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1.
Bone Joint J ; 103-B(7): 1301-1308, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192932

RESUMO

AIMS: Although lumbosacral transitional vertebrae (LSTV) are well-documented, few large-scale studies have investigated thoracolumbar transitional vertebrae (TLTV) and spinal numerical variants. This study sought to establish the prevalence of numerical variants and to evaluate their relationship with clinical problems. METHODS: A total of 1,179 patients who had undergone thoracic, abdominal, and pelvic CT scanning were divided into groups according to the number of thoracic and lumbar vertebrae, and the presence or absence of TLTV or LSTV. The prevalence of spinal anomalies was noted. The relationship of spinal anomalies to clinical symptoms (low back pain, Japanese Orthopaedic Association score, Roland-Morris Disability Questionnaire) and degenerative spondylolisthesis (DS) was also investigated. RESULTS: Normal vertebral morphology (12 thoracic and five lumbar vertebrae without TLTV and LSTV) was present in 531 male (76.7%) and 369 female patients (75.8%). Thoracolumbar transitional vertebrae were present in 15.8% of males and 16.0% of females. LSTV were present in 7.1% of males and 9.0% of females. The prevalence of the anomaly of 16 presacral mobile vertebrae (total number of thoracolumbar vertebrae and TLTV) without LSTV was 1.0% in males and 4.1% in females, and that of the anomaly of 18 vertebrae without LSTV was 5.3% in males and 1.2% in females. The prevalence of DS was significantly higher in females with a total of 16 vertebrae than in those with normal morphology. There was no significant correlation between a spinal anomaly and clinical symptoms. CONCLUSION: Overall, 24% of subjects had anomalies in the thoracolumbar region: the type of anomaly differed between males and females, which could have significant implications for spinal surgery. A decreased number of vertebrae was associated with DS: numerical variants may potentially be a clinical problem. Cite this article: Bone Joint J 2021;103-B(7):1301-1308.


Assuntos
Dor Lombar/etiologia , Vértebras Lombares/anormalidades , Espondilolistese/etiologia , Vértebras Torácicas/anormalidades , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Japão , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
2.
BMC Musculoskelet Disord ; 22(1): 619, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253219

RESUMO

BACKGROUND: With the progress and success in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF), the musculoskeletal injury was minimized. However, the role of postoperative orthosis in MIS TLIF has not been established and there is little evidence supporting the routine use of orthosis in MIS TLIF. METHODS: This is a prospective randomized clinical study. 90 patients who underwent MIS TLIF were randomly divided into groups A (with postoperative spinal orthosis) and B (without postoperative spinal orthosis). Patients were followed up for an average of 12.6 months. Clinical outcome was assessed using the Oswestry disability index (ODI) and visual analogue scale (VAS). Fusion rate was classified with the BSF scale system at postoperative 6-month, and 12-month. RESULTS: Both groups had similar patient demographics. The use of postoperative spinal orthosis had no significant influence on instrumentation-related complications or radiological parameters at each follow-up. CONCLUSIONS: In this study, we conclude that postoperative spinal orthosis is not necessary for MIS TLIF. Patients without postoperative spinal orthosis had the same fusion rates and improvement of VAS and ODI scores.


Assuntos
Vértebras Lombares , Fusão Vertebral , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Aparelhos Ortopédicos , Estudos Prospectivos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
3.
Bone Joint J ; 103-B(7 Supple B): 59-65, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192919

