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BACKGROUND:Patients with severe lumbar degenerative disease may have their bone mineral density incorrectly raised by dual-energy X-ray absorptiometry.While lumbar cancellous bone Hounsfield unit value can assist dual-energy X-ray absorptiometry in reducing osteoporosis misdiagnosis. OBJECTIVE:To identify osteoporosis in woman patients with lumbar degenerative diseases using lumbar CT scans. METHODS:Bone mineral density test results and lumbar CT data of 192 women patients who were treated at the Department of Spine Surgery,Sixth Affiliated Hospital of Xinjiang Medical University were retrospectively reviewed.All patients were divided into a degeneration group(n=107)and a control group(n=85)according to the criteria of severity of vertebral degeneration as assessed on CT of the lumbar spine.The CT value of axial cancellous bone of L1 vertebral body was measured in the two groups.The T score and bone mineral density of the hip and L2-L4 were recorded.According to previously published studies,osteoporosis was diagnosed at L1 vertebral CT values≤110.The prevalence of osteoporosis diagnosed by dual-energy X-ray absorptiometry and CT values was compared between the two groups. RESULTS AND CONCLUSION:(1)CT values were significantly and positively correlated with T scores and mean bone mineral density of the L2-L4 vertebrae in both groups(P<0.001),while the correlation was higher in the control group.(2)Lumbar T scores and bone mineral density values were significantly higher in the degeneration group than those in the control group(P<0.05)and CT values were significantly lower in the degeneration group than that in the control group(P = 0.001).Hip T scores and bone mineral density were not significantly different in the two groups.(3)The prevalence of osteoporosis diagnosed by CT thresholds was higher in all patients than that diagnosed by T values(51.0%and 42.7%).(4)The prevalence of osteoporosis diagnosed by CT values was as high as 23.6%in the 110 patients diagnosed with non-osteoporosis by dual energy X-ray absorptiometry in both groups,and was higher in the degeneration group than that in the control group(31.7%and 14.0%,respectively).(5)The prevalence of missed osteoporosis was as high as 38.6%(27/70)of non-osteoporosis patients diagnosed by dual-energy X-ray absorptiometry of the lumbar spine in the degeneration group compared to 19.6%(11/56)in the control group.(6)It is concluded that osteoporosis is common in female patients with lumbar degenerative diseases aged≥50 years.Measurement of lumbar cancellous bone CT values may be a useful complementary method for diagnosing osteoporosis in patients with lumbar degenerative diseases,especially in patients with severe degenerative lumbar degenerative diseases where more missed osteoporosis patients can be identified.
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BACKGROUND:Interspinous distraction fusion device BacFuse was used for the management of lumbar degenerative disease and obtained good clinical efficacy in recent years.However,the related biomechanical study was lacking. OBJECTIVE:To explore the related biomechanical characteristics of BacFuse,a novel interspinous distraction fusion device,which was used in lumbar degenerative disease. METHODS:After constructing the goat spinal models(L1-L6),they were grouped into four groups based on different simulated surgeries:the control group,the BacFuse group(L3/4),the screw-rod fixation group(L3/4)and the Topping-off group(L3/4 screw-rod fixation + L2/3 BacFuse fixation).The goat lumbar spine surgical model was assembled into a biomechanical testing system.A biomechanical machine was used for mechanical loading,simulating lumbar spine movement of flexion,extension,lateral flexion and rotation with a 4 Nm moment.A visual tracking system was used for positioning and capturing.Finally,mechanical and optical calibration was completed to calculate the range of motion of the L2/3,L3/4 and L4/5 segments. RESULTS AND CONCLUSION:(1)Compared with the control group,the range of motion of the L3/4 segment in the BacFuse group decreased 27.27%,70%,38.1%and 23.08%in the flexion,extension,lateral bending and rotation directions,respectively(P<0.05).The range of motion of L3/4 segment in the screw-rod fixation group decreased 72.73%,80%,71.43%and 73.08%in the flexion,extension,lateral bending and rotation directions,respectively(P<0.05).(2)Compared with the control group,the range of motion of the adjacent segment L2/3 increased by 33.33%,25%and 23.81%in the extension,lateral bending and rotation directions,respectively in the BacFuse group(P<0.05),with no significant change in flexion.In the screw-rod fixation group,there was a 50%,44.44%,50%and 58.96%increase in the adjacent segment L2/3 in the flexion,extension,lateral calibration and rotation directions,respectively(P<0.05).(3)Compared with the control group,the BacFuse group showed an increase in range of motion in proximal segment L4/5 in the extension and rotation directions by 27.3%and 17.39%(P<0.05)respectively,with no significant change in flexion or lateral bending.In the screw-rob fixation group,the proximal segment L4/5 demonstrated 38.89%,22.73%and 26.09%(P<0.05)increases in range of motion in the flexion,extension and rotation directions,respectively,with no significant change in lateral bending.(4)In the Topping-off group,the range of motion of L2/3 was reduced by 37.04%,73.08%,56.67%and 38.46%in flexion,extension,lateral flexion and rotation,respectively,compared to the screw-rob fixation group(P<0.05).Compared with the screw-rob fixation group,the Topping-off group showed a 20%reduction in the range of motion of the L4/5 in the flexion direction(P<0.05),with no significant differences seen in extension,lateral bending and rotation.(5)It is concluded that the interspinous distraction fusion device BacFuse significantly reduces the range of motion of the implanted segment and provides some stability.It still retains more mobility and reduces the impact on the adjacent segment compared to screw-rob fixation,while the Topping-off tip,which can be used for intervertebral fusion fixation,significantly reduces the range of motion of the adjacent segment and reduces the risk of adjacent segment degeneration.
