Research progress of Wallis dynamic stabilization system for lumbar degenerative diseases / 中国骨伤

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.

Effect of adjacent segmental facet joint degeneration on adjacent segment disease after lumbar fusion and fixation / 中国骨伤

OBJECTIVE@#To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease (ASD) after lumbar fusion and fixation.@*METHODS@#A retrospective analysis was performed on 138 patients who underwent L5S1 posterior lumbar interbody fusion (PLIF) from June 2016 to June 2019. Patients were divided into a degeneration group (68 cases) and a non-degenerative group (70 cases) based on the presence or absence of L4,5 facet joint degeneration before surgery (graded using the Weishaupt standard). Age, gender, body mass index (BMI), follow-up time, and preoperative L4,5 intervertebral disc degeneration (graded using the Pfirrmann standard) were collected for both groups. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 and 3 months after surgery. The incidence and time of ASD after surgery were analyzed.@*RESULTS@#There were no significant differences between the two groups in age, gender, BMI, follow-up time, or preoperative L4,5 intervertebral disc degeneration. Both groups showed significant improvement in VAS and ODI at 1 and 3 months after surgery (P<0.001), with no significant difference between the groups(P>0.05). However, there was a statistically significant difference in the incidence and timing of ASD between the groups (P<0.05). The degeneration group had 2 cases of ASD in gradeⅠdegeneration, 4 cases of ASD in gradeⅡdegeneration, and 7 cases of ASD in grade Ⅲ degeneration. There was a statistically significant difference between the number of patients with grade Ⅲ degeneration and those with gradesⅠandⅡASD (P<0.0167, Bonferroni correction).@*CONCLUSION@#Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation, whereas gradeⅢ degeneration will further increase the risk.

Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis / 中国骨伤

OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Early efficacy of three dimensional printed anatomical biomimetic cervical artificial disc replacement in the treatment of cervical degenerative diseases / 中华外科杂志

Objective: To investigate the efficacy and safety of a new cervical artificial disc prosthesis in the treatment of cervical degenerative diseases. Methods: The clinical data of 18 patients with single-level cervical degenerative diseases who underwent three dimensional printed anatomical bionic cervical disc replacement at Department of Spinal Surgery,Honghui Hospital,Xi'an Jiaotong University from May 2019 to July 2020 were analyzed retrospectively. There were 7 males and 11 females,aged (45±8) years old(range:28 to 58 years).The surgical segment was located at C3－4 level in 2 cases, C4－5 level in 5 cases, C5－6 level in 9 cases, and C6－7 level in 2 cases.The clinical and radiographic outcomes were recorded and compared at preoperative,postoperative times of one month and twelve months.The clinical assessments contained Japanese orthopedic association (JOA) score,neck disability index (NDI) and visual analogue scale (VAS).Imaging assessments included range of motion (ROM) of cervical spine, prosthesis subsidence and prosthesis anteroposterior migration.Repeated measurement variance analysis was used for comparison between groups,and paired t test was used for pairwise comparison. Results: All patients underwent the operation successfully and were followed up for more than 12 months.Compared with preoperative score,the JOA score,NDI and VAS were significantly improved after surgery (all P<0.01).There was no significant difference in postoperative ROM compared with 1-and 12-month preoperative ROM (t=1.570,P=0.135;t=1.744,P=0.099). The prosthesis subsidence was (0.29±0.13) mm (range: 0.18 to 0.50 mm) at 12-month postoperatively.The migration of prosthesis at 12-months postoperatively were (0.71±0.20) mm (range: 0.44 to 1.08 mm).There was no prosthesis subsidence or migration>2 mm at 12-month postoperatively. Conclusion: Three dimensional printed anatomical biomimetic cervical artificial disc replacement has a good early clinical effect in the treatment of cervical degenerative diseases, good mobility can be obtained while maintaining stability.

The development of artificial cervical disc replacement from the perspective of orthopedic bionic therapy / 中华外科杂志

The modern surgical treatment of cervical degenerative disc disease can be traced back to the advent of anterior cervical decompression and fusion.With the emergence of fusion-related complications,different scholars have promoted the gradual transformation of cervical degenerative disc diseases from "fusion fixation" to "non-fusion reconstruction" through in-depth fusion with materials science,engineering mechanics and other disciplines.The innovation of this treatment concept is consistent with the original intention of "structural remodeling,functional reconstruction,maximum repair and reconstruction of the morphology and function of skeletal muscle system" in orthopedic bionic treatment,which is essentially in line with the "bionic alternative therapy" in orthopedic bionic therapy.This paper focuses on the surgical treatment of cervical degenerative disc diseases,reviews the development history of artificial cervical disc replacement,analyzes the evolution from orthopedic biomimetic therapy,and explores a new direction for the design of artificial cervical disc prostheses and the treatment of cervical degenerative disc diseases in the future.

Percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion / 中国骨伤

OBJECTIVE@#To explore the clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion.@*METHODS@#From February 2010 to June 2018, 64 patients with adjacent segment lumbar disc herniation after lumbar fusion were retrospectively analyzed and divided into observation group and control group. In observation group, there were 23 males and 10 females performed with percutaneous endoscopic lumbar discectomy, including 27 cases of single segment fusion and 6 cases of double segment fusion, aged from 55 to 83 years old with an average of (65.7±7.4) years old. In control group, there were 22 males and 9 females performed with traditional open fusion revision, including 25 cases of single-segment fusion and 6 cases of double segment fusion, aged from 51 to 78 years old with an average of(64.8±7.8) years old. The operative time, intraoperative blood loss, fluoroscopy times, postoperative ambulation time and length of postoperative hospital stay were recorded. The clinical efficacy was evaluated by visual analogue scale(VAS) and Oswestry Disability Index(ODI). The complications between two groups were observed.@*RESULTS@#All patients were followed up for at least 2 years. The observation group patients were followed up with an average of (2.4±0.5) years. The control group patients were followed up with an average of(2.6±0.7) years. Compared with control group, operation time, intraoperative blood loss, postoperative ambulation time and length of postoperative hospital stay of the observation group were significantly reduced (P<0.05), and the fluoroscopy times of observation group were significantly increased compared with control group(P<0.05). The VAS of low back and lower limb, and ODI at the latest follow-up between two groups were all significantly improved compared to those of pre-operation (P<0.05). The VAS of low back at each point and ODI at 1, 3 months after operation in observation group was significantly reduced compared with control group(P<0.05), however there was no significant difference in VAS for lower limb between two groups (P>0.05). The difference of complications between two groups was statistically significant (P<0.05).@*CONCLUSION@#Compared with traditional open fusion revision surgery, percutaneous endoscopic lumbar discectomy for the treatment of adjacent segment lumbar disc herniation after lumbar fusion has the advantages of reducing operation time and intra-operative blood loss, shortening ambulation time and the length of postoperative hospital stay, and promoting pain and functional improvement, and decrease incidence of complications. However, long-term clinical efficacy needs further study.

Plasma rico en plaqueta en el tratamiento de la enfermedad degenerativa discal / Platelet-rich plasma in the treatment of degenerative disc disease

Introducción: La enfermedad degenerativa discal es una entidad frecuente y uno de los principales motivos de consulta. Genera altas tasas de discapacidad, años útiles perdidos, así como altos costos económicos por asistencia médica y grandes pérdidas monetarias. Su tratamiento es generalmente conservador, aunque en la actualidad se incluyen terapias biológicas novedosas. Objetivo: Describir las principales propiedades biológicas que hacen del plasma rico en plaquetas una terapéutica efectiva para la enfermedad degenerativa discal. Métodos: Se realizó una revisión no sistemática de la bibliografía basada en artículos que se publicaron en bases de datos indexadas en Infomed como Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, LILACS; en idioma español, inglés y portugués, durante los últimos diez años. Desarrollo: Se expusieron características clínico epidemiológicas de la enfermedad degenerativa discal, así como las propiedades biológicas que le permiten al plasma rico en plaqueta tener una función activa en la regeneración del disco intervertebral o el retraso de la cascada de degradación de este. Se resaltan los principales estudios de acuerdo a la vía de administración del plasma rico en plaquetas y sus resultados. Conclusiones: De acuerdo con lo publicado por los autores, el plasma rico en plaquetas es una alternativa efectiva en el tratamiento de la enfermedad degenerativa discal por la producción de factores derivados de las plaquetas, que intervienen en la degeneración del disco intervertebral, siendo la vía intradiscal la que más se emplea(AU)

Introduction: Degenerative disc disease is a frequent condition and one of the main reasons to attend the consultation. It generates high rates of disability, useful years lost, as well as high economic costs for medical assistance and large monetary losses. Its treatment is generally conservative, although novel biological therapies are currently included. Objective: To describe the main biological properties that make platelet-rich plasma an effective therapy against degenerative disc disease. Methods: A nonsystematic review of the bibliography was carried out based on articles published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, and LILACS, in Spanish, English and Portuguese. Development: Clinical-epidemiological characteristics of degenerative disc disease were presented, as well as the biological properties that allow platelet-rich plasma to have an active function in the regeneration of the intervertebral disc or the delay of its degradation cascade. The main studies are highlighted, according to the route of administration of platelet-rich plasma and their results. Conclusions: According to what has been published by authors, platelet-rich plasma is an effective alternative in the treatment of degenerative disc disease, due to the production of factors derived from platelets, which intervene in the degeneration of the intervertebral disc, being the intradiscal pathway the most used(AU)

Analysis of surgical strategy of percutaneous endoscopic lumbar discectomy in young and middle-aged double-segment patients with lumbar disc herniation / 北京大学学报(医学版)

OBJECTIVE@#To investigate clinical efficacy and safety of single and double segmental percutaneous lumbar discectomy for young and middle-aged patients with double-segment disc herniation.@*METHODS@#Retrospective analysis was undertaken for 32 young and middle-aged patients with percutaneous endoscopic lumbar discectomy (PELD) in the treatment of double-segment lumbar disc herniation from January 2015 to October 2018 in Peking University First Hospital. In the study, 18 cases were treated with single-segment treatment and 14 cases with double-segment treatment. Visual analogue score (VAS) and oswestry disability index (ODI) assessment were used to compare clinical symptom outcomes before surgery, 3 months after surgery and at the last follow-up. Macnab criteria were used to assess the patients' overall satisfaction after surgery. Imaging parameters included lumbar lordosis, intervertebral height at each segment and endplate angle of lesion segment on the X-ray. And Michigan State University(MSU) rating and Pfirrmann scoring system were used to evaluate the grade of disc herniation and disc degeneration respectively on magnetic resonance imaging (MRI). The perioperative parameters included the surgeon, anesthesia method, operation time, postoperative hospital stay, postoperative bracing time and perioperative complications.@*RESULTS@#The mean follow-up time was (26.78±10.64) months. There was no significant difference in the follow-up time and baseline information between the two groups(P > 0.05). ODI scores 3 months post-operatively and at the last follow-up were lower in the double segment (P < 0.05). The ODI improvement was also more significant in the double-segment group at the last follow-up (P < 0.05). There was no significant difference in radiographic parameters at baseline (P>0.05). MSU scale for the primary segment was significantly lowered after both operations (P < 0.05). MSU scale for secondary segment was significantly lowered in double segment group but not in single segment group. Other imaging parameters were similar between the two groups (P > 0.05). The operation time of the single-segment group was significantly shorter than that of the double-segment group(P < 0.001). No perioperative complications were found in either group, but three patients underwent secondary lumbar surgery during the postoperative follow-up period in the single-segment group.@*CONCLUSION@#For young and middle-aged patients with double-segment disc herniation, this study suggests double-segment PELD may be more advantageous than single-segment PELD in terms of asuring clinical efficacy without increasing perioperative risks.