RESUMO

AIMS: Cross-table lateral (CTL) radiographs are commonly used to measure acetabular component anteversion after total hip arthroplasty (THA). The CTL measurements may differ by > 10° from CT scan measurements but the reasons for this discrepancy are poorly understood. Anteversion measurements from CTL radiographs and CT scans are compared to identify spinopelvic parameters predictive of inaccuracy. METHODS: THA patients (n = 47; 27 males, 20 females; mean age 62.9 years (SD 6.95)) with preoperative spinopelvic mobility, radiological analysis, and postoperative CT scans were retrospectively reviewed. Acetabular component anteversion was measured on postoperative CTL radiographs and CT scans using 3D reconstructions of the pelvis. Two cohorts were identified based on a CTL-CT error of ≥ 10° (n = 11) or < 10° (n = 36). Spinopelvic mobility parameters were compared using independent-samples t-tests. Correlation between error and mobility parameters were assessed with Pearson's coefficient. RESULTS: Patients with CTL error > 10° (10° to 14°) had stiffer lumbar spines with less mean lumbar flexion (38.9°(SD 11.6°) vs 47.4° (SD 13.1°); p = 0.030), different sagittal balance measured by pelvic incidence-lumbar lordosis mismatch (5.9° (SD 18.8°) vs -1.7° (SD 9.8°); p = 0.042), more pelvic extension when seated (pelvic tilt -9.7° (SD 14.1°) vs -2.2° (SD 13.2°); p = 0.050), and greater change in pelvic tilt between supine and seated positions (12.6° (SD 12.1°) vs 4.7° (SD 12.5°); p = 0.036). The CTL measurement error showed a positive correlation with increased CTL anteversion (r = 0.5; p = 0.001), standing lordosis (r = 0.23; p = 0.050), seated lordosis (r = 0.4; p = 0.009), and pelvic tilt change between supine and step-up positions (r = 0.34; p = 0.010). CONCLUSION: Differences in spinopelvic mobility may explain the variability of acetabular anteversion measurements made on CTL radiographs. Patients with stiff spines and increased compensatory pelvic movement have less accurate measurements on CTL radiographs. Flexion of the contralateral hip is required to obtain clear CTL radiographs. In patients with lumbar stiffness, this movement may extend the pelvis and increase anteversion of the acetabulum on CTL views. Reliable analysis of acetabular component anteversion in this patient population may require advanced imaging with a CT scan. Cite this article: Bone Joint J 2021;103-B(7 Supple B):59-65.


Assuntos
Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Artroplastia de Quadril , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos
4.
Ann Palliat Med ; 10(6): 6694-6705, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237972

RESUMO

BACKGROUND: To explore the feasibility and efficiency of posterior wedge osteotomy assisted by O-arm navigation treatment of ankylosing spondylitis (AS) patients with thoracolumbar fracture. METHODS: This is a case series study. A total of 16 cases of AS accompanied by thoracolumbar fractures from January 2012 to July 2015 were retrospectively analyzed. All patients underwent "posterior wedge osteotomy assisted by O-arm navigation". The operation time, blood loss volume, preoperative and postoperative visual analogue scale (VAS), American Spinal Injury Association (ASIA) classification, and spinal imaging parameters [Cobb angle, C7 plumb line (C7PL), and jaw-brow angle] were collected and analyzed. RESULTS: The operative time consumption was 120-350 mins and the intra-operative blood loss volume was 200-800 mL. No obvious postoperative complications occurred in any participants. The back pain of all participants was relieved, and the neurological functions of eight participants with spinal cord injury (SCI) were recovered in varying degrees except for one patient with severe SCI. The spinal deformities of the participants were corrected to varying degrees. The fracture sites of 16 participants were all healed, and there was no loosening or detachment of internal fixation during the 6-month follow-up period. CONCLUSIONS: Posterior wedge osteotomy assisted by O-arm navigation was shown to be a safe and effective method to treat AS accompanied by thoracolumbar fractures. This treatment strategy can accurately decompress and reduce the fracture and significantly correct the kyphosis, with good surgical effect.


