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3.
Neurol India ; 69(5): 1196-1199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747783

RESUMO

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


Assuntos
Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Espondilolistese/cirurgia , Resultado do Tratamento
4.
Medicina (Kaunas) ; 57(11)2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34833488

RESUMO

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


Assuntos
Estenose Espinal , Espondilolistese , Descompressão , Humanos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Resultado do Tratamento
5.
BMC Musculoskelet Disord ; 22(1): 920, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34724945

RESUMO

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


Assuntos
Parafusos Pediculares , Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Fusão Vertebral/efeitos adversos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
6.
Zhongguo Gu Shang ; 34(11): 1016-9, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34812017

RESUMO

OBJECTIVE: To investigate the effect and correlation of spinopelvic sagittal parameters and facet joint angle on degenerative lumbar spondylolisthesis. METHODS: From July 2016 to September 2019, a total of 120 patients with L4-L5 single segment degenerative spondylolisthesis were selected as observation objects (spondylolisthesis group), and 120 patients with L4-L5 single-segment degenerative spinal stenosis matched by gender and age were selected as the control group. The following parameters were measured by imaging data:pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA), L4-L5 cephalic facet joint angle, caudal facet joint angle and facet asymmetry.The differences of parameters between the two groups were compared and the meaningful parameters were analyzed by Logistic regression. The correlations between facet joint direction and spinopelvic parameters in patients with degenerative lumbar spondylolisthesis were analyzed. RESULTS: There were significant differences in PI, PT, LL, SVA, cephalic facet angle and caudal facet angle between two groups (P<0.05). Logistic regression analysis showed that PI, PT and cephalic facet joint angle were the risk factors for lumbar spondylolisthesis (P<0.05). The sagittal of the cephalic facet joint in spondylolisthesis group was significantly correlated with PI and PT(P<0.05). CONCLUSION: High PI, PT and sagittal of cephalic facet joint are the risk factors for lumbar spondylolisthesis, and the sagittal degree of facet joints is closely related to high PI and PT.


Assuntos
Espondilolistese , Articulação Zigapofisária , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem
7.
Ann Palliat Med ; 10(9): 9848-9858, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628911

RESUMO

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


Assuntos
Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Espondilolistese/cirurgia , Resultado do Tratamento
8.
BMC Musculoskelet Disord ; 22(1): 879, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34649557

RESUMO

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


Assuntos
Lordose , Procedimentos Cirúrgicos Reconstrutivos , Fusão Vertebral , Espondilolistese , Fenômenos Biomecânicos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
9.
BMC Musculoskelet Disord ; 22(1): 850, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34615516

RESUMO

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


Assuntos
Parafusos Pediculares , Espondilolistese , Humanos , Qualidade de Vida , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
10.
Orthop Surg ; 13(7): 2093-2101, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34596342

RESUMO

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


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Parafusos Pediculares , Estudos Retrospectivos
11.
J Pediatr Orthop ; 41(10): 591-596, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34516471

RESUMO

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


Assuntos
Parafusos Pediculares , Fusão Vertebral , Espondilolistese , Adolescente , Criança , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
12.
JNMA J Nepal Med Assoc ; 59(236): 402-405, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508540

RESUMO

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


Assuntos
Fraturas da Coluna Vertebral , Espondilolistese , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Humanos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Espondilolistese/cirurgia
13.
Orthopedics ; 44(5): 306-312, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34590958

RESUMO

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


Assuntos
Cistos , Fusão Vertebral , Espondilolistese , Idoso , Idoso de 80 Anos ou mais , Descompressão , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Resultado do Tratamento
14.
Sci Rep ; 11(1): 17519, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34471158

RESUMO

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


Assuntos
Densidade Óssea , Parafusos Ósseos/efeitos adversos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Espondilolistese/cirurgia , Análise de Falha de Equipamento , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Estudos Retrospectivos , Espondilolistese/patologia , Taiwan/epidemiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Orthop Surg ; 13(7): 1960-1968, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34516712

