The Evidence for Nonoperative Treatment of Lumbar Spinal Diseases

STUDY DESIGN: Review article.OBJECTIVES: To assess the evidence for nonoperative treatment of various degenerative spinal degenerative diseases.SUMMARY OF LITERATURE REVIEW: No study has yet evaluated the evidence for preoperative nonoperative treatment of lumbar spinal diseases.METHODS: The evidence regarding nonoperative treatment for each disease was reviewed through NASS guidelines, and the treatment effect compared to surgical treatment was reviewed through the SPORT series. The efficacy of nonoperative treatment according to disease severity and certain special conditions was investigated through corresponding individual articles.RESULTS: No kind of nonoperative treatment could change the fundamental progression of degenerative spinal disease. The natural course of lumbar disc herniation is favorable regardless of treatment. More than 70% of routine cases improve within 6 weeks. However, it does not take a full 6 weeks to decide whether to perform surgery or not. The evidence for transforaminal epidural steroid injections for short-term pain control is grade A. There is grade B evidence for nonoperative treatment with the goal of mid- to long-term pain control. However, we cannot say that those outcomes are better than the natural course of the disease itself. In cases of radicular weakness, the degree of weakness is correlated with the final outcomes, but it is not evident whether the duration of weakness is correlated with surgical outcomes. Early surgery is usually necessary due to intolerable pain, rather than stable motor weakness. The social cost of herniated discs arises from the loss of patients’ productivity, rather than from direct medical expenses. The natural course of spinal stenosis involves provoked pain and the need for palliative care. Unlike disc herniation, rapid deterioration and marked improvement do not occur. The symptoms of mild to moderate lumbar stenosis are unchanged in 70% of cases, improve in 15%, and worsen in 15%. No study has compared nonoperative treatment with the natural course of the disease. There is no evidence for nonoperative treatment of severe stenosis. Epidural spinal injections are effective for controlling short-term pain. Spontaneous recovery of radicular weakness does not occur, and urgent surgery is necessary in such cases. There is no evidence regarding the natural course and nonoperative treatment of degenerative spondylolisthesis. The working group consensus recommends that it should follow the pattern of nonoperative treatment of spinal stenosis when radicular stenosis symptoms are predominant. Overall, 40%–66% of cases of adult bilateral isthmic spondylolysis progress to symptomatic spondylolisthesis. No studies have investigated nonoperative treatment except physical exercise.CONCLUSIONS: Although short-term symptom amelioration can be achieved by nonoperative treatment, the fundamental progression of the disease is not affected. For conditions excluded from most studies, such as prior spine surgery, cauda equina syndrome, progressive neurological deficit, and uncontrollable severe pain associated with instability, deformity, or vertebral fractures, there were not enough studies to reach informed conclusions. Our review found no evidence regarding nonoperative treatment for such conditions. Furthermore, the treatment methods for each disease are not clearly distinguished from each other, and the techniques used for disc herniation have been applied to other diseases without any evidence.

Management of Elderly Patients with Spinal Disease: Interventional Nonsurgical Treatment / 대한정형외과학회잡지

Owing to the upward shift in age structure, there is an increasing number of spinal diseases specific to elderly patients. Elderly spinal patients typically have a poor general condition with several medical comorbidities, low bone mineral density, more extensive and severe degeneration, and less effective treatment outcomes than young patients. This is why spinal physicians need to establish interventional nonsurgical treatment modalities for elderly patients with spinal disease. The objective of this study was to define the spinal disorders problematic to elderly patients and discuss the nonsurgical treatments for each subject.

