Prediction of risk factors of occurrence and development of degenerative lumbar spondylolisthesis with sagittal parameters of the spine and pelvis / 临床外科杂志

Objective To explore the risk factors related to the development and progression of lumbar degenerative spondylolisthesis (LDS).Methods A total of 71 patients with LDS or degenerative spinal stenosis (DSS) were retrospectively.Thirty-six patients with LDS (group LDS) and 35 patients with DSS (group DSS) were enrolled.Spinopelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), regional lumbopelvic lordosis angles (PR-LI, PR-L2, PR-L3, PR-L4, PR-L5), pelvic morphology (PR-S1), lumbar 4 slope (L4 S) and lumbar 5 slope (L5 S) were assessed on whole spine lateral radiographs in a standing position.All the parameters from LDS will compared with those of DSS and normal population respectively, Student's t-test was used to compare each parameter among the LDS, DSS and normal population.Results PI [ (57.67±11.78) °], SS [ (37.83±9.17) °] and LL [ (54.65±11.45) °] in group LDS were significantly greater than those of group DSS [ (44.47±8.75) °, (28.18±9.02) °, (38.97±15.59) °] and normal reference value [ (44.75±9.01) °, (33.57±7.64) °, (48.75±10.03) °] (P＜0.05).L4 S [ (8.18±9.98) °] and L5 S [ (19.96±8.33) °] in group LDS were greater than the group DSS[ (3.32±7.95) °, (10.87±8.02) °] (P＜0.05).The PR-L4 [ (57.63±13.44) °], PR-L5 [ (45.76±10.92) °] and PR-S1 [ (27.91±10.41) °] in group LDS were significantly smaller than those of group DSS [ (65.48±10.70) °, (56.33±9.15) °, (38.63±7.29) °] (P＜0.05).Conclusion Greater PI may lead to the development and progression of lumbar degenerative spondylolisthesis.L5 S is a parameter that can be used to predict the risk of LDS.The lower regional lumbopelvic lordosis angles in LDS were smaller than those of DSS.

Comparison of Sagittal Spinopelvic Alignment between Lumbar Degenerative Spondylolisthesis and Degenerative Spinal Stenosis

OBJECTIVE: The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS). METHODS: Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value ( or =50 mm). Spinopelvic parameters/PI ratios were assessed and compared between the groups. RESULTS: The PI of DSPL was significantly greater than that of DSS (p=0.000). The SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (p<0.05) in the DSPL group. In sub-group analysis between the positive (12.5%) and normal SVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group. CONCLUSION: Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis.

Combined Treatment of Degenerative Spinal Stenosis and Osteoporotic Compression Fracture / 대한골다공증학회지

OBJECTIVES: To analyze the treatment results of combined treatment with percutaneous vertebroplasty and adhesiolysis in the patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. MATERIALS AND METHODS: A retrospective review was carried out on 38 patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. We performed percutaneous vertebroplasty for osteoporotic compression fractures and adhesiolysis for degenerative spinal stenosis after 4 weeks after vertebroplasty. Radiologic results were evaluated by progression of compression rate, fractures in adjacent segment and change of the BMD. Clinical results were evaluated with Denis pain scale for osteoporotic compression fractures and Katz satisfaction scale for degenerative spinal stenosis. RESULTS: The compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at 12 months postoperatively. There was no fracture in adjacent segment. Clinically, the Denis score were P3 in 13 and P4 in 25, preoperatively, P1 in 11 and P2 in 26, P3 in 1, postoperatively (P=0.03). In regard to degenerative diseases, the Kats scale were 38 to 5, 86.8% in low back pain (P=0.017) and 38 to 4, 89.4% in claudication (P=0.006). The overall Katz satisfaction scale was 81.5% at 12 months postoperatively. The BMD changes in patients who treated neuroplasty was not significant (P=0.175). CONCLUSIONS: The combined treatment with percutaneous vertebroplasty and adhesiolysis may be an effective treatment strategy for the osteoporotic compression fracture and spinal stenosis without surgical intervention in old age patients.

Minimum 2-Year Follow-Up Result of Degenerative Spinal Stenosis Treated with Interspinous U (Coflex(TM))

OBJECTIVE: Clinical and radiological results of posterior dynamic stabilization using interspinous U (ISU, Coflex(TM), Paradigm Spine Inc.(R), NY, USA) were analyzed in comparison with posterior lumbar interbody fusion (PLIF) in degenerative lumbar spinal stenosis (LSS). METHODS: A retrospective study was conducted for a consecutive series of 61 patients with degenerative LSS between May 2003 and December 2005. We included only the patients completed minimum 24 months follow up evaluation. Among them, 30 patients were treated with implantation of ISU after decompressive laminectomy (Group ISU) and 31 patients were treated with wide decompressive laminectomy and posterior lumbar interbody fusion (PLIF; Group PLIF). We evaluated visual analogue scale (VAS) and Oswestry Disability Index (ODI) for clinical outcomes (VAS, ODI), disc height ratio disc height (DH), disc height/vertebral body length x100), static vertebral slip (VS) and depth of maximal radiolucent gap between ISU and spinous process) in preoperative, immediate postoperative and last follow up. RESULTS: The mean age of group ISU (66.2 +/- 6.7 years) was 6.2 years older than the mean age of group PLIF (60.4 +/- 8.1 years; p = 0.003 ). In both groups, clinical measures improved significantly than preoperative values (p 18.6 +/- 5.9%), however decreased significantly in last follow up (13.8 +/- 6.6%, p = 0.027). Vertebral slip (VS) of spondylolisthesis in group ISU increased during postoperative follow-up (2.3 +/- 3.3 --> 8.7 +/- 6.2, p = 0.040). Meanwhile, the postoperatively improved DH and VS was maintained in group PLIF in last follow up. CONCLUSION: According to our result, implantation of ISU after decompressive laminectomy in degenerative LSS is less invasive and provides similar clinical outcome in comparison with the instrumented fusion. However, the device has only transient effect on the postoperative restoration of disc height and reduction of slip in spondylolisthesis. Therefore, in the biomechanical standpoint, it is hard to expect that use of Interspinous U in decompressive laminectomy for degenerative LSS had long term beneficial effect.

