Augmentation of intertransverse process lumbar fusion

2006 ◽  
Vol 19 (02) ◽  
pp. 72-80
Author(s):  
Steven A. Martinez ◽  
Joanne Hughes ◽  
James D. Lincoln ◽  
Mei-Shu Shih ◽  
Hellen Zheng ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Lumbar Vertebrae ◽  
Study Groups ◽  
External Source ◽  
Histological Evaluation ◽  
Control Group ◽  
Failure Rates ◽  
Lumbar Spinal Fusion ◽  
Lumbar Spinal

SummarySpinal fusion surgery for alleviation of intractable lower back pain in humans is currently a primary therapeutic technique, with failure rates averaging between 5 to 35%. Implanted and external source-based electrical stimulation devices have been investigated in an attempt to increase osteogenesis at the fusion site in an attempt to reduce spinal fusion failure rates. The purpose of our study was to evaluate the efficacy of two co-processor systems and an additional system with an SIS generation field at 15.8 mA (rms) using biomechanical, dual-energy X-ray absorptiometry (DXA), and histomorphometric analyses, in rabbits following dorsolateral (= posteriolateral [in humans]) spinal fusion. Fifty-six male New Zealand White underwent bilateral lumbar spinal fusion by performing decortication of the transverse processes of lumbar vertebrae four and five with placement of autogenic cancellous bone graft harvested from the ilial wings. Four study groups were designated based on the type of IES device used for stimulation or as a control. Eight weeks after surgery all subjects were sacrificed and the quality and strength of the fusion masses were compared using radiographic, biomechanical, histomorphometry, and qualitative histological evaluation. While some variation existed within and between groups, Group 2 showed a significant improvement in all parameters measured as compared to the control group (P<0.05). The use of adjunct non-invasive surface IES for improving bony fusion rates for patients undergoing lumbar spinal fusion is supported by this study.

scholarly journals Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: Assessment of functional outcome following lumbar fusion

2014 ◽  
Vol 21 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Zoher Ghogawala ◽  
Daniel K. Resnick ◽  
William C. Watters ◽  
Praveen V. Mummaneni ◽  
Andrew T. Dailey ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Functional Outcome ◽  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Minimum Clinically Important Difference ◽  
Degenerative Disease ◽  
Psychological State ◽  
Lumbar Spinal Fusion ◽  
Patient Reported ◽  
Lumbar Spinal

Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.

scholarly journals Nursing care of the patient undergoing lumbar spinal fusion

2017 ◽  
Vol 8 (5) ◽  
pp. 44 ◽  
Author(s):  
Maureen P. Lall
Keyword(s):  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Cauda Equina ◽  
Research Literature ◽  
Spinal Tumors ◽  
Surgical Approaches ◽  
Lumbar Spinal Fusion ◽  
Advantages And Disadvantages ◽  
Diagnostic Modalities ◽  
Lumbar Spinal

Lumbar spinal fusion is a surgical procedure performed to join—or fuse—2 or more vertebrae in the low back. The procedure is done to stabilize the spine and prevent damage to the cauda equina and emanating nerve roots. Lumbar fusion is commonly indicated for patients with vertebral fractures, infection, or spinal tumors, and it may be appropriate for select patients with degenerative disorders and spinal stenosis. Nurses who care for patients undergoing lumbar fusion require an understanding of lumbar spinal anatomy, spinal pathology, surgical indications, and diagnostic modalities. Knowledge of the distinct surgical approaches and their respective advantages and disadvantages allows nurses to individualize patient care and be alert to postoperative complications. This article reviews clinical and research literature regarding lumbar fusion, with an emphasis on the role of the nurse in promoting a safe perioperative course.

scholarly journals Patient-specific statistical shape modeling for optimal spinal sagittal alignment in lumbar spinal fusion

2021 ◽  
Author(s):  
Pascal R. Furrer ◽  
Sebastiano Caprara ◽  
Florian Wanivenhaus ◽  
Marco D. Burkhard ◽  
Marco Senteler ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Sagittal Alignment ◽  
Shape Modeling ◽  
Patient Specific ◽  
Control Group ◽  
Lumbar Spinal Fusion ◽  
Spinal Sagittal Alignment ◽  
Statistical Shape ◽  
Lumbar Spinal ◽  
Asymptomatic Control

