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1.
Med Sci Monit ; 26: e921119, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32243427

RESUMO

BACKGROUND Percutaneous transforaminal endoscopic surgery has been used as a surgical measure for lumbar lateral recess stenosis. However, the necessary decompressive range has never been clearly documented in detail. Here, we discuss the effectiveness of a percutaneous transforaminal endoscopic procedure with clearly defined decompressive range. MATERIAL AND METHODS The relevant data were retrospectively collected from a series of degenerative lateral recess stenosis patients who acquired a prospectively designed percutaneous transforaminal endoscopic procedure in our department. The decompressive procedure mainly included undercutting of superior articular process and intervertebral disk annuloplasty. Leg pain and back pain was evaluated using visual analogue scale (VAS). The functional status was assessed using Oswestry disability index (ODI). The clinical results were also evaluated using MacNab criteria. RESULTS From May 2014 to October 2018, a total of 33 patients who met our inclusion criteria were included for analysis. There were no perioperative complications. Leg pain VAS decreased from preoperative score of 6.18±2.38 to final follow-up score of 0.45±1.00 (P<0.01). Back pain VAS decreased from preoperative score of 1.88±2.19 to final follow-up score of 0.64±1.02 (P<0.01). ODI (%) decreased from preoperative score of 47.86±18.15 to final follow-up score of 6.29±6.75 (P<0.01). At the final follow-up, the results of MacNab criteria were excellent in 18 cases (54.55%), good in 14 cases (42.42%), fair in 1 case (3.03%) and poor in 0 cases. None of the patients complained of recurrence of the symptoms during follow-up. CONCLUSIONS Undercutting of "superior articular process neck" plus intervertebral disk annuloplasty is sufficient for lumbar lateral recess decompression in a transforaminal approach.


Assuntos
Descompressão Cirúrgica/métodos , Disco Intervertebral/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Endoscopia/métodos , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Dor/epidemiologia , Dor/patologia , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica
2.
Int J Surg ; 76: 136-143, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32165279

RESUMO

BACKGROUND: Percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) has been used in the treatment of lumbar degenerative diseases, as a novel minimally invasive technique. OBJECTIVES: To compare the surgical trauma and the medium-short term postoperative outcomes of PETLIF and traditional minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS: From April to August of 2018, 75 patients with lumbar degenerative diseases received PETLIF (Group PE, 35 cases) or MIS-TLIF (Group MIS, 40 cases) were enrolled in the prospective cohort study. We recorded the serum creatine kinase (CK) and C-reactive protein (CRP), blood loss, visual analog scale (VAS), Oswestry Disability Index (ODI), modified Macnab criteria score, complications, and fusion rates of the 2 groups. RESULTS: There were significant reductions in CRP (P = 0.002) on postoperative day (POD) 3, and CK (P = 0.011) on POD 1 for Group PE than Group MIS. The mean true total blood loss (P < 0.001), intraoperative blood loss (P < 0.001), postoperative drains (P < 0.001), and hidden blood (P = 0.020) in the Group PE were significantly less compared with Group MIS. The VAS score for low-back pain, leg pain and ODI score improved significantly in both groups after surgery (P < 0.05). The VAS of low-back pain on POD 1 was significant less (P < 0.001) for Group PE. There was no statistical difference (P = 0.561) in CT fusion rates between Group PE (85%) and Group MIS (92%). No serious complication was observed in any patients. CONCLUSION: The study indicated that PETLIF had advantages of less surgical trauma, less postoperative low-back pain, less hidden blood loss, and faster recovery, compared with MIS-TLIF. There was no significant difference in medium-short term surgical outcomes between the 2 techniques. However, the indications of PETLIF is relatively limited, and the learning curve of PETLIF is deep, surgeons need to select indications strictly. Further study with big sample size and long-term follow-up is needed.


