CORRELATION BETWEEN DEGENERATIVE DISEASES OF THE LUMBAR SPINE AND TYPES OF LUMBAR LORDOSIS

ABSTRACT Objective: Evaluate the relationship between the incidence of different types of degenerative diseases of the spine and lumbopelvic biomechanics, according to the types of lordosis of Roussouly's classification. Methods: Retrospective study of medical records and results of imaging exams of patients seen at a private hospital in São Paulo. The sagittal alignment of these patients was evaluated by classifying them according to Roussouly into 4 types, based on panoramic radiographs of the spine. These results were correlated with the patient's degenerative diagnosis (Herniated disc, Canal stenosis, Spondylolisthesis, degenerative discopathy and Facet arthrosis). Statistical tests were performed comparing the types of curvature and diagnoses identified. Results: 418 patients were evaluated, 51.4% male and 49.6% female. The vast majority of patients, about 54%, had a diagnosis of herniated lumbar disc. There was a statistically significant difference that showed a predilection for surgical treatment in cases classified as Type I and Type II in the Roussouly classification. There was no statistically significant difference that correlated the types of lumbar lordosis with the diagnosis presented by the patients. Conclusion: There is no statistically significant difference that correlates the type of lumbar lordosis according to Roussouly with lumbar degenerative diseases. In contrast, patients classified as Type 1 and Type 2 by Roussouly underwent a greater number of surgical treatments compared to patients type 3 and 4, with statistical relevance. Level of evidence 2; Retrospective prognostic study.

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Different spinal subtypes with varying characteristics of lumbar disc degeneration at specific level with age: a study based on an asymptomatic population

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1537-7 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Shao-qing Chen ◽

Qing-ping Li ◽

Ying-ying Huang ◽

An-na Guo ◽

Rui-fang Zhang ◽

...

Keyword(s):

Disc Degeneration ◽

Lumbar Disc ◽

Type I ◽

Type Ii ◽

Lumbar Disc Degeneration ◽

Level Of Evidence ◽

Lumbar Intervertebral Disc ◽

Specific Level ◽

Significant Difference ◽

The Relationship

Abstract Background The relationship between spinal sagittal subtypes and lumbar disc degeneration is unclear. Thus, we aimed to investigate the relationship between lumbar intervertebral disc degeneration and age in asymptomatic healthy individuals with different sagittal alignments. Methods In this cross-sectional observational study, we examined 209 asymptomatic young and middle-aged volunteers (123 women and 86 men) who were divided into the following three groups according to age: groups A (20–30 years), B (31–40 years), and C (41–50 years). The volunteers underwent full-spine standing lateral radiography and magnetic resonance imaging (MRI, 3.0 T) of the lumbar spine. Based on panoramic radiography, two observers measured the spinopelvic parameters and classified the spine into Roussouly subtypes. The degree of disc degeneration was assessed based on T2-weighted images according to the Pfirrmann classification. Results There was a statistically significant difference in the degree of degeneration of type I spine between groups B and C at L4-L5 (P < 0.03) and L5-S1 (P < 0.01) and between groups A and C at L1-L2 (P < 0.04) and L4-L5 (P < 0.01). The degeneration degree of type II spine at all levels were significantly different between groups A and C. No statistically significant difference was found between groups A and B in all subtypes except for type II spine at L1-L2 (P < 0.04). A significant difference was found at four levels between groups B and C in type III spine (P < 0.05) and between groups A and C. For type IV spine, there was a significant difference in the degree of degeneration at L4-L5 (P < 0.02) between groups A and C. Moreover, almost all single parameters were not strongly correlated with the degree of disc degeneration. Conclusion The different spinal subtypes have characteristics of lumbar disc degeneration at specific levels with age. We considered that spinal classification could be used as a predictor of lumbar disc degeneration. Our data may be helpful to increase awareness of the relationship between spinal subtypes and lumbar disc degeneration. Level of evidence 3

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Comparison of the efficacy of MIS-TLIF combined with unilateral or bilateral internal fixation on single-segment lumbar degenerative diseases