Assuntos
Espondilite Anquilosante , Cirurgia Assistida por Computador , Humanos , Imageamento Tridimensional , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Osteotomia , Estudos Retrospectivos , Espondilite Anquilosante/cirurgia , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
BMC Musculoskelet Disord ; 22(1): 617, 2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34246252

RESUMO

BACKGROUND: Reoperation is one of the key factors affecting postoperative clinical outcomes. The reoperation rates of cervical surgeries might be different from those of lumbar surgeries due to the anatomical and biomechanical differences. However, there has been no study to compare the reoperation rate between them. The purpose is to compare reoperation rates after fusion surgeries for degenerative spinal diseases depending on the anatomic region of cervical and lumbar spines. METHOD: We used the Korean Health Insurance Review & Assessment Service national database. Subjects were included if they had any of the primary procedures of fusion combined with the procedure of decompression procedures under the diagnosis of degenerative diseases (n = 42,060). We assigned the patients into two groups based on anatomical regions: cervical and lumbar fusion group (n = 11,784 vs 30,276). The primary endpoint of reoperation was the repeat of any aforementioned fusion procedures. Age, gender, presence of diabetes, associated comorbidities, and hospital types were considered potential confounding factors. RESULTS: The reoperation rate was higher in the patients who underwent lumbar fusion surgery than in the patients who underwent cervical fusion surgery during the entire follow up period (p = 0.0275). A similar pattern was found during the late period (p = 0.0468). However, in the early period, there was no difference in reoperation rates between the two groups. Associated comorbidities and hospital type were noted to be risk factors for reoperation. CONCLUSIONS: The incidence of reoperation was higher in the patients who underwent lumbar fusion surgery than those who underwent cervical fusion surgery for degenerative spinal diseases.


Assuntos
Doenças da Coluna Vertebral , Fusão Vertebral , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Reoperação , Estudos Retrospectivos , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos
6.
BMC Musculoskelet Disord ; 22(1): 616, 2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34246272

RESUMO

BACKGROUND: Facetectomy, an important procedure in the in-out and out-in techniques of transforaminal endoscopic lumbar discectomy (TELD), is related to the deterioration of the postoperative biomechanical environment and poor prognosis. Facetectomy may be avoided in TELD with large annuloplasty, but iatrogenic injury of the annulus and a high grade of nucleotomy have been reported as risk factors influencing poor prognosis. These risk factors may be alleviated in TELD with limited foraminoplasty, and the grade of facetectomy in this surgery can be reduced by using an endoscopic dynamic drill. METHODS: An intact lumbo-sacral finite element (FE) model and the corresponding model with adjacent segment degeneration were constructed and validated to evaluate the risk of biomechanical deterioration and related postoperative complications of TELD with large annuloplasty and TELD with limited foraminoplasty. Changes in various biomechanical indicators were then computed to evaluate the risk of postoperative complications in the surgical segment. RESULTS: Compared with the intact FE models, the model of TELD with limited foraminoplasty demonstrated slight biomechanical deterioration, whereas the model of TELD with large annuloplasty revealed obvious biomechanical deterioration. Degenerative changes in adjacent segments magnified, rather than altered, the overall trends of biomechanical change. CONCLUSIONS: TELD with limited foraminoplasty presents potential biomechanical advantages over TELD with large annuloplasty. Iatrogenic injury of the annulus and a high grade of nucleotomy are risk factors for postoperative biomechanical deterioration and complications of the surgical segment.


Assuntos
Deslocamento do Disco Intervertebral , Fenômenos Biomecânicos , Discotomia , Endoscopia , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias
7.
BMJ Case Rep ; 14(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253509

RESUMO

Lumbar spondylodiscitis due to radiation proctitis-related fistula is a rare finding in the literature. After having isolated Actinomyces odontolyticus, a rare finding in the osteomuscular system, we present one of such cases.A 75-year-old patient with a history of rectum adenocarcinoma, submitted to surgery and radiotherapy, presented himself in our emergency department with a 3-month history of lumbar pain radiating to both legs. Physical examination was compatible with cauda equina syndrome and subsequent investigation revealed L4-L5 spondylodiscitis. Despite a 6-month antibiotic therapy regimen, the symptoms recurred. Intravertebral disc biopsy revealed A. odontolyticus and directed antibiotic therapy was started. However, the symptoms recurred after a new 6-month antibiotic therapy regimen, this time with rectal purulent drainage. Additional study revealed two rectal fistulae. It was assumed those were caused by radiation proctitis and constituted the primary cause of spondylodiscitis. Laminectomy was performed with a satisfactory clinical response.


