A Computational and Experimental Investigation Into Biomechanics of Lumbar Spine Stabilized With a Novel Posterior Dynamic Stabilization System

2009 ◽  
Author(s):  
Ali Kiapour ◽  
Vijay K. Goel ◽  
Manoj Krishna ◽  
Sarath Koruprolu ◽  
Rachit Parikh ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Adjacent Segment ◽  
Facet Joints ◽  
Fusion Procedure ◽  
Severe Back Pain ◽  
Posterior Dynamic Stabilization ◽  
Dynamic Stabilizer ◽  
Lumbar Spinal ◽  
Adjacent Segments

Lumbar spinal stenosis is a progressive degenerative condition due to arthritic facet joints. Arthritic facets become inflamed and often develop osteophytes, leading to nerve compression and persistent severe back pain. When conservative treatment fails to reduce pain, surgical management may be pursued to improve the patient’s quality of life. Spinal decompression and fusion is one of the most common surgical procedures for treatment of spinal stenosis. However, fusion may result in accelerated degeneration of the adjacent motion segments and morbidity [1]. Motion preservation instrumentation is being developed to preserve motion at the involved and adjacent segments, as opposed to fusion procedure [2]. In this study, we used experimental and finite element (FE) techniques to assess and compare the biomechanics of intact spines and spines implanted with a novel posterior dynamic stabilizer device (TrueDyn™, Disc Motion Technologies, Boca Raton, FL). The effects on the adjacent segment, including motion and intra-discal pressure were analyzed.

Facet-Sparing Decompression of Lumbar Spinal Stenosis: The Minimally Invasive Bilateral Crossover Approach

2021 ◽  
Author(s):  
Jan Helge Klingler ◽  
Ulrich Hubbe ◽  
Christoph Scholz ◽  
Marie T. Krüger
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Case Series ◽  
Surgical Decompression ◽  
Walking Distance ◽  
Adjacent Segment ◽  
Facet Joints ◽  
Study Objective ◽  
Lumbar Spinal

Abstract Background and Study Objective One risk of established decompression techniques for lumbar spinal stenosis is the resection of facet joints, especially if they are steeply configured, promoting destabilization. Minimally invasive bilateral crossover decompression aims to preserve the facet joints and thus stability of the spine. The purpose of this study is to demonstrate the feasibility and early results of this technique. Methods This retrospective case series includes 10 consecutive patients with lumbar stenosis and steep-angle (<35 degrees) facet joints who were treated with minimally invasive bilateral crossover decompression. Eleven segments were decompressed, most commonly L3/L4 (63.6%), followed by L1/L2 and L2/L3 (18.2% each). The effectiveness of surgical decompression was assessed by self-reporting questionnaires. Results After a follow-up of 10.5 months, the Symptom Severity Scale and Physical Function Scale of the Swiss Spinal Stenosis Questionnaire improved by 0.9 (p < 0.05) and 0.7 points, respectively. The mean Oswestry Disability Index improved from 53.9 to 34.6 (p < 0.05). Local and radiating pain under strain showed statistically significant improvement on the Visual Analog Scale (8.9 vs. 5.0 and 8.4 vs. 4.6, respectively). Maximum walking distance increased from 190 to 1,029 m. Apart from one patient requiring surgical decompression of an adjacent segment, there were no reoperations, neurological deteriorations, or other complications. Conclusion The results of this study indicate that minimally invasive bilateral crossover decompression is a promising technique for the treatment of spinal canal stenosis. With its design to spare facet joints, it can potentially reduce the risk of spinal instability, especially in patients with steep facet joints.

scholarly journals Prediction of walking ability following posterior decompression for lumbar spinal stenosis

2021 ◽  
Author(s):  
Suzanne McIlroy ◽  
Feroz Jadhakhan ◽  
David Bell ◽  
Alison Rushton
Keyword(s):  
Quality Of Life ◽  
Higher Education ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Walking Distance ◽  
Walking Ability ◽  
Poor Outcome ◽  
Lumbar Spinal ◽  
Reduced Risk

Abstract Purpose Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. Methods An observational cohort study was conducted using data from the British Spine Registry (2017–2018) of adults (≥ 50 years) with LSS, who underwent ≤ 2 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor/good outcome. Multivariable regression models were performed. Results 14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12 months follow-up. Predictors associated with poor walking ability at 12 months were: increasing age (≥ 75 years OR 1.54, 95% CI 1.07, 2.18), BMI ≥ 35 kg/m2 (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25) and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12 months; p < 0.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome. Conclusion Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.

