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Objective:To systematically evaluate whether the early use of bracing after posterior lumbar fusion has advantages in terms of the improvement of clinical outcomes such as pain, functional disability, fusion rate, and complication rate in patients with lumbar degenerative diseases.Methods:All randomized controlled trials of bracing performed after posterior lumbar fusion in patients with lumbar degenerative diseases were searched in Pubmed, Web of Science, Embase, China national knowledge infrastructure (CNKI) and Wanfang database from January 1990 to May 2022. The data extracted were authors, year of publication, nationality, subject characteristics, sample size, surgical protocol, type and time of bracing, follow-up duration, preoperative and postoperative Oswestry disability index (ODI) and visual analogue scale (VAS), postoperative fusion rate and complication rate. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. The use of fix- or random-effect models was depended on the magnitude of heterogeneity. Data analysis was performed using Stata 17.0 statistical software for meta analysis.Results:A total of five randomized controlled trials were included, all in English, with a total of 362 patients (male 144, female 218). The results of meta-analysis showed that there was no statistically significant difference in the improvement of ODI scores [ MD=1.25, 95% CI(-2.39, 4.88), P=0.501]and VAS scores[ MD=0.21, 95% CI(-0.22, 0.63), P=0.340]between the brace group and the control group after operation. In terms of fusion rate, there was no significant difference between the brace group and the control group[ OR=0.59, 95% CI(0.25, 1.38), P=0.224]. In addition, there was also no significant difference in the incidence of postoperative complications between two groups[ OR=1.12, 95% CI(0.58, 2.15), P=0.735]. Conclusion:The early use of bracing after lumbar fusion has no significant advantages in improving symptoms and functional recovery, fusion rate and surgical complications. The necessity of postoperative bracing after posterior lumbar fusion requires further high-quality research to prove.
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Objective To qualitatively analyze the main chemical components in compound Jinqiancao granules by ultra high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS). Methods XBridge BEH C18 column (2.1 mm×100 mm, 2.5 µm) was used for chromatographic separation. The mobile phase was composed of 0.1% formic acid water and 0.1% formic acid-acetonitrile, gradient elution, and the flow rate was 0.4 ml/min. Mass spectrometry was characterized by Quadrupole time-of-flight mass spectrometry (Q-TOF/MS) and positive ion mode scanning. Results Under the optimized LC/MS condition, 47 components in compound Jinqiancao granules were identified. The isomers were distinguished by software calculation. The source of medicinal materials was assigned. Conclusion A rapid and efficient analytical method was established for the identification of chemical components in compound Jinqiancao granules by UHPLC-Q-TOF/MS.
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Objective:To explore the predictive value of vertebral trabecular and endplate HU values on cage subsidence after posterior lumbar interbody fusion (PLIF), hope to provide reference for surgical planning.Methods:All of 72 patients with lumbar disc herniation that underwent PLIF were retrospectively reviewed, who were divided into two groups according to the occurrence of cage subsidence at one-year follow up. Cage subsidence was defined as more than 4 mm subsidence into the vertebrae valuated by CT at one-year follow up. There were 18 patients enrolled into Subsidence group and 54 patients enrolled into N-Subsidence group. The lumbar lordosis, segmental lordosis, intervertebral height, off-bed time, hospital stay, complications, the trabecular and endplate HU values of upper instrumented vertebrae (UIV) and lower instrumented vertebrae (LIV) were compared between the two groups. ROC was used to explore the thresholds of HU values.Results:There were 14 patients presented cage subsidence into the L4, 4 patients presented cage subsidence into the L5. There was no significant difference in lumbar lordosis, segmental lordosis, intervertebral height, off-bed time, hospital stay, or complications between the two groups. Both UIV and LIV trabecular and endplate showed a lower HU value in Subsidence group than those in N-Subsidence group. The most appropriate thresholds of HU value were 146, 172, 307, 254 for trabecular of UIV, trabecular of LIV, lower endplate of UIV, and upper endplate of LIV, respectively.Conclusion:Vertebral trabecular and endplate HU values could effectively predict the cage subsidence after PLIF, patients should be completely informed the risk of cage subsidence and larger cage should be recommended if they presented HU values under the certain threshold.
