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2.
Medicine (Baltimore) ; 99(11): e19551, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176111

RESUMO

Sagittal imbalance is a multifactorial complex deformity that can arise from a variety of causes such as spinal stenosis, sarcopenia, vertebral fracture, and neuromuscular diseases. Furthermore, there is lack of research regarding spinal and general conditions that precede the development of sagittal imbalance. Our aim was to evaluate aggravating factors, such as natural history, for sagittal imbalance in a cohort comprising elderly individuals by conducting various examinations.We recruited 96 participants who had a sagittal vertical axis (SVA) larger than 50 mm in a sagittal imbalance study. Finally, 69 participants were followed up and enrolled this study after 2 years. We evaluated full spine radiographs, magnetic resonance imaging (MRI), bone mineral density, and health-related quality of life from patients survey and analyzed factors associated with aggravation of sagittal imbalance. Aggravation was defined by an SVA > 30 mm and T1 pelvic angle (T1PA) > 3° in the third year compared to SVA and T1PA values of the first year.Eighteen participants of the follow-up group had a sagittal imbalance aggravation. According to the deformity severity in the first-year evaluations, the marked deformity group (38 participants) defined as Schwab classification had 11 (28.9%) participants presenting with sagittal imbalance aggravation. These participants had larger mean values of Schwab sagittal modifiers and T1PA compared with the nonaggravation participants. Logistic regression analysis showed a higher pelvic incidence (PI) (OR = 1.201, 95% CI = 1.015-1.422, P = .033) and a small multifidus (MF) volume (OR = 0.991, 95% CI = 0.983-1.000, P = .043) correlated with sagittal imbalance aggravation.From the follow-up group, 18 (26%) subjects of total 69 participants presented a deteriorated sagittal imbalance. A higher PI and smaller MF volume correlated with the aggravation of sagittal imbalance. We should consider that high PI and small MF volume are associated with aggravation of sagittal imbalance.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Equilíbrio Postural , Estenose Espinal/diagnóstico por imagem , Idoso , Estudos de Coortes , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Fusão Vertebral , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia
3.
Medicine (Baltimore) ; 99(11): e19457, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176077

RESUMO

BACKGROUND: Lumbar degenerative disease (LDD) is a very common disease. And decompression alone, posterior lumbar interbody fusion (PLIF), and interspinous device (Coflex) are generally accepted surgical techniques. However, the effectiveness and safety of the above techniques are still not clear. Network meta-analysis a comprehensive technique can compare multiple treatments based on indirect dates and all interventions are evaluated and ranked simultaneously. To figure out this problem and offer a better choice for LDD, we performed this network meta-analysis. METHODS: PubMed and WanFang databases were searched based on the following key words, "Coflex," "decompression," "PLIF," "Posterior Lumbar Interbody Fusion," "Coflex" "Lumbar interbody Fusion." Then the studies were sorted out on the basis of inclusion criteria and exclusion criteria. A network meta-analysis was performed using The University of Auckland, Auckland city, New Zealand R 3.5.3 software. RESULTS: A total of 10 eligible literatures were finally screened, including 946 patients. All studies were randomized controlled trials (RCTs). Compared with decompression alone group, there were no significant differences of Oswestry Disability Index (ODI) in Coflex and lumbar interbody fusion groups after surgery. However, Coflex and PLIF were better in decreasing Visual Analogue Scale (VAS) score compared with decompression alone. Furthermore, we found Coflex have a less complication incidence rate. CONCLUSION: Compared with decompression alone, Coflex and lumbar interbody fusion had the similar effectiveness in improving lumbar function and quality of life. However, the latter 2 techniques were better in relieving pain. Furthermore, Coflex included a lower complication incidence rate. So we suggested that Coflex technique was a better choice to cue lumbar spinal stenosis (LSS). LEVEL OF EVIDENCE: Systematic review and meta-analysis, level I.