Health-related quality of life and comorbidities associated with lumbar spinal stenosis

2012 ◽  
Vol 12 (3) ◽  
pp. 189-195 ◽  
Author(s):  
Michele C. Battié ◽  
C. Allyson Jones ◽  
Donald P. Schopflocher ◽  
Richard W. Hu
Keyword(s):  
Quality Of Life ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Lumbar Spinal

Radiologic Efficacy and Patient Satisfaction after Minimally Invasive Unilateral Laminotomy and Bilateral Decompression in Patients with Lumbar Spinal Stenosis: A Retrospective Analysis

2020 ◽  
Vol 81 (06) ◽  
pp. 475-483
Author(s):  
Seung-Kook Kim ◽  
Sungmo Ryu ◽  
Eun-Sang Kim ◽  
Sun-Ho Lee ◽  
Su-Chan Lee
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Minimally Invasive ◽  
Retrospective Analysis ◽  
Spinal Stenosis ◽  
Surgical Procedure ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Lumbar Spinal

Abstract Background and Study Aims Lumbar spinal stenosis (LSS) is the most common spinal disease in older adults. Although surgical modalities are recommended in patients who are unresponsive to conservative treatment, the most appropriate minimally invasive surgical procedure for patients with LSS remains controversial. Moreover, few previous studies have focused on patient-centered outcomes with radiologic correlation. In the present study, we aimed to investigate radiologic efficacy and patient satisfaction following bilateral decompression via unilateral laminotomy. Materials and Methods We performed a retrospective analysis of radiologic efficacy and patient satisfaction in a series of surgical patients treated at our institution. We classified patients into two groups based on the primary pathology (i.e., central or lateral recess stenosis). Medical records were analyzed retrospectively for radiologic outcomes and clinical parameters including pain and changes in quality of life. Data related to outcomes were collected at 2 weeks, 3 months, and 12 months after surgery in the outpatient clinic. Results Among the 122 patients enrolled in this study, 51 had central spinal stenosis; 71 had lateral recess stenosis. Radiologically, we observed significant improvements in the anteroposterior diameter and cross-sectional area of the dural sac (central stenosis) and the lateral width of the central canal and depth of the lateral recess (lateral recess stenosis). Two weeks and 12 months after the surgical procedure, we observed significant improvements in the extent of symptoms, patient satisfaction, and quality of life (including physical function). Conclusion Our findings suggest that bilateral decompression via a unilateral approach shows improved radiologic outcomes, varying based on the type of stenosis. Furthermore, patient satisfaction significantly improved regardless of the type of disease.

scholarly journals Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

2019 ◽  
Vol 46 (5) ◽  
pp. E10 ◽  
Author(s):  
Siri Sahib Khalsa ◽  
Hyeun Sung Kim ◽  
Ravindra Singh ◽  
Osama Nezar Kashlan
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Facet Joint ◽  
Volumetric Analysis ◽  
Facet Joints ◽  
Bone Removal ◽  
Endoscopic Decompression ◽  
Radiographic Outcomes ◽  
Lateral Recess Stenosis ◽  
Lumbar Spinal

OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.

Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age

1999 ◽  
Vol 91 (2) ◽  
pp. 181-185 ◽  
Author(s):  
Todd W. Vitaz ◽  
George H. Raque ◽  
Christopher B. Shields ◽  
Steven D. Glassman
Keyword(s):  
Surgical Treatment ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Intraoperative Complication ◽  
Content Type ◽  
Fusion Procedure ◽  
Lumbar Decompression ◽  
Preoperative Selection ◽  
Lumbar Spinal ◽  
Fine Print

Object. The purpose of this study was to evaluate the safety and efficacy of the surgical treatment of lumbar spinal stenosis in patients older than 75 years of age. Methods. The authors reviewed the records of 65 patients with lumbar spinal stenosis who were at least 75 years of age at the time of surgery, which was performed between November 1990 and May 1996. The 65 patients (43 women, 22 men; average age 78 years) underwent a total of 71 operations (one patient underwent three, and four patients underwent two). Fifteen patients (21%) underwent isolated lumbar decompression, and 56 patients (79%) underwent decompression in conjunction with posterior spinal fusion. There was an average of 1.7 levels decompressed per isolated lumbar decompression and 2.6 levels per decompression and fusion procedure. Seven patients (10%) experienced one or more serious postoperative complication, which included wound infection, septicemia, small bowel obstruction, stroke, myocardial infarction, gastrointestinal bleeding, and pulmonary embolus. In addition there was one intraoperative complication (hypotension [1%]) that required modification of the planned surgical procedure. No deaths were documented in the perioperative period. Conclusions. With appropriate preoperative selection and evaluation, careful intraoperative monitoring, and attentive perioperative care, the surgical treatment of elderly patients with lumbar spinal stenosis can effect significant improvement with acceptable levels of morbidity and mortality.

scholarly journals Coflex Interspinous Process Dynamic Stabilization for Lumbar Spinal Stenosis: Long-term Follow-up

2020 ◽  
Author(s):  
Mingrui Du ◽  
Fei-Long Wei ◽  
Kai-Long Zhu ◽  
Cheng-Pei Zhou ◽  
Ji-Xian Qian
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Dynamic Stabilization ◽  
Adjacent Segment ◽  
Imaging Data ◽  
Process Dynamic ◽  
The Difference ◽  
Lumbar Spinal

