Anterolateral Corrective Lumbar Corpectomy and Interbody Fusion by Using Extended Screw Fixation without Posterior Instrumentation for Posttraumatic Kyphosis

A 26-year-old paraplegic schizophrenic Japanese woman suffered from severe kyphosis and back pain derived from lumbar burst fractures caused by jumping. She had already undergone resection of the L1 and L2 spinous processes for sharp angular kyphosis, but she still had severe kyphosis and back pain at the L1 and L2. Radiographical examination revealed fused anterior columns at L1 and L2 with severe local kyphosis and a significantly decreased percutaneous distance in the back. The patient underwent anterior instrumented bony resection including an L2 vertebral osteotomy: bilateral L2-L3 facetectomy and partial posterior osteotomy of the L2 vertebrae via a posterior approach followed by an anterior corpectomy of the L2 vertebrae and insertion of a cylindrical cage. No posterior instrumentation was used owing to the presence of atrophied paraspinal soft tissues. Lumbar interbody fusion was performed with vertebral body screws extending from T12 to L4 and corresponding anterior distension and posterior compression. The procedure corrected the kyphosis by 15° and enhanced local stability. Postsurgical visual analogue scale improved from 9.0 to 2.0 and Oswestry Disability Index from 40 to 17.8, respectively. In conclusion, we have demonstrated that anterolateral interbody fusion using extended fixation can compensate for posterior corrective surgery.

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Fluoroscopically-Guided Injections to Treat “Kissing Spine” Disease

January 2018 - Pain Physician ◽

10.36076/ppj.2008/11/549 ◽

2008 ◽

Vol 4;11 (8;4) ◽

pp. 549-554 ◽

Cited By ~ 2

Author(s):

Tim Lamer

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Soft Tissues ◽

Nerve Fibers ◽

Low Back ◽

Mri Findings ◽

Mri Features ◽

Spinous Processes ◽

Spine Disease

Background: Any spine structure that is innervated by afferent nociceptive nerve fibers is a potential pain generator. In the lumbar spine, the most studied pain generators include: sacroiliac joints, the zygapophysial joints, the intervertebral discs, myofascial structures. Anomalous lumbosacral articulations, the spinous processes, and lumbar spine osteophytes are less commonly reported. Objective: To describe the diagnostic and therapeutic features of “kissing spine” disease or Baastrup’s Sign with particular attention to MRI findings and fluoroscopicallyguided injection therapy. Design: A series of 3 patients with axial low back pain presented with exam findings and MRI changes suggestive of pain emanating from adjacent spinous processes that appeared to be in direct contact or very closely opposed. This has been described in the literature as “kissing spine” disease or Baastrup’s sign. Fluoroscopically-guided injections were performed and the responses were studied. Results: The 3 patients had MRI findings consisting of inflammation and/or edema in the spinous processes and surrounding soft tissues. Fluoroscopically-guided injections provided pain relief in all 3 patients. One patient with recurrent pain eventually underwent successful surgical resection of the involved spinous processes. Conclusion: Painful adjacent and closely opposed spinous processes can be a source of axial low back pain. We have described MRI features and the responses to fluoroscopically-guided injections in 3 patients with this condition. Key words: Baastrup’s, kissing spine, spine injection

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A Rare Case of Spinal Leprosy Mimicking Spinal Tuberculosis

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v0i0.151 ◽

2019 ◽

pp. 33

Author(s):

K Thuraikumar ◽

V Naveen ◽

Mustaqim A ◽

Arieff AA ◽

K Shri ◽

...

Keyword(s):

Back Pain ◽

Soft Tissue ◽

Histopathological Examination ◽

Posterior Instrumentation ◽

Spinal Tuberculosis ◽

Previous History ◽

Skin Lesions ◽

Titanium Implants ◽

Paravertebral Abscess ◽

History Of

Introduction: Spinal tuberculosis is the most common manifestation of extrapulmonar y tuberculosis. A combination of leprosy and tuberculosis is a rare entity.Case report: A 44-year-old male patient working as a laborer presented to our hospital with complaints of severe back pain and swelling over the back, difficulty in walking, associated with constitutional symptoms. On admission, he was febrile and had leukocytosis. Initial spine X-ray showed end plate destruction and increase in soft tissue shadow at the level of T8-T9. CT spine revealed thoracic paravertebral collection extending from T7 to T9 levels, suggest ive of tuberculous spondylitis with cold abscess. Patient refused a transpedicular biopsy and was started on anti-tubercular therapy. Two weeks after commencement of treatment, he developed worsening back pain and weakness of the lower extremities. MRI spine showed a paravertebral abscess and posterior soft tissue edema involving level of T7 to T11. Patient underwent a posterior decompression, debridement and posterior instrumentation. He was discharged well, there was improvement of his lower limb power. Upon clinic review, he complained of multiple hyperpigmented, painless, nonpruritic skin lesions over the trunk and back. No previous history of eczema, psoriasis and Tinea corporis. Given the history of allergy, initial impression was hypersensitivity reaction towards the titanium implants, and he was started on anti-histamines. However, there was no improvements seen. Histopathological examination of skin lesions revealed presence of granuloma within the dermis layer, composed of epitheloid, histiocytes, lymphocytes and plasma cells. Wade-Fite stain for Mycobacterium leprae is positive. Slit skin smear shows multibacillary leprosy. Patient was started on multidrug therapy (rifampicin, clofazimine and dapsone) for 1 year. He has recovered well.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 33

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6. Do parameters of provocative discography predict clinical outcome in lumbar interbody fusion for discogenic back pain?