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BACKGROUND:Minimally invasive surgery is developing rapidly.Robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are important posterior minimally invasive surgical approaches to treat lumbar degenerative diseases.However,it is worth discussing which operation method is more advantageous. OBJECTIVE:To compare the clinical efficacy and imaging examination between different operation groups,and discuss the clinical application value of robot-assisted minimally invasive lumbar posterior fusion technology to treat lumbar degenerative diseases. METHODS:Clinical data of 83 patients with lumbar degenerative diseases from January 2018 to June 2022 at the Department of Orthopedics,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital were retrospectively analyzed.Of them,27 patients received robot-assisted minimally invasive transforaminal lumbar interbody fusion treatment(group A);30 patients received robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion treatment(group B),and 26 traditional minimally invasive transforaminal lumbar interbody fusion patients were selected as the control group(group C).There were no significant differences in gender,age,body mass index,surgical segment,preoperative visual analog scale score and Oswestry Disability Index among the three groups(P＞0.05).The operation time,intraoperative blood loss,complications,fluoroscopic dose,fluoroscopic time,and fluoroscopic frequency were compared among the three groups.Gertzbein-Robbins'classification was used to evaluate the accuracy of percutaneous pedicle screw.Visual analog scale and Oswestry Disability Index scores were evaluated after surgery.The excellent and good rate of the three surgical options was evaluated using Macnab's criteria. RESULTS AND CONCLUSION:(1)The operation time of group A was significantly shorter than that of groups B and C(P＜0.05),but there was no significant difference between group B and group C(P＞0.05).The intraoperative blood loss in group B was significantly less than that in group A,and that in group A was significantly less than that in group C(P＜0.05).(2)The fluoroscopic dose,fluoroscopic time,and fluoroscopic frequency of group C were significantly higher than those of groups A and B(P＜0.05).(3)Visual analog scale score and Oswestry Disability Index in the three groups significantly improved after operation when compared with that before operation(P＜0.05),but there was no significant difference among the three groups 1 day and 6 months after surgery(P＞0.05).(4)Postoperative imaging showed that the accuracy of percutaneous pedicle screw placement in groups A and B was better than that in group C(P＜0.05).(5)There was no significant difference in the excellent and good rate of MacNab criteria among the three groups(P＞0.05).(6)There was no significant difference in complications among the three groups(P＞0.05).(7)The results indicated that robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are effective surgery methods for lumbar degenerative diseases.Compared with traditional minimally invasive transforaminal lumbar interbody fusion,robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery has higher efficiency,less intraoperative radiation and higher internal fixation accuracy,which has a good clinical application value.
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BACKGROUND:With the rapid development of minimally invasive spinal surgery and enhanced recovery after surgery,endoscopic intervertebral fusion techniques have gradually emerged and been widely used in clinical practice in recent years. OBJECTIVE:To analyze the early clinical efficacy of uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the treatment of lumbar degenerative diseases. METHODS:135 patients with lumbar degenerative diseases treated by uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the Suining Central Hospital from October 2020 to December 2021 were enrolled in this study.There were 59 males and 76 females,aged 47-79 years.The lower limb and lumbar pain was evaluated by visual analog scale and lumbar function was assessed by Oswestry disability index before the operation,1 week,1,and 6 months after the operation,and at the end of follow-up.The overall pain recovery of patients was evaluated by the scoring criteria for low back pain surgery of Spine Group of Chinese Orthopedic Association and the lumbar physiological curvature and intervertebral fusion were evaluated on lumbar lateral X-ray preoperatively and at the end of follow-up. RESULTS AND CONCLUSION:(1)The 135 patients were followed up for(17.8±3.0)months after surgery.There was 1 case of endplate injury,1 case of cerebrospinal fluid leakage,1 case of nerve root injury,1 case of intervertebral cage subsidence and displacement,1 case of chronic infection,and 1 case of pedicle screw rupture.The complication rate was 5.2%.(2)The lumbar visual analog scale score and Oswestry disability index significantly decreased in the waist and lower limbs at various time points postoperatively compared with those preoperatively in 135 patients(P<0.05).The scoring criteria for low back pain surgery of the Spine Group of the Chinese Orthopedic Association were significantly better at the last follow-up than that preoperatively in 135 patients(P<0.05).(3)At the last follow-up,there was no significant difference in physiological curvature of lumbar vertebra as compared with that preoperatively in 135 patients(P>0.05),with a fusion rate of 95.8%.(4)It is concluded that uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the treatment of lumbar degenerative diseases has shown satisfactory early clinical results and is a highly safe minimally invasive spinal surgery mode.
