Dimensional Characterization of the Human Lumbar Interlaminar Space as a Guide for Safe Application of Minimally Invasive Dilators

2021 ◽  
Author(s):  
Jennifer N Lehrman ◽  
Celene B Mulholland ◽  
Bernardo de Andrada Pereira ◽  
Anna G U Sawa ◽  
Brian P Kelly ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Level ◽  
Flexion Extension ◽  
Minimally Invasive Spine ◽  
The Mean ◽  
Lumbar Spinal ◽  
Neutral Posture ◽  
Coordinate Data ◽  
Flexion And Extension

Abstract BACKGROUND The risk of interlaminar passage of a dilator into the lumbar spinal canal in minimally invasive approaches is currently unknown. Among anthropometric data reported in the medical literature, there is no cadaveric report of the interlaminar dimensions of the lumbar spine. OBJECTIVE To report the lumbar interlaminar dimensions in neutral, flexion, and extension postures. METHODS A total of 8 spines were sectioned into lumbar segments. Digitized coordinate data defining the locations and movements of chosen anatomic points on the laminar edges at a given spinal level were used to measure changes in the opening dimensions during static neutral posture and flexion-extension movements. Interlaminar dimensions were averaged and categorized for each vertebral level and spinal posture. RESULTS The mean interlaminar distance increased from neutral posture to flexion across all vertebral levels. The mean interlaminar distances in the neutral posture ranged from 12.21 mm (L5-S1) to 14.88 mm (L1-L2). In flexion, the range was from 17.15 mm (L5-S1) to 18.50 mm (L4-L5). These measurements are greater than the first several diameters of dilators in all minimally invasive dilator sets. CONCLUSION The precise measurements of the lumbar interlaminar space are valuable to minimally invasive spine surgeons for the dilatation phase of the operation. The risk of interlaminar passage of a minimally invasive dilator is greatest in flexion with dilators that have a diameter of 16 mm or less. There is considerably less risk of interlaminar passage in patients positioned on an extended Jackson table.

Dimensional Characterization of the Human Cervical Interlaminar Space as a Guide for Safe Application of Minimally Invasive Dilators

2020 ◽  
Vol 19 (3) ◽  
pp. E275-E282 ◽  
Author(s):  
Luis M Tumialán ◽  
Jennifer N Lehrman ◽  
Celene B Mulholland ◽  
Bernardo de Andrada Pereira ◽  
Anna G U S Newcomb ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Minimally Invasive ◽  
Small Diameter ◽  
Spinal Level ◽  
Vertebral Level ◽  
Neutral Posture ◽  
Coordinate Data ◽  
Theoretical Risk ◽  
Flexion And Extension

Abstract BACKGROUND The risk of interlaminar passage of a dilator into the cervical spinal canal in minimally invasive approaches is currently unknown. Among the various anthropometric data reported in the literature, there is no report of the interlaminar dimensions in the cervical spine. OBJECTIVE To report the cervical interlaminar dimensions in neutral, flexion, and extension. METHODS A total of 8 spines were sectioned into cervical (C2-T1) segments. Digitized coordinate data defining the locations and movements of chosen anatomic points on the laminar edges at a given spinal level were used to compute the dimensions during a static neutral posture, flexion, and extension positions to mimic the positions during surgery. Interlaminar dimensions were averaged and categorized for each vertebral level and spinal posture. RESULTS Based on the reported measurements, the smallest diameter dilator in commonly used dilator sets has the potential to traverse the interlaminar space at all levels in flexion. In a neutral posture, the average interlaminar distance at C2-3, C6-7, and C7-T1 was still greater than 2.0 mm, the smallest diameter of the initial dilator. The largest interlaminar distance was at C6-7 in flexion (7.68 ± 1.60 mm). CONCLUSION Because dilators pass directly onto the cervical lamina without visualization of the midline structures, the interlaminar distances have increased relevance in the minimally invasive cervical approaches of foraminotomy and laminectomy. The data in this report demonstrate the theoretical risk of interlaminar passage with small diameter dilators in posterior minimally invasive approaches to the cervical spine.