European Journal of Inflammation ◽

10.1177/2058739219844393 ◽

2019 ◽

Vol 17 ◽

pp. 205873921984439

Author(s):

Lisheng Zhao ◽

Huijin Yu ◽

Yan Zhang ◽

Wenjun Zhen

Keyword(s):

Internal Fixation ◽

Lumbar Lordosis ◽

Clinical Effects ◽

Degenerative Diseases ◽

Single Segment ◽

Tnf Α ◽

Significant Difference ◽

Lumbar Degenerative Diseases ◽

Serum Crp

In this study, to compare the efficacy of minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) combined with unilateral or bilateral internal fixation for the treatment of single-segment lumbar degenerative diseases, patients with single-segment lumbar degenerative diseases treated with MIS-TLIF combined with unilateral or bilateral internal fixation in Rehabilitation Center, Gansu Province Hospital from January 2014 to November 2015 were retrospectively enrolled, and the related data of 85 patients with 2-year follow-up were obtained. The patients were divided into unilateral group (40 cases) and bilateral group (45 cases) according to the method of internal fixation, and the Oswestry dysfunction index (ODI), visual analogue scale (VAS), lumbar lordosis angle, surgical segmental lordosis angle, lumbar scoliosis angle, surgical segmental scoliosis angle, lumbar lordosis index (LI), intervertebral height index (IHI), fusion rates, and serum inflammatory factors, including C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor alpha (TNF-α), were calculated to evaluate the efficacy of these two surgical methods. The results showed that the VAS and ODI of the two groups at 1 month, 6 months after surgery, and the last follow-up were significantly improved when compared with those before surgery ( P < 0.05). However, there were no significant differences in VAS and ODI between the two groups at preoperative, 1 month, 6 months after surgery, and the last follow-up ( P > 0.05). The lumbar lordosis and LI decreased at 1 month, 6 months, and the last follow-up ( P < 0.05), while the IHI increased when compared with that before surgery ( P < 0.05). Besides, no significant differences were observed in lumbar lordosis, LI, and IHI between the two groups at preoperative, 1 month, 6 months after surgery, and final follow-up ( P > 0.05). In addition, the fusion rates between these two groups had no significant difference ( P > 0.05). The levels of serum CRP, IL-6, and TNF-α at 12 and 24 h after operation in the two groups were higher than those before operation ( P < 0.05), but there was no significant difference in the levels of serum CRP, IL-6, and TNF-α between the two groups at 12 and 24 h after operation ( P < 0.05). In addition, none of the patients of both groups had permanent nerve injury, incision infection, and other complications. These results showed that MIS-TLIF combined with unilateral or bilateral percutaneous internal fixation technique causes less damage to the body tissues of patients with single-segment lumbar degenerative diseases, and they were considered to have similar clinical effects and imaging.

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Expression of matrix metalloproteinases 2 and 9 and TGF-b in ligamentum flavum hypertrophy

Coluna/Columna ◽

10.1590/s1808-18512014130300451 ◽

2014 ◽

Vol 13 (3) ◽

pp. 206-209

Author(s):

Marcelo Ferraz de Campos ◽

Cintia Pereira de Oliveira ◽

Maria Aparecida da Silva Pinhal ◽

Luciano Miller Reis Rodrigues

Keyword(s):

Matrix Metalloproteinases ◽

Spinal Stenosis ◽

Ligamentum Flavum ◽

Statistical Significance ◽

Herniated Disc ◽

Older Individuals ◽

Younger Patients ◽

Canal Stenosis ◽

Significant Difference ◽

Hematoxylin Eosin

OBJECTIVE: To evaluate the expression of matrix metalloproteinases and TGFb in patients with spinal stenosis and in younger patients who have herniated disc. METHODS: 19 samples of LA were analyzed, nine of them with lumbar canal stenosis and 10 with disc herniation. Of the total, five patients were aged between 15 and 40 years, 10 were between 40 and 65 years and four had more than 65 years. Representative areas of LF were chosen based on the staining of tissues with hematoxylin-eosin. The 3µm-thick sections embedded in paraffin and fixed in formalin were deparaffinized and rehydrated. All ligaments were incubated overnight at 4 °C with primary antibodies. RESULTS: An increase of TGFb was verified in older individuals, although without statistical significance. CONCLUSION: Metalloproteinases showed no significant difference between both groups with respect to age and type of abnormality of the spine.

