Mid-long-term effect of only placed expandable Interbody fusion cage in the treatment of lumbar spinal Stenosis with vertebral instability using micro-endoscopic Discectomy system / 中国组织工程研究

BACKGROUND: The incidence of lumbar spinal stenosis with vertebral instability is increasing year by year, which can cause symptoms such as waist and leg pain, lower limbs feeling numbness and intermittent claudication. In recent years, scholars have tried various minimally invasive treatment methods to further reduce the trauma and complications of surgery. The improvement of the clinical effect of minimally invasive surgery for lumbar spinal stenosis with vertebral instability is an important issue to be solved. OBJECTIVE: To evaluate the mid-long-term effect of only placed expandable interbody fusion cage in the treatment of lumbar spinal stenosis with vertebral instability using micro-endoscopic discectomy system. METHODS: A retrospective, self-control clinical trial was conducted in the First Affiliated Hospital of Zhengzhou University from 2012 to 2014. Totally 35 patients with lumbar spinal stenosis combined with vertebral instability were treated by only placed expandable interbody fusion cage using micro-endoscopic discectomy system. This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University. RESULTS AND CONCLUSION: (1) All 35 patients were followed-up for 60-85 months, mean (70.17±5.40) months. Among these patients, lumbar interbody fusion in 1 segment, 2 segments and 3 segments was performed in 6, 20 and 9 cases, respectively. A total of 73 intervertebral spaces were fused. (2) The mean operation time was 53.49±9.13 minutes (range, 35-75 minutes). The mean blood loss was 114.86±54.23 mL (range, 50-250 mL). (3) Dural rupture occurred in one case during operation and then hypotensive cranial pressure headache occurred after operation. Headache gradually eased after the patient received rehydration and analgesic treatment for 3 days. Poor incision healing occurred in one case after operation and then healed well after one-week vacuum sealing drainage technique. (4) The Visual Analogue Scale scores, Oswestry Disability Index, and height of intervertebral space were significantly decreased at 1 week, 6 months, 1 year, 2 years after surgery and the final follow-up compared to the preoperative ones. At 6 months after the operation, 31(42.5%) intervertebral spaces reached a strong fusion, 25(34.2%) possible fusion, and 17(23.3%) did not reach fusion. At 1 year after surgery, 51(69.9%) intervertebral spaces achieved a strong fusion and 22(30.1%) achieved possible fusion. At 2 years after surgery, 57(78.1%) intervertebral spaces achieved a strong fusion and 16(21.9%) achieved possible fusion. During final follow-up, 62(84.9%) intervertebral spaces achieved a strong fusion and 11(15.1%) achieved possible fusion. (5) At the last follow-up, cage migration was found in one case. The patient was not treated because of symptomless. (6) Unilateral approach only placed expandable interbody fusion cage by using micro-endoscopic discectomy system is a safe and reliable minimally surgical method, which has a good mid-long-term effect on lumbar spinal stenosis with vertebral instability.

