Evaluation of functional outcomes in individuals 10 years after posterior lumbar interbody fusion with corundum implants and decompression: a comparison of 2 surgical techniques.

BACKGROUND: The purpose of this study was to evaluate lumbar spine-related functional disability in individuals 10 years after lumbar decompression and lumbar decompression with posterior lumbar interbody fusion (PLIF) with corundum implants surgery for degenerative stenosis and to compare the long-term outcome of these 2 surgical techniques. MATERIAL/METHODS: From 1998 to 2002, 100 patients with single-level lumbar stenosis were surgically treated. The patients were randomly divided into 2 groups that did not differ in terms of clinical or neurological symptoms. Group A consisted of 50 patients who were treated with PLIF and the use of porous ceramic corundum implants; the mean age was 57.74 and BMI was 27.34. Group B consisted of 50 patients treated with decompression by fenestration; mean age was 51.28 and the mean BMI was 28.84. RESULTS: There was no statistical significance regarding age, BMI, and sex. Both treatments revealed significant improvements. In group A, ODI decreased from 41.01% to 14.3% at 1 year and 16.3 at 10 years. In group B, ODI decreased from 63.8% to 18.36% at 1 year and 22.36% at 10 years. The difference between groups was statistically significant. There were no differences between the groups regarding the Rolland-Morris disability questionnaire and VAS at 1 and 10 years after surgery. CONCLUSIONS: Long-term results evaluated according to the ODI, the Rolland-Morris disability questionnaire, and the VAS showed that the both methods significantly reduce patient disability, and this was maintained during next 10 years. The less invasive fenestration procedure was only slightly less favorable than surgical treatment of stenosis by both PLIF with corundum implants and decompression.

Return to work after spinal stenosis surgery and the patient's quality of life.

INTRODUCTION: The return to work of patients who undergo spinal surgery poses important medical and social challenge. OBJECTIVES: 1) To establish whether patients who undergo spinal stenosis surgery later return to work. 2) To establish the patient's attitude towards employment. 3) To assess the quality of life of the patients and its influence on their attitude to work. MATERIALS AND METHODS: The study population consisted of 58 patients aged from 21 to 80 years (the mean age was 52.33±14.12). There were 29 women (50%) and 29 men (50%) in the group. The patients' quality of life was measured by the use of the WHOQOL-BREF instrument. Individual interviews were conducted 3 to 8 months (a mean of 5.72 months ±1.6) after the surgery. RESULTS: 1) Although 13 patients (22.3%) returned to work, 44 (75.9%) did not, these being manual workers of vocational secondary education. 2) Almost half of the patients (27 patients, i.e. 44%) intend to apply for disability pension, 16 patients (27.6%) consider themselves unfit to work, 22 patients (37.9%) do not feel like working again. 3) The quality of life of the patients decreased. Domain scores for the WHOQOL-BREF are transformed to a 0-100 scale. The mean physical health amounted to 60.67 (±16.31), the mean psychological health was 58.78 (±16.01), while the mean social relations with family and friends were 59.91 (±20.69), and the mean environment 59.62 (±12.48). CONCLUSIONS: 1) A total of 75% of the patients operated for lumbar spinal stenosis do not return to their preoperative work. Difficulties in returning to work and decreased quality of life are associated with female sex, lower-level education, hard physical work and low income. 2) Physical health, psychological health, social relations and environment decreased to the mean of approximately 60. 3) The quality of life of the patients who did return to work was similar to that of healthy people.

Diagnostic and therapeutic problems of back pain syndromes and their distribution according to a colour coding system of flags.

