scholarly journals Operative Treatment of Degenerative Lumbar Spine Spondylolisthesis/ Оперативен Третман На Лумбосакрална Дегенреативна Спондилолистеза

PRILOZI ◽  
2015 ◽  
Vol 36 (1) ◽  
pp. 129-135
Author(s):  
Igor Kaftandziev ◽  
Simon Trpeski ◽  
Venko Filipce ◽  
Oliver Arsovski ◽  
Ilir Hasani ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Functional Outcome ◽  
Spinal Stenosis ◽  
Operative Treatment ◽  
Degenerative Spondylolisthesis ◽  
Clinical Results ◽  
Grade Ii ◽  
Functional Outcome Measures ◽  
Lumbosacral Spondylolisthesis

Abstract Introduction: Management of degenerative lumbosacral spondylolisthesis with spinal stenosis is still controversial. Surgery is widely used, as well as non-surgical treatment. Aim: To evaluate the clinical results and functional outcome after operative treatment in Grade II and III lumbar spine spondylolisthesis. Material and methods: Twelve patients with symptoms and image-confirmed degenerative spondylolisthesis entered the study. Mean patient age was 57 years. Spondylolisthesis Grade II or III, segment L4-L5 or L5-S1 were evaluated. All patients underwent similar protocols. Operative treatment was decompressive laminectomy, posterior one segment fixation, and fusion with autologous bone grafting. Functional outcome measures were Visual Analog Scale (VAS, 10-point scale) and Oswestry Disability Index (ODI, 100-percent scale) after 6 and 12 months. Results: Patient follow-up was 12 months. Preoperatively, 7 patients had severe disability according to ODI, 4 had moderate disability. VAS measured 6 and 7 points in 6 patients, lowest score of 4 points and the highest score of 9. After 6 months, ODI showed 5 patients had minimal and 7 had moderate disability; 2 patients had 0 points on the VAS, 2 had a score of 1, 4 had a score of 2, highest score of 4 points. Treatment outcome effects after 1 year were 9 patients with minimal disability, 3 with moderate; VAS - 2 patients with O points, 3 with 1 point, 4 with 2 points. Conclusion: Patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and functional outcome during a period of 1 year.

scholarly journals Lumbar lordosis in patients undergoing non-instrumented spinal stenosis

2021 ◽  
pp. 004-010
Author(s):  
Isart Anna ◽  
Vila-Canet Gemma ◽  
Cancer David ◽  
Covaro Augusto ◽  
Caceres Enric ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Lumbar Lordosis ◽  
Degenerative Spondylolisthesis ◽  
Standing Position ◽  
Decompression Surgery ◽  
Grade Ii ◽  
Lumbar Spinal ◽  
Conventional Radiology

Objective: To study the behaviour of Lumbar Lordosis (LL) after non-instrumented decompression surgery in patients diagnosed with Lumbar Spinal Stenosis (LSS). Methods and materials: Retrospective analysis of patients undergoing non-lumbar instrumented decompression surgery for lumbar spine stenosis, operated on between January 2011 and December 2017. The variables collected were age, sex, affected segment, and presence or not of degenerative spondylolisthesis (ELS). The Lumbar Lordosis (LL) parameter was analysed using conventional radiology in standing position pre and postoperatively. Results: 64 patients were selected, 17 women and 47 men, with an average age of 68 (35-83). 65% stenosis was located in a single level, and 39.1% had degenerative ELS grade I. The average follow-up was 26 months (6m-104m). A preoperative LL angle of 43.2º (9.8º-70.8º) and 47º (8º-76º) were found at the postoperative follow-up, with an average difference of 3.8º (-15.7º-20.2º). 9.4% (6 patients) of degenerative ELS evolved to grade II, and 8 patients needed reoperation for different reasons. In patients with ELS, we found a greater increase in postoperative LL (5.59º) than in patients without ELS (2.61º) (p = 0.08). No statistically significant relationship was found between the behaviour of the LL with the number of decompressed levels (p = 0.43) and the need for reoperation (p = 0.26). Conclusions: According to our study, the technique of posterior decompression without instrumentation of the lumbar spine stenosis is not associated with a decrease of lumbar lordosis parameter. Conversely, there is a slight tendency for LL to increase in cases where a degenerative ELS is present.

Simple Decompression with Small Skin Incision for Cubital Tunnel Syndrome

2002 ◽  
Vol 27 (6) ◽  
pp. 559-562 ◽  
Author(s):  
Y. TANIGUCHI ◽  
M. TAKAMI ◽  
T. TAMAKI ◽  
M. YOSHIDA
Keyword(s):  
Clinical Results ◽  
Skin Incision ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Endoscopic Assistance ◽  
Tunnel Syndrome ◽  
Grade Ii ◽  
The Mean ◽  
Simple Decompression

Eighteen elbows in 17patients with cubital tunnel syndrome were treated by simple decompression using only a 1.5–2.5 cm skin incision with no endoscopic assistance. According to McGowan’s criteria, three elbows were classified preoperatively as grade I, six as grade II and nine as grade III. The mean follow-up period was 14 months (range 3–25). Clinical results were evaluated as excellent for four elbows, good for ten and fair for four. Improvement of symptoms occurred in all patients and dislocation of the ulnar nerve was not observed. Simple decompression through a small skin incision can be recommended for the treatment of cubital tunnel syndrome, if the indication is appropriate.

