw insertion depths on sagittal balance and prognosis after posterior lumbar interbody and fusion (PLIF) in patients with lumbar degenerative spondylolisthesis (LDS). METHODS: A total of 88 patients with single-level PLIF for LDS from January 2018 to December 2019 were enrolled. Long screw group (Group L): 52 patients underwent long pedicle screw fixation (the leading edge of the screw exceeded 80% of the anteroposterior diameter of vertebral body). Short screw group (Group S): 36 patients underwent short pedicle screw fixation (the leading edge of the screw was less than 60% of the anteroposterior diameter of vertebral body). Local deformity parameters of spondylolisthesis including slip degree (SD) and segment lordosis (SL), spino-pelvic sagittal plane parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL), Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) for back pain of both groups were compared. Postoperative complications, including vertebral fusion rate and screw loosening rate, were recorded. RESULTS: Except that PI in Group S at the final follow-up was not statistically different from the preoperative value (P > 0.05), other parameters were significantly improved compared with preoperative values one month after surgery and at the final follow-up (P < 0.05). There was no significant difference in parameters between Group L and Group S before and one month after surgery (P > 0.05). At the final follow-up, SD, SL, LL, PT and PI-LL differed significantly between the two groups (P < 0.05). Compared with the preoperative results, ODI and VAS in both groups decreased significantly one month after surgery and at the final follow-up (P < 0.05). Significant differences of ODI and VAS were found between the two groups at the final follow-up (P < 0.05). Postoperative complications were not statistically significant between the two groups (P > 0.05). CONCLUSIONS: PLIF can significantly improve the prognosis of patients with LDS. In terms of outcomes with an average follow-up time of 2 years, the deeper the screw depth is within the safe range, the better the spino-pelvic sagittal balance may be restored and the better the quality of life may be.


Assuntos
Parafusos Pediculares , Espondilolistese , Humanos , Qualidade de Vida , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
15.
JNMA J Nepal Med Assoc ; 59(236): 402-405, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508540

RESUMO

Burst fracture of C5 with traumatic anterior spondyloptosis of C6 and posterior spondylolisthesis of C4 vertebra is an exceedingly rare high energy injury. Treatment includes decompression, reduction, stabilization, and fusion via anterior or posterior or combined anterior-posterior approach with or without prior traction. We report this rare subaxial cervical spine injury associated with quadriplegia managed with combined anterior and posterior instrumented fusion. A multidisciplinary approach with preoperative assessment and planning is crucial in managing cervical spine injury. Immediate postoperative critical care support, rehabilitation, and dedicated nursing care are required for a favorable outcome in traumatic quadriplegia.


Assuntos
Fraturas da Coluna Vertebral , Espondilolistese , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Humanos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Espondilolistese/cirurgia
16.
J Pediatr Orthop ; 41(10): 591-596, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34516471

RESUMO

BACKGROUND: Accurate pedicle screw placement is critical to surgically correct pediatric high-grade spondylolisthesis (HGS). The recent advent of robotics coupled with computer-assisted navigation (RAN) may represent a novel option to improve surgical outcomes of HGS, secondary to enhanced pedicle screw placement safety. This series presents the HGS-RAN technique adopted by our site, describing its surgical outcomes and feasibility. METHODS: Consecutive patients with a diagnosis of HGS (Meyerding grade III to V), operated on using RAN from 2019 to 2020 at a single-center were reviewed. Demographics, screw accuracy, sagittal L5-S1 parameters, complications, and perioperative outcomes were described. All patients were treated with instrumentation, decompression, posterior lumbar interbody fusion, and reduction. Robotic time included anatomic registration to end of screw placement. Screw accuracy-defined as a screw placed safely within the planned intrapedicular trajectory-was characterized by the Gertzbein-Robbins system for patients with additional 3-dimensional imaging. RESULTS: Ten HGS patients, with an average age of 13.7 years old, were included in the series. All 62 screws were placed without neurological deficit or complication. Seven patients had additional 3-dimensional imaging to assess screw accuracy (42 of 62 screws). One hundred percent of screws were placed safely with no pedicle breaches (Gertzbein-Robbins-grade A). Thirty screws (48%) were placed through separate incisions that were percutaneous/transmuscular and 32 screws (52%) were inserted through the main incision. There were statistically significant improvements in L5 slippage (P=0.002) and lumbosacral angle (P=0.002), reflecting successful HGS correction. The total median operative time was 324 minutes with the robotic usage time consuming a median of 72 minutes. Median estimated blood loss was 150 mL, and length-of-stay was a median 3 days. CONCLUSIONS: This case-series demonstrates that RAN represents a viable option for HGS repair, indicated by high screw placement accuracy, safety, and L5-S1 slippage correction. Surgeons looking to adopt an emerging technique to enhance safety and correction of pediatric HGS should consider the RAN platform. LEVEL OF EVIDENCE: Level IV-therapeutic study.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Espondilolistese , Adolescente , Criança , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
17.
Orthop Surg ; 13(7): 1960-1968, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34516712