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Analysis of Revision Surgery of Microsurgical Lumbar Discectomy

Asian Spine Journal ◽

10.4184/asj.2018.12.1.140 ◽

2018 ◽

Vol 12 (1) ◽

pp. 140-146 ◽

Cited By ~ 3

Author(s):

Taku Inada ◽

Sei Nishida ◽

Taigo Kawaoka ◽

Toshiyuki Takahashi ◽

Junya Hanakita

Keyword(s):

Disc Herniation ◽

Revision Surgery ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Herniated Disc ◽

Pathological Changes ◽

Video Footage ◽

Primary Surgery ◽

Surgery Group ◽

Significant Difference

<sec><title>Study Design</title>A retrospective study.</sec><sec><title>Purpose</title>Our objectives were to determine the association between the pathological changes of disc herniation and the interval between primary and revision surgeries and to investigate the frequency and site of the dural laceration in the primary and revision surgeries.</sec><sec><title>Overview of Literature</title>Among 382 patients who underwent microsurgical lumbar discectomy, we investigated 29 who underwent revision surgery to analyze recurrent herniation pathologies and complications to determine the manner in which lumbar disc herniation can be more efficiently managed.</sec><sec><title>Methods</title>Of 29 patients, 22 had recurrent disc herniation at the same level and site. The pathological changes associated with compression factors were classified into the following two types depending on intraoperative findings: (1) true recurrence and (2) minor recurrence with peridural fibrosis (>4 mm thickness). The sites of dural laceration were examined using video footage and operative records.</sec><sec><title>Results</title>The pathological findings and days between the primary and revision surgeries showed no statistical difference (<italic>p</italic>=0.14). Analysis of multiple factors, revealed no significant difference between the primary and revision surgery groups with regard to hospital days (<italic>p</italic>=0.23), blood loss (<italic>p</italic>=0.99), and operative time (<italic>p</italic>=0.67). Dural lacerations obviously increased in the revision surgery group (1.3% vs. 16.7%, <italic>p</italic><0.01) and were mainly located near the herniated disc in the primary surgery group and near the root shoulder in the revision surgery group, where severe fibrosis and adhesion were confirmed. To avoid dural laceration during revision surgery, meticulous decompressive manipulation must be performed around the root sleeve.</sec><sec><title>Conclusions</title>We recommend that meticulous epidural dissection around the scar formation must be performed during revision surgery to avoid complications.</sec>

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Statistical Power and Research in Occupational Therapy

The Occupational Therapy Journal of Research ◽

10.1177/153944928200200102 ◽

1982 ◽

Vol 2 (1) ◽

pp. 13-25 ◽

Cited By ~ 11

Author(s):

Kenneth Ottenbacher

Keyword(s):

Occupational Therapy ◽

Experimental Error ◽

Statistical Tests ◽

Error Rates ◽

Effect Sizes ◽

Statistical Hypothesis ◽

Medium Effect ◽

Type I ◽

Type Ii ◽

Significant Difference

The rationale of statistical hypothesis testing is reviewed, and the concepts of experimental error and power are introduced and discussed. A post hoc power analysis of 205 statistical tests from 22 articles reporting occupational therapy research is presented. The effect sizes and power coefficients for each of the statistical tests reviewed were analyzed, and the evaluation revealed a significant difference in power values based on effect-size calculations: Studies reporting small and medium effect sizes were associated with low power and were subject to a high probability of Type II experimental error. The power of the tests reviewed and the estimated Type II error rates were shown to vary significantly for small, medium, and large effects. This was not true for Type I error rates, which remained constant for all effect sizes. The implications of the findings and the importance of pre-experimental power evaluations for fields such as occupational therapy, where research endeavors frequently reveal small effects, are discussed.