OBESITY AND SELF-REPORTED OUTCOME AFTER MINIMALLY INVASIVE LUMBAR SPINAL FUSION SURGERY

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 956-960 ◽  
Author(s):  
David S. Rosen ◽  
Sherise D. Ferguson ◽  
Alfred T. Ogden ◽  
Dezheng Huo ◽  
Richard G. Fessler
Keyword(s):  
Minimally Invasive ◽  
Linear Models ◽  
Short Form ◽  
Length Of Hospital Stay ◽  
Fusion Surgery ◽  
Body Habitus ◽  
Short Form 36 ◽  
Spinal Fusion Surgery ◽  
The Mean ◽  
Lumbar Spinal

Abstract OBJECTIVE Many patients undergoing lumbar spine fusion are overweight or obese. The relationship between body habitus and outcome after lumbar spine fusion surgery is not well defined. METHODS We analyzed a prospectively maintained database of self-reported pain and quality of life measures, including Visual Analog Scale pain score, Short Form 36, and Oswestry Disability Index. We selected patients undergoing minimally invasive transforaminal lumbar interbody fusion between September 2002 and June 2006 at a single institution. We used linear regression models and mixed-effects linear models to examine the relationships between body habitus and self-reported outcomes. RESULTS The analysis identified 110 patients meeting the study criteria, with a median follow-up period of 14.8 months. The mean age was 56 years, mean height was 169 cm, and mean weight was 82.2 kg. The mean body mass index (BMI) was 28.7 kg/m2; 31% of patients were overweight (BMI, 25–29.9), and 32% of patients were obese (BMI, >30). Linear regression analysis did not identify a correlation between weight or BMI and pre- and postsurgery changes in any of the outcome measures. The significant findings observed in the mixed-effects linear models were that the changing patterns of Short Form 36 Body Pain subscale and Short Form 36 Vitality subscale varied significantly by category of BMI (P = 0.01 and P = 0.002, respectively), but not significantly if continuous BMI was used (P = 0.53 and P = 0.46, respectively). BMI correlated marginally with estimated blood loss (P = 0.08), but not operative time, length of hospital stay, or complications. CONCLUSION Among this cohort of minimally invasive lumbar fusion patients, body habitus measured by BMI, weight, or height did not have a significant relationship with most self-reported outcome measures, operative time, length of hospital stay, or complications. Obesity should not be considered a contraindication to minimally invasive lumbar spinal fusion surgery.

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Pain Practice ◽  
2018 ◽  
Vol 19 (3) ◽  
pp. 250-274 ◽  
Author(s):  
Timothy R. Deer ◽  
Jay S. Grider ◽  
Jason E. Pope ◽  
Steven Falowski ◽  
Tim J. Lamer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Consensus Group ◽  
Minimally Invasive Spine ◽  
Lumbar Spinal

A radiographic analysis of degenerative spondylolisthesis at the L4–5 level

2012 ◽  
Vol 16 (2) ◽  
pp. 130-134 ◽  
Author(s):  
D. Greg Anderson ◽  
Worawat Limthongkul ◽  
Amirali Sayadipour ◽  
Christopher K. Kepler ◽  
James S. Harrop ◽  
...  
Keyword(s):  
Degenerative Spondylolisthesis ◽  
Lateral View ◽  
Disc Height ◽  
Data Set ◽  
Osteophyte Formation ◽  
Radiographic Parameters ◽  
Wide Range ◽  
Flexion Extension ◽  
The Mean ◽  
Flexion And Extension

Object Lumbar degenerative spondylolisthesis (LDS) is common and has generally been characterized as a homogeneous disease entity in the literature and in clinical practice. Because disease variability has not been carefully characterized, stratification of treatment recommendations based on scientific evidence is currently lacking. In this study, the authors analyzed radiographic parameters of patients with LDS at the L4–5 level to better characterize this entity. Methods Demographic data were collected from 304 patients (200 women and 104 men) with LDS at the L4–5 level. Plain radiographs including anteroposterior, lateral, and flexion-extension lateral radiographs were analyzed for disc height, segmental angulation, segmental translation, and osteophyte formation. Correlations were sought between the variables of age, sex, disc height, segmental angulation, segmental translation, and osteophyte formation. Results The mean patient age was 63.8 years (range 40–86 years). The mean mid-disc height was 7 mm (range 0–14 mm) on the neutral lateral view. The mean angulation between the superior endplate of L-5 and the inferior endplate of L-4 was 6° of lordosis (range 13° of kyphosis to 23° lordosis) on the neutral lateral view. The mean angular change between flexion and extension lateral radiographs was 5° (range 0°–17°). The mean translation on the neutral lateral view was 6 mm (range 0–15 mm). The mean change in translational between flexion and extension was 2 mm (range 0–11 mm). Twenty patients (7%) exhibited spondylolisthesis only on the flexion view. A significant positive correlation was found between the change in angulation and the change in translation on flexion and extension views (ρ = 0.18, p = 0.001). No significant correlation was found between anterior osteophyte size and mobility with flexion-extension radiographs. Conclusions The wide range in all radiographic parameters for LDS confirms the heterogeneous nature of this condition and suggests that a grading system to subclassify LDS may be clinically useful. On flexion and extension radiographs, increased translational motion correlated with increased angular motion. Anterior osteophyte size was not found to be predictive of segmental stability. This data set should prove beneficial to those seeking to subcategorize LDS in the future.