Assuntos
Descompressão Cirúrgica , Fixadores Internos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Avaliação da Deficiência , Humanos , Dor Lombar/cirurgia , Manejo da Dor , Qualidade de Vida
4.
Medicine (Baltimore) ; 99(1): e18555, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895797

RESUMO

BACKGROUND: Lumbar spinal stenosis (LSS) is a common and frequently-occurring disease in the elderly. Percutaneous endoscopic decompression (PED) has become the first choice for the treatment of LSS because of its small wound, mild pain and rapid recovery. The surgical approaches are mainly divided into percutaneous interlaminar approach and transforaminal approach. However, these two surgical approaches have their own advantages, disadvantages and indications. Hence, the present study aims to synthesize the available direct and indirect evidence of transforaminal approach and interlaminar approach to prove their respective advantages and disadvantages. METHODS: The following databases will be searched: Cochrane Library, PubMed, Web of Science, Embase, CNKI, Wanfang data, and China Biomedical Literature Database (CBM). The search dates will be set from the inception to November 2019. Two researchers independently screened the literature, extracted the data and assessed the risk of bias in the included studies. The efficacy outcomes including: Back and Leg Visual Analog Scale (VAS) score, the MacNab criteria, the Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) score. The safety outcomes including: incidence of complications (dura tear, incomplete decompression, reoperation, etc.). The meta-analysis will be conducted using Stata 12.0 software. Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess evidence quality. RESULTS: The results of this meta-analysis will be published in a peer-reviewed journal. CONCLUSION: The meta-analysis will provide a comprehensive summary of the evidence for 2 approaches to PED in patients with LSS. PROTOCOL REGISTRATION NUMBER: CRD42019128080.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Adulto , Feminino , Humanos , Masculino , Metanálise como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
5.
World Neurosurg ; 133: 314-317, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31648054

RESUMO

BACKGROUND: The adult spinal cord is typically resistant to hypoxic-ischemic injury because of collateral blood supply; however, congenital or acquired stenosis may result in baseline maximal vasodilation, such as superimposed hemodynamic stresses, that cannot be accommodated, leaving the spinal cord vulnerable to ischemic injury. We present a rare case of spinal cord hypoxic-ischemic injury in an adult with underlying cervical spinal stenosis. CASE DESCRIPTION: A 37-year-old man with a history of morbid obesity, diabetes mellitus, hypertension, and obstructive sleep apnea presented after developing progressive weakness in the extremities. Preoperative computed tomography myelography demonstrated ossification of the posterior longitudinal ligament and severe spinal canal narrowing. Approximately 1 week after posterior decompression, the patient experienced spinal hypoxic-ischemic injury. Imaging revealed cord expansion and abnormal T2 signal intensity. Axial diffusion tensor images of the brain revealed delayed ischemic leukoencephalopathy with restricted diffusion in the cerebral cortex and deep white matter; this led to the decision to withdraw care, and the patient died. CONCLUSIONS: We hypothesize that vascular dysregulation due to cervical stenosis made the cord parenchyma vulnerable to hypoxic and/or hypoperfusion stresses.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Isquemia/etiologia , Leucoencefalopatias/etiologia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Medula Espinal/irrigação sanguínea , Estenose Espinal/cirurgia , Adulto , Evolução Fatal , Humanos , Isquemia/diagnóstico por imagem , Leucoencefalopatias/diagnóstico por imagem , Masculino , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Medula Espinal/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem
6.
World Neurosurg ; 133: e452-e458, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526879

RESUMO

OBJECTIVE: The most common cause of contralateral symptoms after unilateral transforaminal lumbar interbody fusion (TLIF) is contralateral foraminal stenosis (FS). This retrospective cohort study aimed to investigate the cause of and risk factors for contralateral FS after unilateral TLIF with a single cage. METHODS: Patients with degenerative lumbar spinal disorders who underwent unilateral TLIF at L4-5 were divided into 2 groups: those without contralateral radicular symptoms after surgery (group A; n = 340) and those with contralateral radicular symptoms after surgery (group B; n = 16). We investigated the influence of various radiological and cage-related factors on postoperative contralateral FS with radicular symptoms. The cage location indicates whether the cage's anterior tip crosses the disc midline-exceeding 50%-and in such a case, how far. RESULTS: Group B showed significantly increased postoperative coronal angle and sagittal angle and decreased contralateral foraminal height and foraminal area. Statistically significant (P < 0.01) factors according to the multivariate logistic regression analysis were the preoperative sagittal range of motion (odds ratio [OR]: 1.562, P = 0.004) and cage location (OR: 2.047, P = 0.015). The cutoff values for the sagittal range of motion and the cage location were 9.0° and 50.5%, respectively. The preoperative and postoperative 6-month visual analog scale scores and Oswestry disability index values were not significantly different between the groups. CONCLUSIONS: The 2 most meaningful risk factors were the preoperative sagittal range of motion and cage location. Inserting the cage beyond the disc midline, especially in patients with a high preoperative sagittal range of motion (≥9.0°), would help reduce postoperative complications.