Efficacy evaluation of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in treating lumbar disc herniation with lumbar instability / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in the treatment of lumbar disc herniation with lumbar instability.</p><p><b>METHODS</b>The clinical data of 146 patients with unilateral lumbar disc herniation with lumbar instability underwent surgical treatment from March 2008 to March 2013 were retrospectively analyzed. Patients were divided into two groups according to osteotomy replantation pattern. There were 77 patients in the traditional group (underwent traditional lamina osteotomy replantation), including 42 males and 35 females with an average age of (49.4±18.5) years;the lesions occurred on L₄,₅ in 46 cases, on L₅5S₁ in 31 cases. There were 69 patients in modified group (underwent modified lamina osteotomy replantation), including 37 males and 32 females with an average age of (49.8±17.9) years;the lesions occurred on L₄,₅ in 40 cases, on L₅S₁ in 29 cases. The operation time, intraoperative blood loss, complication rate during operation, lamina healing rate, recurrence rate of low back and leg pain were compared between two groups. Visual analogue scales (VAS) and Japanese Orthopadic Association (JOA) scores were used to evaluate the clinical effects.</p><p><b>RESULTS</b>The operation time and intraoperative blood loss were similar between two group (>0.05). There was significantly different in nerve injury rate(5.80% vs 16.9%) and dural injury rate(1.45% vs 9.09%) between modified group and traditional group(<0.05). The recurrent rate of low back pain of modified group was higher (91.30%, 63/69) than that of traditional group (76.62%, 59/77), and the intervertebral fusion rate of modified group was lower(8.70%, 6/69) than that of traditional group (29.9%, 23/77) at 3 years after operation. Postoperative VAS scores of all patients were significantly decreased at 6 months, 1, 2, 3 years, and JOA scores were obviously increased (<0.05). At 1, 2, 3 years after operation, VAS scores of modified group were significantly lower than that of traditional group(<0.05), and JOA scores of modified group were higher than that of traditional group(<0.05).</p><p><b>CONCLUSIONS</b>Modified lamina osteotomy replantation has better long-term efficacy(in the aspect of recurrent rate of low back pain, intervertebral fusion rate, VAS and JOA score at three years follow-up) in treating lumbar disc herniation with instability.</p>

Effects of 3D Stabilization Exercise on the Muscle Activity and Static Balance of Patients with Lumbar Instability

PURPOSE: The paper presents an intervention for clinical applications in the future by examining the effects of 3D stabilization exercise on patients with lumbar instability, which causes problems in the muscles and balance, and analyzing the effects of balanced lumbar muscles on the static balance. METHODS: After collecting samples randomly from thirty patients with lumbar instability, fifteen patients selected for 3D stabilization exercise were placed in the stability group and fifteen patients selected for Swiss ball exercise were placed in the ball exercise group. The intervention program was applied for thirty minutes a session, once a day, three days a week for four weeks. Before the intervention, the lumbar muscle activity and static balance were measured. After four weeks, they were re-measured in the same way and the data were analyzed. RESULTS: In relation to the within-group changes in muscle activity, all groups except for the LEO and REO groups showed significant differences. Regarding the between-group changes in muscle activity depending on the left and right difference, ES, RA, and TrA but not EO showed significant differences. In addition, there were significant differences in the between-group change in static balance. CONCLUSION: 3D stabilization exercise improves the muscle activity by promoting a balanced posture of lumbar muscles and changing senses, such as a proprioceptor but this had a positive influence on the static balance by controlling the balance of muscles.

Case control study of interbody fusion with simple decompression bone block in treating degenerative lumbar instability and spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the value of the self-decompression bone block in interbody fusion.</p><p><b>METHODS</b>From April 2014 to May 2015, 42 patients with degenerative lumbar instability and spinal stenosis were treated by posterior vertebral lamina decompression and pedicle nail-rod fixation and unilateral modified transforaminal lumbar interbody fusion, including 18 males and 24 females. The treatment group had 24 cases with autologous pure decompression bone block as single interbody fusion material and the control group had 18 cases with cage and autologous bone as interbody fusion material. Clinical data, bone healing time, interbody fusion rate, intervertebral height and curative effect were analyzed in two groups.</p><p><b>RESULTS</b>All the patients were followed up for 12 to 24 months with an average of 16 months. There was no significant difference in age, sex ratio, degree of lumbar instability, or follow-up time between two groups(>0.05); and there was no significant difference in curative effect, intervertebral height loss, or interbody fusion rate between two groups(>0.05).</p><p><b>CONCLUSIONS</b>Using self-decompression bone block fusion can get high fusion rate, maintain good intervertebral height, obtain satisfactory curative effect. Its design was scientific and reasonable with less complication, which provide an effective, economic, and practical method for degenerative lumbar instability and spinal stenosis.</p>