RESUMO

OBJECTIVE: To compare the clinical efficacy between robot-assisted minimally invasive transforaminal lumbar interbody fusion (robot-assisted MIS-TLIF) and traditional open TLIF surgery in the treatment of lumbar spondylolisthesis. METHODS: According to the inclusion and exclusion criteria, 48 cases with lumbar spondylolisthesis who received surgical treatment from June 2016 to December 2017 in the spinal surgery department of Beijing Jishuitan Hospital were analyzed in this study, including 23 patients who received robot-assisted MIS-TLIF and 25 patients who received traditional open TLIF surgery. The two groups were compared in terms of pedicle screw accuracy evaluated by Gertzbein-Robbins classification on postoperative computed tomography (CT), operation time, blood loss, postoperative drainage, hospitalization, time to independent ambulation, low back pain evaluated by visual analog scale (VAS), lumbar function evaluated by Oswestry Disability Index (ODI), paraspinal muscles atrophy on magnetic resonance imaging (MRI), and complications. RESULTS: Postoperative CT showed that the rate of Grade A screws in the robot-assisted MIS-TLIF group was significantly more than that in the open surgery group (χ2 = 4.698, P = 0.025). Compared with the open surgery group, the robot-assisted MIS-TLIF group had significantly less intraoperative blood loss, less postoperative drainage, shorter hospitalization, shorter time to independent ambulation, and lower VAS at 3 days post-operation (P < 0.05). However, the duration of surgery was longer. The VAS of the robot-assisted MIS-TLIF group decreased from 6.9 ± 1.8 at pre-operation to 2.1 ± 0.8 at post-operation, 1.8 ± 0.7 at 6-month follow-up and 1.6 ± 0.5 at 2-year follow-up. The VAS of the open surgery group decreased from 6.5 ± 1.7 at pre-operation to 3.7 ± 2.1 at post-operation, 2.1 ± 0.6 at 6-month follow-up and 1.9 ± 0.5 at 2-year follow-up. The ODI of the robot-assisted MIS-TLIF group decreased from 57.8% ± 8.9% at pre-operation to 18.6% ± 4.7% at post-operation, 15.7% ± 3.9% at 6-month follow-up and 14.6% ± 3.7% at 2-year follow-up. The ODI of the open surgery group decreased from 56.9% ± 8.8% at pre-operation to 20.8% ± 5.1% at post-operation, 17.3% ± 4.2% at 6-month follow-up and 16.5% ± 3.8% at 2-year follow-up. Paraspinal muscle cross-sectional area in 2-year follow-up in patients of the open surgery group decreased significantly compared to patients of robotic-assisted MIS-TLIF group (P = 0.016). CONCLUSION: In the treatment of lumbar spondylolisthesis, robot-assisted MIS-TLIF may lead to more precise pedicle screw placement, less intraoperative blood loss, less postoperative drainage, less postoperative pain, quicker recovery, and less paraspinal muscle atrophy than traditional open surgery.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos/métodos , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
18.
Sci Rep ; 11(1): 17519, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34471158

RESUMO

Although osteoporosis has negative impacts on lumbar fusion, its effects on screw loosening in dynamic stabilization remain elusive. We aimed to correlate bone mineral density (BMD) with screw loosening in Dynesys dynamic stabilization (DDS). Consecutive patients who underwent 2- or 3-level DDS for spondylosis, recurrent disc herniations, or low-grade spondylolisthesis at L3-5 were retrospectively reviewed. BMD was assessed by the Hounsfield Unit (HU) in vertebral bodies (VB) and pedicles with and without cortical bone (CB) on pre-operative computed tomography (CT). Screw loosening was assessed by radiographs and confirmed by CT. HU values were compared between the loosened and intact screws. 176 patients and 918 screws were analyzed with 78 loosened screws found in 36 patients (mean follow-up: 43.4 months). The HU values of VB were similar in loosened and intact screws (p = 0.14). The HU values of pedicles were insignificantly less in loosened than intact screws (including CB: 286.70 ± 118.97 vs. 297.31 ± 110.99, p = 0.45; excluding CB: 238.48 ± 114.90 vs. 240.51 ± 108.91, p = 0.88). All patients had clinical improvements. In conclusion, the HU values, as a surrogate for BMD, were unrelated to screw loosening in DDS. Therefore, patients with compromised BMD might be potential candidates for dynamic stabilization rather than fusion.