Comparison of clinical effects of different anterior surgical methods for the treatment of single segment cervical disc herniation / 中国骨伤

OBJECTIVE@#To compare the clinical effects of different anterior surgical methods in treating single segment cervical disc herniation.@*METHODS@#The clinical data of 46 patients with single-segment cervical disc herniation underwent surgical treatment from September 2013 to September 2018 were retrospectively analyzed. The patients were divided into three groups according to different surgical methods. Among them, 23 patients in the anterior percutanousendomic cervical dissection (APECD) group, there were 8 males and 15 females, aged (47±3) years old, prominent segments were C@*RESULTS@#All 46 patients were followed up for 12 to 24 (17.57±3.15)months. The follow-up time of APECD, CDR, ACDF groups were (17.30±3.25), (17.80±3.16), (17.85±2.88) months, and operation time were (95.48 ±13.85), (58.50±7.09), (76.00±15.72) min, respectively, there were no significant differences in follow-up time and operation time between two groups(@*CONCLUSION@#The three anterior surgical approaches can achieve satisfactory clinical results for the treatment of single-segment cervical disc herniation. However, the improvement rate of the CDR group and the activity of the retained responsibility segment are better than those of the other two groups. APECD surgery may have recurrence.

Clinical application of self-made minimally invasive hood-assisted transforaminal lumbar interbody fusion via modified bilateral Wiltse approach in the treatment of lumbar degenerative diseases / 中国骨伤

OBJECTIVE@#To explore the advantages of self made minimally invasive hook assisted transforaminal lumbar interbody fusion (TLIF) via modified bilateral Wiltse approach in the treatment of lumbar degenerative diseases.@*METHODS@#The clinical data of 140 patients underwent lumbar spine fusion surgery from October 2016 to October 2017 were retrospectively analyzed. Among them, 72 cases were treated by self-made minimally invasive hook-assisted TLIF via modified bilateral Wiltse approach (group A), there were 37 males and 35 females, aged (48±16) years old;68 cases were treated by TLIF via traditional posterior median approach (group B ), there were 38 males and 30 females, aged (45±15) years old. The surgical incision size, operation time, intraoperative blood loss volume, postoperative drainage volume, postoperative wound healing, and intervertebral fusion rate at the final follow-up were recorded between two groups. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to assess the clinical efficacy.@*RESULTS@#All the patients were followed up for 3 to 13 (8±5) months. The wound in group A healed well after operation, and 1 case in group B occurred wound necrosis after operation, and healed after debridement and suture. There were no significant differences in operation time and postoperative fusion rate between two surgical methods (@*CONCLUSION@#The self made minimally invasive hook assistedTLIF via modified bilateral Wiltse approach has the characteristics of minimally invasive, less intraoperative blood loss, less postoperative drainage, fewer complications, and more stable fusion in the treatment of lumbar degenerative desease.

Clinical observation on the treatment of cervical degenerative diseases with Hybrid surgery / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases (CDD) and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery.@*METHODS@#From January 2015 to April 2018, 35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow up data were analyzed retrospectively. Complete imaging follow-up data were obtained from 24 patients. There were 15 males and 20 females, aged from 39 to 70(55.57±7.73) years old. The amount of bleeding was for 20 to 100 (40.29±18.39) ml, and the hospitalstay was for 4 to 28(11.03±4.63) days, and the follow-up time was(12.97±1.36) months. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score (YT20), and Japanese Orthopaedic Association (JOA) score. The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation. Patients with or without heterotopic ossificationwere divided into two groups and their clinical effects were compared.@*RESULTS@#At the final follow up, the mean YT20 score and JOA score were significantly higher than those before operation (P <0.05), and the average improvement rate of JOA was (70.66 ±0.44)%. One year after operation, the heterotopic ossification occurred in 10 of 24 segments, with incidence of 41.70%(10/24), including 29.20% in gradeⅠand 12.50% in gradeⅡ. The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation (@*CONCLUSION@#The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases, and the cause of heterotopic ossification still needs tobe further explored.

