scholarly journals Analysis of the structure of revision interventions in elderly and senile patients with degenerative pathology of the lumbar spine

2021 ◽  
Vol 23 (1) ◽  
pp. 47-61
Author(s):  
V. S. Klimov ◽  
A. V. Evsyukov ◽  
R. V. Khalepa ◽  
S. O. Ryabykh ◽  
E. V. Amelina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Early Period ◽  
Older Age ◽  
Adjacent Segment ◽  
Rigid Fixation ◽  
Age Group ◽  
Adjacent Level ◽  
Study Objective

The study objective is to study the causes of repeated surgical treatment in patients of an older age group with degenerative pathology of the lumbar spine.Materials and methods. A retrospective analysis of the treatment of 962 patients who underwent surgical treatment of degenerative pathology on the basis of the FCN of Novosibirsk from 2013 to 2017. A total of 360 men, 602 women; average age 66 years. 624 (64.9 %) patients underwent decompression, 338 patients (35.1 %) underwent stabilizing intervention in combination with decompression. The study group consisted of 98 (10.2 %) patients who underwent repeated operations taking into account the inclusion and exclusion criteria. On average, the period after the previous intervention is 17 months (from 1 day to 6 year). 68 patients (69.4 %) previously underwent decompression interventions, 30 (30.6 %) rigid stabilization. The indication for revision treatment was the presence of pain and (or) neurological deficiency, resistant to treatment for at least 6 weeks. Evaluation criteria are described, and the structure of complications is analyzed. The minimum follow-up period after repeated surgery was 1 year, the maximum 6 years.Results. Iatrogenic factors were detected in 39 patients (39.8 %). Progression of degenerative pathology in 59 (60.2 %) patients. More often, repeated intervention was performed at the level of L4–L5 (36.1 %), the cranial adjacent segment was 76.5 %, and the caudal segment was 23.5 %. The minimum period of manifestation of continued degeneration is 3 months. The development of the disease of the adjacent segment after fixation is higher in the period of 3–4 years (p = 0.015). Patients with repeated surgical treatment after decompression for continued degeneration had a higher BMI of 32.3 (p = 0.12), as well as patients with damage to the adjacent segment 32.5 (p = 0.10), compared with the group of primary patients (BMI 30.6 on average). The similar dependance is registered for patients after stabilization: BMI of patients with repeated interventions is 34.5 that is higher than BMI of primary interventions group (on average 33.2, р = 0.13).Conclusions. The main reason for repeated interventions in patients of an older age group is the progression of degenerative pathology on the segments on the segment operated as as well as the adjacent segments (60.2 % repeated interventions, 46.9 % at the adjacent level including).Repeated surgical treatment of patients of an older age group in the early period (for up to 1 year) is most often due to insufficiently effective primary surgical intervention with prevailing early recurrence of disk herniation (1.6 % patients of total number of primarily operated). In the long term (more than 3 years), the reason for repeated surgical treatment is due to the development of an adjacent segment disease where the number of operations of patients with primarily made rigid fixation is increasing progressively in the course of time.High BMI is a predictor of the development of instability of the vertebral motor segment and continued degeneration of the operated one as well as the adjacent level in the long follow-up time.

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.

Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis

2013 ◽  
Vol 19 (1) ◽  
pp. 90-94 ◽  
Author(s):  
Hironobu Sakaura ◽  
Tomoya Yamashita ◽  
Toshitada Miwa ◽  
Kenji Ohzono ◽  
Tetsuo Ohwada
Keyword(s):  
Lumbar Spine ◽  
Clinical Outcome ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
The Mean

Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

scholarly journals Treatment of Injuries of the Lumbar Spine

2019 ◽  
Vol 5 (12) ◽  
pp. 156-162
Author(s):  
M. Sabyraliev
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Spinal Canal ◽  
Thoracolumbar Spine ◽  
Spinal Injuries ◽  
Long Term Results ◽  
Results Of Treatment ◽  
Post Traumatic

Surgical treatment of patients with spinal injuries, accompanied by traumatic stenosis of the spinal canal, is an urgent and discussed problem of modern vertebrology. Surgical treatment of 111 patients with various injuries of the thoracolumbar spine was performed. In 40 patients, post-traumatic stenosis was eliminated using ligamentotaxis using transpedicular osteosynthesis. The immediate results of treatment were followed up in all patients: good results were obtained in 33 (82.5%) cases; satisfactory — in 6 (15.0%), unsatisfactory — in 1 (2.5%). Long-term results with a follow-up of more than 1 year were followed up in 27 (67.5%) patients; good results were obtained in 20 (74.0%), satisfactory in 7 (25.0%).