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Objective:To explore the relationship between kinesiophobia and somnipathy among inpatients with lumbar degenerative disease after surgery, and analyze the mediating effects of post-traumatic stress disorder and family care.Methods:A cross-sectional survey method was adopted, from July 2020 to July 2022, a total of 130 lumbar degenerative disease patients from Wuhan Dongxihu District People′s Hospital were enrolled as research object by convenience sampling method. General information questionnaire, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Posttraumatic Stress Checklist-civilian version and Family APGAR index were used for investigation. A structural equation model was established to evaluate the mediating effect of post-traumatic stress disorder, family care on kinesiophobia and somnipathy.Results:The scores of kinesiophobia, somnipathy, post-traumatic stress disorder and family care were (39.95 ± 3.90), (7.63 ± 0.46), (25.99 ± 4.99), (5.67 ± 1.76) points, respectively. There were significant differences in the scores of somnipathy in terms of age, monthly income, course of disease and pain degree ( F values were 3.21 to 10.12, all P<0.05). The dimensions and total scores of somnipathy were positively correlated with kinesiophobia ( r values were 0.347 to 0.800, all P<0.05) and post-traumatic stress disorder ( r values were 0.385 to 0.825, all P<0.05), negatively correlated with the scores of family care ( r values were - 0.653 to - 0.282, all P<0.05); the scores of family care was negatively correlated with kinesiophobia and post-traumatic stress disorder ( r = - 0.695, - 0.637, both P<0.05); the scores of kinesiophobia was positively correlated with post-traumatic stress disorder ( r = 0.773, P<0.05). The indirect effect of kinesiophobia on somnipathy was identified, and the total indirect effect value was 0.44; the indirect effect value of family care and post-traumatic stress disorder was 0.09, which accounted for 12.0% of the total effect. Conclusions:Post-traumatic stress disorder and family care play a multiple mediating role on the relationship between kinesiophobia and somnipathy in patients with lumbar degenerative disease after surgery.
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Wallis dynamic stabilization system is a surgical approach in the non-fusion technique of lumbar spine, consisting of interspinous blockers and dacron artificial ligaments that provide stability to the spine while maintaining a degree of motion in the affected segment. Recent studies have demonstrated the significant benefits of Wallis dynamic stabilization system in treating lumbar degenerative diseases. It not only improves clinical symptoms, but also effectively delays complications such as adjacent segmental degeneration. This paper aims to review the literature related to the Wallis dynamic stabilization system and degenerative diseases of the lumbar spine to describe the long-term prognostic effect of this system in the treatment of such diseases. This review provides a theoretical basis and reference for selecting surgical methods to treat degenerative diseases of the lumbar spine.
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Humans , Spinal Fusion/methods , Lumbar Vertebrae/surgery , Lumbosacral Region , Decompression, Surgical/methods , Intervertebral Disc Degeneration/surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#To evaluate the effects of electromyography on the clinical manifestations and prognosis after posterior lumbar interbody fusion(PLIF) of degenerative lumbar diseases.@*METHODS@#A retrospective analysis was performed on 68 patients with degenerative lumbar diseases, including 29 males and 39 females, aged 21 to 84 years old, who underwent electromyogram (EMG) from January 2018 to October 2019. The patients were divided into negative and positive groups according to whether theresults of EMG was normal or abnormal, PLIF surgery was performed in both groups. The preoperative duration of illness, postoperative recovery time, operative time, intraoperative blood loss, postoperative ambulation time and length of postoperative hospital stay were recorded. The clinical efficacy was evaluated by visual analogue scale(VAS) of low back and lower limb, the Japanese Orthopedic Association(JOA) score before and after operation.@*RESULTS@#All patients were follow-up from 26 to 39 months. The subjective symptoms, clinical signs, daily activities and JOA total scores after operation in two groups were significantly higher than those before preoperation(P<0.05);the clinical signs score and total JOA score in the negative group at 3 months after operation were higher than those in the positive group(P<0.05). The VAS score of leg pain in the negative group after 1 and 3 months was less than that in the positive group(P<0.05). Patients 's illness time, postoperative recovery time, hospitalization time and implantation time in the negative group were shorter than those in the positive group(P<0.05). At other time points, there was no significant difference in low pain VAS, leg pain VAS, JOA scores in the two groups(P>0.05). There was no significant difference in the operation time and intraoperative bleeding volume between the two groups(P>0.05).@*CONCLUSION@#Patients with normal electromyography had shorter disease duration than ones with abnormal electromyography in lumbar degenerative disease;after PLIF, patients with normal electromyography recovered faster than ones with abnormal electromyography, but the results of electromyography had no effect on the final prognosis of PLIF surgery.