Biomechanical affect of percutaneous transforaminal endoscopic discectomy on adjacent segments with different degrees of degeneration:a finite element analysis / 中国骨伤

OBJECTIVE@#To investigate the biomechanical affect of percutaneous transforaminal endoscopic discectomy(PTED) on adjacent segments with different degrees of degeneration and related risk of adjacent segment diseases (ASD) caused by this operation.@*METHODS@#A healthy male adult volunteer was selected, and the lumbosacral vertebra image data was obtained by CT scan, and the external contour of the bone structure was reconstructed. On this basis, the external contour of the bone structure was fitted by using the smooth curve in 3D-CAD software, and the complete three-dimensional finite element modelof the non degenerate L@*RESULTS@#In the finite element model without adjacent segmental disc degeneration, the annulus fibrosus von Mises stress and intradiscal pressure of the PTED model showed only a slight increase under most stress conditions, and a slight decrease in a few conditions, and there was no significant change trend before and after surgery. In the original degenerated adjacent segment disc model, the biomechanical indicators related to disc degeneration in the pre- and post-PTED model showed significant deterioration, leading to an increased risk of potential adjacent spondylopathy.@*CONCLUSION@#PTED surgery will not lead to the significant deterioration of postoperative biomechanical environment of non-degeneration adjacent intervertebral discs, and the original degeneration of adjacent intervertebral discs is a important risk factor for ASD.

Age - Does it really count? A study of the Perioperative Morbidity and Long-Term Outcome in Patients Above 70 Years of Age Undergoing Spine surgery for Lumbar Degenerative Disorders / Idade - Deve ser levada em conta? Estudo da morbidade perioperatória e a evolução no longo prazo dos pacientes acima de 70 anos submetidos à cirurgia da coluna vertebral, devido a doenças degenerativas lombares

Abstract Objective To assess the long-term outcome and perioperative morbidity in spine surgeries for lumbar degenerative disorders and, thereby, to evaluate the safety of surgery in the aging population. Methods Retrospective study of patients aged > 70 years, operated for degenerative lumbar disorders between 2011 and 2015. We evaluated patient demographic, clinical and surgical data; comorbidities, perioperative complications, pre & postoperative pain scores and Oswestry disability index (ODI) scores, patient satisfaction and overall mortality. Results A total of 103 patients (Males: Females55:48) with mean age 74.6 years (70-85yrs) were studied. 60 patients (58.2%) had decompression alone, while 43 (41.8%) had decompression & fusion. Mean hospital stay was 5.7days. Mean follow-up was 47.6months (24-73mnths). Patients reported significant improvement in backpain (Numerical pain score 7.7 vs 1.6; p < 0.001), leg pain (Numerical pain score 7.4 vs 1.7; p < 0.001), disability (ODI 82.3 vs 19.1; p < 0.001) and walking distance (p < 0.001). 76% patients were satisfied with the results at the time of final follow-up. 26 patients (25.24%) had perioperative complications which were all minor, without mortality. Most common intraoperative & postoperative complications were dural tear (6.79%) & urinary tract infection (6.79%) respectively. Conclusions With meticulous perioperative care lumbar spine surgery is safe and effective in elderly population. Patients had longer mean hospital stay in view of the gradual and comprehensive rehabilitation program. Presence of comorbidities or minor perioperative complications did not increase the overall morbidity or affect the clinical outcomes of surgery in our study.

Resumo Objetivos Avaliar o resultado no longo prazo e a morbidade perioperatória em cirurgias da coluna vertebral, devido a doenças lombares degenerativas e, assim, avaliar a segurança da cirurgia na população idosa. Métodos Estudo retrospectivo de pacientes com idade superior a 70 anos, submetidos à cirurgia em virtude de distúrbios lombares degenerativos, entre 2011 e 2015. Foram avaliados os dados demográficos, clínicos e cirúrgicos dos pacientes; comorbidades; complicações perioperatórias; escores de dor no pré e no pós-operatório; índice de incapacidade de Oswestry (ODI, na sigla em inglês); satisfação do paciente e a mortalidade geral. Resultados Foram estudados 103 pacientes (homens:mulheres, 55:48) com idade média de 74,6 anos (70 a 85 anos). 60 pacientes (58,2%) apresentaram somente descompressão, enquanto 43 (41,8%) apresentaram descompressão e fusão. O tempo médio de internação foi de 5,7 dias. O tempo médio de acompanhamento foi de 47,6 meses (24-73 meses). Os pacientes relataram melhora significativa da dor nas costas (pontuação numérica da dor 7,7 versus 1,6; p < 0,001), dor nas pernas (pontuação numérica da dor 7,4 versus 1,7; p < 0,001), incapacidade (ODI 82,3 versus 19,1; p < 0,001) e distância percorrida a pé (p < 0,001). Um total de 76% dos pacientes estavam satisfeitos com os resultados no momento do acompanhamento final. 26 pacientes (25,24%) apresentaram complicações perioperatórias, todas sem relevância e sem mortalidade. As complicações intra e pós-operatórias mais comuns foram ruptura dural (6,79%) e infecção do trato urinário (6,79%), respectivamente. Conclusões Com meticulosos cuidados perioperatórios, a cirurgia da coluna lombar é segura e eficaz na população idosa. Os pacientes tiveram um maior tempo médio de internação hospitalar, em virtude do programa de reabilitação gradual e abrangente. A presença de comorbidades ou complicações perioperatórias sem relevância, não aumentou a morbidade geral, nem afetou os resultados clínicos da cirurgia em nosso estudo.

