scholarly journals The predictive value of preoperative paraspinal muscle morphometry on complications after lumbar surgery: a systematic review

2021 ◽  
Author(s):  
Han Gengyu ◽  
Dai Jinyue ◽  
Gong Chunjie ◽  
Zhang Bo ◽  
Jiang Yu ◽  
...  
Keyword(s):  
Strong Evidence ◽  
Adjacent Segment Degeneration ◽  
Risk Of Bias ◽  
Paraspinal Muscle ◽  
Adjacent Segment ◽  
Lumbar Surgery ◽  
Paraspinal Muscles ◽  
High Quality ◽  
Bone Nonunion ◽  
Pedicle Screw Loosening

Abstract Purpose The effect of paraspinal muscles atrophy and fat infiltration (FI) on the complications of spinal surgery has not been established. Methods A review of the literature was conducted from a search of the PubMed, EMBASE, and Web of Science databases from inception through January 2021. The literature was searched and assessed by independent reviewers based on criteria that included an assessment of preoperative paraspinal muscle morphology in addition to measuring its relationship to surgical complications. All relevant papers were assessed for risk of bias according to the modified Newcastle Ottawa Scale and the Joanna Briggs Institute Critical Appraisal Tools. A narrative synthesis was conducted. Results The initial search yielded 5632 studies, of which 16 studies were included in the analysis. All included studies were at a low risk of bias. There existed strong evidence that the atrophy and FI of paraspinal muscles had an association with the development of bone nonunion (two high quality studies), pedicle screw loosening (two high quality studies), adjacent segment degeneration (three high quality studies) and proximal junctional kyphosis (five high quality studies) after lumbar surgery. Besides, there is also limited evidence for association between atrophy and FI of paraspinal extensor muscles and less local and global curve improvement. Conclusions Strong evidence was found for an association between preoperative paraspinal muscle degeneration and multiple postoperative complications after lumbar surgery. However, the findings should be interpreted with caution due to the small quantity of the available literature and high heterogeneity among studies.

Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion

2016 ◽  
Vol 16 (7) ◽  
pp. 867-875 ◽  
Author(s):  
Jong Yeol Kim ◽  
Dal Sung Ryu ◽  
Ho Kyu Paik ◽  
Sang Soak Ahn ◽  
Moo Sung Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Facet Joint ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Paraspinal Muscle ◽  
Adjacent Segment

scholarly journals Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Surgery for Adjacent Segment Degeneration and Recurrent Disc Herniation

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Huan-Chieh Chen ◽  
Chih-Hsun Lee ◽  
Li Wei ◽  
Tai-Ngar Lui ◽  
Tien-Jen Lin
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Disc Herniation ◽  
Operating Time ◽  
Adjacent Segment Degeneration ◽  
Lumbar Discectomy ◽  
Adjacent Segment ◽  
Lumbar Surgery ◽  
Surgery Group ◽  
Endoscopic Lumbar Discectomy

Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar surgery for patients with adjacent segment degeneration (ASD) and recurrence of disc herniation.Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients) or repeated open lumbar surgery (25 patients), due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared.Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery groupP<0.0001. Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery groupP<0.0001. Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and −0.56 in the open lumbar surgery groupP<0.0001.Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort.

Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

2011 ◽  
Vol 16 (2) ◽  
pp. 8-9
Author(s):  
Marjorie Eskay-Auerbach
Keyword(s):  
Clinical Symptoms ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Disc Space Narrowing ◽  
Disc Disease ◽  
Disc Space ◽  
Radiographic Findings ◽  
Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up

2021 ◽  
Vol 34 (1) ◽  
pp. 83-88
Author(s):  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Minghao Wang ◽  
Andrew K. Chan ◽  
Bo Li ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Inclusion Criteria ◽  
Single Level ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Surgery Rates

OBJECTIVEIn this study, the authors’ aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.METHODSPatients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters.RESULTSA total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24–135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49–0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05).CONCLUSIONSIn patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.

scholarly journals TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jingchi Li ◽  
Chen Xu ◽  
Xiaoyu Zhang ◽  
Zhipeng Xi ◽  
Mengnan Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Poor Prognosis ◽  
Adjacent Segment Degeneration ◽  
Iatrogenic Injury ◽  
Adjacent Segment ◽  
Fe Model ◽  
High Grade ◽  
Endoscopic Lumbar Discectomy ◽  
Adjacent Segments