Subject(s)
Male , Female , Humans , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Spinal Fusion/methods , Lumbar Vertebrae/surgery , Treatment Outcome , PainABSTRACT
Objective:To investigate the correlation between lumbar degenerative disease and bone mineral density in postmenopausal women.Methods:A total of 97 patients with postmenopausal lumbar degenerative degeneration who were admitted to our hospital from Jan. 2019 to Mar. 2022 were selected for study, and the average bone mineral density of L1-L4 vertebral bodies was measured by lumbar dual-energy X-ray absorptiometry (DXA) . BMD T values divided them into normal bone mass (group A, n = 28) , low bone mass (group B, n = 30) and osteoporosis group (group C, n = 39) . All patients underwent lumbar spine MRI, and the degree of lumbar intervertebral disc degeneration (L1/2, L2/3, L3/4, L4/5, L5/S1) was evaluated by the Pfirrmann grading system, and the relationship between lumbar spine degeneration and bone loss was analyzed. density relationship.Results:In this study, the incidence of osteoporosis in postmenopausal women was 40.21%. The ages of group A, group B and group C were (66.08±4.05 vs 56.78±3.97 vs 52.34±3.17) years, respectively. Menopause time was (14.05± 2.08 vs 8.04±2.04 vs 4.06±1.02) years, respectively. BMI was (22.02±1.68 vs 24.05±1.52 vs 26.47±1.67) kg/m2, respectively. The menopause time and age of group C were significantly longer than those of group A and B (P<0.05) , the BMI of group C and B was significantly lower than that of group A, and the BMI of group C was significantly lower than that of group B, with statistical significance (P < 0.05, Table 1) . Group A, group B and group C lumbar intervertebral disc degeneration score: L1/2: (1.80±0.47) points, (2.25±0.48) points, (2.62±0.58) points, L2/3: (1.97±0.44 vs 2.49±0.51 vs 2.97±0.47) points, L3/4: (2.61±0.22 vs 2.97±0.34 vs 3.96±0.25) points, L4/5: (3.45±0.32 vs 3.78±0.34 vs 3.88±0.24) points, L1/S1: (3.52±0.46 vs 3.77±0.52 vs 3.97±0.47) points, L5/S1: (2.64±0.43 vs 3.05±0.52 vs 3.34±0.74) points, the mean values of L1/2, L2/3, L3/4, L1-S1 and disc degeneration scores in groups C and B were higher than those in group A ( P<0.05) , and the scores in group C were higher than those in group B ( P<0.05) . L4/5 and L5/S1 disc degeneration scores in group C were higher than those in group A ( P<0.05) , there was no statistical significance between group C and group B ( P>0.05) , there was no statistical significance between group B and group A ( P>0.05) , and there was statistical significance between group B and group A in L4/5 lumbar disc degeneration scores ( P=0.018) . The L5-S1 lumbar disc degeneration score was significantly different among the three groups ( P=0.012) . BMD was positively correlated with BMI, and negatively correlated with menopause time, age, L1/2, L2/3, L3/4, L4/5, L5/S1 and L1-S1 intervertebral disc degeneration degree. Conclusion:In postmenopausal women, BMD was negatively correlated with menopause time, age, and degree of lumbar intervertebral disc degeneration, and was positively correlated with BMI. The lower the BMD, the more severe the lumbar degenerative disease.
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The implantation of interspinous process device is a minimal invasive surgical procedure for degenerative lumbar spinal diseases. At present, a variety of interspinous process devices designed can be subdivided into three categories based on different application principles: interspinous distraction device, interspinous fixation device and interspinous fusion device. The interspinous distraction devices distract interspinous interspace, enlarge spinal canal area and alleviate neurological symptom, which are mainly applied for lumbar spinal stenosis with intermittent neurogenic claudication. Interspinous fixation device has been used as an alternative technique to the pedicle screw fixation in lumbar interbody fusion due to gripping and fixating to spinous process. Interspinous fusion device utilizes rigid fixation to support fusion, which can be used as not only simple distraction device but also additional instrumentation for direct decompression and interbody fusion. All types of interspinous process devices are different in biomechanical characteristics due to its application concept. In this review, the author mainly focus on biomechanical research progress of interspinous process device in lumbar degenerative disease.
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Objective: To analyze the restoration of intervertebral height and lordosis of fusion segment after open-transforaminal lumbar interbody fusion (Open-TLIF) and minimally invasive-TLIF (MIS-TLIF). Methods: Between January 2013 and February 2016, patients who treated with TLIF due to lumbar degenerative diseases and met the selection criteria were selected as the study objects. Among them, 41 patients were treated with open-TLIF (Open-TLIF group), 34 patients were treated with MIS-TLIF (MIS-TLIF group). There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, disease type, disease duration, pathological segment, and other general data. The intraoperative bleeding volume, hospital stay, visual analogue scale (VAS) score of waist and leg, and Oswestry disability index (ODI) were recorded before and after operation. The anterior disc height (ADH), posterior disc height (ADH), and segmental lordosis (SL) of fusion segment were measured by X-ray film before and at 6 months after operation. The differences of ADH, PDH, and SL between pre- and post-operation were calculated. Results: The intraoperative bleeding volume and hospital stay in Open-TLIF group were significantly higher than those in MIS-TLIF group ( t=14.619, P=0.000; t=10.021, P=0.000). All incisions healed by first intention without early complications. All patients were followed up 6-24 months (mean, 12.6 months) in Open-TLIF group and 6-24 months (mean, 11.5 months) in MIS-TLIF group. The preoperative VAS scores of waist and leg and ODI of the two groups significantly improved ( P0.05). Imaging examination showed the good intervertebral fusion. There was no significant difference in ADH, PDH, and SL between the two groups before operation and at 6 months after operation ( P>0.05). The differences of ADH, PDH, and SL between the two groups were not significant ( P>0.05). The ADH, PDH, and SL after operation significantly increased in the two groups ( P<0.05). Conclusion: Open-TLIF and MIS-TLIF show similar effectiveness and radiological change in the treatment of single lumbar degenerative diseases and the improved intervertebral height and lordosis, but MIS-TLIF can significantly reduce hospital stay and intraoperative blood loss.