RESUMO

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


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos/métodos , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
16.
Spine (Phila Pa 1976) ; 46(18): 1218-1225, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34435984

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare the clinical outcomes 5 years after minimally invasive posterior decompression for lumber spinal stenosis (LSS) between patients with and without degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: Indications for surgical procedures for patients with LSS and DS are still under investigation. Since minimally invasive surgery does not affect most anatomical structures, preoperative DS may not negatively affect the clinical outcomes of minimally invasive posterior decompression. METHODS: Overall, 198 patients with LSS who underwent microendoscopic or microscopic decompression and were followed up for more than 5 years postoperatively were included in the present study. Patients who showed a segmental kyphosis >5° at the surgical level during flexion were treated with fusion surgery. However, other patients, including those with DS, were treated with posterior decompression. The patients were divided into two groups: the DS group included 82 patients with >3-mm slip and the non-DS group included 112 patients with ≤3-mm slip or without slip. A mixed-effects model adjusted for age and sex was used to compare the improvements in the visual analog scale score for low-back pain and the Japanese Orthopaedic Association score of the two groups. For subgroup analysis (n = 53), the changes in the preoperative physical component summary and the mental component summary of Short Form-36 of the two groups at 5 years after surgery were evaluated. RESULTS: There was no significant difference in the improvement of preoperative low-back pain visual analog scale score and Japanese Orthopaedic Association score 5 years after surgery between the two groups. Subgroup analysis showed no significant difference between the two groups in the improvement of preoperative physical component summary and mental component summary 5 years after surgery. CONCLUSION: After carefully eliminating patients with segmental instability, DS did not affect the clinical outcomes of minimally invasive decompression surgery.Level of Evidence: 3.


Assuntos
Estenose Espinal , Espondilolistese , Descompressão Cirúrgica , Humanos , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Resultado do Tratamento
17.
J Clin Neurosci ; 91: 152-158, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34373021

RESUMO

The objectives of this study were to (a) develop a standing MRI imaging protocol, tolerable to symptomatic patients with degenerative spondylolisthesis (DLS), and (b) to evaluate the morphometric changes observed in DLS patients in both supine and standing postures. Patients with single level, Meyerding grade 1 DLS undergoing surgery at a single institution between November 2015 to May 2017 were consented. Patients were imaged in the supine and standing positions in a 0.5 T vertically open MRI scanner (MROpen, Paramed, Genoa, Italy) with sagittal and axial T2 images. The morphometric parameters measured were: cross-sectional area of the thecal sac (CSA), lateral recess height, disc height, degree of anterolisthesis, disc angle, lumbar lordosis, the presence of facet effusion and restabilization signs. Measures from both postures were compared using paired T-test. Associations of posture with the magnitude of change in the various measurements was determined using Pearson correlation or paired T-test when appropriate. All fourteen patients (mean age 64.4 years) included tolerated standing for the time required for image acquisition. All measurements with the exception of lumbar lordosis and disk height showed a statistically significant difference between the postures (p < 0.05). In the standing position, CSA and lateral recess height were reduced by 28% and 50%, respectively. There was no relationship between the change in CSA of the thecal sac and any measures. Standing images acquired in an upright MRI scanner demonstrated postural changes associated with Meyerding grade 1 DLS and images acquisition was tolerated in all patients.


Assuntos
Espondilolistese , Posição Ortostática , Humanos , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Projetos Piloto , Espondilolistese/diagnóstico por imagem
18.
Orthopade ; 50(10): 866-870, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34402943

RESUMO

Anterior column support in posterior lumbar fusion surgery is essential for the outcome of the operation, particularly in the case of unstable pathologies such as spondylolisthesis or spondylodiscitis. The complicated case of a patient with simultaneous spondylolisthesis and spondylodiscitis is presented and reevaluated based on the literature and our own treatment algorithm. In the case of spondylodiscitis alone, iliac crest interposal is sufficient as a support. In the case of additional disturbances of the sagittal profile, a cage implantation is preferred.