Assuntos
Discite , Proctite , Actinomyces , Idoso , Discite/tratamento farmacológico , Discite/etiologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia , Proctite/diagnóstico , Proctite/etiologia
8.
Clin Interv Aging ; 16: 1275-1283, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34262267

RESUMO

Purpose: Osteoporosis and endplate damage, two primary orthopedic disorders that have adverse effects on the quality of life of older adults, may have some previously unknown relationship. The purpose of this study was to determine the potential association between osteoporosis and endplate damage with two specific imaging scoring systems and analyze the underlying mechanisms. Patients and Methods: A cross-sectional study including 156 patients with degenerative disc disease (DDD) who visited our department in 2018 was performed. Data including age, sex, body mass index, Hounsfield unit (HU) values utilizing computed tomography (CT), and total endplate scores (TEPSs) using magnetic resonance imaging (MRI) of all patients were retrospectively collected and analyzed. The average HU value and TEPS of L1-L4 were used to represent the degrees of bone mineral density (BMD) and endplate damage, respectively. Patients with an HU value < 110 were defined as having osteoporosis and placed in the low-BMD group; otherwise, they were placed in the normal-BMD group. Multivariate logistic regression models were used to determine the independent factors of endplate damage. Results: The TEPSs in the low-BMD group were significantly higher (6.4 ± 1.6 vs 5.0 ± 0.9, p < 0.001) overall and in every segment of L1-L4 (p < 0.01). A significant negative correlation was found between TEPS and HU values (p < 0.001). The HU value (odds ratio [OR] 0.221; 95% confidence interval [CI], 0.148-0.295, p < 0.001), age (OR 0.047; 95% CI, 0.029-0.224, p < 0.001), and BMD (OR 3.796; 95% CI, 2.11-7.382, p < 0.05) were independent factors influencing endplate damage. Conclusion: A significantly positive correlation was observed between osteoporosis and endplate damage, indicating the requirement for a more comprehensive therapeutic regimen for treating patients with DDD complicated with osteoporosis.


Assuntos
Degeneração do Disco Intervertebral , Vértebras Lombares , Osteoporose , Qualidade de Vida , Idoso , Densidade Óssea , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/psicologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Osteoporose/complicações , Osteoporose/diagnóstico , Osteoporose/psicologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
9.
Stud Health Technol Inform ; 280: 37-39, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34190057

RESUMO

The purpose of this study was to evaluate the morphological changes of intervertebral discs (IVD) and vertebral bodies (VB) in AIS girls according to the subgroups with different curve severity by magnetic resonance imaging (MRI). This study included 33 age-matched female controls and 76 AIS girls with a right-sided thoracic curvature. Wedge angle, height ratio and distance ratio of VB and IVD were measured on the best midline coronal and sagittal planes from reformatted MRI spine. Volumes of VB, IVD and nucleus pulposus (NP) were evaluated on volumetric images. One-way ANOVA with Bonferroni correction was used. There was significant difference in wedge angle and height ratio of VB and IVD between AIS and controls. In severe-AIS, the position of NP was significantly shifted to the convexity when compared with non-severe AIS and controls. Whereas, the volume of IVD and NP in severe-AIS was found to be significantly smaller. On top of coronal wedging of VB and IVD, there was significantly reduced volume of IVD and NP in severe-AIS patients, despite T2 signal of IVD was preserved. The current findings indicate that early mechanical effects on the discs and vertebrae in adolescent scoliotic spine is evident on quantitative imaging. Importantly, these patients may be vulnerable to disc degeneration if no operative treatment is prescribed.