BACKGROUND: Back pain poses a serious clinical problem in some cases, because under the clinical symptoms of back pain might be other hidden diseases. The aim of this study was to present difficulties in diagnosis and treatment of various diseases of the spine and 2. description to the flagship division, based on the traffic lights. MATERIALS AND METHODS: The clinical material is based on a group of 20 patients with diagnostic and therapeutic difficulties, among 1825 patients treated due to low back pain. Diagnosis was based on clinical examination and various imaging techniques. In the case of cancer biopsy was performed, and in specific and nonspecific infections of the spine treated surgically toward the microscopic examination of tuberculous granulation tissue or inflammatory. The diagnosis of osteoporotic fractures was based on the digital 3D CT. The studied group of 20 patients were divided according to color flag system. RESULTS: Among the analyzed patients 14 received red flag, 5 yellow and 1 black. The red flag has received seven patients with spinal infection, 3 patients with cancer and two with osteoporotic fracture, and 2 patients with low back pain due to an aortic aneurysm. Yellow flag received 5 patients with compensation claims. CONCLUSIONS: 1. In patients with back pain, diagnostic examinations should be administered according to a particular order. Clinical and radiographic examinations are basic tools which should be supplemented by the modern techniques of MRI and CT. 2. Histopathological evaluation of tissue preparations facilitates the diagnosis of an infection or tumour. 3. Classification according to colored flags are useful in clinical practice. It describes the degree of risk of serious illness and difficulties in therapy.

Digital computed tomography evaluation of spinal canal and dural sac before and after surgical decompression of lumbar stenosis.

INTRODUCTION: Advances in digital computed tomography prompted the authors to use this technique to measure correlations between the lumbar spinal canal and the dural sac. The aim of the study was to: 1. Evaluate the value of surgical decompression of neural structures using digital computed tomography. 2. Establish mathematical correlations between the surface area of the dural sac and the narrowed spinal canal before and after the operation. MATERIAL AND METHODS. The analysis involved 33 patients who underwent lumbar stenosis surgery. Complete clinical records and imaging examination reports were available for this group of patients. RESULTS: 1. Statistically significant differences in spinal canal height at L4 and L5 were found between the control group (N) and the surgically treated group before and after surgery. L4: Reference--16.85 mm, before surgery--14.10 mm; after surgery--15.8 mm. L5: Reference--17.77 mm, before surgery--15.79 mm; after surgery--15.83 mm. 2. Statistically significant differences were found in the ratio of the surface area of the spinal canal and vertebral body surface area at L4 and L5 between the control group (N) and the operated group before surgery. L4: Reference--19.5%, before surgery--17.7%, after surgery--20.3%. L5: Reference--19.37%, before surgery--14.25%; after surgery--17.93%. 3. Statistically significant differences were found in the ratio of the surface area of the dural sac to the spinal canal surface area at L4 and L5 between the control group (N) and the operated group before surgery. L4: Reference--69.84%, before surgery--51.82%, after surgery--67.36%. L5: Reference--70.31%, before surgery--61.40%; after surgery--69.46%. CONCLUSIONS: 1. The ratio of the surface area of the spinal canal to the vertebral body surface area at L4 and L5 after surgery was statistically comparable to the value obtained for a normal spine. 2. The ratio of the surface area of the dural sac to the spinal canal surface area at L4 and L5 after surgery was statistically comparable to the value obtained for a normal spine.

Assessment of spinal canal shape and intervertebral joint angles in lumbar spine.

BACKGROUND: Publications concerning the shape of the spinal canal and degenerative changes in the intervertebral joints have not described this issue in full detail to date, especially with regard to the causes of pain syndromes associated with degenerative changes in intervertebral joints. The aim of the study was to assess the shape of the spinal canal and joint surface angles at L3, L4 and L5. MATERIAL AND METHODS: The study involved 176 patients with clinical and radiological evidence of spinal canal stenosis confirmed by computed tomography. RESULTS: Morphometric measurements were conducted to a precision of 0.01 degrees . At the level of L4-L5, a triangular spinal canal was found in 66 patients, and a trefoil spinal canal in 71. The results demonstrate that, in the group of 176 patients with spinal canal stenosis, mean differences between right and left angles were 11.37 degrees at the L3 level, 9.40 degrees at the L4 level, and 11.57 degrees at the L5 level. In the control group, mean differences were 2.15 degrees at the L3 level, 2.26 degrees at the L4 level, and 2.98 degrees at the L5 level. Statistically significant differences between the groups were found for p= 0.05 at each level (L3, L4, L5). The level of significance of angular differences at these levels warrants the conclusion that there is joint incongruence that may give rise to degenerative changes. CONCLUSIONS: While the most common pathomechanism underlying degenerative changes is vertebral sinking in the course of disc disease and emerging intervertebral instability, abnormal intervertebral angles can also lead to instability that gives rise to degenerative changes.