Expression of Estrogen Receptor Gene in Degenerative Spinal Stenosis / 대한정형외과학회잡지

PURPOSE: The purpose of this experiment was to investigate the relationship between sex hormones and degenerative spinal disorder. MATERIALS AND METHODS: 22 ligamentum flavum were obtained from 22 patients who had undergone spinal surgery. Patients' specimens were divided into three groups. The experimental group contatining 16 postmenopausal female patients, diagnosed as having degenerative spinal stenosis. As a control group, two groups were formed. The first control group was composed of 4 male patients diagnosed as having same disease and the second group was two premenopausal females, who were diagnosed as having disc herniation and fracture. The relative amount of estrogen receptor expression at gene level was measured by reverse transcription-polymerase chain reaction (RT-PCR). The amounts of expressed gene in each group were compared: receptor subtypes (ER-alpha, ER-beta), sex and age (pre, postmenopausal). The calculated amount of ER-alpha and ER-beta gene expression was standardizised with respect to the mRNA of GAPDH. RESULTS: The mean density of the estrogen receptor, signals were 55.0+/-12.3, 143.0+/-32.1 in the experimental group, 39.6+/-8.0, 89.7+/-20.1 in the first control group and 34.1+/-2.0, 102.5+/-2.7 in the second control group. The mean density of the estrogen receptor alpha, beta, signals were higher in the experimenal group than in the control group. A statistically significant difference was found between the experimental group and the control group (p<0.05) CONCLUSION: The expression of ER-alpha, beta, gene in the human ligamentum flavum was confirmed. It was inferred from this study that a high expression of estrogen receptor might affect ligamentum flavum hypertropy in postmenopausal women and that this is likely to be a pre-disposing factor for degenerative spinal disorder.

Surgical Outcome of Degenerative Spinal Stenosis Clinical: Clinical Correlation of Patient Satisfaction and Surgical Results / 대한척추외과학회지

STUDY DESIGN: This study is a retrospective evaluation of the surgical outcome by the patient satisfaction and Oswestry low back pain questionnaire. OBJECTIVE: The goal of this study was to evaluate the clinical correlations of various factors with the patient's satisfaction and with the surgical results in degenerative spinal stenosis. SUMMARY OF LITERATURE REVIEW: The patients satisfaction and surgical outcome of the degenerative spinal stenosis by the objective method have not been well described in the literature. MATERIAL AND METHODS: Mean follow-up period was 4.8 years after surgery in 114 patients. Outcome was based on subjective disability using Oswestry low back pain questionnaire. Patient satisfaction degree was rated to 'very satisfied(1)', 'somewhat satisfied(2)', 'somewhat dissatisfied(3)' and 'very dissatisfied(4)'. Several factors that might be associated with patient satisfac-tion and outcome were investigated. RESULTS: Of the one hundred and fourteen patients, 84(73.9%) were satisfied to the surgery and mean satisfaction degree was 1.94. Ninety two patients(80.7%) had excellent-to-good results with the mean Oswestry disability score 26.9. There were 7 complications including dural tear in 3 cases, pseudarthrosis in 1 case, dissociation between rod and screw in 1 case, pedicle screw breakage in 1 case and termination of operatin due to massive bleeding during operation in 1 case. CONCLUSION: Clinical results and patient satisfaction were better in the cases with short segments fusion than long segments fusion and the patients with preoperative leg symptom as major symptom had significantly lower Oswestry disability score.

Effect of Estrogen Receptor on Degenerative Change and Displacement of Facet Joint / 대한척추외과학회지

STUDY DESIGN: Thirty-two postmenopausal female patients, with the facet angle less than 40 degrees, were selected for this study. All patients underwent spinal surgery. Displacement group, diagnosed by the displacement of facet joint above 2mm was noted in 15 patients. Control group had 17 patients and was defined when the displacement of facet joint was less than 2mm. OBJECTIVES: Our study evaluated the expression of estrogen receptor and degenerative change depending on the displacement of facet joints. SUMMARY OF LITERATURE REVIEW : Despite the fact that degenerative spondylolisthesis is more common in female than in male, a few attempts have been made to evaluate estrogen as one of the predisposing factors for displacement of facet joint. MATERIALS AND METHODS: After harvesting the articular cartilage of facet joint, the expression of estrogen receptors was evaluated with immunohistochemical staining, and the degenerative change of the articular cartilage with hematoxylin-eosin and alcian blue staining. RESULTS: All facets showed a positive correlation between the estrogen receptor scores and histological-histochemical scores(r=0.78, p<0.05). The average score of the estrogen receptors was 9.1+/-0.4SEM in displacement group, and 5.0+/-0.6SEM in control group(p<0.05). The histological-histochemical grading of cartilage lesion was 12.4+/-0.6SEM in displacement group, 8.0+/-0.3SEM in control group(p<0.05). CONCLUSIONS : This study suggest that a high expression of estrogen receptors, which affected the severity of degenerative changes in facet articular cartilage, might be one of the predisposing factors for the displacement of facet joint.