Effects of lumbar instability after lamina decompression on prognosis / 天津医药

Objective To study the influence of spinal instability after lamina decompression in symptoms and progno?sis. Methods The 76 patients were followed up for a minimum of 4 more years. The patients were divided into instability group (n=27) and non-instability (n=49) group according to the X-ray result of the final follow-up. The visual analogue scale (VAS) score, JOA score and improvement rate were compared between two groups at preoperation, 3-month after operation and the final follow-up. Results There were no significant differences in gender, age and mean follow-up time between two groups. There were no significant differences in VAS and JOA scores before surgery, 3-month after surgery and final follow-up between two groups. Postoperative VAS score decreased and JOA score increased with the increase in follow-up time (P 0.05). Conclusion Although some patients show instability even with lumbar spondylolisthesis after lamina decompression on radiograph,which is no correlation with improvement of symptoms. With appropriate indications, lamina decompression is a simple and effective surgical method,which also retains the spinal movement function.

Uso de un nuevo implante: U-Force N6 a nivel L5 S1 para evitar la inestabilidad lumbar tras discectomía simple / Using a new implant: U-Force N6 to level L5 S1 to avoid lumbar instability after single discectomy

Resumen: Introducción: Estudio prospectivo en pacientes afectos de hernia discal lumbar L5 S1 tratados mediante la U-Force interespinosa N6. El espaciador interespinoso denominado "U" está realizado en titanio y es colocado entre las apófisis interespinosas. Material y métodos: 50 pacientes operados de hernia discal lumbar fueron evaluados; 25 pertenecían al grupo U-N6 y 25 sólo fueron tratados con microcirugía. Se les realizó valoración clínica y estudios radiológicos seriados. Todos los individuos tuvieron un seguimiento durante dos años (2013-2014). Resultados: Nuestro estudio revela que el uso del dispositivo fue más efectivo (estadísticamente significativo) para el retraso de la inestabilidad que sólo la técnica quirúrgica (p < 0.01). Permitió su colocación en 90% de los sujetos. Conclusión: El uso de este dispositivo retrasa el colapso vertebral y, por ende, la inestabilidad del segmento operado. Noventa por ciento de los casos del grupo N6 presentan el dispositivo a nivel de L5 S1 versus 60% del grupo histórico con otros dispositivos (2004-2011).

Abstract: Introduction: We conducted a retrospective study in patients with disc herniation and compared the results obtained in individuals treated with the U device N6 with those acquired in patients treated without any device. The U device is a titanium alloy implant that is placed between the spinous processes. Material and methods: In a cohort of 50 patients with degenerative lumbar disc, 25 underwent surgical treatment in which the U device was placed and 25 control individuals were treated with discectomy alone. Patients underwent serial follow-up evaluations, and radiographic assessment was used to determine the outcome. Up to two years of follow-up data were obtained in all patients (2013-2014). Results: Statistically significant improvement was seen in patients treated with the coflex device in the management of lumbar disc degeneration to avoid lumbar instability in the future (p < 0.01). It allowed its placement in 90% of the patients. Conclusions: Our study shows that the coflex device was more effective than the discectomy group in the management of lumbar instability. Ninety percent of the cases of the N6 group present the device at L5 S1 versus 60% of the historical group with other devices (2004-2011).

Application of DR in diagnosis of lumbar instability / 医疗卫生装备

Objective To apply DR to the diagnosis of lumbar instability.Methods Totally 198 patients suspected with lumbar instability underwent routine lateral side DR radiograph and examination of flexion-extension position to analyze the forward and backward displacements of the lumbar.Results Totally 35 patients with lumbar instability were determined based on the method proposed by White and Panjabi.Conclusion Film of flexion-extension position gains advantages over films of lateral position and oblique position in lumbar instability and malfunction, and thus helps for clinical diagnosis and efficacy observation.