Resultados en el tratamiento quirúrgico de hernia discal lumbar, reporte a siete años de seguimiento / Results in the surgical treatment of lumbar disc hernia, report of seven years follow up

Resumen: Introducción: La lumbalgia por hernia discal es provocada por el movimiento anormal intersomático, considerándose éste como factor etiológico de hernia discal, que en ocasiones es la indicación quirúrgica. Material y métodos: Con un diseño de estudio prospectivo, descriptivo, observacional y longitudinal en un período de Enero de 2000 a Diciembre de 2006. Muestra inicial de 195 pacientes, con 20 pacientes con criterios de inclusión a los siete años de seguimiento. Se tomaron en cuenta variables demográficas, dependientes e independientes. Se realizó análisis estadístico descriptivo comparando preoperatorio con la evolución a siete años. Resultados: Se englobaron los resultados en dos procedimientos: estabilización dinámica interespinosa y artroplastía, con 10 pacientes por cada procedimiento. Mediante la prueba de T y χ2 se observó significancia estadística al comparar los resultados de dolor y escala de Oswestry con parámetros de imagenología según Pfirrmann prequirúrgicos contra seguimiento final en los pacientes sometidos a estabilización dinámica. Para el grupo de artroplastía fue estadísticamente significativa la comparación de resultados de dolor con EVA (escala visual análoga) y función con escala de Oswestry, con una p < 0.05. Conclusión: Con este trabajo comprobamos que hubo significancia estadística al comparar los resultados clínicos de ambos procedimientos, observamos un porcentaje mínimo de complicaciones en los pacientes a quienes se les realizó estabilización dinámica en comparación con la artroplastía; por lo tanto, sugerimos realizar esta última sólo en casos en los que se reúnan adecuadamente todos los criterios para que los resultados clínicos y funcionales sean iguales a los esperados.

Abstract: Introduction: Low back pain by herniated disc is caused by abnormal intersomatic movement, considering this as an etiological factor of disc herniation and the surgical indication. Material and methods: A prospective, descriptive, observational, longitudinal study design, in a period from January 2000 to December 2006. Initial sample of 195 patients, with inclusion criteria in 20 patients at seven years follow up. Demographic, dependent and independent variables were taken into account. Descriptive statistical analysis was conducted comparing preoperative with evolution to seven years. Results: Two groups were compared: dynamic interspinous stabilization and lumbar arthroplasty, with 10 patients for each procedure. Using T and χ2 test, statistical significance was observed when comparing the results of pain and Oswestry scale with parameters of imaging according to Pfirrmann pre surgical against final follow-up in patients undergoing dynamic stabilization. And for Arthroplasty was statistically meaningful comparison of results of pain with VAS (visual analogue scale) and function with Oswestry scale, with a p < 0.05. Conclusion: With this work we can see that there was statistical significance to compare clinical outcomes of both procedures, observing a minimum percentage of complications in patients who underwent dynamic stabilization compared with arthroplasty; therefore we suggest to perform the latter only in cases in all criteria, to meet adequately to be equal to the anticipated clinical and functional outcomes.

Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data / Impacto da cirurgia na dor, incapacidade e qualidade de vida de portadores de doença degenerativa lombar: dados brasileiros

ABSTRACT Objective: To study the impact of surgery on pain, disability, quality of life, and patient satisfaction in a sample of patients with Degenerative Lumbar Disease (DLD). Methods: Retrospective analysis of prospectively collected data. Comparison between pre and postoperative (6 - 12 months) ODI and SF-36, plus postoperative Patient Satisfaction Index. Results: From a total of 216 patients included, improvement was observed in average scores of pain (201.2%), disability (39.7%), physical quality of life (42%), and mental quality of life (37.8%). Among these patients, 57.7% reached or surpassed the minimal clinically important difference (MCID) for ODI, 57.7% for the SF-36 pain component, 59.7% for the SF-36 physical component summary, and 50.5% achieved or surpassed the MCID for the SF-36 mental component summary. Conclusions: Surgery produced a significantly positive impact on pain, disability, and quality of life of patients. Overall, 82.5% of the patients were satisfied.

RESUMO Objetivo: Descrever o impacto da cirurgia na dor, incapacidade, qualidade de vida e a satisfação global do paciente numa amostra unificada de pacientes portadores de DDL. Métodos: Análise retrospectiva de dados colhidos prospectivamente em pacientes operados no período de janeiro de 2014 a março de 2017, que tivessem avaliação pré-operatória e pelo menos uma avaliação pós-operatória entre 6 e 12 meses com os questionários de ODI, SF-36 e o ISP. Resultados: Um total 216 pacientes preenchia os critérios de inclusão. Houve melhora no escore médio de dor (201,2%), incapacidade (39,7%), qualidade de vida física (42%) e mental (37,8%). Da amostra, 57,7% alcançaram o MCID de dor, 59,7% de ODI, 59,7% 50,5% de PCS e 50,5% de MCS; 82,5% dos pacientes se consideraram "Satisfeitos". Conclusões: O efeito da cirurgia foi amplamente favorável na dor, incapacidade e qualidade de vida dos pacientes portadores de DDL. Estes dados podem servir de guia para aconselhamento pré-operatório quanto às perspectivas de sucesso.

Lumbar herniated disc treatment with percutaneous hydrodiscectomy

SUMMARY Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.

RESUMO Hérnias discais lombares são manifestações comuns das doenças degenerativas da coluna, sendo a principal causa de dor lombar irradiada. Esta diretriz seguiu padrão de uma revisão sistemática com recuperação de evidências com base no movimento da Medicina Baseada em Evidências. Utilizamos a forma estruturada de formular a pergunta sintetizada pelo acrônimo P.I.C.O., em que o P corresponde à Hérnia de disco lombar, I à intervenção Tratamento com hidrodiscectomia percutânea, C comparando com Outras modalidades de tratamento, O de desfecho de Evolução clínica e complicações. A partir da pergunta estruturada, identificamos os descritores que constituíram a base da busca da evidência nas bases de dados Medline-PubMed (636 trabalhos) e, assim, após os critérios de elegibilidade (inclusão e exclusão), oito trabalhos foram selecionados para responder à dúvida clínica. Os detalhes da metodologia e dos resultados desta diretriz estão expostos no Anexo I.

