1,721,011 research outputs found
Vascular anatomy and surgical approach in oblique lateral interbody fusion at lumbosacral transitional vertebrae
No full textBackground: Oblique lateral interbody fusion (OLIF) at lumbosacral junction is typically performed on the central window between the bifurcations of iliac vessels. However, the central window of lumbosacral transitional vertebrae (LSTVs) is usually obstructed by the iliocaval venous structures. We aimed to describe the vascular anatomy and surgical approach in OLIF at LSTVs compared with those in OLIF at typical L5-S1 junction. Methods: Sixty-eight consecutive patients who underwent OLIF at lumbosacral junction were included. Of these, 31 patients had LSTVs and 37 patients had typical L5-S1 junction. The position of the iliocaval junction and the configuration of the left common iliac vein were compared using the preoperative CT and MR images of the lumbar spine. The surgical approach and intraoperative vascular findings were analyzed. Results: Almost 70% of LSTVs had the iliocaval junction at low or very low position. Mobilization of left common iliac vein for central window was potentially difficult in almost 74% of OLIF at LSTVs while it was not required or was potentially easy in almost 80% of OLIF at typical L5-S1. Vascular injury was identified in 2 (6.5%) patients with OLIF at LSTVs and in 3 (8.1%) patients with OLIF at typical L5-S1 junction (P = 0.904). Conclusions: In our series, OLIF at LSTVs was performed through lateral window in 93.5% of the cases. Preoperative evaluation of the iliocaval junction using CT/MR of lumbar spine was reliable and valid in the determination of OLIF approach at lumbosacral junction
The Impact of Vertebral End Plate Lesions on the Radiological Outcome in Oblique Lateral Interbody Fusion
Full text linkSTUDY DESIGN: Retrospective case-control study. OBJECTIVES: Vertebral end plate (EP) lesions include Modic changes, Schmorl's nodes, EP erosion, EP sclerosis, and so on. While previous studies have mostly focused on the association between vertebral EP lesions and low back pain, few studies evaluated the influence of vertebral EP lesions on the radiological outcomes in lumbar interbody fusion. METHODS: This study included a total of 125 operated disc levels from 86 consecutive patients who underwent a 1- or 2-level oblique lateral interbody fusion (OLIF) and had more than 1-year regular follow-up. The presence of vertebral EP lesions, changes in disc heights/angle, cage subsidence, and fusion grade were examined. The associations between vertebral EP lesions and radiological parameters were analyzed. RESULT: The presence of Modic changes, Schmorl's node, EP cartilage erosion, and EP sclerosis were found in 72 (57.6%), 26 (20.8%), 31 (24.8%), and 44 (35.2%) disc levels, respectively. The mean anterior disc height increased from 6.9 +/- 3.8 mm to 13.1 +/- 2.7 mm (P < .001) and the mean segmental angle increased from 2.9 degrees +/- 5.8 degrees to 9.2 degrees +/- 4.8 degrees (P < .001) at the last follow-up. The overall fusion rate was 98.4% (123/125) and cage subsidence rate was 7.2% (9/125). All radiological parameters and cage subsidence rate were not different regardless of vertebral EP lesions. CONCLUSIONS: Vertebral EP lesions did not affect the overall radiological outcome in 1- or 2-level OLIF. These results come from the stable contact between lateral cage and peripheral rim of vertebral EP
Degenerative changes of sagittal alignment in patients with Roussouly type 1
No full textSTUDY DESIGN: A cross-sectional radiological study. OBJECTIVES: We aimed to examine the degenerative changes of sagittal alignment in patients with Roussouly type 1. Roussouly type 1 is unique in shape, characterized by short lumbar lordosis (LL) with the apex at L5 and thoracolumbar kyphosis (TLK). Because of the unique shape of sagittal alignment and the small pelvic incidence (PI) in Roussouly type 1, the degenerative changes of sagittal alignment may differ. METHODS: A total of 145 patients with Roussouly type 1 were recruited and distributed into three age groups; Group I (N = 40) were young patients (20-40 years of age), Group II (N = 47) were middle-aged patients (45-60 years of age), and Group III (N = 48) were elderly patients (>65 years of age). Sagittal parameters including sagittal vertical axis (SVA), PI, pelvic tilt (PT), L1S1 LL, L4S1 LL, thoracic kyphosis (TK), and TLK were measured using Surgimap((R)) software. The occurrence of lumbar retrolisthesis was also examined. RESULTS: The SVA, PI, PT, L1S1 LL, L4S1 LL, TK, and TLK in group I were - 25.9 degrees +/- 23.4 mm, 37.1 degrees +/- 5.3 degrees , 10.3 degrees +/- 5.5 degrees , 42.7 degrees +/- 8.8 degrees , 35.5 degrees +/- 6.9 degrees , 29.5 degrees +/- 23.5 degrees , and 9.7 degrees +/- 5.9 degrees , respectively. Among the Groups I, II, and III, there was a stepwise increase in the SVA, PT, TLK, and lumbar retrolisthesis (all P < 0.001). The PI, L4S1 LL, and TK were identical among the three groups. CONCLUSIONS: Degenerative changes of Roussouly type 1 include increase in the SVA, PT, TLK, and lumbar retrolisthesis, while the PI, L4S1 LL, and TK remain unchanged. LEVEL OF EVIDENCE: Level IV
Does Mechanical Bowel Preparation Ameliorate Surgical Performance in Anterior Lumbar Interbody Fusion?
