scholarly journals Cajas intersomáticas lumbares: ¿medios de fusión o solo espaciadores?

10.15417/211 ◽  
2013 ◽  
Vol 78 (2) ◽  
pp. 74
Author(s):  
Diego Nicolas Flores Kanter ◽  
Alberto Javier Jabif ◽  
Pablo Nicolás Ortiz
Keyword(s):  
Computed Tomography ◽  
Lumbar Spine ◽  
Lumbar Fusion ◽  
Pedicle Screws ◽  
Fusion Rate ◽  
Title Page ◽  
Anterior Fusion ◽  
Surgical Fusion ◽  
Circumferential Fusion ◽  
Spine Pathology

<div class="page" title="Page 1"><div class="layoutArea"><div class="column"><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p>RESUMEN</p><p><span>Introducción: </span><span>La fusión quirúrgica de la columna lumbar es un método muy utilizado para el tratamiento de la inestabilidad segmentaria lumbar dolorosa. En la actualidad, las dos técnicas de fusión instrumentada más utilizadas son la fusión posterolateral con tornillos pediculares y la fusión circunferencial mediante asociación de caja intersomática. Si bien hay evidencia de que la asociación de dispositivos intersomáticos aumenta la tasa de fusión, la mayoría de los estudios no discriminan si esta se produce solo de forma posterolateral o si se asocia una fusión anterior. El objetivo de este trabajo es determinar si existe fusión ósea real a nivel de las cajas intersomáticas o si estas actúan solo como espaciadores.</span></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Materiales y métodos: </span><span>Se analizaron 28 pacientes con patología de la columna lumbar sometidos a artrodesis lumbar circunferencial en un solo nivel entre mayo de 2007 y enero de 2012, mediante tomografía computarizada posquirúrgica para valorar la presencia o no de artrodesis anterior. Se efectuó un estudio de valor terapéutico, descriptivo, de observación (nivel de evidencia IV); mediante evaluación estadística se realizó un análisis de frecuencias para describir la proporción de casos con fusión anterior.</span></p></div></div><div class="layoutArea"><div class="column"><p><span>Resultados: </span><span>Se detectó una tasa de fusión del 92,86% y falta de fusión radiológica anterior en el 7,14% de los pacientes.</span></p><p><span>Conclusiones: </span><span>Hay una alta tasa de fusión anterior a nivel de las cajas intersomáticas; de este modo, se demuestra que dichos dispositivos actúan como medios de fusión y no solo como espaciadores.</span></p><div class="layoutArea"><div class="column"><p>PALABRAS CLAVE: Cajas intersomáticas. Fusión lumbar intersomática transforaminal. Tomografía computarizada.</p><p> </p><p>LUMBAR INTERBODY CAGES: FUSING MEANS OR ONLY SPACERS?</p></div></div><div class="layoutArea"><div class="column"><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Background: </span><span>Surgical fusion of the lumbar spine is a frequently used method for the treatment of painful lumbar segmental instability; currently the two instrumented fusion techniques most commonly used are posterolateral fusion with pedicle screws, and circumferential fusion by association of interbody cages. Although evidence shows that the association of intersomatic devices increases the fusion rate, most studies do not discriminate if this fusion occurs only posterolaterally, or an anterior fusion also occurs. The aim of this study is to determine if there is a true bone fusion at the level of interbody cages or if they act only as spacers.</span></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Methods: </span><span>We analyzed 28 patients with lumbar spine pathology surgically treated with one level circumferential lumbar fusion from May 2007 to January 2012, using post-surgical computed tomography, to assess the presence or absence of anterior arthrodesis. A therapeutic value, descriptive, observational study was conducted (evidence level IV); by statistical evaluation, frequency analysis was performed to describe the proportion of cases with anterior fusion.</span></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Results: </span><span>The fusion rate reached 92.86%; while there was no anterior radiological fusion in 7.14% of patients. </span></p><p><span>Conclusions: </span><span>There is a high rate of anterior fusion at the level of the interbody cages, thus demonstrating that these devices act as fusing means and not only as anterior spacers.</span></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>KEY WORDS: Interbody cages; Transforaminal lumbsar interbody fusion. Computed tomography. </span></p></div></div></div><p><span><br /></span></p></div></div></div><p><span><br /></span></p></div></div></div><p><span><br /></span></p></div></div></div><p> </p></div></div><p><span><br /></span></p></div></div></div><p><span><br /></span></p></div></div></div><p> </p></div></div></div>