Vertebrometry and discometry of the lumbar functional segment (rebatú-murguía technique) / Vertebrometria e discometria do segmento lombar funcional (técnica rebatú-murguía) / Vertebrometría y discometría del segmento funcional lumbar (técnica rebatú-murguía)

ABSTRACT Surgical treatment of intervertebral disc degeneration aims to restore the height of the disc space and the release of involved neurological structures. Like any surgical treatment in orthopedics, the success or failure of the lumbar procedure involves the possibility of performing an adequate planning of each particular event. In the case of lumbar stabilization surgery with interbody fusion, it is essential to know the ideal height of the disc space for the fusion to be successful. Objective: To demonstrate that the ideal height of the disc space corresponds approximately to one third of the height of the vertebral body. Methods: X-ray images were taken in AP and lateral views of hospital residents to measure L4-L5 vertebral bodies as well as the disc space. The rule of three was used to check the height of the disc and vertebral bodies. Results: It was verified that the disc space corresponds to 31% of the size of the vertebral body, taking 0.31 as the constant. Conclusions: The size of the disc corresponds to one third of the vertebral body, taking 0.31 as the constant. The multiplication of the constant by the height of the vertebral body results in the exact height of the disc. Thus, in the presence of degeneration of the intervertebral disc, it is possible to know the size of the disc and, therefore, the size of the interbody cage.

RESUMO O tratamento cirúrgico da degeneração de disco intervertebral visa restaurar a altura do espaço discal e a liberação de estruturas neurológicas envolvidas. Como qualquer tratamento cirúrgico em ortopedia, o sucesso ou fracasso do procedimento lombar envolve a possibilidade de realizar um planejamento adequado de cada evento em particular. Em se tratando de cirurgia de estabilização lombar com fusão intersomática, é essencial conhecer a altura ideal do espaço discal para que a fusão seja bem-sucedida. Objetivo: Demonstrar que a altura ideal do espaço discal corresponde aproximadamente a um terço da altura do corpo vertebral. Métodos: Foram realizadas radiografias em visão AP e lateral em residentes do hospital para fazer a medição dos corpos vertebrais do segmento funcional L4-L5, assim como do espaço discal. Realizou-se uma comprovação da regra de três com a altura do disco e dos corpos vertebrais. Resultados: Verificou-se que o espaço discal equivale a 31% do tamanho do corpo vertebral, tomando-se como constante 0,31. Conclusão: O tamanho do disco é correspondente a um terço do corpo vertebral, tomando-se um constante 0,31. A multiplicação da constante pela altura do corpo vertebral resulta na altura exata do disco. Assim sendo, em presença de degeneração do disco intervertebral, é possível conhecer o tamanho do disco e, portanto, o tamanho do cage intersomático.

RESUMEN El tratamiento quirúrgico de la enfermedad discal degenerativa tiene como objetivo reestablecer la altura del espacio discal y la liberación de estructuras neurológicas involucradas. Como cualquier tratamiento quirúrgico en ortopedia, el éxito o fracaso de la cirugía lumbar consiste en la posibilidad de realizar una adecuada planeación de cada evento en particular. Hablando de la cirugía de estabilización lumbar con fusión intersomática, conocer la altura ideal del espacio discal es indispensable para una fusión exitosa. Objetivo: Demostrar que la altura ideal del espacio discal corresponde aproximadamente a una tercera parte de la altura del cuerpo vertebral. Métodos: Fueron tomadas radiografías en vista AP y lateral de residentes del hospital para realizar la medición de los cuerpos vertebrales del segmento funcional L4-L5 así como del espacio discal. Se realizó una comprobación de la regla de tres con la altura discal y de los cuerpos vertebrales. Resultados: Se encontró que el espacio discal equivale al 31% del tamaño del cuerpo vertebral, tomándose como constante 0,31. Conclusión: El tamaño del disco equivale a la tercera parte del cuerpo vertebral, tomándose la constante 0,31. La multiplicación de la constante por la altura del cuerpo vertebral, resulta en la altura exacta del disco. Por lo tanto, en presencia de discartrosis, es posible conocer el tamaño del disco y, por lo tanto, el tamaño de la caja intersomática.

Lumbar spine surgery. Importance of sagittal balance in the quality of life of patients / Cirurgia da coluna lombar. Importância do equilíbrio sagital na qualidade de vida dos pacientes / Cirugía de la columna lumbar. Importancia del equilibrio sagital en la calidad de vida de los pacientes

ABSTRACT Objective: To evaluate whether performing surgery in degenerative diseases of the lumbar spine modify the spinopelvic balance and influences the clinical outcome and the quality of life of patients. Methods: The spinopelvic balance was evaluated in 25 patients using plain radiographs of the lumbosacral region including the proximal femur, as well as evaluating the quality of life on two separated occasions. Results: The measure of spinopelvic balance was obtained by averaging the angles of sacral slope, pelvic version and pelvic incidence. Mean preoperative angles were 59.88º, 22.84º, and 37.44º, respectively, and the mean postoperative values were 61.56º, 24.64º, and 37.32º, respectively. Regarding the questionnaires on quality of life, the Oswestry index showed mean preoperative values of 46.24, characterized as severe disability and mean postoperative values of 13.29 denoting satisfactory response after surgical treatment. The SF-36 questionnaire showed important and significant improvement in quality of life in different domains, with the exception of physical limitation and social aspects, with a p-value of 0.02 and 0.025, respectively. Conclusion: Patients undergoing surgical treatment of degenerative lumbar diseases showed no significant changes in the spinopelvic balance, but showed significant improvement in quality of life after surgery.