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BACKGROUND: Decompression-fixation-fusion is the key to spinal surgery since early effective fixation to achieve intervertebral fusion can restore spinal stability in lumbar degenerative disease. OBJECTIVE: To compare biomechanical stability of fusion segment and adjacent segments of bilateral pedicle screw fixation, unilateral pedicle screw fixation and unilateral pedicle screw combined with contralateral translaminar facet screw fixation under transforaminal lumbar interbody fusion. METHODS: Eighteen fresh calf L3-5 specimens were selected. Different forms of fixation were conducted under transforaminal lumbar interbody fusion. The specimens were divided into group A (complete specimens) and group B (bilateral pedicle screws), group C (unilateral pedicle screws), and group D (unilateral pedicle screw combined with contralateral translaminar facet screw). The range of motion of adjacent segment L3-4 and fusion segment L4-5 in six directions of backward extension, forward bending, left bending, right bending, left rotation and right rotation and the stiffness of fusion segment L4-5 were tested. RESULTS AND CONCLUSION: (1) For the range of motion of fusion segment L4-5, the stability was highest in the group B in six directions, followed by group D, which showed similar results in rotation in the group B (P > 0.05). The stability of right curvature and left rotation in group C was insufficient, and there was no significant difference in range of motion between group A and group C (P > 0.05). The range of motion in group A was largest and the stability was worst in the six motion directions. (2) For the stiffness value of fusion segment L4-5, the stiffness value of group B was largest in six directions, which was significantly different from other groups (P 0.05). There was no significant difference between group C and group A in the range of motion of six directions (P > 0.05). (4) The results showed that the motion ramge of unilateral pedicle screw fixation in the right and left rotation directions was large in the early stage, which was close to that of the complete specimen group. There is a shortage of stability, so we need to use it carefully and grasp the indications strictly. Unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation improves the disadvantages of asymmetric fixation of unilateral pedicle screw, increases the stability of rotation and lateral bending, and avoids the influence of bilateral pedicle screw fixation on adjacent segments, thus becoming an effective clinical surgical treatment.
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BACKGROUND: The non-fusion system of lumbar interspinous process distraction device provides a new treatment option for lumbar degenerative diseases. However, at present, the clinical application and research of lumbar interspinous process distraction device are reported insufficiently in China, especially for the domestic lumbar interspinous process distraction device. OBJECTIVE: To verify the scientific nature and effectiveness of the new domestic lumbar interspinous process distraction device through finite element analysis and in vitro biomechanical experiment of goat lumbar spine. METHODS: (1) Finite element analysis of new domestic lumbar interspinous process distraction device: L2-L5 three-dimensional model of vertebral body was established based on normal adult lumbar CT data. From then on, new domestic lumbar interspinous process distraction device model, new lumbar interspinous process distraction device model of lumbar non fusion system were successively built. The mechanical conditions were given under the physiological conditions of lumbar spine. Biomechanical analysis was carried out before and after the new domestic lumbar interspinous process distraction device was implanted. (2) In vitro biomechanical analysis of new domestic lumbar interspinous process distraction device: the lumbar vertebrae (L1-L5) of 24 adult male goats were obtained, and the new domestic lumbar interspinous process distraction device was implanted between the L3-4 spinous process. Before and after the placement of the lumbar interspinous process distraction device, the lumbar motion range and the pressure of the intervertebral disc under the flexion, extension, lateral bending and rotation of the lumbar specimens were detected. RESULTS AND CONCLUSION: (1) After the new lumbar interspinous process distraction device was implanted, the motion range and the pressure of the intervertebral disc of responsible segment were reduced, while the adjacent segments' mobility and the pressure of the intervertebral disc were almost unaffected. It was theoretically verified that the new domestic lumbar interspinous process distraction device could provide the biomechanical basis for the treatment of the lumbar degenerative diseases, and contribute to the theoretical reference for the prevention of the clinical diseases. (2) In the state of extension, the motion range of L3-4 vertebral body after implanting the new lumbar interspinous process distraction device was significantly lower than that before implantation (P 0. 05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body after implanting the lumbar interspinous process distraction device and that before implantation (P > 0. 05). In the state of extension, the pressure of intervertebral disc after L3-4 vertebral body implantation was significantly lower than that before implantation (P 0. 05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body implantation and that before implantation (P > 0. 05). (3) The results showed that the scientific nature and validity of the new domestic lumbar interspinous process distraction device was verified by three-dimensional finite element analysis and in vitro animal lumbar specimens experiment, which provided a strong basis for the animal experiment, clinical experiment, clinical application and clinical production of the new domestic lumbar interspinous process distraction device.