Assuntos
Disco Intervertebral , Escoliose , Adolescente , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Escoliose/diagnóstico por imagem , Corpo Vertebral
10.
Int J Comput Assist Radiol Surg ; 16(8): 1263-1276, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34117989

RESUMO

PURPOSE: Transforaminal endoscopic surgery (TES) is effective for treatment of intervertebral disc-related diseases. To avoid injury to the critical structures, preoperative planning is required to find a safe working channel. Therefore, accurate patient-specific vertebral segmentation is important. The purpose of this work is to develop a convenient, stable and feasible lumbar vertebrae segmentation method for TES planning. METHODS: Based on the chain structure of the spine, an interactive dual-output vertebrae instance segmentation network was designed to segment the specific vertebrae in CT images. First, an initialization locator module was set up to provide an initial locating box. Then the dual-output network was designed to segment two adjacent vertebrae inside the locating box. Finally, iteration was performed until all the expected vertebrae were segmented. RESULTS: Verification on reconstructed public dataset showed that the vertebral segmentation Dice coefficient was 96.8 ± 1.2% and average surface distance (ASD) was 0.25 ± 0.10 mm. For intervertebral foramen (IVF) region, the Dice coefficient was 96.1 ± 1.5% and ASD was 0.29 ± 0.10 mm. For IVF forming region, the Dice coefficient was 93.4 ± 3.1% and ASD was 0.28 ± 0.13 mm. The evaluation on private dataset showed that more than 90% of the segmentation were suitable for TES planning. For IVF region, the Dice coefficient was 94.4 ± 1.8% and ASD was 0.71 ± 0.49 mm. CONCLUSION: This work provides a convenient, stable and feasible segmentation method for lumbar vertebrae, IVF region, and IVF forming region. The segmentation can meet the requirement for TES planning.


Assuntos
Endoscopia/métodos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Vértebras Lombares/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
Clin Interv Aging ; 16: 1131-1137, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34168436

RESUMO

Purpose: To explore the characteristics and reliability of dual-energy x-ray absorptiometry (DXA) measurements in patients undergoing lumbar fusion for lumbar degenerative diseases (LDD). Patients and Methods: A total of 1041 patients aged ≥50 years undergoing lumbar fusion for LDD were reviewed. The BMDs and T-scores of DXA were retrospectively analysed. The diagnosis of osteoporosis was in accordance with World Health Organization (WHO) criteria. Based on the guidelines of International Society for Clinical Densitometry (ISCD), an abnormal lumbar segment is identified as having unreliable T-scores when there is more than a 1.0 T-score difference between two adjacent vertebrae. Results: The prevalence of osteoporosis diagnosed on DXA was 42.3%, and it was higher in women than in men (50.2% vs 31.8%, P < 0.001). Increasing age resulted in higher prevalence of osteoporosis in females. The prevalence of osteoporosis significantly declined with increasing BMI. The lowest lumbar T-score was mostly found at L1. Unreliable T-scores were mostly seen in the lower lumbar segment (L3-L4) and were the least common in L1-L2. The average amount of abnormal lumbar segments increased with age (P = 0.003) and BMI (P = 0.021). Furthermore, those with degenerative lumbar scoliosis had more abnormal segments (P < 0.001). Of the 95 patients with at least one fractured vertebra, 39 (41.1%) were not diagnosed as having osteoporosis on lumbar DXA. Conclusion: Female, older age and low BMI are the risk factors for osteoporosis in patients undergoing lumbar fusion for LDD. Lower lumbar segments, such as L3-L4, are more likely to have unreliable T-scores. Patients with older age, higher BMI or degenerative scoliosis have more abnormal segments with unreliable T-scores. Lumbar DXA measurements are not sensitive enough to identify patients with vertebral fracture.