Fusion Rates of Intervertebral Polyetheretherketone and Titanium Cages without Bone Grafting in Posterior Interbody Lumbar Fusion Surgery for Degenerative Lumbar Instability

2017 ◽  
Vol 78 (06) ◽  
pp. 556-560 ◽  
Author(s):  
Christof Wrangel ◽  
Ali Karakoyun ◽  
Kaye-Marie Buchholz ◽  
Olaf Süss ◽  
Theodoros Kombos ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Lumbar Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Implant Failure ◽  
Adjacent Segment ◽  
Adjacent Level ◽  
Lumbar Instability ◽  
Titanium Cages

Background Posterior lumbar interbody fusion (PLIF) surgery is a commonly used procedure for degenerative lumbar instability. Locally harvested bone is usually inserted into intervertebral cages to increase fusion rate. The fusion rate without bone application remains unknown. Our aim was to analyze retrospectively the fusion rates of intervertebral polyetheretherketone (PEEK) and titanium cages in PLIF surgery that were implanted without bone grafting using three-dimensional computed tomography (CT) scanning. Material and Methods Forty patients (age 43–83 years) with mono- or bisegmental degenerative instability were included. PEEK cages were used in 28 segments (25 patients), and titanium cages were used in 17 segments (15 patients) undergoing PLIF surgery plus pedicle screws. The primary outcome parameter was radiologic fusion rate measured by CT at follow-up. Secondary parameters included rate of implant failure and adjacent segment disease. Results No difference in mean age between groups was identified (PEEK: 69 ± 10 years; titanium: 62 ± 13 years). Mean follow-up was 39 ± 13 months in PEEK and 24 ± 12 months in the titanium group. Radiologic fusion rate was 32% of operated segments in PEEK and 53% in the titanium group. Screw loosening/adjacent-level disease was observed in 8% and 8% in the PEEK group and in 0% and 7% in the titanium group, respectively. Conclusion Radiologic fusion rates of PEEK and titanium cages without bone grafting is low in PLIF surgery, and therefore bone grafting should be performed if possible. Rate of implant failure and adjacent-level disease remains low despite reduced osseous fusion in the operated segments.

scholarly journals THE USE OF NITINOL RODS IN SURGICAL TREATMENT OF DEGENERATIVE SCOLIOSIS. 2.5-YEAR FOLLOW-UP

2016 ◽  
Vol 15 (1) ◽  
pp. 22-25
Author(s):  
Natalia Sergeyevna Morozova ◽  
Dmitriy Aleksandrovich Kolbovsky ◽  
Arkadiy Ivanovich Kazmin ◽  
Sergey Vasilievich Kolesov
Keyword(s):  
Surgical Treatment ◽  
Interbody Fusion ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Control Group ◽  
Rigid Fixation ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbosacral Region ◽  
Pedicle Fixation

ABSTRACT Objectives: To compare the outcomes of surgical treatment with lumbar fixation using nitinol rods without fusion and with standard lumbar fixation with titanium rods and interbody fusion. Methods: Treatment results of 70 patients with degenerative lumbar scoliosis aged 40 to 82 were analyzed. In all cases pedicle screws and nitinol rods with a diameter of 5.5 mm were used. Thirty patients underwent fixation at L1-S1 and 40 patients underwent fixation at L1-L5. Spinal fusion was not performed. All patients had radiography, CT and MRI performed. The results were assessed according to the Oswestry scale, SRS 22, SF 36 and VAS. The minimum follow-up period for all patients was 2.5 years. For the control group, consisting of 72 patients, pedicle fixation with titanium rods and interbody fusion in the lumbosacral region were performed. Results: The average level of deformity correction equaled 25° (10° - 38°). The analysis of X-ray and CT-scans revealed a single patient with implant instability, two patients with bone resorption around the screws and one patient with rod fractures. Functional radiography 2.5 years after surgery showed an average mobility of the lumbar spine of 21° (15° - 30°). There were no problems at the adjacent levels. Conclusions: The use of nitinol rods in spinal deformity surgery is promising. This technology is an alternative to rigid fixation. Continued gathering of clinical data and its further evaluation is necessary.