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Objective: To analyze the prospective effect of pre-existing spinal stenosis of adjacent segment on the short-term effectiveness after lumbar fusion surgery. Methods: A prospective comparative study was conducted to divide 183 patients with L 4-S 1 lumbar spinal stenosis who met the selection criteria between July 2015 and December 2017 into two groups according to the status of adjacent segment degeneration (ASD) judged by preoperative disc degeneration and spinal stenosis. There were 98 patients in group A (no degeneration of adjacent segments before operation) and 85 patients in group B (adjacent segments degenerated before operation). There was no significant difference in gender, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), combined spondylolisthesis, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) score between the two groups ( P>0.05); the age of group A was significantly younger than that of group B ( t=-3.560, P=0.000). The operation time, intraoperative blood loss, hospitalization stay, and perioperative complications were recorded and compared. The VAS score of low back pain and leg pain, JOA score, and ODI score at last follow-up were used to evaluate the effectiveness. The incidence of ASD after operation was compared between the two groups, and logistic regression was used to analyze the independent risk factors affecting the occurrence of ASD after operation. Results: There was no significant difference in operation time, intraoperative blood loss, and hospitalization stay between the two groups ( P>0.05). The incidence of perioperative complications in groups A and B was 13.3% and 20.0%, respectively, with no significant difference ( χ2=1.506, P=0.220). Two groups of patients were followed up, the follow-up time of groups A and B was (24.9±8.8) months and (24.8±7.8) months, respectively, there was no significant difference ( t=0.050, P=0.960). At last follow-up, no adjacent segment disease was found in either group. There was no significant difference in Pfirrmann grade between the two groups at last follow-up ( P>0.05), and there was significant difference in Pfirrmann grade between the two groups before operation and at last follow-up ( P<0.001). At last follow-up, 21 cases (21.4%) in group A and 53 cases (62.4%) in group B had ASD, with significant difference ( χ2=31.652, P=0.000). The main cause of ASD was the severity of adjacent spinal canal stenosis. The clinical scores of the two groups at last follow-up were significantly improved when compared with those before operation ( P<0.05). The JOA score of group A was significantly higher than that of group B at last follow-up ( P<0.05). In group B, the VAS score of low back pain and ODI score in patients with ASD after operation at last follow-up were significantly higher than those in patients without ASD ( P<0.05). logistic regression analysis showed that preoperative pre-existing degeneration and BMI were independent risk factors for ASD after operation ( P<0.05). Conclusion: Pre-existing mild spinal stenosis in adjacent segment can significantly affect the effectiveness, and can significantly increase the risk of ASD early after operation. The main pathological type of ASD was the severity of adjacent segment spinal stenosis. For preoperative assessment of pre-existing degeneration, we should evaluate the overall degeneration of the adjacent segment of the spinal canal, rather than simply evaluating the degeneration of the adjacent disc and facet joints.
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STUDY DESIGN: A prospective imaging study. PURPOSE: To characterize the distribution of the global sagittal postural patterns in asymptomatic Chinese adults using Roussouly classification. OVERVIEW OF LITERATURE: The norms of sagittal parameters in asymptomatic Chinese population have been previously described, but no report described their global sagittal postural patterns as characterized by Roussouly classification. METHODS: A cohort of 272 asymptomatic Chinese adults was recruited. Data was assimilated by reviewing the films for each subject. Sagittal parameters were measured and sagittal postural patterns were then determined according to Roussouly classification. The pattern distributions were compared across genders within the study cohort. We also compared the data across different ethnicities from our study and a previous study to further characterize Chinese sagittal postures. RESULTS: The cohort included 161 males and 111 females, with mean age of 23.2±4.4 years. The average descriptive results were as below: pelvic incidence (PI) 46.4°±9.6°, thoracic kyphosis (TK) 24.2°±9.0°, lumbar lordosis (LL) 50.6°±10.6°, sacral slope (SS) 37.2°±7.6°, pelvic tilt (PT) 9.4°±6.8°, spinosacral angle (SSA) 131.1°±7.5° and sagittal vertical axis (SVA) 17.24±32.36 mm. Despite a significant difference between two genders in LL, PI, SSA, and SVA, no difference was found in the distribution of Roussouly types among them. 47.8% of our cohort belonged to Roussouly type 3, while type 1, 2 and 4 comprised 23.2%, 14.0% and 15.1% of the subjects, respectively. Roussouly classification was capable of categorizing sagittal parameters except for the PT. This study also found that 4.4% of the recruited subjects belonged to the C7-anterior subgroup. CONCLUSIONS: From a characterization of the sagittal postural patterns of asymptomatic Chinese adults using Roussouly classification, the distribution was similar between Chinese males and females; however, from a cross-study comparison, it was different between asymptomatic Chinese and Caucasian adults, with a higher proportion of Roussouly type 3 in Chinese adults.