Assuntos
Fixadores Internos/efeitos adversos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Radiculopatia/etiologia , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Adulto , Idoso , Antropometria , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Radiculopatia/epidemiologia , Amplitude de Movimento Articular , Fatores de Risco , Ciática/epidemiologia , Ciática/etiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Estenose Espinal/complicações , Espondilolistese/complicações , Espondilolistese/cirurgia
7.
World Neurosurg ; 133: e412-e420, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31536811

RESUMO

OBJECTIVE: The cervical extensor musculature is important in cases of neck pain and loss of cervical lordosis after laminoplasty. Therefore, various surgical methods have been developed to preserve the muscle during laminoplasty. We have developed a posterior cervical muscle-preserving interspinous process (MIS) approach and decompression method. We have described the operation details and clinical outcomes of selected patients who have undergone this procedure. METHODS: The MIS approach and decompression method were performed in 20 consecutive patients who had only required central decompression for cervical stenosis. This procedure includes an approach to the interspinous space that is similar to Shiraishi's method but includes decompression without fracturing the spina bifida. RESULTS: The patients had no complications and did not require conversion to conventional laminoplasty. The mean operative time and mean blood loss was 53.0 minutes and 63.0 mL per level, respectively, and the mean hospital stay was 4.0 days. The mean preoperative and 3-month postoperative modified Japanese Orthopedic Association scores were 12.6 and 16.2, and the mean preoperative and 3-month postoperative neck disability index scores were 15.4 and 2.5, respectively. The postoperative neck visual analog scale score was 0.8. The mean preoperative and postoperative sagittal vertical axis was 1.6 and 1.8 cm, respectively. The mean loss of lordosis was 1.0°, and the mean cervical range of motion did not change from preoperatively to postoperatively. CONCLUSIONS: The MIS approach and decompression method was less invasive than both conventional laminoplasty and Shiraishi's selective laminectomy. It is a safe and effective minimally invasive technique for central stenosis caused by cervical spondylotic myelopathy.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Músculos do Pescoço/cirurgia , Procedimentos Neurocirúrgicos/métodos , Tratamentos com Preservação do Órgão/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laminectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Satisfação do Paciente , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Estenose Espinal/cirurgia , Adulto Jovem
8.
World Neurosurg ; 133: 135-141, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505277

RESUMO

BACKGROUND: The occurrence rate of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation is lower than that of ossified ligamentum flavum in the thoracic spine, and the treatment method has rarely been reported. In this paper, we applied an endoscopic technique to a patient with thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation at the T10-11 level. METHODS: We performed surgical decompression of the thoracic spinal cord for a patient diagnosed with thoracic spinal stenosis at the T10-11 level caused by ossification of the ligamentum flavum combined with disk herniation using percutaneous endoscopic surgery via the bilateral translaminar osseous channel approach. Pre- and postoperative computed tomography (CT) scan and magnetic resonance imaging (MRI) examinations were performed, and pre- and postoperative neurologic status was evaluated using the Modified Japanese Orthopaedic Association and visual analog scale scores. RESULTS: The ossified ligamentum flavum and herniated disk material were removed through this osseous channel. Postoperative CT and MRI scanning revealed adequate decompression of the spinal cord at the T10-11 level. The patient was discharged home on postoperative day 3. At 6-month postoperative follow-up, the patient experienced complete resolution of T12 dermatomal numbness. The strength in her bilateral lower extremities improved slightly to grade 5. CONCLUSIONS: We have applied percutaneous endoscopic surgery via bilateral translaminar osseous channels for the treatment of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation. This surgery could provide sufficient decompression for thoracic spinal cord with minimum trauma.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Ligamento Amarelo/patologia , Ossificação Heterotópica/cirurgia , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/patologia , Pessoa de Meia-Idade , Ossificação Heterotópica/complicações , Ossificação Heterotópica/patologia , Estenose Espinal/etiologia , Estenose Espinal/patologia , Resultado do Tratamento
9.
World Neurosurg ; 135: e671-e678, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31884124