Full text linkSTUDY DESIGN: Retrospective case-control study.
OBJECTIVES: To investigate whether mechanical bowel preparation (MBP) improve surgical performance and decrease operative complications in anterior lumbar interbody fusion (ALIF).
METHODS: This study involved a retrospective analysis of 48 consecutive patients who underwent ALIF with MBP and a control cohort of 50 consecutive patients who underwent the same surgeries without MBP. The quality of each surgical procedure, operative time, estimated blood loss (EBL), intraoperative complications, changes in vital signs and patient symptoms on the day of surgery, and bowel function postoperatively were also compared between the procedures.
RESULTS: Baseline demographic characteristics were similar between the 2 groups (all Ps > .05). The quality of each procedure, operative time, EBL, intraoperative complications, and changes in body temperature and heart rate were not different between the groups (all Ps > .05). The MBP group showed more headache, tiredness, thirst, and abdominal discomfort (all Ps < .001) and decrease of the systolic blood pressure (P = .041) on the day of surgery. The return of bowel movement was not different between the groups (P = .278).
CONCLUSIONS: Given the similar surgical result with the substantial patient discomfort, MBP can be omitted in ALIF
Differences in lumbar segment angle among Roussouly types of global sagittal alignment in asymptomatic adult subjects
No full textSTUDY DESIGN: A radiological study. OBJECTIVES: To examine lumbar segment angle according to the Roussouly type of global sagittal alignment and to determine the reference disc angles in minimally invasive surgery (MIS) for adult spinal deformity. Optimal restoration of lumbar lordosis (LL) in adult spinal deformity surgery includes achieving the ideal shape of LL as well as the amount of LL. However, the distribution of lumbar segment angles by the Roussouly type has yet to be elucidated. METHODS: Forty sets of whole spine lateral radiographs covering the four Roussouly types (N = 160) were obtained from a database of asymptomatic adult subjects. Global and spinopelvic parameters were measured. Disc and vertebral angles at each lumbar level were compared among the Roussouly types. RESULTS: There were 75 (46.9%) men with a mean age of 32.8 +/- 8.9 years among the total of 160 study subjects. A significant difference was found in spino-sacral angle, sacral slope, pelvic incidence, LL, and lower arc of LL (L4S1) among the Roussouly types (all P < 0.001). The ratio of the lower arc of LL (L4S1) to LL was 83.4% in Roussouly type 1, 65.2% in type 2, 64.7% in type 3, and 61.5% in type 4. The disc angles at the L1-2 and L2-3 levels in Roussouly type 1 were significantly smaller than in the other types. The disc angle at the L5-S1 level in Roussouly type 1 was significantly larger than that in type 2. Roussouly type 4 had a larger disc angle at the L2-3 and L4-5 levels than types 1 and 2. CONCLUSIONS: The results of this study showed that the disc angle distribution differs among Roussouly types. The configuration of LL as well as the amount of LL should be considered in adult spinal deformity surgery. LEVEL OF EVIDENCE: Level IV
Rapid Progression to Complete Paraplegia After Electroacupuncture in a Patient With Spinal Dural Arteriovenous Fistula: A Case Report
Full text linkSpinal dural arteriovenous fistula (SDAVF) usually has an insidious clinical course, but 5–15% of the cases have acute exacerbations. In some cases, there is an abrupt progression to paraplegia following an epidural injection or anesthesia. Electroacupuncture is a form of acupuncture that applies a small electrical current to needles inserted at specific points in the body. It is widely used for its analgesic effect on back pain. In this study, we report a rare case of SDAVF in which the symptoms of a patient worsened rapidly to complete paraplegia within a few hours after applying electroacupuncture to his back. A 49-year-old man had rapid progression to complete