Hybrid dynamic stabilization: a biomechanical assessment of adjacent and supraadjacent levels of the lumbar spine

2012 ◽  
Vol 17 (3) ◽  
pp. 232-242 ◽  
Author(s):  
Prasath Mageswaran ◽  
Fernando Techy ◽  
Robb W. Colbrunn ◽  
Tara F. Bonner ◽  
Robert F. McLain
Keyword(s):  
Lumbar Spine ◽  
Lumbar Fusion ◽  
Industrial Robot ◽  
Pedicle Screws ◽  
Axial Rotation ◽  
Dynamic Stabilization ◽  
Follower Load ◽  
Lateral Bending ◽  
Intact Specimen ◽  
Flexion Extension

Object The object of this study was to evaluate the effect of hybrid dynamic stabilization on adjacent levels of the lumbar spine. Methods Seven human spine specimens from T-12 to the sacrum were used. The following conditions were implemented: 1) intact spine; 2) fusion of L4–5 with bilateral pedicle screws and titanium rods; and 3) supplementation of the L4–5 fusion with pedicle screw dynamic stabilization constructs at L3–4, with the purpose of protecting the L3–4 level from excessive range of motion (ROM) and to create a smoother motion transition to the rest of the lumbar spine. An industrial robot was used to apply continuous pure moment (± 2 Nm) in flexion-extension with and without a follower load, lateral bending, and axial rotation. Intersegmental rotations of the fused, dynamically stabilized, and adjacent levels were measured and compared. Results In flexion-extension only, the rigid instrumentation at L4–5 caused a 78% decrease in the segment's ROM when compared with the intact specimen. To compensate, it caused an increase in motion at adjacent levels L1–2 (45.6%) and L2–3 (23.2%) only. The placement of the dynamic construct at L3–4 decreased the operated level's ROM by 80.4% (similar stability as the fusion at L4–5), when compared with the intact specimen, and caused a significant increase in motion at all tested adjacent levels. In flexion-extension with a follower load, instrumentation at L4–5 affected only a subadjacent level, L5–sacrum (52.0%), while causing a reduction in motion at the operated level (L4–5, −76.4%). The dynamic construct caused a significant increase in motion at the adjacent levels T12–L1 (44.9%), L1–2 (57.3%), and L5–sacrum (83.9%), while motion at the operated level (L3–4) was reduced by 76.7%. In lateral bending, instrumentation at L4–5 increased motion at only T12–L1 (22.8%). The dynamic construct at L3–4 caused an increase in motion at T12–L1 (69.9%), L1–2 (59.4%), L2–3 (44.7%), and L5–sacrum (43.7%). In axial rotation, only the placement of the dynamic construct at L3–4 caused a significant increase in motion of the adjacent levels L2–3 (25.1%) and L5–sacrum (31.4%). Conclusions The dynamic stabilization system displayed stability characteristics similar to a solid, all-metal construct. Its addition of the supraadjacent level (L3–4) to the fusion (L4–5) did protect the adjacent level from excessive motion. However, it essentially transformed a 1-level lumbar fusion into a 2-level lumbar fusion, with exponential transfer of motion to the fewer remaining discs.

scholarly journals Confirmation of accuracy/inaccuracy of lumbar pedicle screw placement using postoperative computed tomography

2021 ◽  
Vol 12 ◽  
pp. 518
Author(s):  
Mohamed M. Arnaout ◽  
Magdy O. ElSheikh ◽  
Mansour A. Makia
Keyword(s):  
Computed Tomography ◽  
Lumbar Spine ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Operative Intervention ◽  
Screw Placement ◽  
Lumbar Spine Surgery ◽  
Pedicle Screw Placement ◽  
Lumbar Pedicle ◽  
Ct Studies