Assuntos
Degeneração do Disco Intervertebral , Procedimentos Cirúrgicos Minimamente Invasivos , Fusão Vertebral , Adulto , Perda Sanguínea Cirúrgica , Procedimentos Cirúrgicos de Citorredução , Endoscopia , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Complicações Intraoperatórias , Dor Lombar , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Período Pós-Operatório , Estudos Prospectivos , Fusão Vertebral/métodos , Centros de Atenção Terciária , Resultado do Tratamento , Escala Visual Analógica
4.
World Neurosurg ; 135: e629-e639, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31881340

RESUMO

OBJECTIVE: We sought to assess whether controlled, intraoperative lumbar drainage (LD) of cerebrospinal fluid (CSF) could facilitate resection of pituitary macroadenomas and reduce the rate of CSF leak. METHODS: A retrospective cohort study from a prospective database was conducted on 189 patients with pituitary macroadenoma who received endoscopic transsphenoidal surgery between 2013 and 2017. Patients were classified into 2 groups: 119 patients received an intraoperative LD (LD group) and 70 patients underwent routine endoscopic surgery without LD (control group). In the LD group, lumbar catheters were placed preoperatively and CSF was drained intermittently during tumor resection. The rates of gross total resection (GTR) and CSF leaks were assessed both intraoperatively and postoperatively. RESULTS: Intraoperative LD was associated with a higher rate of GTR (92.4% in the LD group vs. 78.6% in the control group, P = 0.006), especially in macroadenomas with suprasellar extension (90.3% vs. 75.0%, P = 0.012). Both intraoperative and postoperative CSF leak rates were significantly decreased in the LD group (intraoperative: 10.1% vs. 31.4%, P < 0.001; postoperative: 3.4% vs. 11.4%, P = 0.035). In functioning adenomas, a better remission rate of excess-hormone secretion was observed in the LD group compared with the controls (89.1% vs. 60.6%, P = 0.001). Patients in the LD group also had an enhanced recovery with a shorter postoperative length of stay (7 days vs. 5 days, P = 0.020). CONCLUSIONS: Intraoperative LD may assist surgeons during endoscopic transsphenoidal resection of pituitary macroadenomas by achieving a higher rate of GTR and a lower rate of perioperative CSF leaks. Validation in prospective randomized controlled studies is needed.


Assuntos
Adenoma/cirurgia , Vazamento de Líquido Cefalorraquidiano/etiologia , Drenagem/métodos , Neuroendoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
5.
PLoS One ; 14(12): e0226848, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860651

RESUMO

OBJECTIVES: To carry out a systematic review on the basis of overlapping meta-analyses that compare unilateral with bilateral pedicle screw fixation (PSF) in lumbar fusion to identify which study represents the current best evidence, and to provide recommendations of treatment on this topic. METHODS: A comprehensive literature search in PubMed, Embase, and the Cochrane Library databases was conducted to identify meta-analyses that compare unilateral with bilateral PSF in lumbar fusion. Only meta-analyses exclusively covering randomized controlled trials were included. Study quality was evaluated using the Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Then, the Jadad decision algorithm was applied to select the highest-quality study to represent the current best evidence. RESULTS: A total of 9 studies with Level II of evidence fulfilled the eligibility criteria and were included. The scores of AMSTAR criteria for them varied from 5 to 9 (mean 7.78). The current best evidence detected no significant differences between unilateral and bilateral PSF for short-segment lumbar fusion in the functional scores, length of hospital stay, fusion rate, and complication rate. However, unilateral PSF involved a remarkable decrease in operative time and blood loss but increase of cage migration when compared with bilateral PSF. CONCLUSIONS: According to this systematic review, unilateral PSF is an effective method of fixation for short-segment lumbar fusion, has the advantages of reduced operative time and blood loss over bilateral PSF, but increases the risk of cage migration.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Parafusos Pediculares , Fusão Vertebral/métodos , Perda Sanguínea Cirúrgica , Humanos , Tempo de Internação , Duração da Cirurgia , Falha de Prótese , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
6.
Spine (Phila Pa 1976) ; 44(21): E1272-E1280, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634303