Incidence of the adjacent segment disease treated at the issemym medical center / Incidência da doença do segmento adjacente tratada no centro médico issemym / Incidencia de la enfermedad del segmento adyacente tratada en el centro médico issemym

ABSTRACT Objective: To determine the incidence and rate of disc degeneration adjacent to a lumbar fusion, as well as to analyze possible risk factors for its development. Methods: A retrospective study of a level of evidence IIB case series of 125 patients diagnosed with lumbar canal stenosis and spondylolisthesis, who underwent surgery from January 2011 to December 2016, with subsequent instrumentation and posterolateral fusion and outpatient follow-up in which the symptomatology and radiographic findings were evaluated to establish the diagnosis and management. Results: Twelve patients with adjacent segment disease were identified, with an incidence of 9.6%, higher both among female patients and in the seventh decade of life. The most frequent pathology was canal stenosis (42.4%), the most affected level was L4 / L5, and the procedure most associated with the prevalence of adjacent level degeneration was L4-L5 posterior transpedicular instrumentation. Conclusions: Sagittalization of the facet joint was a constant factor in all patients with involvement of the adjacent disc. The main clinical findings were treatment-resistant root pain and radiographic alterations characterized by spondylolisthesis, facet osteoarthritis and intervertebral disc herniation. Level of Evidence IIB; Retrospective study.

RESUMO Objetivo: Determinar a incidência e a taxa de degeneração do disco adjacente, bem como analisar possíveis fatores de risco de degeneração do disco adjacente à fusão lombar. Métodos: Foi realizado um estudo retrospectivo de série de casos com nível de evidência IIB, com uma amostra de 125 pacientes com diagnóstico de estenose de canal lombar e espondilolistese, que foram operados no período de janeiro de 2011 a dezembro de 2016, com instrumentação posterior e fusão posterolateral e acompanhamento ambulatorial, no qual se avaliou a sintomatologia e os achados radiográficos para estabelecer o diagnóstico e o tratamento. Resultados: Foram identificados 12 pacientes com doença do segmento adjacente, com incidência de 9,6%, com maior frequência no sexo feminino e na sétima década de vida. A patologia mais frequente foi estenose do canal (42,4%). O nível mais afetado foi L4/L5, e o procedimento mais relacionado com a prevalência do nível adjacente foi a instrumentação transpedicular posterior em L4/L5. Conclusões: A sagitalização das facetas articulares tem sido um fator constante em todos os pacientes, com envolvimento do disco adjacente. Os principais achados clínicos são dor radicular resistente ao tratamento e alterações radiográficas caracterizadas por espondilolistese, artrose facetária e hérnia de disco intervertebral. Nível de Evidência IIB; Estudo retrospectivo.

RESUMEN Objetivo: Determinar la incidencia y tasa de degeneración del disco adyacente, así como analizar posibles factores de riesgo de desarrollar degeneración del disco adyacente a una fusión lumbar. Métodos: Se realizó un estudio retrospectivo de serie de casos con nivel de Evidencia IIB, con una muestra de 125 pacientes con diagnósticos de canal lumbar estrecho y espondilolistesis, intervenidos quirúrgicamente en el periodo de enero del 2011 a diciembre del 2016, con instrumentación posterior y fusión posterolateral, con seguimiento en consulta externa en el cual se evaluó la sintomatología y hallazgos radiográficos para establecer el diagnóstico y manejo. Resultados: Se identificaron 12 pacientes con enfermedad del segmento adyacente. Con una incidencia de 9,6%, con mayor incidencia en el sexo femenino y mayor incidencia en la séptima década de la vida. La patología más frecuente ha sido la estenosis de canal (42,4%). El nivel de mayor afectación fue en L4/L5, y el procedimiento más relacionado con la prevalencia de nivel adyacente fue la instrumentación posterior transpedicular L4/L5. Conclusiones: La sagitalización de las facetas articulares ha sido un factor constante en todos los pacientes, con afectación del disco adyacente. Los principales hallazgos clínicos son dolor radicular resistente al tratamiento y alteraciones radiográficas caracterizadas por espondilolistesis, artrosis facetaria y hernia de disco intervertebral. Nivel de Evidencia IIB; Estudio retrospectivo.