Comparing the Kinematics of Lumbar Spine: Anatomic Facet Replacement System (AFRS™) vs. Rigid Fixation System

2007 ◽  
Author(s):  
A. Mehta ◽  
A. Faizan ◽  
A. Kiapour ◽  
J. Jangra ◽  
V. K. Goel ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Pedicle Screw ◽  
Facet Joint ◽  
Donor Site ◽  
Rigid Fixation ◽  
Adjacent Level ◽  
Donor Site Pain ◽  
Rigid Rod ◽  
Replacement System ◽  
Fixation System

Problems associated with spinal fusion such as adjacent level degeneration and donor site pain have shifted the focus to motion preservation technologies. The Anatomic Facet Replacement System (AFRS™) (Facet Solutions, Inc., Logan, Utah) attempts to address posterior lumbar spine pathologies while preserving stability and natural biomechanics thereby mitigating any potential adjacent level effects resulting from the reduction or elimination of motion as seen in semi-constrained dynamic stabilization and fusion devices. The AFRS™ is comprised of a precision instrumentation set whose design is based upon a comprehensive CT morphology study of the facet joint. It utilizes traditional pedicle screw fixation of its superior and inferior facet implants and is manufactured from a wear resistant alloy called cobalt-chromium-molybdenum. An experimentally validated finite element model was used for the quantification of facet loads and stresses in various components of the facet replacement system and also in the model stabilized using a pedicle screw rigid rod fixation system.

scholarly journals The Properties Of Mechanical Instability On Lumbar Spine At The Adjacent Segment After Rigid Fixation

2012 ◽  
Vol 16 (3) ◽  
pp. 366-372
Author(s):  
Ahmet Karakasli ◽  
Berivan Cecen ◽  
Mehmet Erduran ◽  
Orcun Taylan ◽  
Onur Hapa ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adjacent Segment ◽  
Rigid Fixation ◽  
Mechanical Instability

scholarly journals Surgical treatment and follow-up study for isthmic spondylolisthesis of the fifth lumbar spine.

1985 ◽  
Vol 33 (4) ◽  
pp. 1043-1045
Author(s):  
Keiichiro Shiba ◽  
Kunio Sasaki ◽  
Eisuke Gondo ◽  
Masaaki Katsuki ◽  
Koichiro Yamano ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Isthmic Spondylolisthesis ◽  
Follow Up Study

scholarly journals Use of Nitinol Rods for Lumbosacral Spine Fixation (Prospective Randomized Clinical Study)

2014 ◽  
Vol 21 (2) ◽  
pp. 19-24
Author(s):  
S. V Kolesov ◽  
V. V Shvets ◽  
D. A Kolobovskiy ◽  
A. I Kaz’min ◽  
N. S Morozova
Keyword(s):  
Lumbar Spine ◽  
Group Formation ◽  
Lumbosacral Spine ◽  
Adjacent Segment ◽  
Rigid Fixation ◽  
X Rays ◽  
Randomized Clinical Study ◽  
Spine Diseases ◽  
Spine Fixation ◽  
Group 1

One hundred thirty operations were performed in patients (57 males, 73 females) with degenerative lumbar spine diseases during the period from 2010 to 2012. Mean age of patients made up 57 (45-82) years. Depending on the type of intervention all patients were divided into 2 groups: in 60patients (1 st group) dynamic stabilization with nitinol rods without fusion and in 70patients (2 nd group) rigid fixation of lumbar spine with titanium rods was performed. Outcomes were analyzed in 1.5 years after surgery. VAS, ODI and SF36 questionnaires showed improvement of patients’ condition in both groups. Restoration of lordosis was from 22 to 35° and from 23 to 37° in 1 st and 2 nd groups, respectively. No screw instability, bone tissue resorption around the screws and adjacent segment pathology was noted in group 1. Functional X-rays showed preservation of mobility (5+1.2°). In 2 nd group formation of pseudarthrosis was recorded in 5patients, adjacent segment pathology - in 20 including 5 patients who required repeated surgical intervention. Transpedicular lumbosacral spine fixation using nitinol rods is an effective technique that enables to preserve movements in lumbosacral spine in combination with stable fixation

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