Finite element analysis on transforaminal lumbar interbody fusion treatment / 医用生物力学

Objective To analyze the clinical feasibility of unilateral transforaminal lumbar interbody fusion (TLIF) for treating lumbar degenerative diseases by finite element method. Methods Based on CT scan data, three-dimensional (3D) finite element models of the normal L3-5 segments under physiological status (intact lumbar model), L4/5 with unilateral pedicle screw fixation plus interbody fusion (unilateral TLIF model) and L4/5 with bilateral pedicle screw fixation plus interbody fusion (bilateral TLIF model) were established by using Mimics, Pro/E, ANSYS software, respectively. Preload of 500 N and load of 10 N•m torque were applied on the superior surface of the L3 segment to simulate 5 physiological activities: body upright, flexion, extension, left lateral bending and right axial rotation. The deformation and stress distributions in vertebral body, vertebral discs, pedicle screw and cage under different loads were then recorded and analyzed to compare mechanical properties of the two fixation methods. Results The deformation of L3-5 segments fixed with unilateral TLIF or bilateral TLIF decreased as compared to the intact lumbar model; the stresses in cage reached the maximum in both unilateral TLIF model and bilateral TLIF model during back extension, meanwhile peak stresses on pedicle screws in unilateral TLIF were significantly higher than those on bilateral TILF model, with the peak stress of 463.39 MPa during back extension. ConclusionsUnilateral TLIF can be selected as a method for treating lumbar degenerative diseases; however, its stability was inferior to bilateral TLIF due to the higher peak stress. Therefore, less stretch exercises may be safe for patients during rehabilitation to avoid surgery failure or pedicle screw fracture.

Quadrant System in lumbar disc herniation treatment of lumbar instability / 中国组织工程研究

BACKGROUND:There are stil about 10%-30%of patients presenting no obvious improvement of symptoms after lumbar disc herniation surgery, which are col ectively known as the lumbar spine post-surgery failure syndrome, and lumbar instability is one of the important reasons. OBJECTIVE:To evaluate the feasibility and efficacy of surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation on lumbar intervertebral disc protrusion concurring lumbar instability via MAST Quadrant retractor. METHODS:From December 2011 to October 2012, 62 cases of lumbar intervertebral disc protrusion concurring lumbar instability were treated with posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor. There were 38 female and 24 male ranging in age from 37 to 69 years (average 53.7 years). After operation, al patients were fol owed-up to evaluate the effect of the treatment. RESULTS AND CONCLUSION:The operative time was 90-210 minutes, average 145 minutes, and the amount of blood loss was 50-300 mL, average 120 mL. The hospitalization time was 5-9 days, average 6 days. Al incisions healed by first intention. Al patients were fol owed up 7.2 months on average (from 3 to 10 months). The preoperative JOA score was (10.25±2.34) points. The postoperative JOA score decreased to (18.31±3.12) points at the fol ow-up after 1 month and (25.35±2.61) points at the last fol ow-up, showing significant difference when compared with preoperative score (P<0.01). The preoperative VAS score was (8.24±1.15) points. The postoperative VAS score decreased to (2.97±1.12) points after 1 month and (1.13±0.39) points at the last fol ow-up, showing significant difference when compared with preoperative score (P<0.01). According to reforming Macnab standard, the results were excel ent in 53 cases and good in 9 cases at the last fol ow-up. The surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor is a safe, effective and minimal y invasive surgical technique in treating lumbar intervertebral disc protrusion concurring lumbar instability.

Effect of B-Twin intervertebral cage in treating lumbar degenerative instability with posterior mini-incision / 中国矫形外科杂志

[Objective] To explore the effect of B-Twin intervertebral cage for degenerative lumbar instability with posterior mini-incision.[Methods]Thirteen patients(13 disc-spaces)treated with B-Twin intervertebral cage in combination with autogenous morselized bone were enrolled in this study.Among the patients,11 had degenerative instability in L4、5 and 2 in L5S1.Patients were graded postoperatively with JOA scoring system.[Results]The lower back pain and leg pain were relieved significantly in all patients after operation.All were followed-up for an average of 16.2 months,and the JOA scores inproved from 4.2 preoperatively to 14.4 at the final follow-up.The good to excelleat rate was 92.3%.The bony fusions presented in an average of 19.8 weeks postoperatively by CT scan.Neither cage loosening nor neurological injury was found.[Conclusion]B-Twin intervertebral cage combined with autogenous morselized bone insertion for lumbar degenerative instability by posterior mini-incision operation is a good technique,which could achieve satisfactory clinical results with less injury.