High cervical spine spondylodiscitis management and literature review / Espondilodiscite da coluna cervical alta: manejo e revisão da literatura

Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

Resumo A espondilodiscite, que acomete a coluna cervical, é a de localização mais rara. Pode ter uma evolução dramática, inclusive causando tetraplegia e óbito. Apresentamos um caso atípico que evoluiu com lesões osteolíticas entre C2 e C3, causando compressão medular e abscesso epidural. O paciente foi submetido a tratamento cirúrgico por dupla abordagem e evoluiu bem, sem déficits neurológicos e com melhora dos marcadores inflamatórios. Revisamos a literatura vigente sobre o assunto.

The observation of curative effect of transcranial direct current stimulation on the treatment of pain after lumbar fusion operation / 天津医药

Objective To observe the clinical efficacy of transcranial direct current stimulation (tDCS) in the treatment of pain after lumbar fusion operation. Methods Patients underwent lumbar fusion surgery in the Department of Minimally Invasive Spine Surgery, Tianjin Hospital from January 2016 to December 2016 were retrospective analyzed. They were divided into tDCS group and control group according to the postoperative analgesic strategies. Patients in tDCS group were given flurbiprofen injection combined with tDCS to control postoperative pain, and morphine was used if necessary. The control group was only given flurbiprofen injection combined with morphine analgesia to manage postoperative pain. The data of preoperative and postoperative pain visual analogue score (VAS), oswestry disability index (ODI), opioid analgesics usage and complications before and after operation were recorded. Results Forty-two patients were included in this study. There were 22 patients in tDCS group with the mean age (56.7±10.5) years, and 20 in control group with the mean age (60.3± 9.2) years. There were no significant differences in preoperative VAS and ODI scores between two groups. The VAS and ODI scores at postoperative 24 h and hospital discharge significantly improved in two groups compared with preoperative data. Data of postoperative 24 h VAS score (2.0 ± 1.7), VAS score (2.1 ± 0.9) and ODI score (20.9 ± 6.5) at hospital discharge were significantly lower in tDCS group than those in control group (3.3 ± 1.4, 2.9 ± 1.3 and 25.4 ± 5.3). The dosage of opioid medication use in controlling postoperative pain was reduced about 25％ in tDCS group (P < 0.01). The complications reported in tDCS group included itching under the electrodes, pain, scorching hot and stinging. Conclusion The use of tDCS after lumbar fusion operation can decrease the pain sensation, reduce the usage of opioids, promote the rehabilitation and with no increasing the incidence of related complications, which has the potential probability to replace opioids for chronic pain.

Risk Factors for Proximal Junctional Kyphosis / 中国康复理论与实践

Objective To investigate the risk factors of proximal junctional kyphosis (PJK) after posterior long segmental lumbar fusion for degenerative lumbar disease. Methods From October, 2012 to July, 2014, 118 degenerative lumbar disease patients who accepted posteri-or long segmental fusion and followed up at least 1.5 years were reviewed. All the PJK were evaluated with X-ray. Results Sixty-six pa-tients completed the follow-up (mean of 3.2 years), in which 12 patients with PJK (PJK group), and the others without (non-PJK group, n=54). There was significant difference in body mass index, bone density and the last Oswestry Disability Index scores (t>2.194, P3.862, P10° (OR=5.789, 95%CI:1.075~31.183) were the independent risk factors of PJK. Conclusion Osteoporosis, UIV located in the thoracolumbar segment (T11-L1) and the pre-surgery PJK angle>10° are risk factors of PJK af-ter posterior long segmental lumbar fusion.

Surgical Outcome Predictor in Degenerative Lumbar Spinal Disease Based on Health Related Quality of Life Using Euro-Quality 5 Dimensions Analysis