scholarly journals Impact of dynamic alignment, motion, and center of rotation on myelopathy grade and regional disability in cervical spondylotic myelopathy

2015 ◽  
Vol 23 (6) ◽  
pp. 690-700 ◽  
Author(s):  
Shian Liu ◽  
Renaud Lafage ◽  
Justin S. Smith ◽  
Themistocles S. Protopsaltis ◽  
Virginie C. Lafage ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Motion Analysis ◽  
Cervical Spondylotic Myelopathy ◽  
Dynamic Motion ◽  
Sf 36 ◽  
Flexion Extension ◽  
Focal Parameters ◽  
The Mean ◽  
Neck Disability ◽  
Flexion And Extension

OBJECT Cervical stenosis is a defining feature of cervical spondylotic myelopathy (CSM). Matsunaga et al. proposed that elements of stenosis are both static and dynamic, where the dynamic elements magnify the canal deformation of the static state. For the current study, the authors hypothesized that dynamic changes may be associated with myelopathy severity and neck disability. This goal of this study was to present novel methods of dynamic motion analysis in CSM. METHODS A post hoc analysis was performed of a prospective, multicenter database of patients with CSM from the AOSpine North American study. One hundred ten patients (34%) met inclusion criteria, which were symptomatic CSM, age over 18 years, baseline flexion/extension radiographs, and health-related quality of life (HRQOL) questionnaires (modified Japanese Orthopaedic Association [mJOA] score, Neck Disability Index [NDI], the 36-Item Short Form Health Survey Physical Component Score [SF-36 PCS], and Nurick grade). The mean age was 56.9 ± 12 years, and 42% of patients were women (n = 46). Correlations with HRQOL measures were analyzed for regional (cervical lordosis and cervical sagittal vertical axis) and focal parameters (kyphosis and spondylolisthesis between adjacent vertebrae) in flexion and extension. Baseline dynamic parameters (flexion/extension cone relative to a fixed C-7, center of rotation [COR], and range of motion arc relative to the COR) were also analyzed for correlations with HRQOL measures. RESULTS At baseline, the mean HRQOL measures demonstrated disability and the mean radiographic parameters demonstrated sagittal malalignment. Among regional parameters, there was a significant correlation between decreased neck flexion (increased C2–7 angle in flexion) and worse Nurick grade (R = 0.189, p = 0.048), with no significant correlations in extension. Focal parameters, including increased C-7 sagittal translation overT-1 (slip), were significantly correlated with greater myelopathy severity (mJOA score, Flexion R = −0.377, p = 0.003; mJOA score, Extension R = −0.261, p = 0.027). Sagittal slip at C-2 and C-4 also correlated with worse HRQOL measures. Reduced flexion/extension motion cones, a more posterior COR, and smaller range of motion correlated with worse general health SF-36 PCS and Nurick grade. CONCLUSIONS Dynamic motion analysis may play an important role in understanding CSM. Focal parameters demonstrated a significant correlation with worse HRQOL measures, especially increased C-7 sagittal slip in flexion and extension. Novel methods of motion analysis demonstrating reduced motion cones correlated with worse myelopathy grades. More posterior COR and smaller range of motion were both correlated with worse general health scores (SF-36 PCS and Nurick grade). To our knowledge, this is the first study to demonstrate correlation of dynamic motion and listhesis with disability and myelopathy in CSM.