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Objective: To analyze the medium and long-term effectiveness of microendoscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases in comparison with conventional tubular retractor-assisted MIS-TLIF. Methods: Between November 2008 and March 2013, 53 patients with single segment lumbar degenerative diseases were enrolled. According to the different working channel performed, 28 patients were treated by microendoscope-assisted MIS-TLIF (observation group), while the remaining cases received conventional tubular retractor-assisted MIS-TLIF via Wiltse approach (control group). Preoperative baseline data, including age, gender, body mass index, disease etiology, operated level, the ration for requiring bilateral canal decompression, and preoperative visual analogue scale (VAS) socre of low back pain and leg pain, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, showed no significant difference between the two groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative analgesic drug dose, postoperation in-bed time, and perioperative complication incidence were recorded respectively and compared between the two groups. Radiographic evaluation of interbody fusion was performed based on Bridwell grading system at 2 years after operation. VAS scores of low back pain and leg pain, JOA score, and ODI score were assessed before operation, at 2 years after operation, and at last follow-up respectively. Surgical outcome satisfaction was assessed by modified MacNab criteria at last follow-up. Results: When compared with those in control group, both intraoperative blood loss and postoperative analgesic drug dose were significantly decreased in observation group ( P0.05). At last follow-up, the results of patients' satisfaction with surgery evaluated by modified MacNab criteria, and the excellent and good rates of the observation group and the control group were 96.4% and 92.0%, respectively, showing no significant difference ( χ2=0.485, P=0.486). Conclusion: The medium and long-term effectiveness of microendoscope-assisted MIS-TLIF are similar to those of conventional tubular retractor-assisted MIS-TLIF for lumbar degenerative diseases. The former operation has the additional advantages in terms of more clear surgical site visually, less intraoperative blood loss, and reduced postoperative analgesic dose, all of which seem more feasible to clinical teaching.
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STUDY DESIGN: Retrospective study. PURPOSE: Associations among risk factors related to adjacent segmental disease (ASD) remain unclear. We evaluated the risk factors and segmental lordosis ratio to prevent ASD developing after lumbar spinal fusion. OVERVIEW OF LITERATURE: Risk factors related to ASD development are age, sex, obesity, pre-existing degeneration, number of fusion segments, and decreased postoperative lumbar lordosis (LL). However, the associations among these factors are still unclear and should be clearly identified. METHODS: We retrospectively reviewed data on 274 patients who underwent lumbar spinal fusion of three segments or below for lumbar degenerative disease from January 2010 to December 2012, with over 5 years of follow-up. Patients with preoperative sagittal vertical axis (SVA) >5 cm were excluded due to sagittal imbalance. A total of 37 patients with ASD and 40 control patients (CTRL) were randomly selected in a similar distribution of matching variables: age, sex, and preoperative degenerative changes. Sex, age, number of fusion segments, radiologic measurements, L4–5–S1/L1–S1 LL ratio, and spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], and SVA) were analyzed. Logistic regression was used to analyze the correlation between PI–LL mismatch and L4–5–S1 segmental lordosis rate. RESULTS: No significant difference was found between ASDs and CTRL groups regarding age, sex, number of fusion segments, fusion method, and preoperative and postoperative spinopelvic parameters (PI, SS, PT, and LL). However, regarding the L4–5–S1/L1–S1 lordosis ratio, 50% (p=0.045), 60% (p=0.031), 70% (p=0.042), 80% (p=0.023), and 90% (p=0.023) were statistically significant; 10 group, and the difference was statistically significant (p=0.048). CONCLUSIONS: Patients with a postoperative L4–5–S1/L1–S1 lordosis ratio >50% had less occurrence of ASD. Correcting LL according to PI and physiologic segmental lordosis ratio is important in preventing ASD.
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Animals , Humans , Follow-Up Studies , Incidence , Logistic Models , Lordosis , Methods , Obesity , Retrospective Studies , Risk Factors , Spinal FusionABSTRACT
STUDY DESIGN: Retrospective study.OBJECTIVES: To compare the degeneration of sacroiliac joint (SIJ) following lumbar or lumbosacral fusion.SUMMARY OF LITERATURE REVIEW: The SIJ is adjacent to lumbosacral junction and its degeneration can be the potential cause of pain. However, the study addressing SIJ degeneration following lumbar or lumbosacral fusion is very limited.MATERIALS AND METHODS: From June 2002 to June 2012, 98 patients who underwent posterior decompression and posterolateral fusion were included in this study. The study group was divided into 2 groups according to the range of fusion. Group A had fusion to L5 and included 34 patients. Group B had fusion to S1 and included 64 patients. We evaluated the five years postoperative radiologic and clinical outcomes retrospectively.RESULTS: There was no statistically significant difference of bilateral preoperative subchondral sclerosis and osteophytes of the SIJ between group A and group B. However, group B revealed statistically significant subchondral sclerosis and osteophyte formation of the SIJ than group A on every radiographs after postoperative 1 year. In group B, the number of fusion segments and age were statistically positively correlated with the degeneration of the SIJ.CONCLUSIONS: Degeneration of the SIJ revealed more rapid and more severe progression in lumbosacral fusion group than in lumbar fusion group. The number of fusion segments and age were positively correlated with the degeneration of the SIJ in lumbosacral fusion group. Therefore, these facts should be taken into account when performing spinal fusion.