PURPOSE: We aim to introduce the predictive value of a quantitatively described formula model in a multicenter prospective analysis using the EuroQol-5 dimensions (EQ-5D) health scale to anticipate postoperative improvement in patients with degenerative lumbar spine disease (DLSD). MATERIALS AND METHODS: Quality of life was evaluated in 376 patients from 17 tertiary hospitals before and after spinal decompression and fusion surgery. The five items of the EQ-5D, mobility (M), self-care (S), usual activities (A), pain/discomfort (P), and anxiety/depression (D), were checked as level 1, 2, or 3, with 3 being the worst. A minimal significant change in the calculated EQ-5D (cEQ-5D) was set as 0.05. Logistic regression analysis was performed to predict the highest successful outcome (cEQ-5D improvement after operation >0.05) with the given sets of 5 items of the EQ-5D. RESULTS: In the cEQ-5D analysis, among patients with a formula score of S+A+2×P+D≤8, 18/68 (27%) showed significant improvement in the cEQ-5D at 1 year postoperatively (p<0.05). However, in patients with a formula score of ≥9, 265/308 (86%) demonstrated significant improvements in the cEQ-5D at 1 year postoperatively (p<0.05). CONCLUSION: We suggest that S+A+2×P+D≥9 in the EQ-5D can quantitatively describe the better surgical outcome predictors for DLSD. With a definite DLSD lesion confirmed by an imaging study, patients who meet the formula scores of 9 or over and have refractory symptoms to non-operative treatment could be better surgical candidates resulting in satisfactory surgical outcomes of over 86%, than those who scored 8 or lower.

Application of multi-slice CT in measurement of morphological parameters of waist muscle and its clinical significance / 吉林大学学报(医学版)

Objective To investigate the changes of waist muscle density and area in the subjects with spiral CT scan examination,and through the quantitative analysis of different age and gender to get the degree of lumbar muscle degeneration.Methods 240 cases of lumbar CT scan reconstruction images (including the patients suffering from low back pain)were collected.According to the age,20 - 29 years old group,30 - 39 years old group,40 -49 years old group,50-59 years old group,60-69 years old group,and 70-79 years old group were set up.The lumbar transverse psoas muscle,lumbar side muscle,erector spinae cross-sectional areas (CSA)and mean CT values were measured at different levels.Scanning equipment:Toshiba Activion 16-slice spiral CT scanners, acquisition range from the waist 1 to S1.Results ①Compared between the measurement results of the same age groups (except 70-79 years old group),the average CSA of the male at the same level waist was higher than the female (P 0.05).Compared between the same level groups of 50-59 years,60-69 years and 70-79 years,there was no significant difference (P >0.05).③Compared the CSA of man’s erector spinae muscle between 40-49 years group and 50-59 years group,there were significant differences (P 0.05).⑤The same level average density of erector spinae muscle was lowest compared with the psoas major muscle and quadratus lumborum muscle,and falling faster,the psoas major muscle was relatively higher.The same level average density of female’s erector spinae muscle was lower than man’s,specially in 70-79 years group.Conclusion Multi-slice spiral CT can be used to diagnose the lumbar degenerative conditions.

Brain Tumor Mimicking Cervical Spinal Disease: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of cerebellar tumor mimicking cervical spinal disease with neck pain for one year. SUMMARY OF LITERATURE REVIEW: Neck pain is one of the most common symptoms of cervical spinal disease. Neck pain in the cervical spine is usually accompanied by radiculopathic or myelopathic symptoms. Pain aggravated with neck motion is another point of differentiation. However, the differential diagnosis of neck pain is not always easy. MATERIALS AND METHODS: A 47-year-old woman presented with neck pain, without other symptoms of radiculopathy or myelopathy. The neck pain was not position-dependent and had exacerbated 1 week previously. Cervical magnetic resonance imaging (MRI) revealed a brain tumor in the cerebellum. RESULTS: The patient underwent surgical craniotomy and tumor resection. The neck pain improved after surgery. CONCLUSIONS: If neck pain cannot be explained by cervical pathological conditions, the possibility of other causes, including brain pathology, should be considered.

