scholarly journals The effects of cages implantation on surgical and adjacent segmental intervertebral foramina

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Changyan Wu ◽  
Xiaojuan Yang ◽  
Xu Gao ◽  
Liwei Shao ◽  
Fang Li ◽  
...  
Keyword(s):  
Clinical Data ◽  
Negative Impact ◽  
Japanese Orthopaedic Association ◽  
Intervertebral Disk ◽  
Adjacent Segment ◽  
Disk Space ◽  
Adjacent Segments ◽  
Intervertebral Foramina ◽  
Intervertebral Disk Space

Abstract Objection The overarching goal of our research was to compare the clinical and radiological outcomes with different sizes of cages implantation in anterior cervical discectomy and fusion (ACDF), and to evaluate the effects on surgical and adjacent segmental intervertebral foramina. Methods The clinical data of 61 patients were analyzed retrospectively. The radiological data included the surgical intervertebral disk space height before (H0) and after surgery (H), the preoperative mean height of adjacent segments (Hm), the area and height of the surgical and adjacent segment foramen, the surgical segmental Cobb angle (α1), and C2-7Cobb angle (α2). The calculation of clinical data was conducted by Japanese Orthopaedic Association Scores (JOA), the recovery rate of JOA scores and visual analog scales (VAS). In accordance with the different ranges of distraction (H/Hm), patients were classified into three groups: group A (H/Hm<1.20, n=13), group B (1.20≤H/Hm≤1.80, n=37), and group C (H/Hm>1.80, n=11). Results After the operation and at the final follow-up, our data has demonstrated that the area and height of surgical segmental foramen all increased by comparing those of preoperation in three groups (all P<0.05). However, except for a decrease in group C (all P<0.05), the adjacent segmental foramina showed no significant changes (all P>0.05). The area and height of the surgical segment foramen and the distraction degree were positively correlated (0<R<1, all P<0.05), while the adjacent segments were negatively correlated with it (0<R<1, P=0.002~0.067). JOA scores improved markedly in all groups with similar recovery rates. However, during the final follow-up (P=0.034), it was observed that there were significant differences in visual simulation scores among the three groups. Conclusion The oversize cage might give a rise to a negative impact on the adjacent intervertebral foramen in ACDF. The mean value of the adjacent intervertebral disk space height (Hm) could be used as a reference standard. Moreover, the 1.20~1.80 fold of distraction (H/Hm) with optimal cages would achieve a better long-term prognosis.

Extraforaminal Lumbar Interbody Fusion at the L5–S1 Level: Technical Considerations and Feasibility

2017 ◽  
Vol 78 (05) ◽  
pp. 507-512
Author(s):  
Denis Kaech ◽  
Pawel Baranowski ◽  
Alicja Baranowska ◽  
Didier Recoules-Arche ◽  
Arthur Kurzbuch
Keyword(s):  
Clinical Outcome ◽  
Interbody Fusion ◽  
Fusion Rate ◽  
Intervertebral Disk ◽  
Spinal Diseases ◽  
Lumbar Interbody Fusion ◽  
Short Term ◽  
Postoperative Result ◽  
Disk Space ◽  
Intervertebral Disk Space

Background Extraforaminal lumbar interbody fusion (ELIF) surgery is a muscle-sparing approach that allows the treatment of various degenerative spinal diseases. It is technical challenging to perform the ELIF approach at the L5–S1 level because the sacral ala obstructs the view of the intervertebral disk space. Methods We reported earlier on the ELIF technique in which the intervertebral disk is targeted at an angle of 45 degrees relative to the midline. In this article we describe the technical process we developed to overcome the anatomic relation between the sacral ala and the intervertebral disk space L5–S1 that hinders the ELIF approach at this level. We then report in a retrospective analysis on the short-term clinical and radiologic outcome of 100 consecutive patients with degenerative L5–S1 pathologies who underwent ELIF surgery. Results The L5–S1 ELIF approach could be realized in all patients. The short-term clinical outcome was evaluated 5 months after surgery: 92% of the patients were satisfied with their postoperative result; 8% had a poor result. Overall, 17% of the patients presented light radicular or low back pain not influencing their daily activity, and 82% of the patients working before surgery returned to work 3 to 7 months after surgery. The radiologic outcome was documented by computed tomography at 5 months after surgery and showed fusion in 99% of the patients. Lumbar magnetic resonance imaging performed in 5 patients at 6 months after surgery revealed the integrity of the paraspinal muscles. Conclusions ELIF surgery at the L5–S1 level is technically feasible for various degenerative spinal diseases. Analysis of the clinical and radiologic data in a consecutive retrospective cohort of patients who underwent this surgical procedure showed a good short-term clinical outcome and fusion rate.

