Influence of Cage Design on Radiological and Clinical Outcomes in Dorsal Lumbar Spinal Fusions: A Comparison of Lordotic and Non‐Lordotic Cages

Background: Our hypothesis was that by identifying certain preoperative predictive factors, we could favorably impact clinical outcomes in patients undergoing decompressive surgery for lumbar spinal stenosis (LSS). Methods: In this retrospective study, there were 65 patients (2016–2018) with symptomatic LSS who underwent decompressive laminectomy without fusion. Their clinical outcomes were assessed utilizing the Oswestry Disability Index (ODI). Multiple preoperative variables were studied to determine which ones would help predict improved outcomes: gender, age, body mass index (BMI), general/neurological examination, smoking, and drug therapies (anxiolytics and/or antidepressants). Results: All patients demonstrated statistically significant improvement on the ODI. Multivariate analysis revealed that those with higher preoperative BMI had significantly lower ODI on 1-year follow-up examinations, reflecting poorer outcomes. Postoperatively, 44 patients (67%) exhibited lower utilization of anxiolytic medications, 52 patients (80%) showed reduced use of antidepressant drugs, and pain medications utilization was reduced in 33 patients (50%). Conclusion: Decompressive laminectomy without fusion effectively managed LSS. It reduced patients’ use of pain, anxiety, and antidepressant medications. In addition, we found that increased preoperative BMIs contributed to poorer postoperative outcomes (e.g., ODI values).

Download Full-text

Impact of Preoperative Total Knee Arthroplasty on Radiological and Clinical Outcomes of Spinal Fusion for Concurrent Knee Osteoarthritis and Degenerative Lumbar Spinal Diseases

Journal of Clinical Medicine ◽

10.3390/jcm10194475 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4475

Author(s):

Hong Jin Kim ◽

Jae Hyuk Yang ◽

Dong-Gune Chang ◽

Seung Woo Suh ◽

Hoon Jo ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Spinal Fusion ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Spinal Diseases ◽

Spinal Disease ◽

Spinopelvic Alignment ◽

Total Knee ◽

Lumbar Spinal

Concurrent knee osteoarthritis (KOA) and degenerative lumbar spinal disease (LSD) has increased, but the total knee arthroplasty (TKA) effect on degenerative LSD remains unclear. The aim of this study was to retrospectively analyze to compare radiological and clinical outcomes between spinal fusion only and preoperative TKA with spinal fusion for the patients with concurrent KOA and degenerative LSD. A total of 72 patients with concurrent KOA and degenerative LSDs who underwent spinal fusion at less than three levels were divided in two groups: non-TKA group (n = 50) and preoperative TKA group (n = 22). Preoperative lumbar lordosis (LL) was significantly lower in the preoperative TKA group than the non-TKA group (p < 0.05). Significantly higher preoperative pelvic incidence (PI), PI/LL mismatch, and pelvic tilt (PT) occurred in preoperative TKA group than non-TKA group (all p < 0.05). There was significant improvement of postoperative Oswestry Disability Index and leg Visual Analog Scale in the preoperative TKA group (all p < 0.01). Preoperative TKA could be a benefit for in proper correction of sagittal spinopelvic alignment by spinal fusion. Therefore, preoperative TKA could be considered a preceding surgical option for patients with severe sagittal spinopelvic parameters in concurrent KOA and degenerative LSD.

Download Full-text

Post-operative Radiographs for Degenerative Lumbar Spinal Fusions?