Rhabdomyolysis and acute renal failure following minimally invasive spine surgery

2011 ◽  
Vol 14 (6) ◽  
pp. 785-788 ◽  
Author(s):  
Elias Dakwar ◽  
Stephen I. Rifkin ◽  
Ildemaro J. Volcan ◽  
J. Allan Goodrich ◽  
Juan S. Uribe
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Operative Time ◽  
Case Series ◽  
Potential Complication ◽  
Minimally Invasive Spine ◽  
The Mean

Minimally invasive spine surgery is increasingly used to treat various spinal pathologies with the goal of minimizing destruction of the surrounding tissues. Rhabdomyolysis (RM) is a rare but known complication of spine surgery, and acute renal failure (ARF) is in turn a potential complication of severe RM. The authors report the first known case series of RM and ARF following minimally invasive lateral spine surgery. The authors retrospectively reviewed data in all consecutive patients who underwent a minimally invasive lateral transpsoas approach for interbody fusion with the subsequent development of RM and ARF at 2 institutions between 2006 and 2009. Demographic variables, patient home medications, preoperative laboratory values, and anesthetic used during the procedure were reviewed. All patient data were recorded including the operative procedure, patient positioning, postoperative hospital course, operative time, blood loss, creatine phosphokinase (CPK), creatinine, duration of hospital stay, and complications. Five of 315 consecutive patients were identified with RM and ARF after undergoing minimally invasive lateral transpsoas spine surgery. There were 4 men and 1 woman with a mean age of 66 years (range 60–71 years). The mean body mass index was 31 kg/m2 and ranged from 25 to 40 kg/m2. Nineteen interbody levels had been fused, with a range of 3–6 levels per patient. The mean operative time was 420 minutes and ranged from 315 to 600 minutes. The CPK ranged from 5000 to 56,000 U/L, with a mean of 25,861 U/L. Two of the 5 patients required temporary hemodialysis, while 3 required only aggressive fluid resuscitation. The mean duration of the hospital stay was 12 days, with a range of 3–25 days Rhabdomyolysis is a rare but known potential complication of spine surgery. The authors describe the first case series associated with the minimally invasive lateral approach. Surgeons must be aware of the possibility of postoperative RM and ARF, particularly in morbidly obese patients and in procedures associated with prolonged operative times.

scholarly journals Revision surgery following minimally invasive decompression for lumbar spinal stenosis with and without stable degenerative spondylolisthesis: a 5- to 15-year reoperation survival analysis

2021 ◽  
pp. 1-7
Author(s):  
Nizar Moayeri ◽  
Y. Raja Rampersaud
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
The Mean ◽  
Lumbar Spinal ◽  
Reoperation Rates ◽  
Minimally Invasive Decompression

OBJECTIVE Minimally invasive decompression (MID) is an effective procedure for lumbar spinal stenosis (LSS). Long-term follow-up data on reoperation rates are lacking. The objective of this retrospective cohort study was to evaluate reoperation rates in patients with LSS who underwent MID, stratified for degenerative lumbar spondylolisthesis (DLS), with a follow-up between 5 and 15 years. METHODS All consecutive patients with LSS who underwent MID between 2002 and 2011 were included. All patients had neurogenic claudication from central and/or lateral recess stenosis, without or with up to 25% of slippage (grade I spondylolisthesis), and no obvious dynamic instability on imaging (increase in spondylolisthesis by ≥ 5 mm demonstrated on supine-to-standing or flexion-extension imaging). Reoperation rates defined as any operation on the same or adjacent level were assessed. Revision decompression alone was considered if the aforementioned clinical and radiographic criteria were met; otherwise, patients underwent a minimally invasive posterior fusion. RESULTS A total of 246 patients (mean age 66 years) were included. Preoperative spondylolisthesis was present in 56.9%. The mean follow-up period was 8.2 years (range 5.0−14.9 years). The reoperation rates in patients with and without spondylolisthesis were 15.7% and 15.1%, respectively; fusion was required in 7.1% and 7.5%, with no significant difference (redecompression only, p = 0.954; fusion, p = 0.546). For decompression only, the mean times to reoperation were 3.9 years (95% CI 1.8−6.0 years) for patients with DLS and 2.8 years (95% CI 1.3−4.2 years) for patients without DLS; for fusion, the mean times to reoperation were 3.1 years (95% CI 1.0−5.3 years) and 3.1 years (95% CI 1.1−5.1 years), respectively. CONCLUSIONS In highly selected patients with stable DLS and leg-dominant pain from central or lateral recess stenosis, the long-term reoperation rate is similar between DLS and non-DLS patients undergoing MIS decompression.

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