Abstract Background Facetectomy, an important procedure in the in–out and out–in techniques of transforaminal endoscopic lumbar discectomy (TELD), is related to the deterioration of the postoperative biomechanical environment and poor prognosis. Facetectomy may be avoided in TELD with large annuloplasty, but iatrogenic injury of the annulus and a high grade of nucleotomy have been reported as risk factors influencing poor prognosis. These risk factors may be alleviated in TELD with limited foraminoplasty, and the grade of facetectomy in this surgery can be reduced by using an endoscopic dynamic drill. Methods An intact lumbo-sacral finite element (FE) model and the corresponding model with adjacent segment degeneration were constructed and validated to evaluate the risk of biomechanical deterioration and related postoperative complications of TELD with large annuloplasty and TELD with limited foraminoplasty. Changes in various biomechanical indicators were then computed to evaluate the risk of postoperative complications in the surgical segment. Results Compared with the intact FE models, the model of TELD with limited foraminoplasty demonstrated slight biomechanical deterioration, whereas the model of TELD with large annuloplasty revealed obvious biomechanical deterioration. Degenerative changes in adjacent segments magnified, rather than altered, the overall trends of biomechanical change. Conclusions TELD with limited foraminoplasty presents potential biomechanical advantages over TELD with large annuloplasty. Iatrogenic injury of the annulus and a high grade of nucleotomy are risk factors for postoperative biomechanical deterioration and complications of the surgical segment.

scholarly journals Stand-Alone Posterior Expandable Cage Technique for Adjacent Segment Degeneration with Lumbar Spinal Canal Stenosis: A Retrospective Case Series

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 237
Author(s):  
Woo-Jin Choi ◽  
Seung-Kook Kim ◽  
Manhal Alaraj ◽  
Hyeun-Sung Kim ◽  
Su-Chan Lee
Keyword(s):  
Sagittal Balance ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Spinal Canal Stenosis ◽  
Adjacent Segment ◽  
Lumbar Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
Lumbar Spinal ◽  
Expandable Cages

Background and Objectives: Symptomatic adjacent segment degeneration (ASD) with lumbar spinal canal stenosis (LSCS) is a common complication after spinal intervention, particularly interbody fusion. Stand-alone posterior expandable cages enable interbody fusion with preservation of the previous operation site, and screw-related complications are avoided. Thus, the aim of this study was to investigate the clinicoradiologic outcomes of stand-alone posterior expandable cages for ASD with LSCS. Materials and Methods: Patients with persistent neurologic symptoms and radiologically confirmed ASD with LSCS were evaluated between January 2011 and December 2016. The five-year follow-up data were used to evaluate the long-term outcomes. The radiologic parameters for sagittal balance, pain control (visual analogue scale), disability (Oswestry Disability Index), and early (peri-operative) and late (implant) complications were evaluated. Results: The data of 19 patients with stand-alone posterior expandable cages were evaluated. Local factors, such as intervertebral and foraminal heights, were significantly corrected (p < 0.01 and p < 0.01, respectively), and revision was not reported. The pain level (p < 0.01) and disability rate (p < 0.01) significantly improved, and the early complication rate was low (n = 2, 10.52%). However, lumbar lordosis (p = 0.62) and sagittal balance (p = 0.80) did not significantly improve. Furthermore, the rates of subsidence (n = 4, 21.05%) and retropulsion (n = 3, 15.79%) were high. Conclusions: A stand-alone expandable cage technique should only be considered for older adults and patients with previous extensive fusion. Although this technique is less invasive, improves the local radiologic factors, and yields favorable clinical outcomes with low revision rates, it does not improve the sagittal balance. For more widespread application, the strength of the cage material and high subsidence rates should be improved.

scholarly journals Radiological Assessment of Postoperative Paraspinal Muscle Changes After Lumbar Interbody Fusion With or Without Minimally Invasive Techniques

2021 ◽  
pp. 219256822199479
Author(s):  
Keigo Kameyama ◽  
Tetsuro Ohba ◽  
Tomoka Endo ◽  
Marina Katsu ◽  
Fujita Koji ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Cross Sectional Area ◽  
Paraspinal Muscle ◽  
Lumbar Interbody Fusion ◽  
Sectional Area ◽  
Paraspinal Muscles ◽  
Cross Sectional ◽  
Muscle Density ◽  
Muscle Changes

Study Design: Retrospective cohort study. Background: Percutaneous pedicle screws (PPS) have the advantage of being able to better preserve the paraspinal muscles when compared with a traditional open approach. However, the nature of changes in postoperative paraspinal muscle after damage by lumbar fusion surgery has remained largely unknown. It is clinically important to clarify and compare changes in paraspinal muscles after the various surgeries. Objective: (1) To determine postoperative changes of muscle density and cross-sectional area using computed tomography (CT), and (2) to compare paraspinal muscle changes after posterior lumbar interbody fusion (PLIF) with traditional open approaches and minimally invasive lateral lumbar interbody fusions (LLIF) with PPS. Methods: We included data from 39 consecutive female patients who underwent open PLIF and 23 consecutive patients who underwent single-staged treatment with LLIF followed by posterior PPS fixation at a single level (L4-5). All patients underwent preoperative, 6 months postoperative, and 1-year postoperative CT imaging. Measurements of the cross-sectional area (CSA) and muscle densities of paraspinal muscles were obtained using regions of interest defined by manual tracing. Results: We did not find any decrease of CSA in any paraspinal muscles. We did find a decrease of muscle density in the multifidus at 1 year after surgery in patients in the PILF group, but not in those in LLIF/PPS group. Conclusions: One year after surgery, a significant postoperative decrease of muscle density of the multifidi was observed only in patients who underwent open PLIF, but not in those who underwent LLIF/PPS.