RESUMO

STUDY DESIGN: Retrospective 1:1 propensity score-matched analysis on a national longitudinal database between 2007 and 2016. OBJECTIVE: The aim of this study was to compare complication rates, revision rates, and payment differences between navigated and conventional posterior lumbar fusion (PLF) procedures with instrumentation. SUMMARY OF BACKGROUND DATA: Stereotactic navigation techniques for spinal instrumentation have been widely demonstrated to improve screw placement accuracies and decrease perforation rates when compared to conventional fluoroscopic and free-hand techniques. However, the clinical utility of navigation for instrumented PLF remains controversial. METHODS: Patients who underwent elective laminectomy and instrumented PLF were stratified into "single level" and "3- to 6-level" cohorts. Navigation and conventional groups within each cohort were balanced using 1:1 propensity score matching, resulting in 1786 navigated and conventional patients in the single-level cohort and 2060 in the 3 to 6 level cohort. Outcomes were compared using bivariate analysis. RESULTS: For the single-level cohort, there were no significant differences in rates of complications, readmissions, revisions, and length of stay between the navigation and conventional groups. For the 3- to 6-level cohort, length of stay was significantly longer in the navigation group (P < 0.0001). Rates of readmissions were, however, greater for the conventional group (30-day: P = 0.0239; 90-day: P = 0.0449). Overall complications were also greater for the conventional group (P = 0.0338), whereas revision rate was not significantly different between the 2 groups. Total payments were significantly greater for the navigation group in both the single level and 3- to 6-level cohorts (P < 0.0001). CONCLUSION: Although use of navigation for 3- to 6-level instrumented PLF was associated with increased length of stay and payments, the concurrent decreased overall complication and readmission rates alluded to its potential clinical utility. However, for single-level instrumented PLF, no differences in outcomes were found between groups, suggesting that the value in navigation may lie in more complex procedures. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Feminino , Fluoroscopia , Humanos , Imageamento Tridimensional/métodos , Laminectomia , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Parafusos Pediculares , Pontuação de Propensão , Estudos Retrospectivos , Técnicas Estereotáxicas
7.
J Ayub Med Coll Abbottabad ; 31(3): 441-444, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535524

RESUMO

BACKGROUND: Conservative management of traumatic CSF rhinorrhoea is associated with a greater risk of developing meningitis in the presence of active CSF leak. Lumbar drains have been reported to be better than conservative management alone in stopping CSF leaks following traumatic brain injury. METHODS: This randomized controlled trial enrolled 60 patients with CSF rhinorrhoea and divided them into two groups. One group was managed with conservative management plus a lumbar drain (group A) and the other was managed with conservative management alone (Group B). Length of CSF rhinorrhoea in days was estimated in both groups. RESULTS: There was a statistically significant difference in in mean length of CSF rhinorrhoea in both groups. In group A, mean Length of CSF rhinorrhoea was found to be 3.4 days ±1.1 SD, while in group B it was 6.75 days ±1.96 SD (p=0.001). Stratification with respect to gender, age, duration and type of trauma showed similar trend (p<0.05 in all cases). CONCLUSIONS: Patients who underwent lumbar drain insertion plus conservative management demonstrated significantly shorter length of CSF rhinorrhoea when compared to conservative management alone in the treatment of traumatic CSF rhinorrhoea.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/terapia , Tratamento Conservador , Drenagem , Humanos , Região Lombossacral/cirurgia , Resultado do Tratamento
8.
Biomed Res Int ; 2019: 9369853, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380443

RESUMO

Purpose: The endplate defects (EDs), Modic changes (MCs), disc degeneration (DD), facet orientation (FO), and facet tropism (FT) were demonstrated to be related to the low back pain (LBP). The aim of this study was to investigate possible correlations between them. Methods: 75 patients were reviewed to evaluate the degenerative change in vertebral bodies (EDs and MCs), intervertebral discs (DD), and facet joint degeneration (FO and FT). All patients were categorized into four groups based on the grade of EDs. Clinical outcomes were evaluated with the visual analog scale (VAS) and Oswestry disability index (ODI) before and after surgery. Results: There was no difference between the four groups in baseline characteristics except for gender and weight. FT is positively correlated with FO. The same rule exists between EDs, the size of MCs II, FO (left) and FO (right), and VAS and ODI. The grade of EDs is positively correlated with the grade of DD. L4-L5 can bear more load than other levels; thus, the grade of EDs is higher than that of other lumbar levels. The preoperative LBP was relieved in all groups in varying degrees. The change of pain and dysfunction is inversely proportional to the grade of EDs in the general trend. Conclusion: The relationship between weight, gender, and disc degeneration provided a mechanism by which increasing weight can predispose to DD. Different grades of EDs had different effects on patients with LBP. There was a significant correlation between EDs, MCs II, DD, FT, and FO.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Dor Lombar/cirurgia , Espondilose/cirurgia , Articulação Zigapofisária/cirurgia , Idoso , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/fisiopatologia , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/fisiopatologia , Dor Lombar/diagnóstico por imagem , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiopatologia , Região Lombossacral/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espondilose/complicações , Espondilose/fisiopatologia , Escala Visual Analógica , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/fisiopatologia
9.
Iowa Orthop J ; 39(1): 81-84, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413679

