Comparison of Biomechanics of Lumbar-Pelvis Segment With Posterior Screw-Rod Versus Interspinous Plate Fixation System

2010 ◽  
Author(s):  
A. Kiapour ◽  
J. O’Donnell ◽  
V. K. Goel ◽  
A. Biyani
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Screw Fixation ◽  
Plate Fixation ◽  
Pedicle Screw Fixation ◽  
Low Back ◽  
Lumbar Degenerative Disease ◽  
Segmental Instability ◽  
Fixation System ◽  
Surgical Option

Spinal fusion is the traditional surgical option to improve the clinical outcome of patients with advanced lumbar degenerative disease. Various techniques including posterolateral arthrodesis, interbody arthrodesis, and circumferential arthrodesis are being pursued as fusion strategies to eliminate segmental instability, which is a recognized cause of low back pain [1]. There are several drawbacks associated with pedicle-screw fixation constructs including failure of implant components and back-out of the screws [2,3].

scholarly journals Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: Pedicle screw fixation as an adjunct to posterolateral fusion

2014 ◽  
Vol 21 (1) ◽  
pp. 75-78 ◽  
Author(s):  
Michael W. Groff ◽  
Andrew T. Dailey ◽  
Zoher Ghogawala ◽  
Daniel K. Resnick ◽  
William C. Watters ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Outcome ◽  
Pedicle Screw ◽  
Chronic Low Back Pain ◽  
Screw Fixation ◽  
Lumbar Fusion ◽  
Pedicle Screw Fixation ◽  
Controlled Study ◽  
Low Back

The utilization of pedicle screw fixation as an adjunct to posterolateral lumbar fusion (PLF) has become routine, but demonstration of a definitive benefit remains problematic. The medical evidence indicates that the addition of pedicle screw fixation to PLF increases fusion rates when assessed with dynamic radiographs. More recent evidence, since publication of the 2005 Lumbar Fusion Guidelines, suggests a stronger association between radiographic fusion and clinical outcome, although, even now, no clear correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence. Furthermore, the largest contemporary, randomized, controlled study on this topic failed to demonstrate a significant clinical benefit with the use of pedicle screw fixation in patients undergoing PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as proof of absence. Several limitations continue to compromise these investigations. For example, in the majority of studies the sample size is insufficient to detect small increments in clinical outcome that may be observed with pedicle screw fixation. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. High-risk patients, including (but not limited to) patients who smoke, patients who are undergoing revision surgery, or patients who suffer from medical conditions that may compromise fusion potential, may appreciate a greater benefit with supplemental pedicle screw fixation. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with only PLF.

Full Percutaneous Lumbar Interbody Fusion: Technical Note

2017 ◽  
Vol 78 (06) ◽  
pp. 601-606 ◽  
Author(s):  
Mitsuto Taguchi ◽  
Shu Nakamura
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Low Back ◽  
Lumbar Interbody Fusion ◽  
Less Invasive ◽  
Disk Degeneration

Introduction Although lumbar interbody fusion is effective for low back pain caused by severe disk degeneration, it is a highly invasive procedure. Less invasive procedures such as transforaminal lumbar interbody fusion (TLIF) and lumbar lateral interbody fusion have become available; however, there is still scope for improvement. We performed full percutaneous endoscopic lumbar interbody fusion (PELIF), a technique designed as a safe and less invasive percutaneous fusion. Method and Subjects Our technique is indicated for patients with chronic low back pain in whom conservative treatment was not effective, thinning of the intervertebral disk was prominent, and temporary pain relief was achieved with a disk block. In the operation, percutaneous endoscopic diskectomy was performed with a 7.5-mm sheath inserted through a small incision, and a cage was inserted percutaneously using an L-shaped retractor. Instead of pedicle screw fixation, hybrid facet screw fixation was performed. Low back pain was improved, and bone union was confirmed on radiography. This technique was used in six patients, and no surgery-related complications occurred. Discussion The L-shaped retractor used in this series can protect the exiting nerve by inserting it into the sheath, then removing the sheath and placing the rounded corner of the retractor on the lateral cranial side. This technique is safe with no other associated risks. Cages larger than the sheath can be inserted, and commercially available cages for TLIF are applicable. Hybrid facet screw fixation can overcome the problems associated with both conventional transfacet pedicle screw fixation and translaminar facet screw fixation by combining these two procedures. Conclusion PELIF is an easy, safe, and fully percutaneous technique with very low invasiveness that uses an L-shaped retractor and hybrid facet screw fixation. This procedure can be a treatment option for patients with severe low back pain related to disk degeneration.