Abstract [Objective]To evaluate the long-term efficacy of Coflex interspinous process dynamic stabilization device in the treatment of lumbar spinal stenosis.[Methods]The clinical and imaging data of 73 patients undergoing Coflex interspinous process dynamic stabilization surgery from July 2008 to June 2012 were retrospectively analyzed. Clinical data include: visual analogue scale of pain (VAS), Owestry disability index(ODI) and Japanese Orthopedic Association Scores(JOA) of preoperation, 6 months after surgery, and last follow-up; complications; reoperation rates and incidence of adjacent segment degeneration(ASD). Imaging data including: lumbar range of motion(ROM), intervertebral space height(ISH) and intervertebral foramen height (IFH) of operative and adjacent segment at preoperative, 6 months after operation and the last follow-up.[Results]56 patients were followed up. The follow-up time was 107.6 ± 13.3 months, the operation time was 10.0 ± 3.1 minutes, the intraoperative blood loss was 153.9 ± 80.6 ml, and the hospitalization time was 10.2 ± 3.2 days. The VAS, ODI and JOA scores improved significantly after surgery. At 6 months after surgery and the last follow-up, ROM was significantly lower than that before surgery with statistical significance (P < 0.001). ROM was slightly increased at the last follow-up compared with that 6 months after operation, but the difference was not statistically significant (P > 0.05). The ROM of adjacent segments increased at 6 months and at the last follow-up compared with that before surgery, but the difference was not statistically significant (P > 0.05). At 6 months after surgery, ISH and IFH of implanted segment was significantly higher than that before surgery, and the difference was statistically significant (P < 0.05). At the last follow-up, there was a decrease in ISH and IFH, with no statistical difference compared with that before the operation. During the follow-up period, a total of 11 patients (19.6%) experienced complications and 6 patients (10.7%) underwent secondary surgery.[Conclusion]Coflex interspinous process dynamic stabilization is effective in the treatment of lumbar spinal stenosis in the long term. The surgical segment retains a small range of motion. The incidence of complications and reoperation is low. However, the ISH and IFH of implanted segment can only be maintained for a short period of time.

scholarly journals Outcomes of Revision Surgery Following Instrumented Posterolateral Fusion in Degenerative Lumbar Spinal Stenosis: A Comparative Analysis between Pseudarthrosis and Adjacent Segment Disease

2017 ◽  
Vol 11 (3) ◽  
pp. 463-471 ◽  
Author(s):  
Seung-Pyo Suh ◽  
Young-Hoon Jo ◽  
Hae Won Jeong ◽  
Won Rak Choi ◽  
Chang-Nam Kang
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Revision Surgery ◽  
Adjacent Segment Disease ◽  
Posterolateral Fusion ◽  
Adjacent Segment ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Group A ◽  
Lumbar Spinal

<sec><title>Study Design</title><p>Retrospective study.</p></sec><sec><title>Purpose</title><p>We examined the clinical and radiological outcomes of patients who received revision surgery for pseudarthrosis or adjacent segment disease (ASD) following decompression and instrumented posterolateral fusion (PLF).</p></sec><sec><title>Overview of Literature</title><p>At present, information regarding the outcomes of revision surgery for complications such as pseudarthrosis and ASD following instrumented PLF is limited.</p></sec><sec><title>Methods</title><p>This study examined 60 patients who received PLF for degenerative lumbar spinal stenosis and subsequently developed pseudarthrosis or ASD leading to revision surgery. Subjects were divided into a group of 21 patients who received revision surgery for pseudarthrosis (Group P) and a group of 39 patients who received revision surgery for ASD (Group A). Clinical outcomes were evaluated using the visual analogue scales for back pain (VAS-BP) and leg pain (VAS-LP), the Korean Oswestry disability index (K-ODI), and each patient's subjective satisfaction. Radiological outcomes were evaluated from the extent of bone union, and complications in the two groups were compared.</p></sec><sec><title>Results</title><p>VAS-LP at final follow-up was not statistically different between the two groups (<italic>p</italic> =0.353), although VAS-BP and K-ODI at final follow-up were significantly worse in Group P than in Group A (all <italic>p</italic> &lt;0.05), and only 52% of the patients in Group P felt that their overall well-being had improved following revision surgery. Fusion rates after the first revision surgery were 71% (15/21) in Group P and 95% (37/39) in Group A (<italic>p</italic> =0.018). The rate of reoperation was significantly higher in Group P (29%) than in Group A (5%) (<italic>p</italic> =0.021) due to complications.</p></sec><sec><title>Conclusions</title><p>Clinical and radiological outcomes were worse in patients who had received revision surgery for pseudarthrosis than in those who had revision surgery for ASD. Elderly patients should be carefully advised of the risks and benefits before planning revision surgery for pseudarthrosis.</p></sec>

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