RESUMO

Background: Increasing emphasis has been placed on segmental lordosis correction, even in short segment constructs. However, the majority of reports on TLIF indicate that lordosis correction is modest at best. TLIF with bilateral facetecomy has been described with better lordosis correction, but is usually performed with the spine in extension throughout the case. This report presents a new technique for lordosis correction during TLIF with the use of bilateral facetectomy and osteotomy closure using a mechanically hinged operative table. Methods: A 78-year-old male presented with claudicatory back and leg pain due to foraminal stenosis and spondylolisthesis at L4-5 and L5-S1, and was operated on with bilateral facetectomies and TLIF while positioned on a motorized-hinged table, which started in flexion for the decompression and was brought into extension at the end of the case for osteotomy closure. Results: Segmental lordosis from L4-S1 increased from 15° pre-operatively to 42° postoperatively. Conclusions: A comparison of pre- and post-operative lateral radiographs showed 27° segmental lordosis correction, and intra-operative fluoroscopy showed correlation between extension of the table and segmental lordosis correction. Bilateral facetectomy and TLIF allows for segmental lordosis correction. Use of the hinged table allowed for ideal positioning during the decompression and controlled osteotomy closure with close correlation between table position and segmental alignment.Level of Evidence: V.


Assuntos
Fixadores Internos , Lordose/cirurgia , Vértebras Lombares/cirurgia , Osteotomia/métodos , Fusão Vertebral/métodos , Articulação Zigapofisária/cirurgia , Idoso , Terapia Combinada/métodos , Humanos , Lordose/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Região Lombossacral/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Posicionamento do Paciente , Prognóstico , Fusão Vertebral/instrumentação , Resultado do Tratamento , Articulação Zigapofisária/diagnóstico por imagem
10.
Orthop Surg ; 11(4): 620-627, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31402585

RESUMO

OBJECTIVE: To evaluate the clinical outcome of reoperation after percutaneous endoscopic lumbar discectomy (PELD) as compared with primary spinal decompression and fusion. METHODS: A retrospective study from December 2014 to December 2017 was conducted at Peking Union Medical College Hospital and comprised 39 patients with symptomatic lumbar degenerative disease (LDD): 13 post-PELD who underwent reoperation (revision surgery group) and 26 who received primary spinal decompression and fusion (primary open surgery group). The two groups were compared regarding: operative time, blood loss, transfusion, hospitalization, postoperative visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopedic Association (JOA) improvement rate, and postoperative complications. The Mann-Whitney U-test was applied to analyze continuous parameters, and the χ2 -test for categorical parameters. Fisher's exact test was used for small data subsets. RESULTS: There was no statistically significant difference between the two groups in mean age (52.7 years vs 52.9 years), gender ratio (6 men-to-7 women vs 12 men-to-14 women), body mass index, medical history, preoperative diagnosis, or surgical spine level (P > 0.05). The mean operative time of the revision surgery group was significantly longer than that of the primary open surgery group (160.0 min vs 130.2 min, P < 0.05). The revision surgery group also had a significantly higher mean estimated blood loss, postoperative drainage, and length of hospital stay (P < 0.05). However, no significant differences were found between the two groups in terms of hemoglobin and hematocrit values, preoperatively and postoperatively. The rate of transitional neurological irritation was higher in the revision surgery group (61.5% vs 3.8%; P < 0.05), as was intraoperative durotomy and cerebrospinal fluid leakage (30.8% vs 3.8%, P < 0.05). At 1 month, the VAS and ODI scores of the primary open surgery group were significantly better than those of the revision surgery group, while the improvement in JOA scores was similar. After 6 and 12 months' follow-up, the VAS and ODI scores and the rates of JOA improvement were comparable. CONCLUSION: Patients with LDD who received primary spinal decompression and fusion experienced lower rates of perioperative complications and shorter hospitalization compared with patients who underwent revision surgery after PELD, but the clinical outcomes at the last follow-up of both groups were satisfactory.