Assuntos
Absorciometria de Fóton/métodos , Vértebras Lombares/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos
12.
J Clin Neurosci ; 89: 199-205, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119266

RESUMO

The purpose of this study aimed to analyze and evaluate the radiologic and clinical outcomes of minimally invasive scoliosis surgery (MISS) for correcting adolescent idiopathic scoliosis (AIS) using the mini-open technique. Thirty-four AIS patients who underwent MISS using the mini-open technique for deformity correction. Using two to four 3-centimeter-long skin incisions (mini-open) and tubular retractors, we performed screw fixations, rod assembly, rod derotation maneuver (RD), and bone graft. For thoracoplasty, four to six ribs were resected using the same incisions. Correction was attempted using rod translation and RD maneuvers. Radiological outcomes and clinical outcomes (SRS-22) were evaluated. Mean preoperative Cobb's angle was 61.3° and curve flexibility (major curve) was 26.1%. This angle was corrected to 21.6° with a correction rate of 65.2% (P < 0.001). The coronal balance was not changed significantly. Sagittal vertical axes were corrected from -3.5 mm to 8.6 mm (-22 to 36.3 mm) (P = 0.009). Thoracic kyphosis angles and lumbar lordosis angles were not changed significantly but the values were within normal range. Each score of self-image in the SRS-22 questionnaire as well as the total score were improved significantly (P < 0.001). In conclusion, the MISS for correcting AIS using the mini-open technique showed comparable radiologic and clinical outcomes with fewer complications in patients with non-rigid scoliosis with Cobb's angle between 50° and 80°. Long-term results of this novel MISS using the mini-open technique could further strengthen the rationale for adopting this technique for curve correction in selected cases of AIS.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Costelas/cirurgia , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Parafusos Ósseos , Transplante Ósseo/métodos , Criança , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Estudos Retrospectivos , Costelas/diagnóstico por imagem , Escoliose/diagnóstico por imagem , Fusão Vertebral/métodos , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
15.
Oper Neurosurg (Hagerstown) ; 21(Suppl 1): S69-S80, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34128070

RESUMO

This review of the literature will focus on the indications, surgical techniques, and outcomes for expandable transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and lateral lumbar interbody fusion (LLIF) operations. The expandable TLIF cage has become a workhorse for common degenerative pathology, whereas expandable ALIF cages carry the promise of greater lordotic correction while evading the diseased posterior elements. Expandable LLIF cages call upon minimally invasive techniques for a retroperitoneal, transpsoas approach to the disc space, obviating the need for an access surgeon and decreasing risk of injury to the critical neurovascular structures. Nuances between expandable and static cages for all 3 TLIF, ALIF, and LLIF operations are discussed in this review.


Assuntos
Lordose , Fusão Vertebral , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Tecnologia
16.
In Vivo ; 35(4): 2197-2205, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34182497

RESUMO

BACKGROUND/AIM: Surgical treatment for spinal deformity aims to correct malformation, release the nerves, and reconstruct spinal stability. To explore and develop a new improved spinal correction system (ISCS) for clinical application, we studied the stability and biomechanical characteristics of the ISCS through finite element analysis and comparison of the ISCS with the pedicle screw and rod system (PSRS). PATIENTS AND METHODS: Using L1-L3 CT image data of a normal adult male lumbar spine for establishment of L1-L3 finite element model, we established posterior internal fixation models for a comparative finite element analysis of PSRS and ISCS. An axial load of 500 N and a moment of 10 N•m were applied to L1 to simulate flexion, extension, lateral bending, and axial rotation. Stress distribution characteristics, load sharing, strain bending stiffness and strain angle change of the models were measured. RESULTS: In flection and extension directions, the maximum stress of the L2 vertebral body and the L1/2 and L2/3 discs in PSRS was less than that of ISCS. In lateral bending and axial rotation directions, the maximum stress between PSRS and ISCS was similar. However, the stress shielding rate of L2, L1/2, and L2/3 intervertebral discs in ISCS was significantly lower than that of PSRS. We also found that both models had similar angular displacement and maximum displacement in lateral bending direction, but PSRS had a lower angular displacement and maximum displacement in flection and extension directions. Finally, we showed that PSRS had similar angular displacement and a lower maximum displacement compared with ISCS in axial rotation, whereas ISCS had lower bending stiffness than PSRS in different directions. CONCLUSION: ISCS can effectively fix spinal deformities compared to PSRS. ISCS provides a new option for orthopedic surgery treatment of scoliosis and, therefore, warrants further clinical studies in patients with other spinal deformities.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino
17.
Artigo em Russo | MEDLINE | ID: mdl-34184471