Association Between Deep Posterior Cervical Paraspinal Muscle Morphology and Clinical Features in Patients With Cervical Ossification of the Posterior Longitudinal Ligament

2021 ◽  
pp. 219256822198965
Author(s):  
Toru Doi ◽  
Nozomu Ohtomo ◽  
Fumihiko Oguchi ◽  
Keiichiro Tozawa ◽  
Hiroyuki Nakarai ◽  
...  
Keyword(s):  
Clinical Features ◽  
Fatty Infiltration ◽  
Neck Disability Index ◽  
Posterior Longitudinal Ligament ◽  
Paraspinal Muscle ◽  
Paraspinal Muscles ◽  
Muscle Area ◽  
Cross Sectional ◽  
Study Results ◽  
Neck Disability

Study Design: A retrospective observational study. Objective: To clarify the association of the paraspinal muscle area and composition with clinical features in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods: Consecutive patients with cervical OPLL who underwent cervical magnetic resonance imaging (MRI) before surgery were reviewed. The cross-sectional area (CSA) and fatty infiltration ratio (FI%) of deep posterior cervical paraspinal muscles (multifidus [MF] and semispinalis cervicis [SCer]) were examined. We assessed the association of paraspinal muscle measurements with the clinical characteristics and clinical outcomes, such as Neck Disability Index (NDI) score. Moreover, we divided the patients into 2 groups according to the extent of the ossified lesion (segmental and localized [OPLL-SL] and continuous and mixed [OPLL-CM] groups) and compared these variables between the 2 groups. Results: 49 patients with cervical OPLL were enrolled in this study. The FI% of the paraspinal muscles was significantly associated with the number of vertebrae ( ρ = 0.283, p = 0.049) or maximum occupancy ratio of OPLL ( ρ = 0.397, p = 0.005). The comparative study results indicated that the NDI score was significantly worse (OPLL-SL, 22.9 ± 13.7 vs. OPLL-CM, 34.4 ± 13.7) and FI% of SCer higher (OPLL-SL, 9.1 ± 1.7% vs. OPLL-CM, 11.1 ± 3.7%) in the OPLL-CM group than those in the OPLL-SL group. Conclusions: Our results suggest that OPLL severity may be associated with fatty infiltration of deep posterior cervical paraspinal muscles, which could affect neck disability in patients with cervical OPLL.

scholarly journals Comparing options for females seeking permanent contraception in high resource countries: a systematic review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Rebecca Gormley ◽  
Brian Vickers ◽  
Brooke Cheng ◽  
Wendy V. Norman
Keyword(s):  
Adverse Events ◽  
Tubal Ligation ◽  
Risk Of Bias ◽  
High Quality ◽  
Tubal Occlusion ◽  
High Resource ◽  
Intrauterine Contraception ◽  
Permanent Contraception ◽  
Long Acting

Abstract Background Multiple options for permanent or long-acting contraception are available, each with adverse effects and benefits. People seeking to end their fertility, and their healthcare providers, need a comprehensive comparison of methods to support their decision-making. Permanent contraceptive methods should be compared with long-acting methods that have similar effectiveness and lower anticipated adverse effects, such as the levonorgestrel-releasing intrauterine contraception (LNG-IUC). We aimed to understand the comparability of options for people seeking to end their fertility, using high-quality studies. We sought studies comparing laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and insertion of the LNG-IUC, for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs among females in high resource countries seeking to permanently avoid conception. Methods We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We used the Newcastle–Ottawa Scale to assess risk of bias and excluded studies with medium–high risk of bias (NOS < 7). Due to considerable heterogeneity, we performed a narrative synthesis. Results Our search identified 6,612 articles. RG, BV, BC independently reviewed titles and abstracts for relevance. We reviewed the full text of 154 studies, yielding 34 studies which met inclusion criteria. We excluded 10 studies with medium–high risk of bias, retaining 24 in our synthesis. Most studies compared hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events; fewer reported tolerability, patient recovery, non-contraceptive benefits, and/or healthcare system costs. No comparisons reported accessibility, eligibility, or follow-up required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No high-quality studies included the LNG-IUC. Conclusions Studies are needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception to support decision-making. Systematic review registration PROSPERO [CRD42016038254].

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