Surgical treatment of degnenerative instability of lumbar spine / 中国矫形外科杂志

[Objective]To investigate diagnosis of lumbar instability,segment of spinal canal decompression and principle of fixation and fusion.[Method]158 cases of degnenerative lumbar instability from Feb 2001 and Oct 2006 in our hospital were analyzed retrospectively,the patients were operated with posterior decompression,instrumentation with pedicle screw and interbody or inter-transverse fusion.Patients all were examined with lumbar radiographys of lateral flexion and extension and with lumbar CT befor operation,Patients began to walk after operation one week,6 months later,restore to normal activities.[Result]The preoperative spinal canal area was 56~114 mm2,averaged 74 mm2,the postoperative spinal canal area 204~296 mm2,averaged 221 mm2.The patients were followed up from 6 months to 5 years(averaged 2 years and 5 months).The score was evaluated according to the JOA score.The preoperative score was averaged 3.7,the postoperative score was averaged 13.2,the improving rate was averaged 85%.108 case excellent,46 good,3 fairand 1 bad,The excellent and good rate was 97.5% in this group.[Conclusion]The spinal stability can be effectively maintained and reconstructed by decompression of spinal canal and instrumentation with pedicle screw system and fusion,which is a good method for treating Degnenerative instability of lumbar spine.

Treatment of Lower Lumbar Instability with Posterior Pedicle Combined with Bone Graft / 医学研究杂志

Objective To investigate clinical results of lower lumbar degenerative instability for the treatment of lumbar posterior pedicle screw system instrumentation combined with bone graft. Methods 38 patinets suffering from lumbar instability were treated with laminectomy ,nerve root canal enlargement and posterior pedicle screw system instrumentate combined with bone graft by pressure.Results All cases were followed up for 7to 13months.According to the system made by Wong xishen and X-ray 13 months after operation,the excellent and good rate of posterior pedicle screw system instrumentate combined with bone graft by pressure was 94.7%,and the stability of fusion lumbar spine reserved. It's fusion rate was 100%.Conclusion Posterior pedicle screw system instrumentate combined with bone graft by pressure is a safe and effective treatment for lumbar instability.

The Effects of Increasing Thoracic Mobility on Lumbar Stability

OBJECTIVE: To determine the effects on the lumbar stability caused by various thoracic exercise programs, the extent of spinal posture correction and the increase in thoracic mobility to the extension direction. METHOD: Exercise programs, which can increase the thoracic mobility to the extension direction, were applied to the exercise group. The control subjects were trained for the correct posture according to ergonomic principles by exercise at home and at the clinic. Both groups had three sessions of exercise program per week for 8 weeks. RESULTS: A comparison of the various parameters in the exercise group before and after exercise showed that the VAS, thoracic kyphosis and lumbar mobility decreased significantly (p <0.05), and the thoracic mobility in the extension direction, chest expansion, maximal elevation of the arms and spinal length increased significantly (p <0.05). In addition, the thoracic kyphosis and lumbar mobility increased significantly (p <0.05), and thoracic mobility in the extension direction, chest expansion, maximum elevation of the arms and the spinal length decreased significantly (p <0.05), but the VAS did not show a significant difference. CONCLUSION: A thoracic exercise program, which can correct the posture, improve the functional restrictions of the thoracic spine and reduce the lumbar mobility, is very important.

