scholarly journals Pedicle Screw-Based Posterior Dynamic Stabilization: Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Dilip K. Sengupta ◽  
Harry N. Herkowitz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Surgical Treatment ◽  
Pedicle Screw ◽  
Clinical Evidence ◽  
Dynamic Stabilization ◽  
Low Back ◽  
Design Rationale ◽  
Clinical Instability ◽  
Posterior Dynamic Stabilization

Posterior dynamic stabilization (PDS) indicates motion preservation devices that are aimed for surgical treatment of activity related mechanical low back pain. A large number of such devices have been introduced during the last 2 decades, without biomechanical design rationale, or clinical evidence of efficacy to address back pain. Implant failure is the commonest complication, which has resulted in withdrawal of some of the PDS devices from the market. In this paper the authors presented the current understanding of clinical instability of lumbar motions segment, proposed a classification, and described the clinical experience of the pedicle screw-based posterior dynamic stabilization devices.

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.

461 LOW BACK PAIN DUE TO HERNIATED LUMBAR DISC: COMPARISON OF EARLY AND LATE SURGICAL TREATMENT

2009 ◽  
Vol 13 (S1) ◽  
Author(s):  
N. Lobjanidze ◽  
M. Janelidze ◽  
A. Gvelesiani ◽  
M. Beridze ◽  
L. Bakradze ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Surgical Treatment ◽  
Lumbar Disc ◽  
Low Back ◽  
Herniated Lumbar Disc

The Relationship Between Clinical Instability and Endurance Tests, Pain, and Disability in Nonspecific Low Back Pain

2016 ◽  
Vol 39 (5) ◽  
pp. 359-368 ◽  
Author(s):  
Carla Vanti ◽  
Cristina Conti ◽  
Federica Faresin ◽  
Silvano Ferrari ◽  
Raffaella Piccarreta
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Clinical Instability ◽  
Endurance Tests ◽  
The Relationship

scholarly journals Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine

2016 ◽  
Vol 24 (3) ◽  
pp. 398-401 ◽  
Author(s):  
Sang-Hyun Han ◽  
Seung-Jae Hyun ◽  
Tae-Ahn Jahng ◽  
Ki-Jeong Kim
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Surgical Treatment ◽  
Lumbar Spine ◽  
Pedicle Screws ◽  
Leg Pain ◽  
Low Back ◽  
Pedicle Fracture ◽  
Effective Option ◽  
Radiological Studies

Spontaneous bilateral pedicle fractures of the lumbar spine are rare, and an optimal surgical treatment has not been suggested. The authors report the case of a 50-year-old woman who presented with low-back pain and right leg radiating pain of 1 year’s duration. Radiological studies revealed a spontaneous bilateral pedicle fracture of L-5. All efforts at conservative treatment failed, and the patient underwent surgery for osteosynthesis of the fractured pedicle using bilateral pedicle screws connected with a bent rod. Her low-back and right leg pain were relieved postoperatively. A CT scan performed 3 months postoperatively revealed the disappearance of the pedicle fracture gap and presence of newly formed bony trabeculation. In rare cases of spontaneous bilateral pedicle fracture of the lumbar spine, osteosynthesis of the fractured pedicle using bilateral pedicle screws and a bent rod is a motion-preserving technique that may be an effective option when conservative management has failed.

scholarly journals Predicting Response to Motor Control Exercises and Graded Activity for Patients With Low Back Pain: Preplanned Secondary Analysis of a Randomized Controlled Trial

2014 ◽  
Vol 94 (11) ◽  
pp. 1543-1554 ◽  
Author(s):  
Luciana Gazzi Macedo ◽  
Christopher G. Maher ◽  
Mark J. Hancock ◽  
Steve J. Kamper ◽  
James H. McAuley ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Low Back Pain ◽  
Motor Control ◽  
Back Pain ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Low Back ◽  
Randomized Controlled ◽  
Clinical Instability ◽  
Graded Activity

Background Current treatments for low back pain have small effects. A research priority is to identify patient characteristics associated with larger effects for specific interventions. Objective The aim of this study was to identify simple clinical characteristics of patients with chronic low back pain who would benefit more from either motor control exercises or graded activity. Design This study was a secondary analysis of the results of a randomized controlled trial. Methods One hundred seventy-two patients with chronic low back pain were enrolled in the trial, which was conducted in Australian physical therapy clinics. The treatment consisted of 12 initial exercise sessions over an 8-week period and booster sessions at 4 and 10 months following randomization. The putative effect modifiers (psychosocial features, physical activity level, walking tolerance, and self-reported signs of clinical instability) were measured at baseline. Measures of pain and function (both measured on a 0–10 scale) were taken at baseline and at 2, 6, and 12 months by a blinded assessor. Results Self-reported clinical instability was a statistically significant and clinically important modifier of treatment response for 12-month function (interaction: 2.72; 95% confidence interval=1.39 to 4.06). Participants with high scores on the clinical instability questionnaire (≥9) did 0.76 points better with motor control exercises, whereas those who had low scores (<9) did 1.93 points better with graded activity. Most other effect modifiers investigated did not appear to be useful in identifying preferential response to exercise type. Limitations The psychometric properties of the instability questionnaire have not been fully tested. Conclusions A simple 15-item questionnaire of features considered indicative of clinical instability can identify patients who respond best to either motor control exercises or graded activity.

Minimally Invasive Surgical Treatment of Bertolotti's Syndrome: Case Report

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS454-ONS455 ◽  
Author(s):  
Kene T. Ugokwe ◽  
Tsu-Lee Chen ◽  
Eric Klineberg ◽  
Michael P. Steinmetz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Lumbar Vertebra ◽  
Transverse Process ◽  
Low Back ◽  
X Rays ◽  
Invasive Approach

Abstract Objective: This article aims to provide more insight into the presentation, diagnosis, and treatment of Bertolotti's syndrome, which is a rare spinal disorder that is very difficult to recognize and diagnose correctly. The syndrome was first described by Bertolotti in 1917 and affects approximately 4 to 8% of the population. It is characterized by an enlarged transverse process at the most caudal lumbar vertebra with a pseudoarticulation of the transverse process and the sacral ala. It tends to present with low back pain and may be confused with facet and sacroiliac joint disease. Methods: In this case report, we describe a 40-year-old man who presented with low back pain and was eventually diagnosed with Bertolotti's syndrome. The correct diagnosis was made based on imaging studies which included computed tomographic scans, plain x-rays, and magnetic resonance imaging scans. The patient experienced temporary relief when the abnormal pseudoarticulation was injected with a cocktail consisting of lidocaine and steroids. In order to minimize the trauma associated with surgical treatment, a minimally invasive approach was chosen to resect the anomalous transverse process with the accompanying pseudoarticulation. Results: The patient did well postoperatively and had 97% resolution of his pain at 6 months after surgery. Conclusion: As with conventional surgical approaches, a complete knowledge of anatomy is required for minimally invasive spine surgery. This case is an example of the expanding utility of minimally invasive approaches in treating spinal disorders.

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