Abstract Purpose The present study compared patients developing ASD after L4/5 spinal fusion with a control group using a patient-specific statistical shape model (SSM) to find alignment-differences between the groups. Methods This study included patients who had undergone spinal fusion at L4/5 and either remained asymptomatic (control group; n = 25, follow-up of > 4 years) or required revision surgery for epifusional ASD (n = 22). Landmarks on preoperative and postoperative lateral radiographs were annotated, and the optimal spinal sagittal alignment was calculated for each patient. The two-dimensional distance from the SSM-calculated optimum to the actual positions before and after fusion surgery was compared. Results Postoperatively, the additive mean distance from the SSM-calculated optimum was 86.8 mm in the ASD group and 67.7 mm in the control group (p = 0.119). Greater differences were observed between the groups with a larger distance to the ideal in patients with ASD at more cranial levels. Significant difference between the groups was seen postoperatively in the vertical distance of the operated segment L4. The patients with ASD (5.69 ± 3.0 mm) had a significant greater distance from the SSM as the control group (3.58 ± 3.5 mm, p = 0.034). Conclusion Patients with ASD requiring revision after lumbar spinal fusion have greater differences from the optimal spinal sagittal alignment as an asymptomatic control group calculated by patient-specific statistical shape modeling. Further research might help to understand the value of SSM, in conjunction with already established indexes, for preoperative planning with the aim of reducing the risk of ASD. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding

scholarly journals Do Clinical Outcomes and Sagittal Parameters Differ Between Diabetics and Nondiabetics for Degenerative Spondylolisthesis Undergoing Lumbar Fusion?

2019 ◽  
Vol 10 (3) ◽  
pp. 286-293
Author(s):  
Jannat M. Khan ◽  
Joseph Michalski ◽  
Bryce A. Basques ◽  
Philip K. Louie ◽  
Oscar Chen ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Spinal Fusion ◽  
Clinical Outcomes ◽  
Lumbar Fusion ◽  
Degenerative Spondylolisthesis ◽  
Diabetic Patients ◽  
Lumbar Spinal Fusion ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Lumbar Spinal

Study Design: Retrospective cohort study. Objective: To assess the effect of diabetes mellitus (DM) on clinical and radiographic outcomes in patient with degenerative spondylolisthesis undergoing posterior lumbar spinal fusion. Methods: Analysis of patients who underwent open posterior lumbar spinal fusion from 2011 to 2018. Patients being medically treated for DM were identified and separated from nondiabetic patients. Visual analogue scale Back/Leg pain and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were also collected. Results: A total of 850 patients were included; 78 (9.20%) diabetic patients and 772 (90.80%) nondiabetic patients. Final PI-LL difference was significantly larger ( P = .032) for patients with diabetes compared to no diabetes, but there were no other significant differences between radiographic measurements, operative time, or postoperative length of stay. There were no differences in clinical outcomes between the 2 groups. Diabetic patients were found to have a higher rate of discharge to a facility following surgery ( P = .018). No differences were observed in reoperation or postoperative complication. Conclusions: While diabetic patients had more associated comorbidities compared with nondiabetic patients, they had similar patient-reported and radiographic outcomes. Similarly, there are no differences in rates of reoperation or postoperative complications. This study indicates that diabetic patients who have undergone thorough preoperative screening of related comorbidities and appropriate selection should be considered for lumbar spinal fusion.

scholarly journals Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7967 ◽  
Author(s):  
Ke Chen ◽  
Lizhen Wang ◽  
Meng Ning ◽  
Lianjie Dou ◽  
Wei Li ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Fusion ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Single Shot ◽  
Lumbar Spinal Fusion ◽  
Ultrasound Guided ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Lumbar Spinal