paraplegia within a few hours of electroacupuncture on his back. MRI showed SDAVF and worsening of cord signal change. An emergency operation was performed to ligate the SDAVF. The patient was able to walk 1 month post-operatively. Most of the neurological deficits had disappeared by 1 year post-operatively, with normalization of MRI. Our case emphasizes that SDAVF patients should be careful when exposed to any circumstances that might affect the circulation around the dural arteriovenous fistula, such as electroacupuncture. Patients should also be warned in advance about the possibility of rapid exacerbation of neurological symptoms. Regardless of the severity of the neurological symptoms, immediate treatment is essential for recovery and a better outcome
Factors affecting disc angle restoration in oblique lateral interbody fusion at L5–S1
No full textBACKGROUND CONTEXT: Optimal restoration of the L5–S1 disc angle (DA) is an important surgical goal in spinal reconstructive surgery. Anterior approach is beneficial for L5–S1 DA reconstruction and fusion. However, factors associated with a greater DA restoration in oblique lateral interbody fusion (OLIF) at L5–S1 have not been studied. PURPOSE: This study aimed to identify factors that aid in achieving a greater DA in OLIF at L5–S1. STUDY DESIGN/SETTING: A retrospective analysis. PATIENT SAMPLE: This study involved 61 consecutive patients who underwent OLIF at L5–S1 for lumbar degenerative disease and were followed for more than 1 year. Patients with incomplete data or posterior column osteotomy at L5–S1 were excluded. OUTCOME MEASURES: The L5–S1 DA was measured preoperatively, postoperatively, and at the last follow-up on standing lateral lumbar radiographs. The associations between demographics and/or surgical and/or radiological factors and the L5–S1 DA at the last follow-up were analyzed using multiple regression analysis. METHODS: Demographics and surgical factors were reviewed from the medical records with respect to age, sex, body mass index, bone mineral density, diagnosis, surgery level, cage parameters (cage lordotic angle and height), laminectomy performed and/or not performed, estimated blood loss, operative time, configuration of the left common iliac vein. Radiological factors were measured with respect to sagittal parameters, the L5–S1 disc parameters, and the postoperative cage parameters. RESULTS: The mean preoperative DA at L5–S1 was 5.4±5.0°, which increased to 18.9±5.6° postoperatively (p<.001) and was maintained as 16.5±5.9° at the last follow-up (p<.001). The preoperative DA, end plate lesions, anterior spur, facet joint osteoarthritis, or cage position at L5–S1 did not affect the DA at the last follow-up (all p>.05). Multiple regression analysis showed four independent variables, including increased age, increased cage lordotic angle, laminectomy performed, and absence of cage subsidence as the factors associated with the greater DA at L5–S1. CONCLUSIONS: OLIF at L5–S1 showed favorable DA restoration regardless of the preoperative conditions. To achieve a greater DA, surgeons should try to distract the anterior disc space for insertion of a larger lordotic cage. Laminectomy during posterior fixation is recommended for achieving additional DA restoration
Comparison of surgical outcomes between oblique lateral interbody fusion (OLIF) and anterior lumbar interbody fusion (ALIF)
No full textObjective: Although oblique lateral interbody fusion (OLIF) utilizes the similar approach in anterior lumbar interbody fusion (ALIF), OLIF is essentially a lateral lumbar interbody fusion (LLIF). Therefore, OLIF may have advantages in LLIF that the lateral cage can achieve greater restoration of the disc height and angle. We aimed to compared the surgical outcomes between OLIF and ALIF. Methods: This study involved 47 consecutive patients who underwent a single-level OLIF and 45 consecutive patients who underwent a single-level ALIF at L2-L5 levels. Radiological measurements included the changes of anterior/posterior disc