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Humans , Decompression , Osteophyte , Retrospective Studies , Sacroiliac Joint , Sclerosis , Spinal FusionABSTRACT
Objectives:To analyze the clinical result and the prognostic factors for postoperative patients with foot drop caused by lumbar degenerative disease.Methods:2341 patients who suffered from lumbar degenerative disease and underwent lumbar surgery from January 2011 to January 2016 were reviewed,among which 125 cases suffered from foot drop and caused by lumbar spinal stenosis(LSS) or lumbar disc herniation (LDH).Among the 125 patients,108 cases were enrolled with complete follow-up.All patients underwent modified PLIF and nerve roots decompression.The mean follow-up period was 2.4±1.5 years(range,1.4-5.2 years).Patients whose tibialis anterior(TA) muscle strength recovered to grade 4 or grade 5,the ankle could move freely,with a relative normal gait,could be considered as recovery.The following indexes were included in the single factor analysis by Log-rank test:age,gender,type of lumbar degeneration,duration of palsy,preoperative tibialis anterior strength,physical sensation disorder of affected lower limbs,number of affected limbs,preoperative VAS score,cauda equine syndrome,affected levels and history of trauma.Cox regression analysis was used to analyze the prognostic factors of surgical treatment effect.Results:Among 108 cases of patients with foot drop,59 cases were cured,the recovery rate was about 54.6％.Among them,44 cases were LSS,and 15 cases were cured,the rate was 34.1％;64 cases were LDH,44 cases were cured,the rate was 68.7％.The single factor analysis showed that age,type of lumbar degeneration,duration of palsy,preoperative TA muscle strength and number of affected limbs had significant relation with prognosis (P＜0.05).The Cox regression analysis showed the following indexes were the prognostic factors of foot drop:age,type of lumbar degeneration,duration of palsy and preoperative TA muscle strength(P＜0.05).Conclusions:Age,type of degeneration,duration of palsy and preoperative TA muscle strength are significantly related to the prognosis of foot drop caused by lumbar degenerative disease.Patiets with younger age,shorter duration,stronger TA muscle strength recover better;compared with LSS,foot drop caused by LDH recover better.
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Objective To analyze the causes of surgical errors and complications of lumbar degenerative diseases treated by transforaminal endoscopic spine system(TESSYS),and explore the treatment and prevention measures.Methods From July 2012 to January 2016,the data of 660 patients with lumbar degenerative diseases who treated with TESSYS were analyzed retrospectively,of which 528 patients were lumbar disc herniation with 192 cases of single segment(L4/L5) and 336 cases of multi-segment.Lumbar spinal stenosis in 132 cases,were lateral recess and nerve root canal stenosis.Surgical errors and complications were recorded,and analyzed the reasons and the treatment and preventive measures.Results Intraoperative errors:1 case of sterile film with the dilating catheter went into the surgical area;1 case with wire fracture,and stump retention in vivo;for discography staining,the proportion of mixed solution was not enough,the leakage of excess concentration of methylene blue caused caudal nerve injury in 3 cases;expansion of the intervertebral foramen,the drilling part of the articular process was too deep and too close to the medial wall of the articular process,which caused cutting injury of nerve fiber sheath in 2 cases;after the rupture of the dura mater,the rinse solution was perfused,caused bloating,elevated intracranial pressure,elevated blood pressure and other symptoms of spinal cord hypertension in 3 cases;low dose of local anesthetic into the blood caused toxic reaction in 2 cases;total spinal cord anesthesia with paravertebral nerve root block in 1 case.Postoperative complications:3 cases of nerve root edema;2 cases of free nucleus pulposus tissue;2 cases of local hematoma led to nerve root compression;1 case of intervertebral space infection and 3 cases of local skin neuritis in the puncture area.Conclusion In the process of intervertebral foramen surgery,there are some deficiency on instruments or operating skill.Therefore,rigorous treatment of each link in the perioperative period,is the guarantee of successful surgery.