RESUMO

OBJECTIVE: The purposes of the present study were to introduce an indirect decompression using oblique lateral lumbar interbody fusion combined with anterolateral screw fixation (OLIF-AF) for the treatment of lumbar degenerative disc disease and examine the clinical efficacy and radiographic outcomes. METHODS: A total of 65 patients had undergone single-level OLIF-AF at L2-L5 from December 2017 to August 2018. The cross-sectional area of the thecal sac was evaluated using magnetic resonance imaging. The disk height, foraminal height (FH), and degree of upper vertebral slippage were evaluated using computed tomography. The visual analog scale score and Oswestry disability index were recorded pre- and postoperatively. RESULTS: The visual analog scale scores and Oswestry disability index had significantly improved after surgery (P < 0.001). At 3 days postoperatively, the cross-sectional area had improved from 93.2 ± 14.4 mm2 to 124.2 ± 7.5 mm2 (P < 0.001), the disk height had increased from 9.9 ± 1.7 mm to 12.7 ± 1.0 mm (P < 0.001), the left FH had increased from 16.6 ± 2.0 mm to 19.6 ± 2.0 mm (P < 0.001). In contrast, the right FH had increased from 16.7 ± 2.1 mm to 19.9 ± 2.0 mm (P < 0.001), and the degree of upper vertebral slippage had decreased from 14.2% ± 3.1% to 4.6% ± 2.8% (P < 0.001), respectively. At the 12-month follow-up examination, these parameters showed no statistically significant differences compared with the values at 3 days postoperatively (P > 0.05). Adverse events were observed in 15 patients (23.1%) patients and included pain at the iliac bone donor site in 1 (1.5%), left thigh pain/numbness in 2 (3.1%), quadriceps weakness in 2 (3.1%), psoas weakness in 3 (4.6%), intraoperative endplate injury in 2 (3.1%) and cage subsidence in 5 (7.7%). CONCLUSIONS: Our results have shown that OLIF-AF surgery is a relatively safe and effective surgical option for LDDD at L2-L5. Cage subsidence was the most common operative complication.


Assuntos
Parafusos Ósseos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transplante Ósseo/métodos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Ílio/transplante , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos , Implantação de Prótese/métodos , Estudos Retrospectivos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Sítio Doador de Transplante , Resultado do Tratamento
10.
World Neurosurg ; 135: 280-296, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887462

RESUMO

OBJECTIVE: Iatrogenic ureteral injury associated with lumbar spine surgery is an uncommon but devastating complication with associated medicolegal implications. METHODS: We performed a systematic review of the English language literature published between 1954 and 2019, accessed through 4 popular databases. We found 44 articles (28 case reports, 9 case-based reviews, 4 case series, 1 original article, 1 case illustration, and 1 pictorial) containing 46 cases of ureteral injuries after posterior or lateral lumbar spine surgery. RESULTS: Except for 5 cases with insufficient data, 24 of the remaining 41 patients were female and 17 were male, with ages ranging from 16 years to 83 years. Excluding 4 cases without enough information, initial diagnoses of lumbar disc herniation (n = 33) or lumbar spinal stenosis (n = 4), spondylolisthesis (n = 3), degenerative disc disease (n = 1), and failed back surgery syndrome (n = 1) were reported from 18 countries; 54% of patients were from the United States, Japan, or Turkey. The interval from spinal surgery to restorative surgery ranged from <24 hours to 1 month to 1 year; in 48% of patients, it was >1 week, and 90% of patients recovered completely. Initial surgery was combined with vascular injury in 15% of patients. CONCLUSIONS: Ureteral injury associated with lumbar spine surgery is overreported in developed or developing countries. It should be considered in the differential diagnosis of any patient who presents with symptoms of acute abdomen after lumbar spine surgery, and patients who underwent restorative surgery had a good prognosis.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ureter/lesões , Discotomia/efeitos adversos , Síndrome Pós-Laminectomia/cirurgia , Humanos , Doença Iatrogênica , Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia
11.
Medicine (Baltimore) ; 98(50): e18277, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852100