Early Union of Grafted Bone in Ankylosing Spondylitis: Comparative Study with Degenerative Spinal Disease

BACKGROUND: Patients with ankylosing spondylitis (AS) achieve early bone union compared to those with other spinal diseases. This study compared the time to bone union after surgery between AS patients and degenerative spinal disease patients. METHODS: Patients with degenerative spinal diseases (control group) and AS (experimental group) underwent pedicle subtraction osteotomy followed by posterolateral fusion, and decompression and posterolateral fusion, respectively. There were 10 patients in the experimental group. The control group included 26 patients who were less than 50 years of age and underwent two-level autogenous grafting after decompression and spinal fusion. Autogenous grafts and a range of bone substitutes were used in the experimental group, whereas only autogenous grafts were used in the control group. Bone union was determined on the radiographs and 3-dimensional CT scan images. The level of union was assessed using the Lenke's and Christensen's classification systems. RESULTS: In the experimental group, the mean age was 41.3 years (range, 30 to 67 years), the mean follow-up period was 21.7 months (range, 12 to 43 months), and bone union was confirmed at an average of 3.5 months (range, 3 to 5 months) after surgery. In the control group, the mean age was 43.1 years (range, 35 to 50 years), the mean follow-up period was 21.8 months (range, 12 to 74 months), and bone union was observed at an average of 5.6 months (range, 4 to 12 months) after surgery. The difference in the time to bone union between the two groups was significant (p = 0.023). CONCLUSIONS: The union of grafted bone was obtained earlier in patients with AS than in those with degenerative spinal diseases. Therefore, future studies should examine the factors affecting the early union in AS patients.

Variação de conduta cirúrgica em doença degenerativa da coluna lombar / Variación de conducta quirúrgica en la enfermedad degenerativa de la columna lumbar / Surgical decision making variation in degenerative lumbar spine

Examinar a variação da decisão de tratamento entre cirurgiões de coluna para cinco situações clínicas que envolvam condições degenerativas da coluna lombar e determinar se fatores como tipo de treinamento do cirurgião, experiência e idade são como preditores da tomada de decisões para cada caso. MÉTODOS: dez ortopedistas e dez neurocirurgiões, de diferentes idades, responderam questões sobre a necessidade de cirurgia, opções de via de acesso, realização de descompressão, realização de artrodese, com ou sem instrumentação, para cinco casos de doença degenerativa da coluna lombar por meio de informações da história, exame clínico e exames de imagem adequados (todos tiveram acesso às mesmas informações e foram orientados a responder com base em sua prática clínica). Os casos foram: discopatia com instabilidade vertebral em um paciente jovem; hérnia de disco extrusa em paciente jovem; estenose de canal vertebral múltiplos níveis sem deformidade; estenose canal múltiplos níveis com cifoescoliose degenerativa; hérnia de disco com artrose facetária. Na análise estatística foi utilizado o teste "t" de student para comparar o fator especialidade e médias de idade com as variáveis de tratamento (significativo quando p<0,05). RESULTADOS: a média de idade dos pacientes era de 42,15 anos (variando de 29 a 56 anos). Dos pacientes entrevistados, 12 (60 por cento) são de origem do Estado de São Paulo e oito (40 por cento) de outros Estados. Não foram observadas variações significativas para diferentes abordagens. De um modo geral, os ortopedistas recomendam a realização de artrodese e instrumentação com mais frequência que os neurocirurgiões, com significância maior no caso de escoliose degenerativa com estenose de canal (p=0,04) e também no caso de hérnia discal (p=0,01). Com relação a idade, cirurgiões mais experientes optaram mais pela instrumentação que os mais jovens no caso de estenose e instabilidade sem deformidade (p=0,001). CONCLUSÃO:...

To determine the surgical decision making variation in five degenerative lumbar spine clinical situations. Determine whether factor related to spinal surgeon training program, experience and age are determinants in surgical decision making for each case. METHODS: ten orthopedists and ten neurosurgeons from different ages were questioned about surgery indication, approach options, need for decompression, need for fusion with instrumentation or not for five degenerative lumbar spinal clinical scenarios. Information about history, examination and image studies (all examiners had the same information and oriented to answer thinking in their own experience). Cases presented: instability and disc disease in a Young patient; extruded lumbar hérnia in a young patient; multiple level spinal stenosis without deformity; multiple spinal stenosis with degenerative kyphoscoliosis; lumbar hernia with facet degeneration. Effects on training background and surgeon mean age on surgical decision making were analyzed using Student "t" test (p<0.05). RESULTS: mean age was 42.15 years (varying 29 to 56 years). Twelve (60 percent) participants were from Sao Paulo while resting eight (40 percent) were from other states. Significative variation was not observed. In a general manner, orthopedists recommend fusion and instrumentation more often then neurosurgeons, reaching significance for degenerative scoliosis with spinal stenosis (p=0.04) and for lumbar hernia (p=0.01). Experienced surgeons were more likely to recommend instrumentations than younger for spinal stenosis and instability without deformity (p=0.001). CONCLUSION: there is a great agreement about surgeon's preferences, resting differences in orthopedists preference for instrumentation for lumbar disc herniation cases and treatment of the deformity for degenerative scoliosis with spinal stenosis case. Surgeon's age and experience were not determinant in surgical decision making. Actually...