Assessment of lumbar spinal canal morphology with digital computed tomography.

BACKGROUND: The study of lumbar spine pathology requires adequate preparation and knowledge of the normal structure of this part of the spine. The main goal of the study was to assess spinal canal morphology with computed tomography. The sagittal and interpedicular dimensions and surface area were considered the most important measurements. An additional goal was to assess the shape of the spinal canal and intervertebral joint angles. MATERIAL AND METHODS: Computed tomography was used to assess the lumbar spinal canals of 42 people to an accuracy of 0.01 using a special console for digital analysis. RESULTS: The mean sagittal dimension showed minor differences and ranged from 15.75+/-0.886 at the L3 level to 17.77+/-1.619 at the L5 level. The mean interpedicular dimension was significantly different between the levels, increasing from 24.75+/-2.173 at L3 to 34.57+/-3.332 at L5. Similar results were obtained as regards the mean surface area of the spinal canal. The surface area was 277.2+/-36.15 mm2 at the L3 level, compared to 297+/-9.90 mm2 at L4 and 386.5+/-50.55 mm2 at L5. The spinal canal shape at the L4-L5 level was triangular or trefoil in all 42 patients. No significant differences were found between the angles of right and left intervertebral joints. CONCLUSIONS: Our results do not differ from those described in literature. A sagittal dimension over 15 mm, and an interpedicular dimension of more than 25 mm are characteristic of a normal spinal canal. The results constitute reference data for further studies concerning lumbar stenosis.

Digital computed tomography affords new measurement possibilities in lumbar stenosis.

INTRODUCTION: The problem of lumbar stenosis has been analysed at length in the literature as the number of patients with low back pain of this aetiology continues to increase. The aim of this study was:1. to carry out a prospective study assessing the dimensions of spinal canal on the basis of CT data and to compare patient data with a control group.2. to determine if the sagittal and transverse dimensions and surface area of the spinal canal are sufficiently sensitive and robust measures of spinal canal stenosis at L3, L4 and L5 levels. MATERIAL AND METHODS: The investigational group consisted of 176 patients (93 men, 83 women). A total of 528 vertebral levels were evaluated and compared with a control group consisting of 42 persons. Digital CT scans were obtained with a precision of 0.01 mm and 0.01 mm2. A discriminative function algorithm was used to classify cases according to the level of stenosis. RESULTS: The mean sagittal dimension at L3 was 13.26 mm and the mean transverse dimension was 23.36 mm, with a surface area of 244.39 mm2. At L4, the mean sagittal dimension was 14.12 mm, the mean transverse dimension was 24.60 mm, and the surface area was 267.70 mm2. At L5, the mean sagittal dimension was 14.76 mm, the mean transverse dimension was 31.38 mm, and the surface area was 303.99 mm2. The most important factors influencing the quality of classification were height, width and surface area. Student's t test with a significance level at p=0.05 revealed statistically significant differences. The accuracy of classification in discriminative analysis was 92.66%. CONCLUSIONS: The proposed indicators of the sagittal and transverse dimensions and surface area of the spinal canal were useful in assessing quantitative changes with this investigational technique. The sagittal dimension had the greatest sensitivity in the evaluation of stenosis.

[Arthroscopy scapulothoracic articulation (introduction of this method)]. / Endoskopia przestrzeni lopatkowo-zebrowej (prezentacja metody).

The authors have introduced arthroscopy of scapulothoracic. They have treated 37 years old patient who suffer from bursitis with pain and crepitus. They have used arthroscopy procedure. The first publication about scapulothoracic arthroscopy was in 1992. The method has been written very rarely by foreigner authors in medical journals.

[Analysis of different constitutional, clinical, radiographic factors of 160 patients with low back pain based on own studies, observations and literature]. / Analiza róznych czynników konstytucjonalnych, klinicznych i obrazowych 160 osób z choroba dyskowa na podstawie wlasnych badan i obserwacji oraz danych z pismiennictwa.