RESUMO

The aim of the study was to evaluate the clinical effect of the limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis (DLSS) with instability. Hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation for treating DLSS with instability as the control group.Follow-up of 54 patients (26 males and 28 females; average age, 59.74 ±â€Š10.38 years) with DLSS with instability treated by limited area decompression, intervertebral fusion, and pedicle screw fixation (LIFP group), and 52 patients as control group with hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation (HIFP group). We assessed clinical effect according to the patients' functional outcome grading (good to excellent, fair, or poor), Oswestry Disability Index (ODI) and visual analogue scale (VAS) for low back pain and lower limb pain, which was administered preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was assessed by radiologists at the last follow-up. Treatment satisfaction was assessed according to the subjective evaluations of the patients.At the 12-month follow-up, 96.2% (52/54) and 90.3% (47/52) of group LIFP and HIFP belonged to good to excellent outcome categories, respectively, while 3.7% (2/54) and 9.6% (5/52) of group LIFP and HIFP belonged to fair respectively, neither group belonged to poor. Satisfaction rates of patients in group LIFP and group HIFP were 98.1% (53/54) and 92.3% (48/52), respectively. The patients' functional outcome grading and satisfaction rate in group LIFP were better than that in group HIFP. The VAS for low back and lower limb pain and the ODI improved significantly during the 12 months after surgery (all P < .001) in 2 groups. The VAS for low back and lower limb pain were no difference between two groups, however, the ODI of group LIFP was lower than that of group HIFP (P < .001). All patients achieved radiological fusion.The limited area decompression, intervertebral fusion, and pedicle screw fixation had a satisfactory effect on patients with DLSS with instability.


Assuntos
Descompressão Cirúrgica/métodos , Instabilidade Articular/cirurgia , Laminectomia/métodos , Vértebras Lombares , Parafusos Pediculares , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Feminino , Fluoroscopia , Seguimentos , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Cirurgia Assistida por Computador/métodos , Fatores de Tempo , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(46): e17849, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725625

RESUMO

BACKGROUND: Although some studies had been published, it was more controversial on the superiority of decompression alone (D) and decompression with fusion (F) for the treatment of lumbar spinal stenosis (LSS) recently, especially newest articles with different opinions. A meta-analysis was performed to compare efficacy on D and F for LSS regardless of degenerative spondylolisthesis (DS) with randomized controlled trials (RCTs). METHODS: The databases include PUBMED/MEDLINE, EMBASE, Cochrane Library, and Web of Science from January 1970 to December 2018. The information of screened studies included demographics, clinical outcomes, and secondary measures, then data synthesis and meta-analysis were progressed. Subgroup analysis was stratified by DS and follow-up time (36 months). Continuous variables and dichotomous variables were respectively reported as weighted mean difference and odds ratios (ORs). The strength of evidence was evaluated by the grades of recommendation, assessment, development, and evaluation (GRADE) system. RESULTS: Nine RCTs met inclusion criteria with a total of 857 patients (367 were in D group and 490 were in F group). There were no statistical difference in visual analog scale changes on back and leg pain between D and F group (mean difference [MD] = -0.03, 95% confidence interval [CI] [-0.38, 0.76], z = 0.08, P = .94; MD = 0.11, 95% CI [-1.08, 1.30], z = 0.18, P = .86, respectively); patients' satisfaction was of no difference between the 2 groups, together with the change of the Oswestry disability index and European quality of life-5 dimensions (P > .05). There were no difference in the rate of complication (P = .50) and reoperation (P = .11) while a statistical significance of longer operation duration (P < .0001), more blood loss (P = .004) but amazing lower rate of adjacent segment degenerative/disease (ASD) (OR = 2.35, P = .02) in F group. The subgroup analysis on DS showed that basically all measures were in consistency with meta-analysis. There was a higher reoperation rate in middle-to-long term (>36 months) in D group and ASD was the most seasons of reoperation no matter the follow-up time. According to the GRADE system, the grade of this meta-analysis was of "High" quality. CONCLUSION: F group has no better clinical results than D alone in LSS, regardless of DS and follow-up. The conclusion is of "High" quality and the grade strength of recommendation was "Strong."


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Avaliação da Deficiência , Humanos , Medição da Dor , Satisfação do Paciente , Complicações Pós-Operatórias , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação , Teste de Caminhada
13.
Oper Orthop Traumatol ; 31(6): 513-535, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31728562

RESUMO

OBJECTIVE: The main goal is bilateral microsurgical decompression of the cauda equina using a unilateral over the top approach. The challenge is to achieve decompression with minimal iatrogenic trauma to anatomical structures in the approach region and in the target area. INDICATIONS: Degenerative spinal disorders including lumbar central stenosis, lumbar lateral recess spinal stenosis, and foraminal narrowing. This technique is performed in patients presenting primarily with neurogenic claudication, leg or buttock symptoms, heaviness in the legs with or without radicular symptoms, with or without neurological deficits, and comparable MRI findings. There are no limitations regarding number of affected segments or the extent of narrowing. CONTRAINDICATIONS: All available conservative treatment modalities not exhausted. Lack of serious neurological deficit. SURGICAL TECHNIQUE: Minimally invasive, muscle-sparing and facet-joint-sparing bilateral enlargement of the lumbar spinal canal through a unilateral microsurgical cross-over approach. POSTOPERATIVE MANAGEMENT: Patients are mobilized early 4-6 h postoperatively. Light sports activities (e.g., ergometer cycling, swimming) are allowed after 2 weeks. The same is true for the return to normal daily or work activities except for heavy physical work (usually 4 weeks out of work). Soft lumbar brace for 4 weeks (optional). RESULTS: The clinical outcomes are good to excellent. Meta-analyses and large case series report success rates for microsurgical decompression procedures of 73.5-95%. The reoperation rates are low (0.5-10%).