RESUMO Objetivo: Avaliar se a realização de procedimento cirúrgico nas doenças degenerativas da coluna lombar modifica o balanço espinopélvico e influencia os achados clínicos e a qualidade de vida dos pacientes. Métodos: O equilíbrio espinopélvico foi avaliado em 25 pacientes utilizando radiografias simples da região lombossacra, incluindo a parte proximal do fêmur, bem como a avaliação da qualidade de vida em dois momentos. Resultados: A medida do equilíbrio espinopélvico foi obtida pela média dos ângulos da inclinação sacral, versão pélvica e incidência pélvica. Os ângulos pré-operatórios médios foram 59,88º, 22,84º e 37,44º, respectivamente, e os valores pós-operatórios médios foram 61,56º, 24,64º e 37,32º, respectivamente. Com relação aos questionários sobre qualidade de vida, no índice de Oswestry obtivemos valores pré-operatórios médios de 46,24, caracterizados como incapacidade intensa e valores pós-operatórios médios de 13,29 denotando resposta satisfatória após o tratamento cirúrgico. O questionário SF-36 demonstrou melhora importante e significativa da qualidade de vida nos diferentes domínios, com exceção dos domínios de limitação física e aspectos sociais que obtiveram valor p de 0,02 e 0,025, respectivamente. Conclusão: Os pacientes submetidos ao tratamento cirúrgico de doenças lombares degenerativas não apresentaram alterações significativas do equilíbrio espinopélvico, mas apresentaram melhora significativa da qualidade de vida no pós-operatório.

RESUMEN Objetivo: Evaluar si la realización de cirugía en las enfermedades degenerativas de la columna lumbar modifica el balance espinopélvico e influye en los resultados clínicos y la calidad de vida de los pacientes. Métodos: El equilibrio espinopélvico fue evaluado en 25 pacientes utilizando radiografías simples de la región lumbosacra, incluyendo la parte proximal del fémur, así como la calidad de vida en dos ocasiones. Resultados: La medida del equilibrio espinopélvico se obtuvo con el promedio de los ángulos del índice sacral, la variación pélvica y el índice pélvico. El promedio de los ángulos preoperatorios fue 59,88º, 22,84º e 37,44º, respectivamente y el promedio de los valores postoperatorios fue 61,56º, 24,64º e 37,32º, respectivamente. En cuanto a los cuestionarios sobre calidad de vida, en el índice de Oswestry los valores preoperatorios medios fueron 46,24, caracterizando discapacidad severa y en el postoperatorio 13,29, denotando respuesta satisfactoria después de la cirugía. El cuestionario SF-36 demostró mejora importante y significativa de la calidad de vida en los diferentes aspectos, con la excepción de los dominios de limitación física y los aspectos sociales, que obtuvieron valor p de 0,02 y 0,025, respectivamente. Conclusión: Los pacientes sometidos al tratamiento quirúrgico para enfermedades lumbares degenerativas no presentaron alteraciones significativas en el equilibrio espinopélvico, pero presentaron mejora significativa de la calidad de vida en el postoperatorio.

Artrodesis cervical mediante fusión intersomática con hueso autólogo versus espaciador intersomático en discopatía cervical / Cervical arthrodesis by means of interbody fusion with autologous bone and/or interbody spacer for cervical disc disease

El objetivo de este estudio fue comparar los resultados de la artrodesis cervical mediante fusión intersomática con hueso autólogo y/o espaciador intersomático en discopatía cervical. Material y métodos: Estudio comparativo transversal en 49 pacientes tratados quirúrgicamente con artrodesis anterior, en el período Enero 2011 a Diciembre 2011; revisión del expediente clínico. Resultados: Incluimos 49 pacientes de los cuales 20 (40.8%) fueron hombres y 29 (59.2%) mujeres; el diagnóstico en todos fue patología discal (hernia cervical) con uno o dos niveles de afectación; el tiempo quirúrgico promedio fue 69.12, mínimo 53 - máximo 110, ± 19.61 minutos para artrodesis cervical con injerto y promedio 61.18, mínimo 50 - máximo 96.00, ± 11.38 minutos para artrodesis cervical con espaciador intersomático (p = 0.00 t de Student); las características sociodemográficas, clínicas y complicaciones se muestran. Los pacientes operados con ambas técnicas tuvieron una adecuada integración radiológica, p = 0.015 consideramos estadísticamente significativa una p ≤ a 0.05, χ². Conclusiones: La integración ósea es buena tanto con la aplicación de caja intersomática como con la aplicación de injerto autólogo de cresta iliaca, en pacientes con patología discal cervical.