Examinar la variación de la decisión de tratamiento entre cirujanos de la columna para cinco escenarios clínicos involucrando condiciones degenerativas de la columna lumbar. Determinar si el tipo del entrenamiento del cirujano, experiencia y edad sirve como factores predictivos en la toma de decisiones de cada caso. MÉTODOS: diez ortopedistas y diez neurocirujanos de diferentes edades respondieron un cuestionario sobre la necesidad de cirugía, opciones de vías de acceso, realización de descompresión, realización de artrodesis con o sin instrumentación para 5 casos de enfermedad degenerativa de la columna lumbar por medio de informaciones de la historia, examen clínico y exámenes de imagen adecuados (todos tuvieron acceso a las mismas informaciones y orientados a responder basados en su práctica clínica). Los casos fueron: discopatía con inestabilidad vertebral en un paciente joven; hernia de disco extrusa en paciente joven; estenosis canal vertebral múltiples niveles sin deformidad; estenosis canal múltiples niveles con cifoescoliosis degenerativa; hernia discal con artrosis facetaria. El análisis estadístico utilizado fue el test "t" de Student para comparar el factor especialidad y promedios de edad con las variables de tratamiento (significativo con p < 0.05). RESULTADOS: el promedio de edad fue de 42.15 años (variando de 29 a 56 años). Doce (60 por ciento) entrevistados son originarios del Estado de Sao Paulo y los ocho (40 por ciento) restantes fueron de otros estados. Variaciones significativas para diferentes abordajes no fueron observadas. De un modo general, los ortopedistas recomiendan la artrodesis e instrumentación con más frecuencia que los neurocirujanos, con una frecuencia significativa en caso de escoliosis degenerativa con estenosis de canal (p = 0.04) y también en el caso de hernia discal (p = 0.01). Con relación a la edad, cirujanos con mayor experiencia optaron más por la instrumentación que los más jóvenes...

Effect of Tramadol/Acetaminophen Combination Drug in Acute Pain After Spinal Surgery / 대한척추외과학회지

STUDY DESIGN: A single center, double-blind, randomized, placebo-controlled trial. OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of Ultracet(TM) compared with a placebo in the treatment of acute pain after spinal surgery. SUMMARY OF LITERATURE REVIEW: Ultracet(TM) is a combination drug of Tramadol and Acetaminophen, and the synergistic effect in pain control was demonstrated by animal experiments. MATERIALS AND METHODS: Seventy-six patients who satisfied the selection and exclusion criteria after spinal surgery were enrolled in this study. The patients measured perceptible pain relief time and meaningful pain relief time using a two stopwatch technique. The pain intensity (PI) and pain relief (PAR) were recorded at 30 minutes and then hourly over a 4 hour period, and the pain intensity difference (PID), the sum of the pain intensity difference (SPID), and the total pain relief (TOPAR) were also checked. RESULTS: The study and control group comprised of 56 and 20 patients, respectively. The baseline pain intensity was an average of 5.9+/-1.2 in the study group and 6.1+/-1.4 in the control group (p=0.683). The final pain intensity was 2.5+/-2.4 and 4.1+/-2.2 in the study and control group, respectively. The study group was superior to placebo (p=0.008). In addition, the study group was statistically superior in terms of the PID (p=0.025), SPID (p=0.028), and TOPAR (p=0.048), particularly over 2 hours, as well as the overall assessment (p=0.005). The median time of the meaningful pain relief time was 90 and 193 minutes in the study and control group, respectively. CONCLUSIONS: The analgesic efficacy of Ultracet(TM) was superior to the placebo on the SPID, TOPAR, and the subjects' overall assessments over the 4 hour observation period. These results suggest that Ultracet(TM) is an effective therapeutic option for the management of acute pain after spinal surgery without serious complications.