RESUMO

OBJECTIVE: To study the clinical manifestations of neurogenic intermittent claudication (NIC) in patients with degenerative lumbar stenosis (DLS). MATERIAL AND METHODS: The neurological status, intensity and nature of pain syndrome, and pain-free walking distance were evaluated in 83 NIC patients with DPS, who underwent surgical treatment. RESULTS: The predominance of the clinical picture of sensorimotor pain (n=30; 36.1%) and isolated pain (n=31; 37.3%) forms of NIC was established. Isolated sensory (n=1; 1.2%), sensorimotor (n=3; 3.6%), and motor-pain (n=4; 4.8%) forms were significantly less common. In 6 (7.2%) patients, there was a pain-free form of NIC. In most patients, surgical treatment led to regression of neurological symptoms and an increase in the distance of pain-free walking. No relationship was found between the demographic and clinical characteristics of patients (gender, age, pain severity, pain-free walking distance), MRI results and the features of NIC clinical picture. In 4 patients, the phenomenon of pacing was revealed in the form of an increase in pain at the beginning of walking and a significant decrease or complete regression as walking continues. CONCLUSION: The clinical picture of NIC is polymorphic, its pain-free course is possible. The decision on the feasibility of surgical treatment of patients with PLS is possible taking into account the clinical picture of NIC and MRI results.


Assuntos
Claudicação Intermitente , Estenose Espinal , Constrição Patológica , Marcha , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/etiologia , Vértebras Lombares/diagnóstico por imagem , Estenose Espinal/complicações , Estenose Espinal/cirurgia
18.
Medicine (Baltimore) ; 100(22): e26191, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087886

RESUMO

ABSTRACT: Case-control studies by examining the lumbar spine computed tomography (CT) findings focusing on the spinous processes."Passing spine" was defined as a lumbar degenerative change observed on CT images. In contrast, kissing spine, which is also an image finding, has been acknowledged as an established clinical condition. Therefore, we compared the passing spine group and the kissing spine group to investigate whether the 2 groups belong to a similar disease group; this would help explain the clinical and imaging characteristics of patients with passing spine.Previous studies have described the gradual increase in the height and thickness of the lumbar vertebral spinous processes that can occur in individuals aged >40 years, and reported that this progressive degeneration can lead to a condition termed "kissing spine."We examined the CT imaging of 373 patients with lumbar spinal disease and divided patients into 2 groups, the kissing spine (K) group and the passing spine (P) group, and compared the clinical (age, sex, presence/absence of lower extremity pain) and imaging data (localization of kissing or passing spine, intervertebral disc height at the level of kissing or passing spine, lumbar lordosis (LL) angle, presence/absence of vacuum phenomenon (VP) in the intervertebral discs and spondylolisthesis at the level of kissing or passing spine between the 2 groups.Compared with patients with kissing spine, patients with passing spine had an increased incidence of lower extremity pain, lower intervertebral disc height at the level of passing spine, relatively static LL, and VP commonly observed in the intervertebral discs at the level of passing spine.Because the clinical and imaging characteristics of patients with passing spine are different from those of patients with kissing spine, passing spine might be a pathological condition distinct from kissing spine.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Corpo Vertebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Disco Intervertebral/patologia , Lordose/diagnóstico por imagem , Extremidade Inferior/patologia , Vértebras Lombares/patologia , Região Lombossacral/patologia , Masculino , Pessoa de Meia-Idade , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/epidemiologia , Espondilolistese/diagnóstico por imagem , Corpo Vertebral/patologia
19.
Medicine (Baltimore) ; 100(25): e26385, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160416