Assuntos
Descompressão Cirúrgica , Vértebras Lombares , Estenose Espinal , Humanos , Vértebras Lombares/cirurgia , Microcirurgia , Estenose Espinal/cirurgia , Resultado do Tratamento
14.
J Pak Med Assoc ; 69(9): 1380-1382, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511730

RESUMO

Sacral insufficiency fracture is a rare complication of the lumbar spinal surgery. It is normally reported as a late complication of the multi-segment spinal fixation in females with osteoporotic bone. We present the case of an elderly gentleman who suffered this complication spontaneously on the second postoperative day. To the best of our knowledge this has never been reported in Pakistan. Sacral alae are directly in line with weight bearingwhile walking and should be kept in mind when mobilizing a postoperative patient whose previous history indicates such risk factors. Once injury is suspected, CT scan is recommended as x-rays may not always reveal the injury. In literature, these fractures have almost always been treated conservatively.1 Conservative management wasnot tolerated well in our case and we proceeded with surgical management using S2 sacral alar iliac screws (S2 AI screws) to extend the previous lumbosacral fusion construct. S2 AI screws are a novel technique used for bone lumbosacral fusion and studies have shown to have lower rate of screw breakage under stress and need for revision surgery with their use.


Assuntos
Fraturas Espontâneas/diagnóstico por imagem , Fraturas de Estresse/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Sacro/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral , Idoso , Repouso em Cama , Tratamento Conservador , Descompressão Cirúrgica , Fixação Interna de Fraturas , Fraturas Espontâneas/cirurgia , Fraturas de Estresse/cirurgia , Humanos , Vértebras Lombares/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Sacro/diagnóstico por imagem , Sacro/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Estenose Espinal/cirurgia , Tomografia Computadorizada por Raios X
15.
Acta Chir Orthop Traumatol Cech ; 86(4): 256-263, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31524586

RESUMO

PURPOSE OF THE STUDY Lumbar spinal stenosis (LSS) is a serious and fairly frequent disorder with prevalence increasing with age which often results in a disability. The surgical procedures are often very risky due to the greater age of patients with severe stenosis and their comorbidities. The study aimed to assess the functional outcomes and complications in patients who underwent surgical treatment for LSS at one year postoperatively and to identify the differences in the functional outcomes, if any, in dependence on the number of operated segments. MATERIAL AND METHODS It was a prospective study which included 33 patients who underwent surgery at the authors department from 1 November 2015 to 1 October 2016 for LSS, the mean age of patients was 69.5 (43-83) years. The surgery was indicated based on the clinical examination, radiography and MR imaging and consisted in posterior decompression with or without stabilisation and fusion. Pre- and post-operatively, a neurological examination and evaluation of patient difficulties were performed by: VAS - particularly for low back pain (VAS-LB) and lower limb pain (VAS-LL), Oswestry Disability Index (ODI) and Swiss Spinal Stenosis Questionnaire (SSSQ). The evaluation was done at a half year and one year after the surgery. The authors made comparisons in dependence on the number of treated segments (1-2, 3-5 and Th-S stabilisation). RESULTS A significant improvement of all the followed-up parameters was reported at one year postoperatively. At one year after the surgery, the VAS-LB score showed a decrease by 2.39 (p = 0.001), the VAS-LL by 3.26 (p < 0.001), while a decrease by 2 or more points is considered clinically significant. When evaluating the SSSQ questionnaire, a decrease in subjective difficulties (SSSQ-S) was by 0.89 (p < 0.001), in physical function (SSSQ-F) by 0.87 (p < 0.001). In this questionnaire, the satisfaction rate with the surgery was 2 - i.e. somewhat satisfied. Altogether 76% of patients were very or somewhat satisfied, no one was very dissatisfied. When evaluating the ODI, an improvement by 20.6% (p < 0.001) was reported. The authors identified neither any significant differences in the outcomes at a one-year follow-up in dependence on the length of stabilisation, nor any significant differences between the six-months and one-year follow-up. Intraoperative complications occurred in 18%, early postoperative complications in 6% of patients. The ASD developed in 9% within one year. DISCUSSION The authors confirmed a significant improvement of the followed-up parameters (VAS-LB, VAS-LL, SSSQ, ODI) which corresponds with recent literature. The decrease in VAS and ODI in the authors study is more marked than the outcomes stated in literature. The authors outcomes clearly show that there is no correlation with the length of stabilisation and the number of decompressed segments. Conversely, the rate of complications was higher in this group than the rates stated in literature, but majority of complications had no consequences for the patients. CONCLUSIONS In the group of patients with a one-year follow-up the authors confirmed that surgical procedures will result in reduced subjective difficulties of patients, reduced pain and improvement of physical function. A significant improvement of all the followed-up parameters was reported. The authors did not confirm the correlation between the postoperative improvement and the number of treated segments. Key words:lumbar spinal stenosis, quality of life, post-operative outcomes, complications.