BACKGROUND: Low back pain has both different etiopatogenesis and clinical symptoms. The most common reason of pain is degeneration of intervertebral disc. Development of civilisation causes an increase in prevalence and treatment's costs. The aim of this study was to: (1) An assesment of different clinical and radiographic factors amonr patients with low back pain; (2) A comparision of autors own observations with literature. MATERIAL AND METHODS: A group of 160 patients with clinical symptoms was analysed. Two groups A and B were distinguished. Group A consisted of 105 persons with centralisation of symptoms, while group B consisted of 55 persons with peripheralisation of pain. The analysis and assesment of several basic and constitutional factors and as well X-rays and MRI findings was done. Statistical analysis was conducted in order to compare a frequency of occurence of studied factors. RESULTS: Results from material analysis and used methods were presented in final conclusions: (1) Centralisation of symptoms was connected with dimishing a pressure on nerve roots; (2) Statistical analysis revealed that among patients with peripheralisation, lateral shift, Lasegue's sign, and MRI were of significant value comparing to patients with centralisation; (3) Psychological problems, compensation demands, and waiting list phenomenon should be taken into consideretion in an assesment of low bac pain.

Correlation between centralization or peripheralization of symptoms in low back pain and the results of magnetic resonance imaging.

Background. One of the main reasons for low back pain is displacement of the nucleus pulposus within the intervertebral disc and spinal canal. In the diagnosis of low back pain a clinical examination is essential, supplemented by magnetic resonance imaging (MRI). The main purpose of our research was to demonstrate that the results of a functional diagnosis based on the McKenzie protocol, when compared to abnormalities found in MRI, allow for more efficient management of conservative therapy. Material and methods. Our clinical material consisted of 98 patients, divided into 2 groups according to whether the symptoms observed were centralized (group A) or peripheralized (group B). The results of the clinical examination was compared with MRI examinations. Results. In order to assess treatment effectiveness and prognosis in low back pain with MRI findings, a precise analysis was done. Three groups were distinguished: 49 patients had herniation and extrusion of the nucleus pulpous, but the annulus fibrosus and the fluid reserve were intact; 46 patients had extrusions or sequestrations, along with stenosis of the spinal canal; 3 patients had no pressure on the nerve roots. Conclusion. Centralization usually implied that the annulus fibrosus would be intact in MRI examination. In these cases the MRI revealed herniations. Centralization also occurred in cases of extrusions where the spinal canal was wide, and the liquid reserve was preserved. Peripheralization occurred in cases of sequestration and extrusions when there was stenosis of the spinal canal.liquid reserve was preserved. 2. Peripheralisation occurred in the cases of sequestration and extrusions when spinal canal was narrow.

[Osteosarcoma of the lumbar spine--a case report]. / Osteosarcoma w odcinku ledzwiowym kregoslupa--opis przypadku.

Primary osteogenic sarcoma of the spine is a very rare tumor. A case of osteosarcoma of the lumbar spine in a 22-year-old man is presented. Diagnosis was obtained by an open biopsy. Tumor was resected. The clinical and radiological pre and postoperative findings are described.

Outcome in the treatment of discopathy by interbody fusion with the posterior approach using metal cages.

Background. Discopathy most often occurs in persons from 20 to 50 years old, in the period of greatest physical and intellectual capacity, and thus poses a major social problem. The goal of our research was to evaluation the outcome of interbody fusion performed with metal cages. Material and methods. We operated 52 patients ranging in age from 29 to 60, who presented with prolapse of the nucleus pulposus (21 patients), instability (8 patients), lumbar stenosis (11 patients), and recurrent discopathy with spondylolisthesis (12 patients). Interbody fusion was performed on these patients from the posterior approach using metal implants. Results. Applying both subjective and radiological criteria, we obtained good outcome in 36 cases, satisfactory in 12 cases, and unsatisfactory in 4 cases. A follow-up at 4 years after surgery showed that the solution was effective in preventing lumbar stenosis and intervertebral instability. However, there were still difficulties in the assessment of bone union. Conclusions. Maintaining or expanding the height of the interbody space by using implants is indicated by radiography in our material to be the most important surgical intervention justifying the use of this method. Interbody fusion in discopathy using metal implants is a logical solution to prevent secondary stenosis of the vertebral canal and intervertebral instability. The outcomes obtained at 4-year follow-up should be regarded as satisfactory.