Effect on Active Exercise Programs in Employees with Chronic Low Back Pain / 대한산업의학회지

OBJECTIVE: To examine the relative efficacy of three active exercise programs for work-related, chronic low back pain, and to observe to what extent the programs affected the mechanical stability of the lumbar region. METHODS: The subjects were 64 employees who were randomly divided into three groups to match the three active exercise programs which were performed 3 times a week for 6 months. All subjects were assessed with the same measurements at a pre-study examination, and then were reassessed at 2 weeks, 3 months and 6 months after the study. RESULTS: The pain intensity didn't show any significant difference among the three groups. However, the Oswestry Disability Index showed significant differences among the three groups at 6 months and the lumbar and thoracic exercise groups showed significant decreases compared to the general physiotherapy group (p<0.05). Maximal stretching with both hands in the overhead direction showed a significant difference among the three groups at 3 months and 6 months, and the thoracic exercise group at 6 months showed a significant increase in overhead stretching compared to the lumbar exercise and general physiotherapy groups (p<0.05). The lumbar region angle of inclination showed significant differences among the three groups at 2 weeks, 3 months and 6 months, with the thoracic exercise group being decreased significantly more than the lumbar exercise and general physiotherapy groups at 6 months (p<0.05). CONCLUSIONS: Exercise aimed at increasing thoracic mobility has an effect on lumbar stability. Furthermore, it is far more effective for lumbar stabilization than general physiotherapy and deep muscle strengthening lumbar exercise.

Effect of Vertebral Plate Resection and Disc Excision from Posterior Approach Combined with Lumbar Interbody Fusion for Treatment of Lumbar Disc Herniation Associated with Lumbar Instability / 广州中医药大学学报

【Objective】To assess the indications and therapeutic effect of surgical treatment for lumbar disc herniation(LDH) associated with lumbar degenerative instability(LDI).【Methods】Fifty-eight LDH associated with LDI patients,which were ineffective after strictly conservative treatment or simple decompression with disc excision,received lumbar vertebral plate resection and disc excision from posterior approach,and transpedicular screw fixation combined with posterior lumbar interbody fusion.【Results】A averaged 13-month follow-up was carried out in 54 patients.The therapeutic effect assessed by Japanese Orthopaedics Association(JOA) was as follows: excellent in 37 patients,good in 13,ordinary in 4,and the excellent +good rate was 92.59%.The results of X radiography 3 months after the operation showed that lumbar interbody fusion was successful in 52 patients,the infusion rating being 96.30%.【Conclusion】Lumbar vertebral plate resection and disc excision from posterior approach,and transpedicular screw fixation combined with posterior lumbar interbody fusion are effective for the treatment of LDH associated with LDI.

Minimal Invasive Retroperitoneal Anterior Lumbar Interbody Fusion with Video-Assistance

INTRODUCTION: Anterior lumbar interbody fusion with video-assistance has become an increasing popular technique to stabilize the anterior vertebral column disease. A minimally invasive technique with reduced soft tissue dissection allows low morbidity and has cosmetic and functional advantages. METHOD: Fifty patients with chronic degenerative lumbar instability [degenerative disc disease(14), degenerative spondylolisthesis(14), Grade I lytic spondylolisthesis(9) and failed back syndrome(13)] who did not respond to conservative treatment for 6 months underwent minimal invasive retroperitoneal ALIF with video-assistance from Oct. 1996 to Sep. 1997. Access to lumbar disc was achieved through retroperitoneal space with a small vertical 4 to 5 cm incision on the midline after retroperitoneal endoscopic ballooning. After performing complete discectomy under guidance of endoscopic viewing and restoring the narrowed disc height, we stabilized the spine with carbon interbody fusion cages filled with allograft bone. RESULTS: Postoperatively the patients were usually allowed to ambulate on the following day and were discharged within 4 days. There were three major complications; one ureter injury, one retroperitoneal hematoma and one osteomyelitis. With an average 10 months follow up, 42 out of 50 patients(84%) have shown relief of symptomatic back pain. And 27 out of 28 patients with degenerative disc disease and degenerative spondylolisthesis(96%) had successful results. CONCLUSIONS: Minimal invasive retroperitoneal ALIF with video-assistance offers an attractive method to significant decreased postoperative pain and hospital stay compared with conventional anterior approaches. The patients with degenerative disc disease or degenerative spondylolisthesis were more likely to have a successful outcome than those with Grade I lytic spondylolisthesis or failed back syndrome(p=0.02).