Assuntos
Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica , Avaliação da Deficiência , Seguimentos , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Fusão Vertebral , Estenose Espinal/diagnóstico , Estenose Espinal/diagnóstico por imagem , Inquéritos e Questionários , Resultado do Tratamento
16.
World Neurosurg ; 132: 273-281, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521758

RESUMO

OBJECTIVE: Although many risk factors for cage retropulsion (CR) after lumbar interbody fusion (LIF) have been described in the literature, they still remain controversial. The purpose of this study is to investigate the risk factors for CR after LIF. METHODS: The literature was searched in PubMed, Cochrane library, and Embase from October 2000 to October 2018. The key words and combinations used in the search included LIF, cage, retropulsion, posterior migration, and risk factors. Only studies with sufficient data to calculate odds ratio for CR were included. Odds ratio and 95% confidence interval were calculated for outcomes via RevMan5.3 and SPSS 22.0. RESULTS: A total of 10 studies were included in this study. Twelve risk factors were assessed by analyzing 4467 patients. The pooled results indicated that a pear-shaped disk and straight cage were significant risk factors for CR. However, factors that had no significant relation with CR were preoperative diagnosis (disk herniation, spinal stenosis, and spondylolisthesis); gender; surgical segments (from L2 to S1); multilevel fusion; and unilateral pedicle screws fixation. CONCLUSIONS: According to current evidence, a pear-shaped disk and straight cage are significant risk factors for CR. However, preoperative diagnosis, gender, multilevel fusion, surgical segments, and unilateral pedicle screws fixation are not the risk factors associated with CR. A revision surgery is needed when neurologic symptoms happen after CR. The conclusion should be consulted cautiously due to the limited number of included studies. Therefore larger-scale studies are still needed to investigate the risk factors for CR.


Assuntos
Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Fusão Vertebral/instrumentação , Humanos , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Parafusos Pediculares , Reoperação , Fatores de Risco , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia
18.
World Neurosurg ; 132: 58-62, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479791

RESUMO

BACKGROUND: Oblique lumbar interbody fusion takes advantage of the wide interval between the aorta and left-sided psoas muscle to access the lumbar spine, allowing a minimally invasive approach for interbody fusion with lower associated morbidity. As this approach is gaining popularity among spine surgeons, it is important to understand the potential pitfalls that may arise in patients with congenital anomalies of the vascular anatomy. CASE DESCRIPTION: We present a case of a persistent left-sided inferior vena cava (IVC) affecting the side of approach in a patient undergoing lumbar interbody fusion through an oblique prepsoas retroperitoneal approach. Preoperative imaging of our patient revealed a persistent left-sided inferior vena cava with a wide interval between the aorta and the right-sided psoas, allowing us a right-sided oblique approach. CONCLUSIONS: Thorough preoperative imaging evaluation is essential to identify vascular anomalies that may hinder oblique prepsoas retroperitoneal approach to the lumbar spine. Although rare, double IVC or isolated left IVC may complicate the oblique approach.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Malformações Vasculares/diagnóstico por imagem , Veia Cava Inferior/anormalidades , Idoso , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Estenose Espinal/diagnóstico por imagem , Malformações Vasculares/complicações , Veia Cava Inferior/diagnóstico por imagem
19.
BMC Musculoskelet Disord ; 20(1): 416, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492137