Journal of Spine ◽

10.4172/2165-7939.s6-004 ◽

2015 ◽

Vol s6 ◽

Author(s):

Robert W Molinari ◽

Robert Molinari Jr ◽

Ryan W McAssey RN

Keyword(s):

Spinal Fusions ◽

Lumbar Spinal

Download Full-text

Minimally Invasive Lumbar Spinal Decompression in Elderly Patients with Magnetic Resonance Imaging Morphological Analysis

Asian Spine Journal ◽

10.4184/asj.2018.12.2.285 ◽

2018 ◽

Vol 12 (2) ◽

pp. 285-293 ◽

Cited By ~ 6

Author(s):

Seungman Ha ◽

Youngho Hong ◽

Seungcheol Lee

Keyword(s):

Minimally Invasive ◽

Elderly Patients ◽

Clinical Outcomes ◽

Spinal Stenosis ◽

Clinical Symptoms ◽

Morphological Features ◽

Radiological Parameters ◽

Significant Difference ◽

Lumbar Spinal

<sec><title>Study Design</title>Case-control study.</sec><sec><title>Purpose</title>In this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with lumbar spinal stenosis (LSS) who were treated by minimally invasive surgery (MIS) unilateral laminectomy for bilateral decompression (ULBD) using a tubular retractor.</sec><sec><title>Overview of Literature</title>Numerous methods using imaging have been attempted to describe the severity of spinal stenosis. But the relationship between clinical symptoms and radiological features remains debatable.</sec><sec><title>Objective</title>In this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with LSS who were treated by MIS-ULBD.</sec><sec><title>Methods</title>We methodically assessed 85 consecutive patients aged >65 years who were treated for LSS. The patients were retrospectively analyzed in two age groups: 66–75 years (group 1) and >75 years (group 2). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria. Outcome parameters were compared between the groups at the 1-year follow-up. Core radiologic parameters for central and lateral stenosis were analyzed and clinical findings of the groups were compared.</sec><sec><title>Results</title>At the 1-year follow-up, patients in both groups 1 and 2 demonstrated significant improvement in their VAS and ODI scores. All clinical outcomes, except postoperative ODI, were not significantly difference between the groups. In addition, no significant difference was noted in the preoperative radiological parameters between the groups. There was no statistically significant correlation between radiological parameters and clinical symptoms or their outcomes. Moreover, no differences were noted in perioperative adverse events and in the need for repeat surgery at follow-ups between the groups.</sec><sec><title>Conclusions</title>MIS-ULBD by tubular approach is a safe and effective treatment option for elderly patients with LSS. Clinical outcomes in patients with LSS and aged >75 years were comparable with those in patients with LSS and aged 66–75 years. Moreover, we did not find any correlation between radiological parameters and clinical outcomes in either of the two patient groups.</sec>

Download Full-text

32. Does the number of patient-reported allergies impact clinical outcomes after lumbar spinal fusion?

The Spine Journal ◽

10.1016/j.spinee.2019.05.045 ◽

2019 ◽

Vol 19 (9) ◽

pp. S16

Author(s):

Jannat M. Khan ◽

Bryce Basques ◽

Dong Gue Oh ◽

Zayd Hayani ◽

Jennifer Hwang ◽

...

Keyword(s):

Spinal Fusion ◽

Clinical Outcomes ◽

Lumbar Spinal Fusion ◽

Patient Reported ◽

Lumbar Spinal

Download Full-text

Indications for fusion following decompression for lumbar spinal stenosis

Neurosurgical FOCUS ◽

10.3171/foc.1997.3.2.5 ◽

1997 ◽

Vol 3 (2) ◽

pp. E4 ◽

Cited By ~ 8

Author(s):

Mark W. Fox ◽

Burton M. Onofrio

Keyword(s):

Clinical Outcomes ◽

Elderly People ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Decompressive Surgery ◽

Common Condition ◽

Decompressive Laminectomy ◽

Degenerative Lumbar Spinal Stenosis ◽

Lumbar Spinal ◽

Better Than

Degenerative lumbar spinal stenosis is a common condition affecting middle-aged and elderly people. Significant controversy exists concerning the appropriate indications for fusion following decompressive surgery. The purpose of this report is to compare the clinical outcomes of patients who were and were not treated with fusion following decompressive laminectomy for spinal stenosis and to identify whether fusion was beneficial. The authors conclude that patients in whom concomitant fusion procedures were performed fared better than patients who were treated by means of decompression alone when evidence of radiological instability existed preoperatively.

Download Full-text