Assuntos
Descompressão Cirúrgica , Discotomia Percutânea , Degeneração do Disco Intervertebral/cirurgia , Região Lombossacral/cirurgia , Reoperação , Fusão Vertebral , Adulto , Idoso , Perda Sanguínea Cirúrgica , Avaliação da Deficiência , Endoscopia , Feminino , Humanos , Tempo de Internação , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor , Estudos Retrospectivos
11.
Med Sci Monit ; 25: 4885-4891, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31260437

RESUMO

BACKGROUND The aim of this study was to investigate the biomechanical fixation effects of different segments of the goat spine on adjacent segmental motion and intradiscal pressure (IDP) change. MATERIAL AND METHODS Eighteen goat spine specimens were randomly divided into 3 groups: group A (single-segment fixation), group B (double-segment fixation), and group C (triple-segment fixation). The motion was tested on each specimen using a spinal motion simulation test system with rational pressure loading. The IDP was measured using a pinhole pressure sensor. RESULTS Range of motion (ROM) and IDP of adjacent segments increased with increased external load. In comparison of the 3 groups, significant differences in ROM were found when the external force was more than 100 N (P<0.05). The differences in IDP of the adjacent segment were statistically significant (P<0.05) when external pressure was greater than or equal to 60 N. However, in comparison of group A with group B, no significant differences in ROM and IDP of the adjacent segments were noted for the motions of anterior flexion, posterior extension, and lateral bending (P>0.05). Moreover, upper adjacent segments had greater ROM than the lower adjacent segments (P<0.05). We found significant differences between IDPs of the upper adjacent segments and lower adjacent segments (P<0.05). CONCLUSIONS As the number of fixated lumbar segments increases, ROM and IDP of the adjacent segments increase. Multisegment fixation is most likely the main factor contributing to the development of adjacent segmental lesions after lumbar fixation.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Animais , Fenômenos Biomecânicos/fisiologia , Cabras , Disco Intervertebral/cirurgia , Região Lombossacral/cirurgia , Pressão , Amplitude de Movimento Articular/fisiologia , Rotação
12.
World Neurosurg ; 130: 244-253, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299304

RESUMO

BACKGROUND: Different transforaminal endoscopic approaches have been developed for the surgical treatment of lumbar disc herniation: Kambin (intradiscal), Yeung (intraforaminal intradiscal), Ruetten (extreme lateral), transforaminal endoscopic surgical system (intraforaminal extradiscal) approach, and modifications. The operative technique for the treatment of foraminal and extraforaminal lumbar disc herniation through these surgical approaches has not been well described in reported studies. Moreover, each of these surgical approaches has limitations in the removal of migrated intra- or extraforaminal disc herniation. We have described, step by step, the operative technique of a modified percutaneous endoscopic transforaminal approach we have termed the "percutaneous endoscopic intra- and extraforaminal extradiscal approach or transforaminal outside-in outside [TOIO] approach" for the treatment of foraminal and extraforaminal lumbar disc herniation. METHODS: From 2012 to 2018, 48 patients had undergone the percutaneous endoscopic TOIO approach for symptomatic foraminal and extraforaminal lumbar disc herniation. The inclusion criteria were the same as the microdiscectomy criteria. The exclusion criteria included patients with severe foraminal stenosis and disc degeneration, listhesis, and scoliosis. The pre- and postoperative clinical data, radiographic findings, and surgical technique were investigated. RESULTS: No intraoperative complications developed. All the patients showed progressive improvement of initial neurological deficits with complete recovery of motor weakness and L4, L5 hypoesthesia at 1 month postoperatively. One patient experienced persistent postoperative dysesthesia on the affected leg for ∼1 month. CONCLUSION: The percutaneous endoscopic TOIO approach is a minimally invasive, safe, and efficacious surgical procedure for the treatment of lumbar foraminal and extraforaminal disc herniation. Proper patient selection is mandatory to ensure a satisfactory outcome.