scholarly journals Association between mild cognitive impairment and lumbar degenerative disease in a Japanese community: A cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258852
Author(s):  
Kazushige Koyama ◽  
Kanichiro Wada ◽  
Gentaro Kumagai ◽  
Hitoshi Kudo ◽  
Sunao Tanaka ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Cognitive Impairment ◽  
Back Pain ◽  
Cross Sectional Study ◽  
Summary Score ◽  
Degenerative Disease ◽  
Low Back ◽  
Sectional Study ◽  
Lumbar Degenerative Disease ◽  
Cross Sectional

Lumbar degenerative disease and dementia are increasing in super-aging societies and are both related to physical dysfunction and pain. However, the relationship between these diseases remains unclear. This cross-sectional study aimed to investigate the comorbidity rates of lumbar spinal canal stenosis (LSS) and mild cognitive impairment (MCI) and clarify the association between LSS presence, lumbar symptoms, and quality of life (QOL) related to low back pain and cognitive impairment in the Japanese population. We enrolled 336 participants (men 124; women 212; mean age 72.2 years) from a medical checkup program. LSS was diagnosed using a self-administered questionnaire, and lumbar symptoms were evaluated using the visual analog scale (low back pain, and pain and numbness of the lower limb). QOL related to low back pain was evaluated using the Japanese Orthopedic Association Back-Pain Evaluation Questionnaire (JOABPEQ: pain, and lumbar, and gait function). Radiological lumbar degeneration was classified using Kellgren-Lawrence grading and lateral radiographs of the lumbar spine. Cognitive function was measured using the Mini Mental State Examination (MMSE), and MCI was defined by a summary score of MMSE ≤27. Logistic and multiple linear regression analyses were performed to analyze the association between MCI, summary score of MMSE, and lumbar degenerative disease. The comorbidity rate of MCI and LSS was 2.1%, and the rate of MCI was 41% in participants with LSS. Lumbar function in JOABPEQ was associated with MCI. The presence of LSS and lumbar function in JOABPEQ were associated with MMSE. Over one-third of the people with LSS had MCI. The presence of LSS and deterioration of QOL due to low back pain were related to cognitive impairment. We recommend evaluating cognitive function for patients with LSS because the rate of MCI was high in LSS participants.

scholarly journals Lumbar degenerative disease after oblique lateral interbody fusion: sagittal spinopelvic alignment and its impact on low back pain

2020 ◽  
Author(s):  
Jia Li ◽  
Di Zhang ◽  
Yong Shen ◽  
Xiangbei Qi
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Degenerative Disease ◽  
Leg Pain ◽  
Low Back ◽  
Lumbar Degenerative Disease ◽  
Single Level ◽  
Vas Scores ◽  
Oblique Lateral Interbody Fusion

Abstract Background: The objective of the retrospective study was to investigated the incidence and risk factors of low back pain (LBP) in patients with lumbar degenerative disease after single-level oblique lateral interbody fusion(OLIF).Methods: In this retrospective study, 120 patients who undergoing single-level OLIF to treat lumbar degenerative disease were recruited. Preoperative and postoperative radiographic parameters, including segmental lordosis(SL), lumbar lordosis(LL), disk height(DH), pelvic incidence(PI), pelvic tilt (PT), sacral slope(SS), thoracic kyphosis(TK), C7-sagittal vertical axis (SVA). Visual analog scale(VAS) for back and leg pain, and Oswestry Disability Index(ODI), were used to evaluate symptoms and quantify disability. All patients achieved at least two-year follow-up.Results: A total of 120 Patients who complained low back pain were apportioned to LBP group (n=38; VAS scores for back pain≥3) or Non-LBP group (n=82;VAS scores for back pain＜3). There was no difference in age(P=0.082), gender(P=0.425), body mass index(P=0.138), degenerative spondylolisthesis or lumbar spinal stenosis(P=0.529) surgical level(P=0.651), blood Loss (P=0.889) and operative time(P=0.731) between the groups. In both groups, the ODI and VAS scores for back pain and leg pain were significantly improved at the final follow-up compared to the preoperative scores (P=0.003). Furthermore, except for the LBP (P=0.000), there were no significant differences in these scores between the two groups at the final follow-up (P > 0.05). According to the radiographic parameters, in Non-LBP group, the LL, SL, DH, TK and SS had all significantly improved; PT and C7-SVA significantly decreased at the final follow-up compared to the preoperative values. The DH in both groups had significantly improved, no significant difference was found(P=0.325). In the final follow-up, LL, PI-LL, PT and C7-SVA in Non-LBP group had more improvements compared to the LBP group (P＜0.05) . Multivariate analysis showed that PT, PI-LL and C7-SVA were identified as significant risk factors for LBP after OLIF.Conclusion: The clinical outcomes of OLIF for single-level lumbar degenerative disease were satisfactory. Our findings showed that PT, PI-LL mismatch and C7-SVA had the greatest impact on the incidence of LBP. Therefore, patients with appropriate decreased PT, improved C7-SVA and PI-LL match experienced less low back pain.

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