What is the Effect of Lumbar Medial Branch Nerve Radiofrequency Ablation on Lumbar Spondylolisthesis: A Single-Center, Observational Study

2021 ◽  
Author(s):  
Trusharth Patel ◽  
Christopher Watterson ◽  
Anne Marie McKenzie-Brown ◽  
Boris Spektor ◽  
Katherine Egan ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Degenerative Spondylolisthesis ◽  
Lumbar Pain ◽  
Spinal Instability ◽  
Medial Branch ◽  
Single Center ◽  
Spine Imaging ◽  
Grade Ii ◽  
Lumbar Spondylolisthesis

Abstract Background Radiofrequency ablation (RFA) is a denervation therapy commonly performed for pain of facet etiology. Degenerative spondylolisthesis, a malalignment of the spinal vertebrae, may be a co-existing condition contributing to pain; yet the effect of RFA on advancing listhesis is unknown. To the extent that denervating RFA can weaken paraspinal muscles that provide stability to the spine, the therapy can potentially contribute to progressive spinal instability. Objectives To test the hypothesis that RFA of painful facets in the setting of spondylolisthesis may contribute to advancement of further degenerative spondylolisthesis. Methods Single-center, prospective, observational pilot study in an interventional pain practice. Fifteen participants with pre-existing degenerative Grade I or Grade II spondylolisthesis and coexisting axial lumbar pain underwent lumbar RFA encompassing spondylolisthesis level and followed with post-RFA imaging at 12 months and beyond to measure percent change in spondylolisthesis. Results The primary outcome was the percent advancement of spondylolisthesis per year measured on post-RFA lateral lumbar spine imaging compared to non-intervention baseline advancement of 2.6% per limited observational studies. Among the 15 participants enrolled, 14 completed the study (median age 66; 64.3% women; median BMI 33.5; mean follow-up time 23.9 months). The mean advancement of spondylolisthesis per year after RFA was 1.30% (95% CI -0.14 to 2.78%), with 9/14 below 1.25%. Conclusion Among patients with lumbar pain originating from facets in the setting of degenerative spondylolisthesis who underwent lumbar RFA, the observed advancement of spondylolisthesis is clinically similar to the baseline of 2.6% per year change. The study findings did not find a destabilizing effect of lumbar RFA in advancing spondylolisthesis in this patient population.

scholarly journals Outcomes in cases of lumbar degenerative spondylolisthesis more than 5 years after treatment with minimally invasive decompression: examination of pre- and postoperative slippage, intervertebral disc changes, and clinical results

2016 ◽  
Vol 24 (3) ◽  
pp. 367-374 ◽  
Author(s):  
Gen Mori ◽  
Yasuo Mikami ◽  
Yuji Arai ◽  
Takumi Ikeda ◽  
Masateru Nagae ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intervertebral Disc ◽  
Disc Degeneration ◽  
Intervertebral Disc Degeneration ◽  
Degenerative Spondylolisthesis ◽  
Clinical Results ◽  
Natural Course ◽  
Disc Height ◽  
Minimally Invasive Decompression

OBJECT There are reports that fusion is the standard treatment of choice for cases of lumbar degenerative spondylolisthesis (LDS) associated with lumbar spinal canal stenosis with a large degree of slippage. The reasons why, however, have not been clarified. On the other hand, it is known that the progress of slippage decreases and restabilization occurs over the natural course of LDS. Therefore, if minimally invasive decompression could be performed, there would be little possibility of it influencing the natural course of LDS, so it would not be necessary to include preoperative percentage slip in the criteria for the selection of fusion. This study examined the course of LDS cases more than 5 years after treatment with minimally invasive decompression to determine whether pre- and postoperative slippage and disc changes influence the clinical results. METHODS A total of 51 intervertebral segments in 51 cases with the chief complaint of radicular or cauda equina symptoms due to lumbar spinal canal stenosis were examined after prospective treatment with minimally invasive decompression for LDS. The mean age of the patients at the time of surgery was 66.7 years and the mean follow-up period was 7 years 4 months. Minimally invasive decompression was performed regardless of the degree of low-back pain or percentage slip. The outcome variables were clinical results and changes in imaging findings. RESULTS Over the follow-up period, postoperative percentage slip increased and disc height decreased, but the Japanese Orthopaedic Association score improved. Regardless of the preoperative percentage slip, disc height, or degree of intervertebral disc degeneration or segmental instability, the clinical results were favorable. In the high preoperative percentage slip group, low disc height group, and progressive disc degeneration group, there was little postoperative progress of slippage. In the group with a postoperative slippage increase of more than 5%, slippage increased significantly at postoperative year 2, but no significant difference was observed at the final follow-up. CONCLUSIONS When minimally invasive decompression was performed to treat LDS, the postoperative change in slippage was no different from that during the natural course. Furthermore, regardless of the degree of preoperative slippage or intervertebral disc degeneration, the clinical results were favorable. Also, the higher the preoperative percentage slip and the more that disc degeneration progressed, the more the progress of postoperative slippage decreased. Because the postoperative progress of slippage decreased, it is believed that even after minimally invasive decompression, restabilization occurs as it would during the natural course. If minimally invasive decompression can be performed to treat LDS, it is believed that preoperative percentage slip and intervertebral disc degeneration do not have to be included in the appropriateness criteria for fusion.