Femoral Neurogram Before Transpsoas Spinal Access at L4–5 Intervertebral Disk Space

2015 ◽  
Vol 28 (7) ◽  
pp. E400-E404
Author(s):  
Timothy T. Davis ◽  
Thomas F. Day ◽  
Hyun W. Bae ◽  
Alexandre Rasouli
Keyword(s):  
Intervertebral Disk ◽  
Disk Space ◽  
Intervertebral Disk Space

scholarly journals Analysis of the influence parameters spine-pelvic balance on the risk of development degeneration and degenerative disease of adjacent segments after lumbar spine rigid fixation

2021 ◽  
pp. 24-30
Author(s):  
A. V. Spiridonov ◽  
Yu. Ya. Pestryakov ◽  
A. A. Kalinin ◽  
V. A. Byvaltsev
Keyword(s):  
Lumbar Spine ◽  
Lumbar Lordosis ◽  
Degenerative Disease ◽  
Adjacent Segment ◽  
Rigid Fixation ◽  
Inclusion Criteria ◽  
Biomechanical Stress ◽  
Lumbar Stabilization ◽  
Adjacent Segments

Introduction An increase in the load on adjacent segments causes changes in the parameters of the spinal-pelvic balance and, as a consequence, the development of the so-called biomechanical «stress». Such pressures are a key link in the pathogenesis of degeneration, and in the presence of clinical and neurological manifestations of the latter and adjacent segment degenerative disease (ASD/ASDd).Objective of this study was to assess the effect of the parameters of the spinal pelvic balance on the risk of developing ASD/ASDd after dorsal decompression-stabilizing interventions (DDSI).Material and Methods The study included medical records of patients who underwent DDSI for lumbar spine degenerative diseases. Clinical and instrumental parameters were assessed.Results Based on the inclusion criteria, 98 patients (48 with signs of ASD/ASDd and 50 without) were included in the study. The average postoperative follow-up period for the respondents was 46.6 ± 9.8 months. If PI/ LL parameters were <10 and the ratio of segmental and global lumbar lordosis (LIV-SI/LI-SI) was 50% or more, the incidence of ASD/ASDd was significantly lower in patients who underwent rigid lumbar stabilization surgery.Conclusion The values of PI/LL parameters and the ratio of segmental and global lumbar lordosis are obvious risk factors for the development of ASD/ASDd after rigid lumbar spine DDSI.

scholarly journals Clinical effect analysis and radiographic outcomes of Isobar TTL system for two-segmental lumbar degenerative disease: a retrospective study

2019 ◽  
Author(s):  
zhisheng ji ◽  
Zhi-Sheng Ji ◽  
Hua Yang ◽  
Yu-Hao Yang ◽  
Shao-Jin Li ◽  
...  
Keyword(s):  
Clinical Effect ◽  
Degenerative Disease ◽  
Adjacent Segment ◽  
Intervertebral Space ◽  
Lumbar Degenerative Disease ◽  
Effect Analysis ◽  
Radiographic Outcomes ◽  
Adjacent Segments ◽  
Rigid Group

Abstract Background: Non-fusion fixation is an effective way to treat lumbar degeneration. The present study evaluated the clinical effect analysis and radiographic outcomes of Isobar TTL system for two-segmental lumbar degenerative disease. Method: Forty-one patients with two-segmental lumbar degenerative disease who underwent surgical treatment by Isobar TTL dynamic stabilization system (n=20) and rigid system (n=21) from January 2013 to June 2017. The mean follow-up period was 23.6 (range 15–37) months. Clinical outcomes were evaluated by oswestry dysfunction index (ODI), visual analogue score (VAS) and modified Macnab. Radiographic evaluations included the height of intervertebral space and range of motion (ROM) of the operative segments and proximal adjacent segment. The intervertebral disc signal change was classified by the modified Pfirrmann grade and University of California at Los Angeles (UCLA) system. Results: The clinical outcomes including the ODI and VAS were significantly improved in two groups after operation, but the difference between two groups was not significant. In addition, the clinical efficacy of modified Macnab in two groups was similar too. Radiologic outcomes include height of intervertebral space, lumbar mobility and intervertebral disc signal. The height of intervertebral space of upper adjacent segments of L2/3 in the rigid group were significantly lower than those in the Isobar TTL group at the last follow-up. Furthermore, the number of fixed segment ROM of L3/4 in Isobar TTL group was significantly lower than pre-operation, suggesting that fixed segment ROMs in Isobar TTL group were limited. And, the ROM of upper adjacent segments of L2/3 in the last follow-up of rigid group increased significantly, while the ROM of L2/3 in Isobar TTL group haven’t changed after operation. At last, the incidence of adjacent segment degeneration was significantly greater in the rigid group than the Isobar TTL group according to modified Pfirrmann grading system and the UCLA system. Conclusion: Isobar TTL system could get a good clinical effect for treatment of two-segmental lumbar degenerative disease. Compared with rigid fixation, Isobar TTL system can get better radiographic outcomes and maintain the mobility of the stabilized segments with less influence on the proximal adjacent segment.

Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion With an Autologous Iliac Crest Graft: A Magnetic Resonance Imaging Study of 59 Patients With a Mean Follow-up of 27 Years

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 799-807 ◽  
Author(s):  
Benedikt W Burkhardt ◽  
Andreas Simgen ◽  
Gudrun Wagenpfeil ◽  
Wolfgang Reith ◽  
Joachim M Oertel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Adjacent Segment Degeneration ◽  
Disc Height ◽  
Adjacent Segment ◽  
Resonance Imaging ◽  
Physiological Aging ◽  
Repeat Procedure ◽  
Adjacent Segments

Abstract BACKGROUND Anterior cervical decompression and fusion (ACDF) is a widely accepted surgical technique for the treatment of degenerative disc disease. ACDF is associated with adjacent segment degeneration (ASD). OBJECTIVE To assess whether physiological aging of the spine would overcome ASD by comparing adjacent to adjoining segments more than 18 yr after ACDF. METHODS Magnetic resonance imaging of 59 (36 male, 23 female) patients who underwent ACDF was performed to assess degeneration. The mean follow-up was 27 yr (18-45 yr). Besides measuring the disc height, a 5-step grading system (segmental degeneration index [SDI]) including disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis was used to assess the grade of adjacent and adjoining segments. RESULTS The SDI of cranial and caudal adjacent segments was significantly higher compared to adjoining segments (P &lt; .001). The disc height of cranial and caudal adjacent segments was significantly lower compared to adjoining segments (P &lt; .001, P &lt; .01). The SDI of adjacent segments in patients with repeat cervical procedure was significantly higher than in patients without repeat procedure (P = .02, P = .01). The disc height of the cranial adjacent segments in patients with repeat procedure was significantly lower than in patients without repeat procedure (P = .01). CONCLUSION The physiological aging of the cervical spine does not overcome ASD. The disc height and the SDI in adjacent segment are significantly worse compared to adjoining segments. Patients who underwent repeat procedure had even worse findings of disc height and SDI.

scholarly journals Radiographic and Clinical Outcomes of Dynesys Dynamic Stabilization Versus Instrumented Fusion for Degenerative Lumbar Spine Diseases With a Minimum Follow-Up Period of 2 Years: A Meta-Analysis

2020 ◽  
Author(s):  
Lu-Ping Zhou ◽  
Ren-Jie Zhang ◽  
Lai Zhang ◽  
Jing-Yu Ding ◽  
Cailiang Shen
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Adjacent Segment ◽  
Screw Loosening ◽  
Intraoperative Blood Loss ◽  
Surgical Time ◽  
Instrumented Fusion ◽  
Adjacent Segments

Abstract ObjectiveDynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology (ASP) in clinical practice. However, the advantages of DS method remain controversial. This meta-analysis was to compare the radiographic and clinical outcomes between DS and instrumented fusion in patients with or without grade I spondylolisthesis at a minimum follow-up period of 2 years. MethodsWe conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases for potentially eligible articles. Clinical outcomes were assessed in terms of surgical time, intraoperative blood loss, length of hospital stay, in-hospital complications, VAS and ODI scores, screw loosening and breakage, and reoperation. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated. Data are expressed as risk ratio or standardized mean difference with the associated 95% confidence intervals. The meta-analysis was performed using RevMan 5.3 and STATA 15.1 software.ResultsFourteen studies with 1078 patients were included in the meta-analysis. The mean durations of follow-up ranged from 26.64 ± 5.16 months to 93.6 ± 16.5 months. The DS group was associated with significantly shorter surgical time, fewer intraoperative blood loss, shorter length of hospital stay, less in-hospital complications, lower postoperative VAS scores for low-back and leg pain than the fusion group (P < 0.05). Moreover, the ROM at the stabilized segments of the fusion group decreased significantly (P < 0.01) and that at the adjacent segments increased significantly compared with those of the Dynesys group (P < 0.01). Additionally, the Dynesys group showed significantly less ASDeg than the fusion group (P < 0.01) but showed no significant advantage over the fusion group in terms of preventing ASDis (P = 0.33). Furthermore, the Dynesys group was insignificantly different from the fusion group in terms of ODI, screw loosening, screw breakage, surgical reoperation, and disc heigh at stabilized and adjacent segments (P > 0.05).ConclusionDynesys stabilization showed satisfactory clinical outcomes and provided additional benefits in preserving the motion at the stabilized segments and limiting the hypermobility at the adjacent segments compared with fusion method. Dynesys stabilization represented a complementary choice in the treatment of degenerative spinal lumbar disease with or without grade I spondylolisthesis.