Background: Transpedicular screws are extensively utilized in lumbar spine surgery. The placement of these screws is typically guided by anatomical landmarks and intraoperative fluoroscopy. Here, we utilized 2-week postoperative computed tomography (CT) studies to confirm the accuracy/inaccuracy of lumbar pedicle screw placement in 145 patients and correlated these findings with clinical outcomes. Methods: Over 6 months, we prospectively evaluated the location of 612 pedicle screws placed in 145 patients undergoing instrumented lumbar fusions addressing diverse pathology with instability. Routine anteroposterior and lateral plain radiographs were obtained 48 h after the surgery, while CT scans were obtained at 2 postoperative weeks (i.e., ideally these should have been performed intraoperatively or within 24–48 h of surgery). Results: Of the 612 screws, minor misplacement of screws (≤2 mm) was seen in 104 patients, moderate misplacement in 34 patients (2–4 mm), and severe misplacement in 7 patients (>4 mm). Notably, all the latter 7 (4.8% of the 145) patients required repeated operative intervention. Conclusion: Transpedicular screw insertion in the lumbar spine carries the risks of pedicle medial/lateral violation that is best confirmed on CT rather than X-rays/fluoroscopy alone. Here, we additional found 7 patients (4.8%) who with severe medial/lateral pedicle breach who warranting repeated operative intervention. In the future, CT studies should be performed intraoperatively or within 24–48 h of surgery to confirm the location of pedicle screws and rule in our out medial or lateral pedicle breaches.

scholarly journals Dual-Energy X-Ray Absorptiometry vs Computed Tomography: Comparison of Bone Mineral Density Measurements in Predicting Postoperative Spinal Fusion Outcomes

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Awais Vance ◽  
Alexander Mazal ◽  
Salah G Aoun ◽  
Najib El Tecle ◽  
Matthew Thomas Davies ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Lumbar Fusion ◽  
Dual Energy ◽  
Mineral Density ◽  
Hounsfield Units ◽  
X Ray ◽  
Hardware Failure ◽  
Increased Risk

Abstract INTRODUCTION Diminished bone mineral density (BMD) places patients at increased risk for complications from lumbar fusion procedures. Dual-energy X-Ray absorptiometry (DEXA) scanners have been used as the gold standard in measuring BMD. More recently, various studies have suggested that Hounsfield unit measurements from computed tomography (CT) scans may be more accurate. METHODS After obtaining IRB approval, we retrospectively reviewed all patients aged 18 and older who underwent lumbar fusion procedures between 01/01/2010 and 12/31/2016 at our institution. We used linear regression to assess for a correlation between CT Hounsfield units and DEXA t scores. Student's t-test was used to compare CT Hounsfield units, lumbar spine t score and hip t scores for patients with and without pseudoarthrosis as well as those with and without hardware failure. RESULTS A total of 167 patients with lumbar fusion procedures met inclusion criteria. Ages ranged 24 to 88 yr old with a mean of 64. Using linear regression there was no correlation between CT Hounsfield units and Dexa T scores. There was no difference between the groups with respect to CT Hounsfield units or DEXA T scores when comparing patients with and without pseudoarthrosis and when comparing patients with or without hardware failure. CONCLUSION Diminished BMD is an important factor to consider when contemplating lumbar spine fusion procedures as this has been associated with increased risk of hardware failure or pseudoarthrosis. Traditionally DEXA scans and more recently CT Hounsfield units have used to screen patients for decreased BMD, however, in this relatively large retrospective series we found that neither correlate well with complications from lumbar spine fusion procedures. CT and DEXA scans may not be as reliable as once thought in assessing BMD.