Results of Multilevel Lumbar Fusion for Degenerative Disorder of the Lumbar Spine / 대한척추외과학회지

PURPOSE: To investigate the causative factors of the complications and clinical results of 82 patients that underwent multilevel fusion due to degenerative lumbar disease. MATERIALS AND METHODS: This was a retrospective study, between October 1994 and July 2001, of 101 patients that had undergone spinal fusion at more than 3 levels, due to degenerative lumbar disease, and excluding 19 patients, which included 8 revisions, 1 postop infection and 10 lost to follow-up. The average age of the 82 patients was 61, ranging from 49 to 81 years. There were 22 men and 60 women, with an average follow up of 35, ranging from 12 to 79 months. Inclusion in the study required a minimum of 1 year of radiographic follow-up, where the lumbar lordotic angle, lateral sagittal angle of the fusion segments, problems associated with instrumentation (screw loosening, breakage and rod breakage), nonunion, fusion level, extension to sacrum, medical comorbidities and their influences on the clinical results were evaluated. Evaluation of the clinical results were quantified using Kirkaldy-Willis'criteria. T-test, Chi-square test and Pearson correlation tests were performed to evaluate the statistical significance, using SPSS version 10.0. RESULTS: 12, 35, 20 and 15 of the 82 patients declared their outcomes to be excellent, good, fair and poor, respectively. The clinical results were statistically associated with the difference between the postoperative and final sagittal angle in the fusion segments (p<0.05). The more fusion segments involved, the more problems associated with the instrumentation occurred. The number of fusion levels affected the clinical results. CONCLUSION: It seems to be difficult to reach satisfactory results in the case of multilevel spinal fusion, which was mostly associated with problems of instrumentation and nonunion, which showed poorer clinical results. Maintenance of the sagittal angle in the fusion segments was challenging when the number of fusion levels was increased.

PROSTHETIC DISC NUCLEUS REPLACEMENT FOR TREATMENT OF DEGENERATIVE LUMBAR DISC DISEASES / 解放军医学杂志

Objective To eveluate the result of the use of prosthetic disc nucleus (PDN) for treatment of degenerative disc diseases in the lumbar spine. Methods Twenty-two patients with degenerative disc diseases were treated with PDN replacement after the removal of the degenerated intervertebral disc. Results The patients were followed-up for an average 12 months (4-18 months). Both lumbago and leg pain disappeared in all the 22 patients who resumed their work and normal life one month after the operation. PDN translocation was found in 2 out of 10 patients in the early period, but no PDN translocation was found in the remaining 12 patients in the later period. Conclusion PDN could restore disc height and flexibility after nucleotomy. Artificial nucleus replacement was a good option for the treatment of degenerative lumbar disc disease.

Clinical application of cervical interbody fusion device made from carbon fiber reinforced polyether-ether-ketone / 第二军医大学学报

0.05). X ray film revealed that there was no loosening and displacement of internal fixation device in the test group 3 days after operation. In control group, there were 2 cases of slight graft bone displacement. Both groups exhibited a stiff bone fusion at operative level 3 months later. The intervertebral disc height of fusion level increased by (1.2?0.7) mm in the test group while decreased by (1.5?0.8) mm in the control group. CT scan revealed that there was tight contact between the internal fixation device and bone 3 days after operation. Both groups had obtained bone fusion in CT image 3 months later. Conclusion:Threaded cervical interbody fusion device made from carbon fiber reinforced PEEK has an excellent biocompatibility and can restore the intervertebral disc hight effectively with satisfactory fusion rate.