Nonfusion stabilization of the degenerative lumbar spine

2011 ◽  
Vol 15 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Alberto Maleci ◽  
Rafael Donatus Sambale ◽  
Michele Schiavone ◽  
Franz Lamp ◽  
Fahir Özer ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Donor Site ◽  
Visual Analog Scale Score ◽  
Clinical Results ◽  
Degenerative Disease ◽  
Operative Trauma ◽  
Implant Complications ◽  
Rod System ◽  
Adjacent Disc

Object The goal of this study was to assess whether a stable but nonrigid nonfusion implant can stabilize the spine in degenerative diseases and also prevent instability following decompression. Instrumented spondylodesis is a recognized surgical treatment in degenerative disease of the lumbar spine. However, pain can develop at the bone graft donor site and the operative trauma can be very stressful in elderly patients, and it is suspected that there may be increased degenerative changes in the adjacent segments. In 2002, a nonrigid but rotationally stable pedicle screw and rod system was introduced, which could be used without additional fusion (referred to hereafter as the Cosmic system). Methods A total of 139 patients with degenerative disease of the lumbar spine underwent spinal stabilization with the Cosmic system without additional spondylodesis. Seventy patients had an additional decompression. The minimum follow-up was 2 years. The perioperative course, the clinical results, and the erect anteroposterior and lateral radiographs were recorded and compared with the preoperative data. The data were obtained from 6 different spine centers in Europe and documented on an Internet platform. Results The Oswestry Disability Index score improved from 48.9% to 22.5%, and the visual analog scale score decreased from 7.3 to 2.5. Lumbar lordosis did not change, nor did the adjacent disc height. Eleven patients underwent revision, 4 of them for implant failure. Of the 139 patients, 110 assessed the result as excellent, very good, or good; 24 as fair; and 5 as poor. A total of 122 patients would undergo surgery again. There were no significant differences between patients with or without an additional decompression. Conclusions The Cosmic system is a stable but nonrigid posterior nonfusion system. Implant complications are low and the clinical outcome is good. Longer follow-up is necessary to confirm the 2-year results.

scholarly journals Definitions of segmental instability in the degenerative lumbar spine and validation of these definitions: a systematic review protocol article according to PRISMA-P 2015 statement

2020 ◽  
Author(s):  
Signe Forbech Elmose ◽  
Gustav Østerheden Andersen ◽  
Leah Yacat Carreon ◽  
Freyr Gauti Sigmundsson ◽  
Mikkel Østerheden Andersen
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Diagnostic Imaging ◽  
Spinal Stenosis ◽  
Systematic Reviews ◽  
Literature Search ◽  
Degenerative Spondylolisthesis ◽  
Data Synthesis ◽  
Segmental Instability ◽  
Lumbar Degenerative Spondylolisthesis

Abstract Background The concept of segmental lumbar spine instability is controversial with varying definitions. However, suspicion of instability is used as an indication for vertebral fusion surgery in patients with lumbar degenerative spondylolisthesis and spinal stenosis. The objectives of this systematic review are to describe, the definitions of segmental instability in the degenerative lumbar spine, in studies of patients with lumbar spinal stenosis and/or lumbar degenerative spondylolisthesis, involving diagnostic imaging. And to describe which of the measurable radiological variables used to define instability have been validated against dynamic flexion-extension radiographs. Method Systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Systematic literature search will be conducted in MEDLINE and EMBASE databases, supplemented by search in Cochrane Library. International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov will be searched for ongoing or recently completed trials. PROSPERO (International Prospective Register of Systematic Reviews) will be searched before initiating this review. In addition, a gray literature search will be conducted. Studies eligible for inclusion are clinical and biomechanical studies on adult patients with degenerative spondylolisthesis and spinal stenosis and surgical treatment hereof, studies involving diagnostic imaging. We will include studies giving a definition or describing patho-anatomical findings of segmental instability or any synonym or antonym hereof. Two reviewers will independently screen articles, involving a third reviewer as referee. Screening process and data extraction conducted using Covidence software. Data synthesis presented in results checklist and systematic narrative synthesis. Data synthesis on secondary objective by contingency table. Discussion With this systematic review we want to contribute to evidence based treatment planning of lumbar degenerative spondylolisthesis with spinal stenosis. We also aim to present our result in a comprehensive manner, to encourage consensus regarding the definition of segmental instability. Registration This protocol was submitted to the International Prospective Register of Systematic Reviews (PROSPERO) on 29. April 2020, submission ID: 182827

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