The purpose of this study was to compare the results of cervical arthrodesis performed through interbody fusion with autologous bone and/or interbody spacer for cervical disc disease. Material and methods: Comparative cross-sectional study that included 49 patients who underwent surgery for anterior arthrodesis between January and December 2011, whose clinical records were reviewed. Results: We included 49 patients: 20 (40.8%) males and 29 (59.2%) females. All of them were diagnosed with disc disease (cervical disc herniation) involving one or two levels. Mean operative time was 69.12, with a minimum of 53 and a maximum of 110 ± 19.61 minutes for cervical arthrodesis with a graft. Mean operative time was 61.18 with a minimum of 50 and a maximum of 96.00 ± 11.38 minutes for cervical arthrodesis with an interbody spacer (p = 0.00, Student t test). Patient sociodemographic and clinical characteristics and complications are shown. Patients in whom both surgical techniques were used had appropriate radiological integration, with p = 0.015, considering p ≤ a 0.05 as significant, χ2. Conclusions: In patients with cervical disc disease bone integration is appropriate with the use of either an interbody cage or an autologous iliac crest graft.

Result of the arc of movement of lower cervical spine after seven years of arthroplasty / Resultado do arco de movimento da coluna cervical baixa depois de sete anos de artroplastia / Resultado del arco de movimiento de la columna cervical baja después de siete años de artroplastia

OBJECTIVE: To quantify the mobility of the lower cervical spine after seven years of total cervical disc replacement at two levels. METHOD: This clinical study was designed randomly and prospectively at the spine surgery center at the Hospital Nossa Senhora das Graças, in Canoas, RS-Brazil and at the Hospital Don João Becker, in Gravataí, RS-Brazil. Seventeen patients were included in the study that was designed to compare the data obtained from annual and sequential manner until the end of seven years. A comparison was made with the prior range of motion (ROM) of each patient. All patients were diagnosed with not tractable symptomatic cervical degenerative disc disease with two adjacent levels between C-3 and C-7. RESULTS: A total of patients underwent TDR in two levels and at the end of seven years, only one patient was lost to follow-up. The pre and postoperative ROM was the same in the first three years however after the fourth year there was a gradual decline with a loss of 12% of preoperative ROM in flexion, 21% in extension and 23% in the right and left lateral bending at the end of seven years. CONCLUSIONS: The clinical outcome of this study is evidence level IV in evaluating the ROM for Moby-C(r) for TDR in two adjacent levels at the lower cervical spine. These results show that the ROM is maintained during the first three years, gradually declining after that. .

OBJETIVO: Quantificar a mobilidade da coluna cervical baixa após sete anos de artroplastia de disco cervical em dois níveis. MÉTODO: O ensaio clínico foi elaborado de maneira aleatória e prospectiva nos centros de cirurgia da coluna vertebral no Hospital Nossa Senhora das Graças em Canoas, RS, Brasil e no Hospital Don João Becker, em Gravataí, RS, Brasil. Dezessete pacientes foram submetidos ao estudo que foi delineado seguindo a comparação dos dados obtidos de maneira sequencial e anual até o final dos sete anos. A comparação foi feita com o arco de movimento (ADM) pré-operatório de cada paciente. Todos os pacientes foram diagnosticados com doença cervical degenerativa sintomática e não tratável, com dois níveis contíguos entre C-3 e C-7. RESULTADOS: Todos os pacientes receberam o procedimento de ADC para dois níveis sendo que ao final dos sete anos, apenas um paciente não terminou o acompanhamento. O ADM pré e pós-operatório manteve-se inalterado nos primeiros 3 anos, mas após o quarto ano houve declínio gradual com perda de 12% do ADM pré-operatório em flexão, 21% em extensão e 23% em inclinação lateral direita e esquerda ao cabo de sete anos. CONCLUSÕES: O resultado clínico desse estudo representa nível de evidência IV na avaliação de ADM para ADC em dois níveis contíguos, utilizando o Mobi-C(r) na coluna cervical baixa. Esses resultados evidenciam que o ADM apresenta manutenção pré-operatória nos primeiros três anos, declinando gradualmente através dos anos. .

OBJETIVO: Cuantificar la movilidad de la columna cervical baja después de siete años de artroplastia de disco cervical en dos niveles. MÉTODO: El ensayo clínico fue elaborado de manera aleatoria y prospectiva en los centros de cirugía de la columna vertebral en el Hospital Nossa Senhora das Graças en Canoas, RS, Brasil y en el Hospital Don João Becker, en Gravataí; RS-Brasil. Diecisiete pacientes fueron sometidos al estudio que fue delineado siguiendo la comparación de los datos obtenidos de manera secuencial y anual hasta el fin de los siete años. La comparación fue hecha con el arco de movimiento (ADM) preoperatorio de cada paciente. Todos los pacientes fueron diagnosticados con enfermedad cervical degenerativa sintomática y no tratable, con dos niveles contiguos entre C-3 y C-7. RESULTADOS: Todos los pacientes recibieron el procedimiento de ADC para dos niveles siendo que al fin de los siete años, solamente un paciente no terminó el acompañamiento. El ADM pre y postoperatorio se mantuvo inalterado en los primeros 3 años, pero después del cuarto año hubo disminución gradual con pérdida de 12% del ADM preoperatorio en flexión, 21% en extensión y 23% en inclinación lateral derecha e izquierda al cabo de siete años. CONCLUSIONES: El resultado clínico de este estudio representa nivel de evidencia IV en la evaluación de ADM para ADC en dos niveles contiguos, utilizando Mobi-C(r) en la columna cervical baja. Estos resultados evidencian que el ADM presenta mantenimiento preoperatorio en los primeros tres años, declinando gradualmente a través de los años. .