Assuntos
Discite , Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Resultado do Tratamento
19.
Bratisl Lek Listy ; 122(9): 653-656, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34463112

RESUMO

BACKGROUND: Lumbar spondylolisthesis is a relatively common cause of low back and lower extremity pain. The most common type, degenerative lumbar spondylolisthesis (DLS), is a disease that causes stenosis of the spinal canal. Two surgical methods of treatment are widely accepted, namely posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). MATERIALS AND METHODS: Between 2015 and 2017, the findings of 333 consecutive DLS patients who underwent surgical decompression with instrumented fusion were analyzed in a prospective study at the Department of Neurosurgery University Hospital and Faculty of Medicine at Safarik University in Kosice. The PLIF and TLIF procedures were performed in 214 and 119 patients, respectively. The clinical results and quality of life were compared. RESULTS: In comparison with PLIF, the TLIF procedures show better results as to the mean time of surgery (118.61±24.74 vs 147.56±38.62 min), blood loss (271.74±104.45 vs 361.23±142.78ml) and number of blood transfusions (6 vs 38); p=0.015, p=0.023, and p=0.001, respectively. PLIF and TLIF groups were compared as to the number of cases with nerve root injuries (14 vs 2), dural tear (17 vs 3), wound infections (8 vs 3) and reoperations (15 vs 2); p=0.04, p=0.04, p=0.55 and p=0.03, respectively. The quality of life at follow-up examinations significantly improved as measured with VAS and ODI (p=0.001). CONCLUSION: This research found that both surgical techniques, TLIF and PLIF, are suitable for DLS treatment. The two methods differed in postoperative complications which were less frequent in TLIF. There were no significant differences in the postoperative quality of life (Tab. 5, Ref. 19). Text in PDF www.elis.sk.


Assuntos
Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/cirurgia , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Espondilolistese/cirurgia , Resultado do Tratamento
20.
Sci Rep ; 11(1): 16472, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389750

RESUMO

Tantalizing connections between type 2 diabetes and degenerative lumbar spine disorders have become increasingly evident. However, the association of type 2 diabetes with degenerative lumbar spine disorders remains unclear. We sought to clarify the association between type 2 diabetes and lumbar spine disorders using nationwide data in Korea. Furthermore, we explored the association of diabetes with the prevalence of spinal procedures. The data in this study was obtained from Korean health claim database. Between 2016 and 2019, totals of 479,680 diabetes and 479,680 age- and sex-matched control subjects were enrolled. Patients with diabetes had more likely to have degenerative lumbar spine disorders and spinal procedures than controls. Using multivariate-adjusted analysis, patients with diabetes were at increased risk of being concomitantly affected by lumbar disc disorder [adjusted odds ratio 1.11 (95% confidence interval 1.10-1.12)], lumbar spondylotic radiculopathy [1.12 (1.11-1.13)], spondylolisthesis [1.05 (1.02-1.08)] and spinal stenosis [1.16 (1.15-1.18)], compared to controls. Furthermore, diabetic patients had an increased risk of undergoing lumbar spinal injection [1.13 (1.12-1.14)], laminectomy [1.19 (1.15-1.23)], and fusion surgery [1.35 (1.29-1.42)]. We demonstrated that type 2 diabetes was significantly associated with lumbar spine disorders and frequent spinal procedures. Our results suggest diabetes as a predisposing factor for lumbar spine disorders.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Vértebras Lombares , Doenças da Coluna Vertebral/etiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Degeneração do Disco Intervertebral/etiologia , Degeneração do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Radiculopatia/etiologia , Radiculopatia/patologia , Fatores de Risco , Doenças da Coluna Vertebral/patologia , Estenose Espinal/etiologia , Estenose Espinal/patologia , Espondilolistese/etiologia , Espondilolistese/patologia , Adulto Jovem
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