height, coronal/sagittal disc angle, foramen cross-sectional area (CSA), cage position from the anterior margin of the lower vertebra, fusion rate, and cage subsidence using the serial radiographs and computed tomography preoperatively and at the postoperative 1-year follow-up. Clinical outcomes were assessed by visual analog scale (VAS) for back/leg pain, Oswestry disability index (ODI), and the occurrence of perioperative complications. Results: The baseline radiological and clinical parameters were similar between the OLIF and ALIF groups (all P > 0.05). At postoperative 1 year, the mean anterior disc height was higher in the OLIF group than the ALIF group (11.4 ± 1.9 mm vs. 9.6 ± 2.6 mm, P = 0.021). The mean sagittal disc angle was also greater in the OLIF group than the ALIF group (10.9 ± 4.4° vs. 8.9 ± 5.8°, P < 0.001). The mean cage position was 5.8 ± 2.1 mm in the OLIF group and 8.7 ± 2.3 mm in the ALIF group (P < 0.001). There was no difference in the postoperative changes of coronal disc angles, foramen CSA, fusion rate, cage subsidence, VAS for back/leg pain, ODI, and the occurrence of perioperative complications between the OLIF and ALIF groups (all P > 0.05). Conclusions: OLIF showed a greater increase in disc height and segmental lordosis than ALIF with comparable complications. OLIF is a meaningful progress from ALIF
척추 기기 고정술과 유합술로 치료한 불안정성, 외상성 흉추 및 요추의 불안정성 골절 환자에서 추체 종판 골절의 심각도가 추간판 퇴행의 발생에 미치는 영향
No full textStudy Design: Retrospective analysis. Objectives: To determine the impact of the severity of endplate fracture (EF) on intervertebral disc degeneration (DD) in patients treated with instrumented fusion for unstable traumatic thoracic and lumbar fractures. Summary of Literature Review: The relationship between the severity of EF and DD has not been established. Materials and Methods: This study analyzed 90 levels of intervertebral discs adjacent to EF and 180 adjacent vertebral endplates. We enrolled 34 consecutive patients who had suffered a traumatic thoracic or lumbar fracture and were treated surgically. Magnetic resonance imaging (MRI) was used to assess the Pfirrmann grade of the intervertebral discs adjacent to the fractured vertebra at injury (baseline) and follow-up (mean, 16.1±3.9 months from baseline). MRI at baseline was used to evaluate the severity of EF using the total endplate defect sore (TEPS). Multivariate logistic regression analysis was used to identify independent risk factors among baseline parameters for predicting the development of DD (Pfirrmann grade ≥ III) at follow-up. Results: All discs were grade II at baseline and changed to grade III in 20 (21.2%) discs and grade IV in 4 (4.3%) discs at follow-up. TEPS at baseline had the strongest association with the development of DD at follow-up in the analysis. Receiver operating characteristic curve analysis indicated that the optimal cut-off value of TEPS for the development of DD was 6. Conclusions: The severity of EF at the time of the injury was associated with the development of DD. Severe EF (TEPS ≥6) at the time of the injury resulted in DD.연구 계획: 후향적 분석
목적: 본 연구에서는 척추 기기 고정술과 유합술로 치료한 불안정성, 외상성 흉추 및 요추의 불안정성 골절 환자 코호트를 이용하여 추체종판 골절의 심각도가 인접 추간판의 퇴행에 미치는 영향을 알아보고자 하였다.
선행 연구문헌의 요약: 종판 골절의 심각도와 추간판의 퇴행의 관계에 대해서는 알려진 바가 없다.
대상 및 방법: 본연구는 골절된 척추체에 인접한 총 90분절의 추간판과 그 추간판에 인접한 총 180개의 추체종판을 분석하였다. 본 연구는 본원에서 흉추 및 요추의 불안정성 골절로 수술적 치료를 받은 34명의 연속적인 환자를 대상으로 하였다. 수상 당시 및 최종 추시(수상 당시로부터 평균 16.1±3.9개월)에서의 Magnetic resonance imaging (MRI)에서 골절에 인접한 90분절의 추간판을 Pfirrmann grade를 이용하여 분석하였다. 수상 당시의 추체 종판 골절의 심각도는 MRI에서 total endplate defect score (TEPS)를 측정하여 평가하였다. 다중 로지스틱 회귀 분석을 이용하여 추간판의 퇴행(Pfirrmann grade ≥III)에 대한 수상 당시의 위험인자를 분석하였다.
결과: 모든 추간판은 수상당시 grade II였으며, 최종 추시에서 20개의 분절(21.2%)은 grade III로 퇴행성 변화가 진행됨이 관찰되었으며, 4개의 분절(4.3%)는 grade IV로 진행된 것이 관찰되었다. 수상당시의 TEPS가 추간판 퇴행의 발생에 가장 중요한 위험인자였다. Receiver operating characteristic curve분석에서 TEPS의 cut-off 값은 6점이었다.
결론: 추체종판의 골절의 정도는 추간판의 퇴행의 위험인자이며, 수상 당시의 심각한 추체 종판의 손상은(TEPS ≥ 6) 추간판 퇴행에 매우 밀접한 관계가 있다
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