Objective Ultrasound-guided lateral thoracolumbar interfascial plane block (US-TLIP block) is a novel regional technique for anesthesia or analgesia. However, there has been no prospective, randomized and controlled clinical trial investigating the perioperative analgesic effect of US-TLIP block on lumbar spinal fusion surgery. The aim of this study was to investigate the analgesic effect of bilateral single-shot US-TLIP in patients undergoing lumbar spinal fusion surgery. Methods A prospective and randomized comparative clinical study was conducted. A total of 60 patients (ASA classes: I–II), aged 21–74 years who were scheduled for lumbar spinal fusion surgery were randomized and divided into the TLIP group (Group T, n = 30) and control group (Group C, n = 30). The patients in Group T received preoperative bilateral single-shot US-TLIP with 30 ml of 0.375% ropivacaine at the third lumbar spine (L3) vertebral level, and the patients in Group C received an injection of 30 ml 0.9% saline through same technique. All patients received patient-controlled analgesia (PCA) after their operation. The frequency of PCA compressions and rescue analgesic administrations were recorded. Opioids (sufentanil and remifentanil), anesthetic consumption, the number of postoperative days spent in a hospital bed, overall hospital stay time and postoperative complications were recorded. The Visual Analogue Scale (VAS) and Bruggemann Comfort Scale (BCS) scores for pain and comfort assessment were recorded at 1, 12, 24, 36, and 48 hours postoperatively. Results Opioids and anesthetic consumption in the perioperative period decreased significantly in the TLIP group compared to the control group (P < 0.05). The VAS and BCS scores in the TLIP group were lower at 12, 24, and 36 hours postoperatively (P < 0.05). US-TLIP block has been shown to shorten postoperative hospital stays (P < 0.05). There was no significant difference in postoperative complications between the two groups. Conclusion Our study findings show that bilateral US-TLIP block exhibits significant analgesia and safety in patients undergoing lumbar spinal fusion surgery.

Does adding case management to standard rehabilitation affect functional ability, pain, or the rate of return to work after lumbar spinal fusion? A randomized controlled trial with two-year follow-up

2020 ◽  
Vol 34 (3) ◽  
pp. 357-368 ◽  
Author(s):  
Lisa Gregersen Oestergaard ◽  
Finn Bjarke Christensen ◽  
Cody Eric Bünger ◽  
Rikke Søgaard ◽  
Randi Holm ◽  
...  
Keyword(s):  
Return To Work ◽  
Spinal Fusion ◽  
Controlled Trial ◽  
Case Manager ◽  
Physical Rehabilitation ◽  
Rehabilitation Programme ◽  
Leg Pain ◽  
Control Group ◽  
Lumbar Spinal Fusion ◽  
Lumbar Spinal

Objective: To examine the effect of a case manager–assisted rehabilitation programme as an add-on to usual physical rehabilitation in patients undergoing lumbar spinal fusion. Design: A randomized controlled trial with a two-year follow-up. Settings: Outpatient clinics of a university hospital and a general hospital. Subjects: In total, 82 patients undergoing lumbar spinal fusion. Interventions: The patients were randomized one-to-one to case manager–assisted rehabilitation (case manager group) or no case manager–assisted rehabilitation (control group). Both groups received usual physical rehabilitation. The case manager–assisted rehabilitation programme included a preoperative meeting with a case manager to determine a rehabilitation plan, postsurgical meetings, phone meetings, and voluntary workplace visits or roundtable meetings. Main measures: Primary outcome was the Oswestry Disability Index. Secondary outcomes were back pain, leg pain, and return to work. Results: Of the 41 patients in the case manager group, 49% were men, with the mean age of 46.1 (±8.7 years). In the control group, 51% were male, with the mean age of 47.4 (±8.9 years). No statistically significant between-group differences were found regarding any outcomes. An overall group effect of 4.1 points (95% confidence interval (CI): –1.8; 9.9) was found on the Oswestry Disability Index, favouring the control group. After two years, the relative risk of return to work was 1.18 (95% CI: 0.8; 1.7), favouring the case manager group. Conclusion: The case manager–assisted rehabilitation programme had no effect on the patients’ functional disability or back and leg pain compared to usual physical rehabilitation. The study lacked power to evaluate the impact on return to work.

Predicting postoperative complications in patients undergoing lumbar spinal fusion by using the modified five-item frailty index and nutritional status

2020 ◽  
Vol 102-B (12) ◽  
pp. 1717-1722
Author(s):  
TaeWook Kang ◽  
Si Young Park ◽  
Joon Suk Lee ◽  
Soon Hyuck Lee ◽  
Jong Hoon Park ◽  
...  
Keyword(s):  
Vitamin D ◽  
Postoperative Complications ◽  
Nutritional Status ◽  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Frailty Index ◽  
Lumbar Spinal Fusion ◽  
Nutritional Parameters ◽  
Posterior Surgery ◽  
Lumbar Spinal