Assuntos
Discotomia Percutânea , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adulto , Discotomia/métodos , Discotomia Percutânea/métodos , Endoscopia/métodos , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
13.
World Neurosurg ; 130: 285-292, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323414

RESUMO

BACKGROUND: Flat back deformity is a disabling adverse outcome following instrumented lumbar fusion. As patients are often fused in this non-physiologic alignment, correction is complex and has conventionally required fracture of the preexisting fusion mass. Sacral osteotomy may be one effective means of correcting the positive sagittal balance in these patients. Here we report a case of flat back deformity corrected using a 3-column sacral osteotomy, and systematically review the available literature on the effectiveness of 3-column sacral osteotomy for correcting flat back deformity. METHODS: A systematic review was performed using the results of a search of the PubMed, EMBASE, Web of Science, and Cochrane databases according to PRISMA guidelines. We also include our patient as an example of the technique. RESULTS: Eight studies-all case reports or small case series-were identified describing 37 patients, including our case example. The variety of techniques was too heterogeneous for meta-analysis, but all studies reported good correction of sagittal deformity. Transient L5 palsy was the most common side effect of this technique, being reported in 21 patients (56.8%) across all studies. CONCLUSIONS: Sacral osteotomy is potentially an effective means of correcting positive sagittal balance in patients with flat back deformity secondary to high pelvic incidence.


Assuntos
Vértebras Lombares/cirurgia , Osteotomia , Sacro/cirurgia , Vértebras Torácicas/cirurgia , Feminino , Humanos , Região Lombossacral/cirurgia , Pessoa de Meia-Idade , Osteotomia/métodos , Complicações Pós-Operatórias/epidemiologia , Sacro/diagnóstico por imagem , Fusão Vertebral/métodos
14.
Neurochirurgie ; 65(6): 421-424, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31301389

RESUMO

Bertolotti's syndrome is a little-known and little-discussed pathology. We report the case of a 13-year-old child diagnosed with Bertolotti's syndrome after several years of functional complaints. Conventional radiography was used to diagnose the transverse mega-apophysis of L5, while sectional and functional imaging confirmed a lumbosacral-iliac impingement. In view of the transient efficacy of medical management, surgical resection of the transverse mega-apophysis was performed. The medium-term decline in symptoms was excellent and the patient resumed physical activities without limitation or pain.


Assuntos
Dor Lombar/cirurgia , Região Lombossacral/cirurgia , Adolescente , Humanos , Processamento de Imagem Assistida por Computador , Vértebras Lombares/cirurgia , Região Lombossacral/diagnóstico por imagem , Masculino , Procedimentos Neurocirúrgicos , Resultado do Tratamento
15.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(6): 736-739, 2019 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-31270055

RESUMO

OBJECTIVE: To compare the effect of erector spinae plane block and retrolaminar block for relieving acute pain after posterior lumbar surgery. METHODS: Eighty-nine patients undergoing selective posterior lumbar surgery under general anesthesia in our hospital between January and December, 2018, were recruited. Of these patients, 30 received total intravenous general anesthesia to serve as the control group, 28 received total intravenous general anesthesia (TIVA) combined with erector spinae plane block (ESPB), and 31 had TIVA combined with retrolaminar block (RLB). All the patients received patient-controlled intravenous analgesia (PCIA) for postoperative analgesia, and their heart rate, blood pressure, and pulse oximetry were routinely monitored during the anesthesia. VAS scores were evaluated before and at 2, 8, 12, 24, and 48 h after the surgery. Sufentanil consumption during the operation and PCIA were also recorded. The postoperative complications such as nausea and vomiting, urinary retention, itching and respiratory depression within 48 h after the surgery were also recorded. RESULTS: At 2, 8 and 12 h postoperatively, VAS scores in the ESPB group and RLB group were significantly lower than those in the control group; the scores were significantly lower in RLB group than in ESPB group (P < 0.05). Compared with that in the control group, sufentanil consumption during the operation and PCIA were significantly decreased in both ESPB and RLB groups, particularly in the latter group (P < 0.05). Two patients experienced nausea and vomiting and 1 patient complained of pruritus in control group; 1 patient had over sedation and 1 had urinary retention in ESPB group; 1 patient had urinary retention in RLB group. CONCLUSIONS: Ultrasound-guided RLB has better analgesic effect than ESPB for management of perioperative pain following posterior lumbar surgery.