An Overview of Radiography, Computed Tomography, and Magnetic Resonance Imaging in the Diagnosis of Lumbar Spine Pathology

2006 ◽  
Vol 25 (6) ◽  
pp. 415???420 ◽  
Author(s):  
Elwin R. Tilson ◽  
Gloria Deal Strickland ◽  
Sharyn D. Gibson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Lumbar Spine ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Spine Pathology

scholarly journals Comparison of mechanical motion profiles following instrumented fusion and non-instrumented fusion at the L4-5 segment

2009 ◽  
Vol 32 (1) ◽  
pp. 64 ◽  
Author(s):  
Ho-Joong Kim ◽  
Seong-Hwan Moon ◽  
Heoung-Jae Chun ◽  
Kyoung-Tak Kang ◽  
Hak-Sun Kim ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Lumbar Fusion ◽  
Angular Motion ◽  
Anterior Fusion ◽  
Mechanical Motion ◽  
Fusion Surgery ◽  
Instrumented Fusion ◽  
Plain Films ◽  
Flexion Extension ◽  
Posterior Instrumented Fusion

Purpose: To investigate the difference in motion profiles between instrumented and non-instrumented fusion of the lumbar spine.. Method: In vivo retrospective radiological analysis of dynamic (flexion-extension) lateral plain films was performed in different lumbar spine fusion types. Twenty-eight patients underwent lumbar fusion surgery at the L4/5 level. Fourteen patients underwent anterior fusion surgery without implantation, and the others underwent posterior instrumented fusion. Segmental angular motion was measured at the fused and adjacent levels using dynamic plain lateral film 2 years after operation. Results: The anterior uninstrumented fusion group showed mean 2.0° of segmental angular motion at the fused level compared with mean of 0.8° in the posterior instrumented fusion group (P < 0.05). In contrast, at the proximal adjacent level, decreased angular motion (mean 7.7°) was noted in the anterior uninstrumented fusion group compared with mean 11.6° in the posterior instrumented fusion group (P < 0.05). Conclusion: This study suggests that differing stiffness of fusion segments could cause different mechanical motion profiles at adjacent segments.

scholarly journals Cage or Pelvic Graft—Study on Bony Fusion of the Ventral Thoracic and Lumbar Spine in Traumatic Vertebral Fractures

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 786
Author(s):  
Katharina Jäckle ◽  
Theresa Brix ◽  
Swantje Oberthür ◽  
Paul Jonathan Roch ◽  
Stephan Sehmisch ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Bone Grafts ◽  
Fusion Rate ◽  
Pelvic Bone ◽  
Anterior Fusion ◽  
Intervertebral Disc Space ◽  
Bony Fusion ◽  
Bone Fusion ◽  
Surgical Methods ◽  
Significant Difference

Background and Objectives: Stabilization of the spine by cage implantation or autologous pelvic bone graft are surgical methods for the treatment of traumatic spine fractures. These methods serve to stably re-adjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. They both involve ventral interventions using interbody fusion to replace the intervertebral disc space between the vertebral bodies either by cages or autologous pelvic bone grafts. We examined which of these methods serves the patients better in terms of bone fusion and the long-term clinical outcome. Materials and Methods: Forty-six patients with traumatic fractures (12 cages; mean age: 54.08/34 pelvic bone grafts; mean age: 42.18) who received an anterior fusion in the thoracic or lumbar spine were included in the study. Postoperative X-ray images were evaluated, and fusion of the stabilized segment was inspected by two experienced spine surgeons. The time to discharge from hospital and gender differences were evaluated. Results: There was a significant difference of the bone fusion rate of patients with autologous pelvic bone grafts in favor of cage implantation (p = 0.0216). Also, the stationary phase of patients who received cage implantations was clearly shorter (17.50 days vs. 23.85 days; p = 0.0089). In addition, we observed a significant gender difference with respect to the bony fusion rate in favor of females treated with cage implantations (p < 0.0001). Conclusions: Cage implantations after spinal fractures result in better bony fusion rates as compared to autologous pelvic bone grafts and a shorter stay of the patients in the hospital. Thus, we conclude that cage implantations rather than autologous pelvic bone grafts should be the preferred surgical treatment for stabilizing the spine after fracture.

scholarly journals Cortical Bone Trajectory Screw Fixation of Lumbar Spine in Adult Patients with Degenerative and Traumatic Spine Disorders