Perioperative Complications of Posterior Lumbar Spinal Surgery for Degenerative Lumbar Diseases in the Elderly / 대한척추외과학회지

STUDY DESIGN: A retrospective study of perioperative complications was performed in elderly patients undergoing posterior decompression and fusion for lumbar degenerative conditions. OBJECTIVES: To identify the perioperative complications and to analyze the influence of posterior decompression and fusion on the occurrence of the morbidity. SUMMARY OF BACKGROUND DATA: Because of the better long-term results, the decompression and fusion with instrumentation have been recently recommended for treatment of degenerative lumbar disease in the elderly. However, the perioperative complication rate and their correlating factors have not been adequately defined. MATERIALS AND METHODS: A retrospective review of the medical charts of fifty-one patients aged 65 years or older operated during June 1997 to July 1998 was undertaken. The minimum follow-up required for inclusion was three months. All medical and surgical perioperative complications directly related to the surgical procedure were noted. The association of fusion levels and other factors with the occurrence of perioperative complications were analyzed. RESULTS: Perioperative complications occurred in 17(33.3%) of the 51 patients. Seven patients(13.7%) had at least one major complication, 5(9.8%) had at least one minor complication and 9(17.6%) had insignificant complications. Hematoma and wound infection were the most common surgical complications. Paralytic ileus was the most common medical complication. There was no difference in the rate of perioperative complications between the long and short fusion groups. An age of more than seventy-five years at the time of surgery was associated with a higher risk of complications. There was no statistically significant relationship between the perioperative complications and sex diagnosis, operative time, type of bone grafting, amount of blood transfusion, or preoperative comorbidity of the patients. CONCLUSION: Perioperative complications were quite common in the present series, occurring in 33.3% of the patients. An age over seventy-five years was a risk factor for associated with morbidity. The number of levels fused and the comorbidity did not associated the development of the complications.

Clinical Analysis of Spinal Diseases in YUH

A total cases of 1080 inpatients of spinal disease in neurosurgical department of Yeungnam University Hospital(YUH) from May 1983 to March 1988 were analysed statistically. 1) Of the total 1080 cases, the vast majority was degenerative disease 749(69.3%), and others were trauma 265(24.5%), tumor 28(2.5%), congenital anomaly 4(0.3%), infection 22(2.0%) and miscellaneous 12(1.1%). 2) In degenerative disease, male to female ratio in disc disease was 1.7:1 and in degenerative spondylolisthesis 1:3. And frequent age group of disc disease was 20~40(50%) and other degenerative diseases were 40~60(66.6%). 3) Most frequent site of cervical disc disease was C5~6(40%) and lumbar disc disease was L4~5(79.4%). 4) There were 265 patients of trauma, among them, spinal fracture without neurological deficit was 97(36.6%), soft tissue injury was 133(50.0%) and fracture associated with cord injury was 25(13.2%). 5) In 28 cases of spinal tumors, the most frequent site was extradural space 23(82.1%).

Clinical Analysis of Spinal Diseases in YUH

A total cases of 1080 inpatients of spinal disease in neurosurgical department of Yeungnam University Hospital(YUH) from May 1983 to March 1988 were analysed statistically. 1) Of the total 1080 cases, the vast majority was degenerative disease 749(69.3%), and others were trauma 265(24.5%), tumor 28(2.5%), congenital anomaly 4(0.3%), infection 22(2.0%) and miscellaneous 12(1.1%). 2) In degenerative disease, male to female ratio in disc disease was 1.7:1 and in degenerative spondylolisthesis 1:3. And frequent age group of disc disease was 20~40(50%) and other degenerative diseases were 40~60(66.6%). 3) Most frequent site of cervical disc disease was C5~6(40%) and lumbar disc disease was L4~5(79.4%). 4) There were 265 patients of trauma, among them, spinal fracture without neurological deficit was 97(36.6%), soft tissue injury was 133(50.0%) and fracture associated with cord injury was 25(13.2%). 5) In 28 cases of spinal tumors, the most frequent site was extradural space 23(82.1%).