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Adult , Animals , Female , Humans , Male , Asian People , Axis, Cervical Vertebra , Classification , Cohort Studies , Incidence , Kyphosis , Lordosis , Posture , Prospective StudiesABSTRACT
<p><b>BACKGROUND</b>For young patients, the surgical method for lumbar disc herniation remains controversial. The aim of this study was to prospectively determine the short-term clinical outcome after surgery for young patients with lumbar disc herniation.</p><p><b>METHODS</b>In this prospective comparative study between April 2010 and August 2011, a total of 80 patients underwent primary surgery at a single level for lumbar disc herniation. The patients were divided into two groups: decompression alone and decompression with instrumented fusion. An independent examiner clinically evaluated the patients at preoperation and at 1, 3, 6, and 12 months after surgery. The patients filled out the instruments for back and leg pain using a Visual Analog Scale (VAS), Oswestry Low Back Pain Disability Questionnaire (ODI), and Japanese Orthopaedic Association (JOA) scores. The differences between the two groups were analyzed.</p><p><b>RESULTS</b>The mean age of all the patients at the time of surgery was 33.7 years. Of the 80 patients, 38 patients underwent decompression alone and 42 patients underwent posterior lumbar interbody fusion. Increasing complexity of surgery was associated with a longer surgery time, greater blood loss, and a longer hospital stay after surgery. Both methods of surgery independently improved outcomes compared with baseline status based on VAS, ODI, and JOA scores (P < 0.05), and no significant differences were found between the two groups at most of the measuring points in time, although patients with decompression alone had a higher JOA score (P = 0.016) and higher JOA recovery rate (P = 0.010) at the 3-month follow-up.</p><p><b>CONCLUSIONS</b>The short-term results of our study showed that both methods of surgery obtained effective clinical outcomes, but decompression alone had some advantages (shorter surgery time, less blood loss, shorter hospital stay, and lower cost) compared with decompression with instrumented fusion. Young patients with decompression alone could achieve great physical function earlier.</p>
Subject(s)
Adult , Female , Humans , Male , Decompression, Surgical , Intervertebral Disc Displacement , General Surgery , Lumbar Vertebrae , General Surgery , Prospective Studies , Spinal Fusion , Treatment OutcomeABSTRACT
Objective To describe sagittal pelvic pattern,and to analyze sagittal spino-pelvic alignment in asymptomatic Chinese adults.Methods This was a prospective radiological analysis.Anteroposterior and lateral radiographs of the whole spine were taken in 139 Chinese volunteers,including 94 males and 45 females,aged from 21 to 28 years (average,23.5±1.5 years).By using picture archiving and communication systems,several pelvic and spinal parameters (pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,thoracic kyphosis,cervical lordosis,sagittal vertical axis,apex of total lumbar lordosis,total lumbar lordosis,upper arc of total lumbar lordosis,lower arc of total lumbar lordosis,junctional level,apex of total thoracic kyphosis,total thoracic kyphosis,total cervical lordosis,and lordosis tilt) were measured and the correlations of all parameters were analyzed.Results The mean value of pelvic incidence was 45.1°±9.6°,which was significantly less than those reported in western and Korean subjects.Total lumbar lordosis has a significant correlation with pelvic incidence,sacral slope,total thoracic kyphosis,cervical lordosis and sagittal vertical axis.The sagittal lumbar-pelvic alignment was classified into 4 types according to position of apex of total lumbar lordosis:type Ⅰ (11 cases),the apex was located in L5 or intervertebral space between L4 and L5; type Ⅱ (61 cases),the apex was located in bottom or middle of L4; type Ⅲ (33 cases),the apex was located in upper part of L4 or in intervertebral space between L3 and L4; type Ⅳ (34 cases),the apex was located at L3 level or more high level.Conclusions The sagittal pelvic pattern of Chinese adults is significantly different from those of western and Korean.Lumbar lordosis plays a critical role in regulating spinal sagittal balance.With upper shift of apex of total lumbar lordosis,the lower lumbar lordosis angle and sacral slope increase,but the lordosis tilt decreases.