RESUMO

BACKGROUND: Obesity is an important factor affecting incidence and development of musculoskeletal degenerative changes. In addition, obese patients are considered less favorable surgical candidates for decompression surgery in degenerative lumbar spinal canal stenosis and lower limb arthroplasty. The purpose was to assess disease characteristics of lumbar spinal canal stenosis as well as lower limb osteoarthritis, and to investigate surgical times based on body mass index (BMI) in lumbar decompressive surgery and lower limb arthroplasties. METHODS: A total of 1161 patients with a diagnosis of lumbar canal stenosis (LCS), hip osteoarthritis (HOA) and knee osteoarthritis (KOA) were enrolled. The present investigation was conducted as a retrospective study using routinely collected data. All patients underwent primary decompressive surgery (laminoplasty: LAM) or lower limb arthroplasty (total hip arthroplasty: THA and total knee arthroplasty: TKA). All of the patients were divided into 3 groups based on BMI (kg/m2) (Group A: ≤ 24.9; Group B: 25-29.9; Group C: ≥ 30) within each disease category. To assess disease characteristics, age, gender, and BMI were evaluated for each disease category. Moreover, surgical times for LAM, THA and TKA were also assessed based on BMI classification. RESULTS: A total of 269, 470, and 422 patients were allocated to the HOA category, the KOA category, and the LCS category, respectively. The KOA category included the oldest patients and largest BMI, compared to the HOA and the LCS categories. Regarding gender difference, LCS was more common in males than in females, while opposite phenomenon was observed in the HOA and the KOA categories. The heaviest group (Group C) was significantly younger than Groups A or B in TKA and LAM. Surgical time was significantly longer in patients with overweight or obese patients than in those with normal weight in TKA and LAM, while BMI didn't affect the time in THA. CONCLUSIONS: Disease characteristics of the KOA category and the LCS category were notably affected by BMI, and surgical times in TKA and LAM were significantly longer for overweight or obese patients, whereas THA was less affected by BMI concerning disease characteristics and surgical time.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Índice de Massa Corporal , Laminoplastia/estatística & dados numéricos , Duração da Cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/cirurgia , Sobrepeso/complicações , Estudos Retrospectivos , Estenose Espinal/etiologia , Estenose Espinal/cirurgia
20.
BMC Musculoskelet Disord ; 20(1): 390, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31470844

RESUMO

BACKGROUND: The purpose of this meta-analysis is to evaluate the efficacy and safety of tranexamic acid (TXA) for patients with degenerative lumbar disc herniation, stenosis or instability undergoing posterior lumbar fusion (PLF) surgery. METHODS: We searched PubMed, Embase, and Cochrane Library until May 1, 2018. Two reviewers selected studies, assessed quality, extracted data, and evaluated the risk of bias independently. Weighted mean difference (WMD) and relative risk (RR) were calculated as the summary statistics for continuous data and dichotomous data, respectively. We chose fixed-effects or random-effects models based on I2 statistics. RevMan 5.0 and STATA 14.0 software were used for data analysis. RESULTS: Nine studies enrolling 713 patients for the study. The pooled outcomes demonstrated that TXA can decrease total blood loss (TBL) in patients underwent PLF surgery [WMD = -250.68, 95% CI (- 325.06, - 176.29), P<0.001], intraoperative blood loss (IBL) [WMD = -72.57, 95% CI (- 103.94, - 41.20), P<0.001], postoperative blood loss (PBL) [WMD = -127.57, 95% CI (- 149.39, - 105.75), P<0.001], and the loss of hemoglobin (Hb) in postoperative 24 h [WMD = -0.31, 95% CI (- 0.44, - 0.18), P<0.001]. However, there is no significant difference between two groups in transfusion rate [RR =0.34, 95% CI (0.09, 1.28), P = 0.11], and none thrombotic event was happened in the two groups. CONCLUSION: Our meta-analysis demonstrated that TXA can decrease the Hb loss, TBL, IBL, PBL, and without increasing the risk of thrombotic event in patients with degenerative lumbar disc herniation, stenosis or instability underwent PLF surgery. However, there was no significant difference in blood transfusion rates between the two groups.


Assuntos
Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Fusão Vertebral/efeitos adversos , Ácido Tranexâmico/administração & dosagem , Antifibrinolíticos/efeitos adversos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Hemoglobinas/análise , Humanos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/epidemiologia , Estenose Espinal/cirurgia , Ácido Tranexâmico/efeitos adversos , Resultado do Tratamento
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