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Minimally invasive intramedullary fixation with flexible nails in the treatment of metatarsal neck fractures

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.839 ◽

2019 ◽

Vol 13 (2) ◽

pp. 97-103 ◽

Cited By ~ 1

Author(s):

Victor Chammas ◽

Inácio Diogo Asaumi ◽

Alfonso Apostólico Netto ◽

Rafael Da Rocha Macedo ◽

Donato Lo Turco ◽

...

Keyword(s):

Minimally Invasive ◽

Statistical Tests ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Intramedullary Fixation ◽

Level Of Evidence ◽

Significant Difference ◽

Fracture Consolidation ◽

Flexible Intramedullary Nails

Objective: This study was designed to retrospectively assess patients with deviated central metatarsal neck fractures subjected to reduction and fixation with flexible intramedullary nails. Methods: Thirty-six patients (36 feet) diagnosed with acute fractures of one or more metatarsals and whose therapeutic indication was exclusively surgical were evaluated between June 2010 and August 2011. Considering the metatarsophalangeal joint, such injuries should be located up to two centimeters in the proximal direction of this segment, with plantar deviation greater than 10 degrees and translation greater than three millimeters in any plane. Minimally invasive intramedullary fixation with two flexible titanium nails was used when adequate stability was not obtained with the use of one nail. The visual analog scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) forefoot score and specific statistical tests were used. Results: There was a significant (p<0.001) improvement in the results until 6 months of follow-up. There was no significant difference (p>0.05) in the results between 6 and 12 months of follow-up. The average time of consolidation was 8 weeks, and there were no complications during the period evaluated. Conclusion: This technique provided a significant (p<0.001) improvement in the VAS and AOFAS forefoot scores at 6 months of follow-up. Between 6 and 12 months of postoperative follow-up, we did not observe a significant (p<0.05) difference in the results of the analysis due to stabilization of the condition and fracture consolidation. Although the results were considered excellent, the level of evidence of studies should be increased to effectively demonstrate the efficacy of this technique. Level of Evidence IV; Therapeutic Studies; Case Series.

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Combined 5 × 2 cv F Test for Comparing Supervised Classification Learning Algorithms

Neural Computation ◽

10.1162/089976699300016007 ◽

1999 ◽

Vol 11 (8) ◽

pp. 1885-1892 ◽

Cited By ~ 225

Author(s):

Ethem Alpaydm

Keyword(s):

Type I Error ◽

Statistical Tests ◽

Error Rates ◽

Type I ◽

Classification Learning ◽

F Test ◽

Robust Test ◽

Significant Difference ◽

Higher Power ◽

Test Result

Dietterich (1998) reviews five statistical tests and proposes the 5 × 2 cvt test for determining whether there is a significant difference between the error rates of two classifiers. In our experiments, we noticed that the 5 × 2 cvt test result may vary depending on factors that should not affect the test, and we propose a variant, the combined 5 × 2 cv F test, that combines multiple statistics to get a more robust test. Simulation results show that this combined version of the test has lower type I error and higher power than 5 × 2 cv proper.

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The Clinical Results of Percutaneous Endoscopic Interlaminar Discectomy (PEID) in the Treatment of Calcified Lumbar Disc Herniation: A Case-Control Study

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.69 ◽

2016 ◽

Vol 19 (2;2) ◽

pp. 69-75

Author(s):