Assuntos
Densidade Óssea , Parafusos Ósseos/efeitos adversos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Espondilolistese/cirurgia , Análise de Falha de Equipamento , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Estudos Retrospectivos , Espondilolistese/patologia , Taiwan/epidemiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Orthopedics ; 44(5): 306-312, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34590958

RESUMO

Favorable clinical outcomes have been reported for oblique lateral interbody fusion (OLIF) for various lumbar degenerative diseases. However, there is only limited evidence on the safety and effectiveness of OLIF in degenerative spondylolisthesis with lumbar facet cyst (LFC), and OLIF is often regarded as a relative contraindication for these patients. The authors prospectively enrolled patients who underwent a single-level OLIF for degenerative spondylolisthesis with LFC to evaluate the morphological changes of LFC and their clinical significance following OLIF. Twenty patients with a mean age of 69.6 years (range, 65-86 years) were enrolled. At 1 week postoperative, 5 (25%) patients had a residual cyst, whereas 15 (75%) patients had completely resolved cysts on magnetic resonance imaging (MRI). No patient had a residual cyst on the 1-year postoperative MRI. Patients with cyst resolution (n=15) on the 1-week postoperative MRI had a larger slip percentage difference on the preoperative dynamic radiograph when compared with patients with no cyst resolution (n=5) (4.7%±2.8% vs 1.3%±0.3%, P=.002). The group with cyst resolution also showed a greater expansion of facet fluid width following OLIF, although this was not statistically significant (1.2±0.7 mm vs 0.7±0.5 mm, P=.098). For both groups, all preoperative clinical scores showed a significant improvement at 1 year after OLIF, but there was no significant difference between the groups at all time points. Preliminary 1-year follow-up results from this prospective series suggest that OLIF can be a useful option for fusion surgery in LFC patients with apparent segmental instability. [Orthopedics. 2021;44(5):306-312.].


Assuntos
Cistos , Fusão Vertebral , Espondilolistese , Idoso , Idoso de 80 Anos ou mais , Descompressão , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Resultado do Tratamento
20.
N Engl J Med ; 385(6): 526-538, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34347953

RESUMO

BACKGROUND: In patients with lumbar spinal stenosis and degenerative spondylolisthesis, it is uncertain whether decompression surgery alone is noninferior to decompression with instrumented fusion. METHODS: We conducted an open-label, multicenter, noninferiority trial involving patients with symptomatic lumbar stenosis that had not responded to conservative management and who had single-level spondylolisthesis of 3 mm or more. Patients were randomly assigned in a 1:1 ratio to undergo decompression surgery (decompression-alone group) or decompression surgery with instrumented fusion (fusion group). The primary outcome was a reduction of at least 30% in the score on the Oswestry Disability Index (ODI; range, 0 to 100, with higher scores indicating more impairment) during the 2 years after surgery, with a noninferiority margin of -15 percentage points. Secondary outcomes included the mean change in the ODI score as well as scores on the Zurich Claudication Questionnaire, leg and back pain, the duration of surgery and length of hospital stay, and reoperation within 2 years. RESULTS: The mean age of patients was approximately 66 years. Approximately 75% of the patients had leg pain for more than a year, and more than 80% had back pain for more than a year. The mean change from baseline to 2 years in the ODI score was -20.6 in the decompression-alone group and -21.3 in the fusion group (mean difference, 0.7; 95% confidence interval [CI], -2.8 to 4.3). In the modified intention-to-treat analysis, 95 of 133 patients (71.4%) in the decompression-alone group and 94 of 129 patients (72.9%) in the fusion group had a reduction of at least 30% in the ODI score (difference, -1.4 percentage points; 95% CI, -12.2 to 9.4), showing the noninferiority of decompression alone. In the per-protocol analysis, 80 of 106 patients (75.5%) and 83 of 110 patients (75.5%), respectively, had a reduction of at least 30% in the ODI score (difference, 0.0 percentage points; 95% CI, -11.4 to 11.4), showing noninferiority. The results for the secondary outcomes were generally in the same direction as those for the primary outcome. Successful fusion was achieved with certainty in 86 of 100 patients (86.0%) who had imaging available at 2 years. Reoperation was performed in 15 of 120 patients (12.5%) in the decompression-alone group and in 11 of 121 patients (9.1%) in the fusion group. CONCLUSIONS: In this trial involving patients who underwent surgery for degenerative lumbar spondylolisthesis, most of whom had symptoms for more than a year, decompression alone was noninferior to decompression with instrumented fusion over a period of 2 years. Reoperation occurred somewhat more often in the decompression-alone group than in the fusion group. (NORDSTEN-DS ClinicalTrials.gov number, NCT02051374.).


Assuntos
Descompressão Cirúrgica , Vértebras Lombares/cirurgia , Fusão Vertebral , Espondilolistese/cirurgia , Idoso , Dor nas Costas , Feminino , Humanos , Análise de Intenção de Tratamento , Perna (Membro) , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Resultado do Tratamento
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