scholarly journals QOL-06. QUALITY OF LIFE IN MEDULLOBLASTOMA SURVIVORS IN WESTERN MEXICO

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii432-iii432
Author(s):  
Regina M Navarro-Martin del Campo ◽  
Jorge L Macias-Toscano ◽  
Erika Toral-Casillas ◽  
Fernando Sánchez-Zubieta ◽  
Ana L Orozco-Alvarado
Keyword(s):  
Quality Of Life ◽  
Functional State ◽  
Clinical Data ◽  
Negative Impact ◽  
Hormone Replacement ◽  
Academic Development ◽  
Western Mexico

Abstract BACKGROUND Treatment of children with medulloblastoma (MB) can lead survivors to lidiate with long term sequelae and affect their quality of life (QoL). This study evaluates QoL in long term MB survivors. DESIGN/ METHODS Clinical files of MB survivors from 1997 to 2016 were retrospectively analyzed. QoL was defined by Schipper Criteria in a five dimensional evaluation: clinical data, physic effects of treatment, academic develop, functional state and self welfare report. RESULTS Clinical data: Twenty eight survivors were identified, mean age at review was 18 years, median follow up was 106 months. Functional state: Last visit Karfnosky/lansky were 90 to 80% in 25% of patients. Physic effects of treatment: Cerebellar Mutism or ataxia were present in 25% of cases. Two patients required external dispositives. Audiometry detected an auditive tonal decrease in 25% of cases. An endocrine disfunction was present in 46% of cases, 32% required hormone replacement and 28% having short size. Renal damage without dialysis was detected in 7% and 10% had a transient tubulopaty. One case had bilateral amaurosis and 14% uses glasses. Three patients had a life partner. One female has offspring and two males had azoospermia. Academic development: While 90% attends to school, 35.7% complained of learning difficulties and 18% needed special education. Self welfare report: Difficulties in social environment were described in 21% and 14% still feeling sick during years. CONCLUSIONS Survivors of MB had adverse physical effects, followed by academic development, functional state and self welfare report and all this has a negative impact in their QoL.

Use of zero-profile device for contiguous three-level anterior cervical discectomy and fusion: comparison with cage and plate construct

2021 ◽  
pp. 1-8
Author(s):  
Zhipeng Chen ◽  
Shuizhong Cen ◽  
Jionglin Wu ◽  
Rui Guo ◽  
Zhenhua Liu ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Sagittal Alignment ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Patient Choice ◽  
Adjacent Segment ◽  
Radiographic Findings ◽  
Significant Difference ◽  
Patient Reported

OBJECTIVE The aim of this study was to compare a traditional cervical cage with a zero-profile (ZP) fixation device in patients who underwent three-level anterior cervical decompression and fusion (ACDF) in terms of patient-reported outcomes (visual analog scale [VAS], Japanese Orthopaedic Association [JOA], and Neck Disability Index [NDI] scores), radiographic findings (sagittal alignment 2 years after surgery and likelihood of fusion), and complications. METHODS This study was a retrospective case series. Between January 2012 and December 2016, 58 patients with cervical spondylotic myelopathy (CSM) who required three-level ACDF procedures, as identified by spinal surgeons, were treated with three-level ACDF and an anterior cage-plate construct (ACPC) (n = 38) or a three-level stand-alone ZP device (n = 20). On the basis of patient choice, patients were divided into two groups (ACPC group and ZP group). All patients completed a minimum of 2 years of follow-up. Patient-reported outcome scores included VAS, JOA, and NDI scores. The radiographic findings included sagittal alignment and likelihood of fusion 2 years after surgery. Data related to patient-reported outcomes and sagittal alignment were collected preoperatively, postoperatively, and at the final follow-up. Intraoperative and postoperative complications were also documented and analyzed. RESULTS The clinical outcomes, including VAS, JOA, and NDI scores, showed improvement in both groups, and no significant difference was observed between the two groups. Sagittal alignment and height of the fused segments were restored in all patients. However, the authors found no differences between the ZP and ACPC groups, and the groups exhibited similar fusion rates. The authors found no differences in complications, including dysphagia, adjacent-segment degeneration, and postoperative hematoma, between the groups. CONCLUSIONS Use of ZP implants yielded satisfactory long-term clinical and radiological outcomes that were similar to those of the standard ACPC. Additionally, the rates of complications between the groups were not significantly different. Although the best surgical option for multilevel CSM remains controversial, the results of this work suggest that ACDF with the ZP device is feasible, safe, and effective, even for multilevel CSM.

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