RESUMO

RATIONALE: For isthmic lumbar spondylolisthesis (ILS) associated with the removal of herniation, it remains challenging to perform less invasive and minimally disruptive procedures. Good results could potentially be obtained by further preserving the posterior elements in full-endoscopic lumbar discectomy (FESS), which is less invasive than microenscopic surgery (MES). PATIENT CONCERNS: One patient complained of left leg pain, and another patient complained of right leg pain and low back pain. DIAGNOSES: Two patients with ILS and Meyerding Grade 1 lumbar spondylolisthesis. INTERVENTIONS: We performed a full-endoscopic lumbar discectomy via the interlaminar space (FESS-IL) for L5/S1 lumbar disc herniation (LDH) accompanied by isthmic lumbar spondylolisthesis. FESS-IL was performed in 2 patients with radiculopathy caused by different types of LDH using a full endoscopic system with a 4.1 mm working channel and 6.9 mm outer diameter. A 3.5-mm diameter high-speed drill was used in one patient for an upward-migrated LDH in the inner-rim of the infravertebral border. The other patient underwent minimal resection without bone resection. OUTCOMES: The one-year clinical outcome included confirmation of pain relief and evacuation of migrated LDH on magnetic resonance imaging in all patients. There was no progression of slippage on radiography. The mean operative time was 82 min, and no complication was observed. The one-year clinical outcome demonstrated sufficient pain relief. LESSONS THE Y: ear postoperative outcome showed improvement. We believe that FESS-IL is a viable alternative operative approach for LDH for ILS.


Assuntos
Discotomia/métodos , Endoscopia/métodos , Vértebras Lombares/cirurgia , Espondilolistese/cirurgia , Discotomia/instrumentação , Endoscopia/instrumentação , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/etiologia , Deslocamento do Disco Intervertebral/cirurgia , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espondilolistese/complicações , Espondilolistese/diagnóstico , Espondilólise/diagnóstico , Espondilólise/etiologia , Espondilólise/cirurgia , Resultado do Tratamento
20.
J Appl Physiol (1985) ; 131(1): 356-368, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34080918

RESUMO

Exposure to axial unloading induces adaptations in paraspinal muscles, as shown after spaceflights. This study investigated whether daily exposure to artificial gravity (AG) mitigated lumbar spine flattening and muscle atrophy associated with 60-day head-down tilt (HDT) bed rest (Earth-based space analog). Twenty-four healthy individuals participated in the study: 8 received 30-min continuous AG; 8 received 6 × 5-min AG interspersed with rest periods; and 8 received no AG exposure (control group). Magnetic resonance imaging (MRI) of the lumbopelvic region was conducted at baseline (BDC) and at day 59 of HDT (HDT59). Longitudinal relaxation time (T1)-weighted images were used to assess morphology of the lumbar spine (spinal length, intervertebral disk angles, disk area) and volumes of the lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles from L1/L2 to L5/S1 vertebral levels. A chemical shift-based two-point lipid/water Dixon sequence was used to evaluate muscle composition. Results showed that spinal length and disk area increased (P < 0.05); intervertebral disk angles (P < 0.05) and muscle volumes of LM, LES, and QL reduced (P < 0.01); and lipid-to-water ratio for the LM and LES muscles increased (P < 0.01) after HDT59 in all groups. Neither of the AG protocols mitigated the lumbar spinae deconditioning induced by HDT bed rest. The increase in lipid-to-water ratio in LM and LES muscles indicates an increased relative intramuscular lipid concentration. Altered muscle composition in atrophied muscles may impair lumbar spine function after body unloading, which could increase injury risk to vulnerable soft tissues. This relationship needs further investigation.NEW & NOTEWORTHY This study presents novel insights into the morphological adaptations occurring in the lumbar spine after 60-day head-down bed rest and the potential role of artificial gravity (AG) to mitigate them. Results demonstrated no protective effect of AG protocols used in this study. In atrophied paraspinal muscles, the ratio of lipids versus intramuscular water increased in the postural lumbar muscles, which could impair muscle function during upright standing. These findings have relevance for future space explorations.


Assuntos
Repouso em Cama , Gravidade Alterada , Repouso em Cama/efeitos adversos , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral , Imageamento por Ressonância Magnética , Atrofia Muscular/etiologia
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