Aims As the population ages and the surgical complexity of lumbar spinal surgery increases, the preoperative stratification of risk becomes increasingly important. Understanding the risks is an important factor in decision-making and optimizing the preoperative condition of the patient. Our aim was to determine whether the modified five-item frailty index (mFI-5) and nutritional parameters could be used to predict postoperative complications in patients undergoing simple or complex lumbar spinal fusion. Methods We retrospectively reviewed 584 patients who had undergone lumbar spinal fusion for degenerative lumbar spinal disease. The 'simple' group (SG) consisted of patients who had undergone one- or two-level posterior lumbar fusion. The 'complex' group (CG) consisted of patients who had undergone fusion over three or more levels, or combined anterior and posterior surgery. On admission, the mFI-5 was calculated and nutritional parameters collected. Results Complications occurred in 9.3% (37/396) of patients in the SG, and 10.1% (19/167) of patients in the CG. In the SG, the important predictors of complications were age (odds ratio (OR) 1.036; p = 0.002); mFI-5 (OR 1.026 to 2.411, as score increased to 1 ≥ 2 respectively; p = 0.023); albumin (OR 11.348; p < 0.001); vitamin D (OR 2.185; p = 0.032); and total lymphocyte count (OR 1.433; p = 0.011) . In the CG, the predictors of complications were albumin (OR 9.532; p = 0.002) and vitamin D (OR 3.815; p = 0.022). Conclusion The mFI-5 and nutritional status were effective predictors of postoperative complications in the SG, but only nutritional status was successful in predicting postoperative complications in the CG. The complexity of the surgery, as well as the preoperative frailty and nutritional status of patients, should be considered when determining if it is safe to proceed with lumbar spinal fusion. Cite this article: Bone Joint J 2020;102-B(12):1717–1722.

Comparison of the osteogenic effects between two surface interferential stimulation devices to enhance surgically based spinal fusion

2004 ◽  
Vol 17 (01) ◽  
pp. 41-47
Author(s):  
S. A. Martinez ◽  
L. V. Smith ◽  
W. J. Carroll ◽  
J. A. Zimmermann ◽  
M. S. Shih ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Spinal Fusion ◽  
Bone Mineral ◽  
Controlled Study ◽  
Control Group ◽  
Lumbar Spinal Fusion ◽  
Fusion Model ◽  
Mineral Density ◽  
Disc Space ◽  
Lumbar Spinal

SummaryIn human medicine, lumbar spinal fusion procedures for chronic degenerative conditions have significant failure rates leading to the formation of pseudoarthroses. Adjunct procedures including the use of electrical stimulation devices have been developed in animal models, and utilized in human clinical cases, in an attempt to reduce the incidence of nonunion. A randomized, controlled study was performed to compare the effects of two surface interferential stimulation devices (SIS) on a rabbit lumbar spinal fusion model. Twenty-five rabbits underwent bilateral intertransverse process arthrodesis at the L2-L3 disc space. The rabbits were divided into five groups: one control group receiving sham stimulation, and four treatment groups receiving interferential stimulation from one of two devices (RS4i at 13.3 mA, RS4i at 15.8 mA, RS4v at 11.6 mA, and RS4v at 14.8 mA). Dual energy X-ray absorptiometry analyses (DXA) were performed and at 2 week intervals to evaluate fusion site bone mineral density. All rabbits were euthanitized at eight weeks and fusion sites were evaluated for biomechanical strength and histomorphometric properties. There was not any difference in bone mineral density between the groups during the eight week test period. The uniaxial tension tests evaluating maximum load to failure, stiffness, and energy absorbed also resulted in no statistical differences between the groups. The RS4i device at 15.8 mA yielded an increased amount of lamellar bone compared to the control group (p = 0.02). The RS4v device at 11.6 mA resulted in less total bone than the control group (p = 0.04).

scholarly journals The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

2017 ◽  
Vol 26 (5) ◽  
pp. 645-649 ◽  
Author(s):  
Anuj Singla ◽  
Scott Yang ◽  
Brian C. Werner ◽  
Jourdan M. Cancienne ◽  
Ali Nourbakhsh ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Postoperative Infection ◽  
Lumbar Fusion ◽  
Posterior Spinal Fusion ◽  
Infection Risk ◽  
Site Infection ◽  
Lumbar Spinal Fusion ◽  
Epidural Injections ◽  
Lumbar Spinal ◽  
Insurance Database

OBJECTIVELumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion.METHODSA nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI.RESULTSThe overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1–3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI.CONCLUSIONSLumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar fusion was performed more than 3 months after LESI.

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