Assuntos
Região Lombossacral/cirurgia , Bloqueio Nervoso , Dor Pós-Operatória , Analgesia Controlada pelo Paciente , Humanos , Sufentanil
16.
Spine (Phila Pa 1976) ; 44(19): E1122-E1129, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31261275

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To analyze complications associated with minimally invasive anterolateral retroperitoneal antepsoas lumbosacral fusion (MIS-ATP). SUMMARY OF BACKGROUND DATA: MIS-ATP provides anterolateral access to the lumbar spine allowing for safe anterior lumbar interbody fusions between T12-S1. Anecdotally, many surgeons believe that ATP approach is not feasible at L5-S1 level, predisposing to catastrophic vascular injuries. This approach may help overcome limitations associated with conventional straight anterior lumbar interbody fusions, MIS lateral lumbar interbody fusion, and oblique lateral interbody fusion. METHODS: A detailed retrospective chart review of patients who had underwent MIS-ATP approach for lumbar fusion between T12-S1 was performed. Available electronic data from surgeries performed between January 2008 and March 2017 was carefully screened for surgical patients treated for spondylolisthesis, spondylosis, stenosis, sagittal, and/or coronal deformity. Detailed review of electronic medical records including operative notes, progress notes, discharge summaries, laboratory results, imaging reports, and clinic visit notes performed by a single independent reviewer not involved in patient care for documented complications. A complication is defined as any adverse event related to the index spine procedure for which patient required specific intervention or treatment. RESULTS: Nine hundred forty patients with a total of 2429 interbody fusion levels performed via MIS-ATP were identified during the study period. Sixty-seven patients (7.2%) sustained one or more complications during the perioperative period, of which 25.5% were surgical and 74.5% were medical. Overall, 78 (8.2%) surgical complications pertaining to the index procedure were noted during a postoperative period of 1 year from the date of surgery. No major vascular or direct visceral injuries were encountered. CONCLUSIONS: MIS-ATP approach provides a safe access to anterolateral interbody fusions between T12-S1. The ATP approach is performed by the spine surgeon, does not require neuromonitoring, and warrants minimal to no psoas muscle retraction resulting in significantly reduced postoperative thigh pain and rare neurologic injuries. Additionally, the direct and clear visualization of the retroperitoneal vasculature provided by the ATP approach minimizes the risk of inadvertent vascular injury. LEVEL OF EVIDENCE: 4.


Assuntos
Região Lombossacral/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias , Fusão Vertebral/efeitos adversos , Humanos , Estudos Retrospectivos , Espondilose/cirurgia
17.
World Neurosurg ; 130: 235-239, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302271

RESUMO

BACKGROUND: Relatively few cases of total en bloc spondylectomy (TES) for the L5 tumors have been reported. TES in the lower lumbar region is usually performed through a combined anterior and posterior approach. TES for L5 tumors by a posterior-only approach is technically challenging. CASE DESCRIPTION: A 62-year-old woman with persistent pain in her lumbosacral area and lower extremities and numbness of her lateral left lower extremity for 2 months came to our department. She had undergone radical mastectomy 4 years earlier. X-ray and magnetic resonance imaging (MRI) showed that the tumor had destroyed the vertebral body of L5. No other lesions were revealed by emission computed tomography (ECT) or positron emission tomography/computed tomography (PET/CT). With a diagnosis of breast cancer and a solitary metastasis to L5, the patient was treated with posterior-only TES of the L5 tumor and reconstruction. The whole procedure took 10 hours, and her intraoperative blood loss was 9000 mL. The lumbar and leg pain of the patient disappeared postoperatively without serious complications. She started walking 4 weeks after surgery and resumed her daily life. New multiple metastases developed 6 months after surgery, with no sign of local recurrence. Despite active treatment, she died 18 months after surgery. CONCLUSION: TES of the L5 tumor can be achieved by a posterior-only approach, with good results and limited complications.