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Elbadrawy ◽  
T M S Elkhateeb ◽  
E M M A Hassan
Keyword(s):  
Lumbar Spine ◽  
Random Effects ◽  
Screw Fixation ◽  
Meta Analysis ◽  
Pedicle Screws ◽  
Fusion Rate ◽  
Random Effects Models ◽  
Fixed And Random Effects ◽  
Spine Disorders ◽  
Lumbar Pedicle

Abstract Background the CBT for placing lumbar pedicle screws is a technique used to improve fixation during instrumented fusion of the lumbar spine. In comparison with traditional trajectory (TT) for pedicle screws, CBT screws (otherwise known as pars screws or cortical screws) have a more medial starting point and are aimed in a medial to lateral, caudal to cranial direction. First reported in 2009 as a method to increase the purchase of lumbar pedicle screws within bone.(1) Aim of the Work to perform a systematic review and meta-analysis to determine whether traditional Pedicles Screw Fixation (PS Fx) or Cortical Bone Trajectory Screw Fixation (CBT Fx); has been successful for the treatment and fixation of lumbar spine in adult patients with degenerative and traumatic spine disorders; and to compare the 2 techniques to identify risk factor for unfavorable outcome through the recent researches about that issue. Methodology this review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Results meta-analysis study showed that; Successful fusion rate in fixed and random-effects models were (92.24% respectively); in SP group.Successful fusion rate in fixed and random-effects models were (92.44% respectively); in CBT group.Fixed and random-effects models showed non-significant difference in successful fusion rate; between the 2 groups of studies (p &gt; 0.05). We calculated safety for each technique through post-operative (failed fusion rate). Conclusion Although there were insignificant p-values in the most of the comparative items but the CBT showed lower average of intraoperative blood loss, operation time and higher average of decrease in VAS & increase in ODI, slightly higher fusion rate in comparison with PS. So we recommend, the use of CBT as an acceptable alternative of PS in lumbar spine fixation.

Clinical Evaluation and Computed Tomography Scan Analysis of Screw Tracts After Percutaneous Insertion of Pedicle Screws in the Lumbar Spine

Spine ◽  
2000 ◽  
Vol 25 (5) ◽  
pp. 615-621 ◽  
Author(s):  
Lothar Wiesner ◽  
Ralph Kothe ◽  
Klaus-Peter Schulitz ◽  
Wolfgang Rüther
Keyword(s):  
Computed Tomography ◽  
Lumbar Spine ◽  
Clinical Evaluation ◽  
Pedicle Screws ◽  
Computed Tomography Scan ◽  
Tomography Scan ◽  
Percutaneous Insertion

scholarly journals A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

2016 ◽  
Vol 7 (4) ◽  
pp. 188-196 ◽  
Author(s):  
Charla R. Fischer ◽  
Gregory Hanson ◽  
Melinda Eller ◽  
Ronald A. Lehman
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Lumbar Fusion ◽  
Treatment Strategies ◽  
Pedicle Screws ◽  
Spine Fusion ◽  
Current Evidence ◽  
Review Of The Literature ◽  
Degenerative Lumbar Spine ◽  
Lumbar Spine Fusion

Purpose: To evaluate the current evidence in the literature on treatment strategies for degenerative lumbar spine fusion in patients with osteoporosis. Methods: A systematic review of the literature from 1950 to 2015. Results: The review of the literature yielded 15 studies on the effect of treatment options for osteoporosis on lumbar fusion rates. This study evaluated only degenerative lumbar spine conditions and excluded deformity patients. One study demonstrated an association between low bone mass as measured by Hounsfield units and lower fusion rates. Six studies evaluated perioperative medical treatment of osteoporosis and showed higher fusion rates in patients treated with alendronate and teriparatide. The strongest evidence was for perioperative teriparatide. Eight studies evaluated surgical treatment strategies in patients with osteoporosis and showed that cement augmentation of pedicle screws and expandable pedicle screws demonstrated improved fusion rates than traditional pedicle screws. The strongest evidence was for expandable pedicle screws. Conclusion: There are 15 articles evaluating osteoporosis in patients undergoing lumbar fusion and the highest level of evidence is for perioperative use of teriparatide.

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