The Spine Journal ◽

10.1016/s1529-9430(03)00186-4 ◽

2003 ◽

Vol 3 (5) ◽

pp. 69

Author(s):

Matthew Pollard ◽

Louis Jenis ◽

Robert Banco ◽

Scott Tromanhauser ◽

Brian Agganis

Keyword(s):

Back Pain ◽

Clinical Outcome ◽

Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Provocative Discography

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Effect of Physiotherapy Treatment in the Autonomic Activation and Pain Perception in Male Patients with Non-Specific Subacute Low Back Pain

Journal of Clinical Medicine ◽

10.3390/jcm10081793 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1793

Author(s):

Vanesa Abuín-Porras ◽

Vicente Javier Clemente-Suárez ◽

Gonzalo Jaén-Crespo ◽

Emmanuel Navarro-Flores ◽

Helios Pareja-Galeano ◽

...

Keyword(s):

Nervous System ◽

Low Back Pain ◽

Back Pain ◽

Pain Perception ◽

Soft Tissues ◽

Low Back ◽

Physiotherapy Treatment ◽

Subacute Low Back Pain ◽

Subjective Pain ◽

System Activation

Introduction: Physiotherapy treatment is a common intervention for low back pain (LBP) patients. These interventions have been related to physiological effects in the central nervous system. Thus, the aim of this study was to analyze the effect of physiotherapy treatment in patients with LBP in the autonomic nervous system activation and subjective pain perception of patients. Methods: A total of 30 male subjects diagnosed with non-specific subacute LBP received a 50 min session consisting of (a) a manual therapy based on joint mobilization and soft tissues techniques in the lumbo-pelvic area, (b) a stretching program, and (c) motor control exercises of the core muscles. The autonomic modification of participants was assessed prior to and after the physiotherapy treatment. Results: Heart rate variability (HRV) analysis reported a significant increase in average RR (p = 0.001), RMSSD (p = 0.008), LRMSSD (p = 0.001), SDNN (p = 0.005), and PNN50 (p = 0.024) after the session. Frequency-domain measures showed a significant increase in LF (p = 0.030) and HF (p = 0.014), and a decrease in LF/HF ratio (p = 0.046). A significant decrease was found in minimum HR values (p = 0.001) and average HR (p = 0.001). Moreover, maximal HR decreased its value from 116.7 ± 26.1 to 113.7 ± 40.8 after intervention. In addition, subjective pain perception (VAS scores) was significantly lower (p = 0.001) in the post-session assessment. Conclusions: Physiotherapy treatment produced an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients.

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Alloplastic or Autologous? Bone Chips versus PEEK Cage for Lumbar Interbody Fusion in Degenerative Spondylolisthesis

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1718770 ◽

2021 ◽

Author(s):

Stefan Koehler ◽

Christopher Held ◽

Christian Stetter ◽

Thomas Westermaier

Keyword(s):

Interbody Fusion ◽

Posterior Instrumentation ◽

Degenerative Spondylolisthesis ◽

Leg Pain ◽

Lumbar Interbody Fusion ◽

Peek Cage ◽

Cheap Alternative ◽

Autologous Bone ◽

Group 2 ◽

Group 1

Abstract Introduction This study was conducted to compare bone-filled intervertebral cages with autologous bone chips for instrumented lumbar interbody fusion in patients with spinal stenosis and degenerative spondylolisthesis. Methods Surgery consisted of posterior instrumentation and decompression, diskectomy, and intervertebral fusion using a polyetheretherketone (PEEK) cage surrounded and filled with spongious bone chips (group 1, n = 57) or spongious bone chips alone (group 2, n = 37). The choice of method was left to the discretion of the surgeon. Postoperative results were prospectively evaluated using a standardized protocol. Radiological assessment included fusion rates and vertebral height, while clinical assessment included the visual analog scale (VAS) and Oswestry Disability Index (ODI). Results In group 1, a mean of 1.38 ± 0.64 segments were fused. In group 2, a mean of 1.58 ± 0.65 segments were fused. In both groups, the VAS for back pain and leg pain and the ODI improved without significant differences between the two groups. Osseous fusion was documented by computerized tomography in 73% in group 1 and 89% in group 2 after a mean of 18 months. The loss of height was 2.8 ± 4.0% in group 1 and 2.4 ± 5.2% in group 2. Conclusion Regardless of whether a PEEK cage filled with spongious bone chips or spongious bone chips alone were used for lumbar interbody fusion, clinical parameters improved significantly after surgery. There were no significant differences in the rate of bony fusion and loss of height between the two groups. The results of this nonrandomized cohort study indicate that the implantation of autologous spongious bone chips harvested during the decompression procedure is a useful and cheap alternative to an intervertebral cage in patients with degenerative pseudospondylolisthesis.

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