Assuntos
Neoplasias da Mama/cirurgia , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , Humanos , Região Lombossacral/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Coluna Vertebral/diagnóstico
18.
J Clin Neurosci ; 67: 156-162, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31208836

RESUMO

Reduction of the slipped vertebra as a part of surgical approach is still debatable. The author investigated the usefulness of percutaneous reduction fixation system for the treatment of lumbar spondylolisthesis via a comparison with traditional open pedicle screw fixation after posterior decompression and interbody fusion. This study included 65 patients with lumbar spondylolisthesis, who underwent either open transpedicular screw fixation (OTPSF) with posterior lumbar interbody fusion (PLIF) (OTPSF group, n = 33) or PPSF with reduction system (PPSFr group, n = 32) after PLIF. The slippage degree (SD); the intervertebral disc height (IDH); lumbar lordosis (LL); and segmental angle (SA) were measured on the follow-up simple lateral radiographs. For pain and functional assessment in patients, visual analogue scale (VAS) scores for low back pain and leg pain, and Oswestry Disability Index (ODI) scores were measured. SA (P < 0.05) and LL (P < 0.05) were significantly improved and well maintained in the PPSFr group compared to the OTPSF group. Reduction of SD was significantly greater in the PPSFr group than the OTPSF group (P < 0.05). Although there were no significant differences in VAS scores for back pain and radiculopathy between the two groups during the follow-up, the final ODI score was significantly lower in the PPSFr group than the OTPSF group (P < 0.05). PPSFr combined with PLIF showed superior clinical and radiological outcomes compared to traditional OTPSF with PLIF in the treatment of lumbar spondylolisthesis. This study showed that reduction of the SD was important factors for maintaining LL.


Assuntos
Vértebras Lombares/cirurgia , Parafusos Pediculares , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Adulto , Idoso , Dor nas Costas , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Dor Lombar , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia
20.
Medicine (Baltimore) ; 98(23): e15941, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169716

RESUMO

Increasing number of studies have shown growing incidence of lumbosacral tuberculosis and its complications. However, the treatment options for this disorder are still limited.To evaluate the long-term therapeutic effect and prognosis of minimally invasive puncture catheter drainage and Isoniazid local chemotherapy for the treatment of lumbosacral tuberculosis without neural symptoms under the guidance of computed tomography (CT).A total of 45 patients with asymptomatic lumbosacral tuberculosis were treated by minimally invasive catheter drainage under CT guidance. Forty-two cases had been followed up, which included 22 women and 20 men with an average age of 36.45 years old. Isoniazid was injected locally and antituberculotic drugs were administered for postoperative treatment. Oswestry Disability Index (ODI), visual analogue scale (VAS) evaluation and Cobb angle were recorded before and after operation.Forty-two patients had been followed up and the follow-up term was from 1.2 to 8.5 years (average 60 months). All patients were healed without recurrent cases. The ODI were improved from 14.86 ±â€Š2.02 before operation to 1.48 ±â€Š1.55 after operation. The post-operative (4.19 ±â€Š1.17) VAS score was improved compared to the pre-operative VAS score (0.55 ±â€Š0.55). The post-operative Cobb angle (6.19°â€Š±â€Š3.85°) was also improved relatively to the preoperative Cobb angle (5.90°â€Š±â€Š3.71°).Minimally invasive puncture catheter drainage combined with Isoniazid local chemotherapy is an effective method for lumbosacral tuberculosis without neural symptom. Meanwhile, it can be applied for the treatment of spinal tuberculosis before open surgery.


Assuntos
Antibacterianos/administração & dosagem , Cateterismo/métodos , Drenagem/métodos , Região Lombossacral/microbiologia , Tuberculose da Coluna Vertebral/terapia , Adulto , Drenagem/instrumentação , Feminino , Humanos , Vértebras Lombares , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose da Coluna Vertebral/microbiologia
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