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Objective To evaluate the accuracy and safety of pedicle-scope assisted pedicle screw fixation and percutaneous pedicle screw fixation for treating lumbar degenerative disease(LDD).Methods Thirty cases of LDD treated by mini-invasive transforaminal lumbar interbody fusion(TLIF) under microscope plus percutaneous pedicle screw fixation with fluoroscopy or pedicle-scope of lumbar spine from December 2013 to September 2015 were selected and divide into the percutaneous group and pediclescope group,15 cases in each group.The operative duration,intraoperative blood loss volume,hospital stay and complications were compared between the two groups.The clinical effects were assessed with visual analogue scale(VAS) and Oswestry disability index(ODI).The plain radiography,dynamic radiology and lumbar magnetic resonance imaging(MRI) and computed tomography (CT) were re-examined after operation for assessing the screw location and fusion rate.Results Eighty-four screws were placed in the percutaneous group and 70 screws in the pedicle-scope group.In the percutaneous group and pedicle-scope group,the mean intraoperative blood loss volume,mean operative duration,average times of C-arm fluoroscopy,mean length of hospital stay,mean time of off-bed and complication occurrence rate were measured,and the differences were not statistically significant (P＞ 0.05).In 6-month follow up,the VAS score and ODI score in the two groups were significantly improved compared with before operation(P＜0.01);the VAS score and ODI score were(2.50 ± 1.30) and (50.00-±-3.50) in pediclescope group,(3.00± 1.50) and (58.00 ±4.50) in percutaneous group,respectivehy,and the differences were statistically significant(P＜0.05);the improvement rates of clinical symptoms in the percutaneous group and pedicle-scope group were 73.33 ％ and 80.00 ％ respectively.The imaging reexamination showed that the placed screw location was good and lesion segment fusion was good without screw loosening.The location of 3 screws in the percutaneous group was deviated and adjusted by the second operation.Conclusion The accuracy and safety of pedicle-scope assisted screw placing for treating LDD are higher than those of conventional percutaneous pedicle screw fixation,moreover the operative time is shorter with less intraoperative bleeding.
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Objective To investigate the clinical efficacy of unilateral small incision Quadrant channel assisted MIS?TLIF unilateral pedicle screw fixation system in the treatment of degenerative lumbar disease. Methods From January 2011 to December 2013,a total of 56 cases with low back and leg pain were selected in the People′s Hospital of Dongguan,including 25 cases with lumbar disc herniation,18 cases with lumbar tube stenosis,10 cases with discogenic low back pain,2 cases of recurrence after posterior lumbar spine surgery,1 case of recurrence after transforaminal endoscopic surgery. Unilateral pedicle screw fixation was performed in the treatment of MIS?TLIF with expandable pipeline system. VAS and Oswestry dysfunction index scoring system( ODI) were used to evaluate of pain and functional recovery in patients with preoperative and postoperative pain and functional recovery,the Suk method was used to observe the bone graft fusion. Results There were 5 cases of non operative side waist back pain after operation,and the waist circumference and anti?inflammatory pain relief were improved after treatment. One case of postoperative subcutaneous fat liquefaction, was cured by dressing change. One patient with recurrence of MED intraoperatie cerebrospinal fluid leakage,was cured after treatment by the bed,dehydration and others. Other complications such as infection,screw loosening, nerve root injury and other complications had no found. After 1 month,the VAS score from preoperative ( 6. 82 ±0. 92) points fell to (1. 95±0. 55) points,ODI score from preoperative (35. 21±2. 73) points fell to (10. 05 ±1. 72) points, significantly improved compared with the preoperative, the differences were statistically significant( t=36. 775,65. 858,P<0. 05) ,based on the fusion of Suk judgment method,2 cases of patients with possible fusion,the rest were fusion. Conclusion Unilateral small incision under the quadrant assisted MIS?TILF unilateral pedicle nail stick system has obvious advantages in treatment of degenerative lumbar spine disease,as long as we choose to suitable cases and most patients can obtain satisfactory results.
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STUDY DESIGN: A review of the literature. OBJECTIVES: To discuss how to evaluate, interpret, and utilize measurements of spino-pelvic alignment before and after spinal surgery in patients with lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: Various spino-pelvic parameters are currently utilized in the evaluation of spinal patients; however, interpretation of these parameters is not easy. MATERIALS AND METHODS: Each spino-pelvic parameter and factors affecting its value, and how to interpret and utilize the spino-pelvic parameters before and after spinal surgery were discussed for patients with lumbar degenerative disease with and without sagittal spinal deformity. RESULTS: Sagittal modifiers in the SRS-Schwab classification including pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), and pelvic tilt (PT) are widely accepted in the evaluation of lumbar degenerative disease with sagittal deformity. Surgery for sagittal realignment is meant to restore both the SVA and PT by restoring the LL in reference to the PI. However, patients with an extremely high SVA and PT or those with a high SVA and low PT can end up with postoperative residual malalignment. In patients without deformity, PI-LL mismatch (> 10°) should be highlighted and should be actively corrected by restoring the lordosis of the pathologic segment. CONCLUSIONS: Sagittal modifiers are beneficial for their simplicity and comprehensibility; however, they are insufficient for evaluating sub-regional spinal deformity. Spino-pelvic parameters can be useful for evaluating spinal patients in a clinical setting, but the measurements are greatly affected by confounding factors such as poor patient posture, unqualified testers, and manual measurement techniques.