Fu Qiang

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Case Control Study ◽

Lumbar Disc ◽

Case Control ◽

Lumbar Discectomy ◽

Herniated Disc ◽

Significant Difference ◽

Endoscopic Lumbar Discectomy ◽

Control Study

Background: Percutaneous endoscopic interlaminar discectomy (PEID), which poses advantages for certain types of herniated disc, is gaining wider acceptance in clinical practice. We retrospectively analyzed the efficacy of the PEID technique in treatment of calcified lumbar disc herniation. Study Design: A retrospective case-control study. Setting: University hospital in China. Objective: To evaluate the efficacy of the PEID technique in treatment of calcified lumbar disc herniation, and a comparison between calcified and noncalcified disc herniation was drawn to analyze the causes of herniated disc calcification. Methods: Data from patients who underwent full-endoscopic lumbar discectomy in our department between March 2011 and May 2013 were collected. Thirty cases with calcified lumbar disc herniation were included in the study group, and 30 age-, gender-, and body mass index (BMI)-matched cases with noncalcified lumbar disc herniation served as controls. Perioperative data, preoperative and postoperative Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) values, MacNab scores, and postoperative low-extremity dysesthesia among patients in the 2 groups were collected. Results: The values of computed tomography (CT) in the calcified group were significantly higher than those in the noncalcified group (P < 0.01). The preoperative disease courses in the 2 groups were similar. However, there was a statistically significant difference in the duration of traditional Chinese medicines (TCM) administration (P < 0.01). VAS and ODI scores improved significantly after surgery, but there were no significant differences between the 2 groups (P > 0.05). Three months after surgery, the rate of low-extremity dysesthesia in the calcified group was significantly higher than that in the control group (P = 0.03) but became similar at 6 months. By applying MacNab criteria the proportions of good and excellent were greater than 90% in both groups, and there was no difference between groups (P > 0.05). Limitations: The sample size was small in this retrospective study. Conclusion: The PEID technique is an effective method in the treatment of calcified lumber disc herniation, although the rate of postoperative dysesthesia is higher in this group during the early postoperative period. Long-term TCM administration may be related to the calcification of herniated lumbar discs. Key words: Lumbar disc herniation, percutaneous endoscopic lumbar discectomy, interlaminar approach, calcification

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Analysis of Sagittal Profile and Radiographic Parameters in Symptomatic Thoracolumbar Disc Herniation Patients

10.21203/rs.3.rs-34221/v1 ◽

2020 ◽

Author(s):

Ang Gao ◽

Yongqiang Wang ◽

Miao Yu ◽

Xiaoguang Liu

Keyword(s):

Disc Herniation ◽

Thoracic Spine ◽

Lumbar Disc ◽

Sagittal Profile ◽

Type I ◽

Type Ii ◽

Sagittal Vertical Axis ◽

Radiographic Parameters ◽

Significant Difference ◽

Thoracolumbar Region

Abstract Background Few studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH)The aim of study is to investigate sagittal alignment in TLDH, and analyze sagittal profile with radiographic parameters.Methods Data from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameters values in each subtype. Results We found two subtypes differentiated by the apex of thoracic kyphotic curves. The apex of the thoracic kyphotic curve located in the middle thoracic spine in type I, and the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9±24.8°, 8.2±7.3° and 6.2±4.9°, respectively. There was significant difference (p<0.001) of thoracolumbar angle between type I patients (14.9±7.9°) and type II patients (29.1±13.7°).Conclusions We presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In view of the different curvatures, different aetiologies were discovered in each subtype. Mismatch between shape and SS value was observed, and better agreement was found in Type II patients.

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Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients

10.21203/rs.3.rs-34221/v2 ◽

2020 ◽

Author(s):

Ang Gao ◽

Miao Yu ◽

Yongqiang Wang ◽

Xiaoguang Liu

Keyword(s):

Disc Herniation ◽

Thoracic Spine ◽

Lumbar Disc ◽

Sagittal Profile ◽

Sacral Slope ◽

Type I ◽

Type Ii ◽

Radiographic Parameters ◽

Significant Difference ◽

Thoracolumbar Region

Abstract Background Few studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH). The aim of study is to investigate sagittal alignment in TLDH and analyze sagittal profile with radiographic parameters.Methods Data from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameter values in each subtype. Results We found two subtypes differentiated by the apex of thoracic kyphotic curves. The apex of the thoracic kyphotic curve located in the middle thoracic spine in type I, and the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9±24.8°, 8.2±7.3° and 6.2±4.9°, respectively. There was significant difference (p<0.001) of thoracolumbar angle between type I (14.9±7.9°) and type II patients (29.1±13.7°).Conclusions We presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In view of the different curvatures, different aetiologies were discovered in each subtype. Mismatch between shape and sacral slope value was observed, and better agreement was found in Type II patients.

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