Preliminary study of the use of a CBT screw to treat lumbar adjacent segment degeneration

Abstract Objective: To investigate the feasibility of using the cortical bone trajectory (CBT) screw in revision surgery for lumbar adjacent segment degeneration (LASD) and to provide a reference for clinical practice.Methods:The computed tomography (CT) scans of the lumbar spine of 40 patients in our hospital were used. Three-dimensional (3D) reconstruction was performed using Mimics 19.0 software, screws with appropriate sizes were selected for the L1 to L5 vertebral segments, and the traditional pedicle (TP) screws were placed using the standard method. After the completion of screw placement, the simulated placement of CBT screws with appropriate sizes was performed separately. During screw placement, the site and the direction were adjusted accordingly to complete the screw placement as much as possible. Under the premise of safe and feasible placement, penetration of the screw through the CBT and overlap between the TP and CBT screws should be avoided. If these requirements are met, screw placement is considered successful. Otherwise, the screw placement is considered failed. After all simulated screw placements were complete, the success rate of the screw placement in each segment of the lumbar vertebra was calculated from the statistical results. Finally, the pedicle trajectory reference width (TRW) was used for grouping to investigate the correlation between the TRW and sucess rate of screw placement. Results: Four hundred simulated screw placements (80 in each pedicle) were performed in the L1-L5 pedicles. The overall success rate of CBT screw placement in the lumbar spine was 57.00%. The success rates in the L1 to L5 segments were 47.50%, 62.50%, 57.50%, 70.00%, and 47.50%, respectively. The success rate in L4 was greater than in L2 and L3, while the lowest success rates were observed in L1 and L5. The groups were established based on the TRW. The success rate of CBT screw placement increased as the TRW increased.Conclusions: CBT screws are not suitable treatments for all cases of LASD. The success rate of screw placement varies in different lumbar segments. A preoperative measurement of TRW has important reference value for evaluating the feasibility of CBT screw placement in revision surgery for LASD.

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ADJACENT SEGMENT DEGENERATION IN THE LUMBAR SPINE

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200407000-00020 ◽

2004 ◽

Vol 86 (7) ◽

pp. 1497-1503 ◽

Cited By ~ 479

Author(s):

GARY GHISELLI ◽

JEFFREY C. WANG ◽

NITIN N. BHATIA ◽

WELLINGTON K. HSU ◽

EDGAR G. DAWSON

Keyword(s):

Lumbar Spine ◽

Adjacent Segment Degeneration ◽

Adjacent Segment

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Does Atherosclerosis Have Negative Impacts on Early Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion?

Global Spine Journal ◽

10.1177/2192568220919370 ◽

2020 ◽

pp. 219256822091937

Author(s):

Hironobu Sakaura ◽

Daisuke Ikegami ◽

Takahito Fujimori ◽

Tsuyoshi Sugiura ◽

Yoshihiro Mukai ◽

...

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Surrogate Marker ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Significant Difference ◽

Degenerative Lumbar Spondylolisthesis ◽

Negative Impacts

Study Design: Retrospective study. Objective: To examine whether atherosclerosis has negative impacts on early adjacent segment degeneration (ASD) after posterior lumbar interbody fusion using traditional trajectory pedicle screw fixation (TT-PLIF). Methods: The subjects were 77 patients who underwent single-level TT-PLIF for degenerative lumbar spondylolisthesis. Using dynamic lateral radiographs of the lumbar spine before surgery and at 3 years postoperatively, early radiological ASD (R-ASD) was examined. Early symptomatic ASD (S-ASD) was diagnosed when neurologic symptoms deteriorated during postoperative 3-year follow-up and the responsible lesions adjacent to the fused segment were also confirmed on magnetic resonance imaging. According to the scoring system by Kauppila et al, the abdominal aortic calcification score (AAC score: a surrogate marker of systemic atherosclerosis) was assessed using preoperative lateral radiographs of the lumbar spine. Results: The incidence of early R-ASD was 41.6% at the suprajacent segment and 8.3% at the subjacent segment, respectively. Patients with R-ASD had significantly higher AAC score than those without R-ASD. The incidence of early S-ASD was 3.9% at the suprajacent segment and 1.4% at the subjacent segment, respectively. Patients with S-ASD had higher AAC score than those without S-ASD, although there was no significant difference. Conclusions: At 3 years after surgery, the advanced AAC had significantly negative impacts on early R-ASD after TT-PLIF. This result indicates that impaired blood flow due to atherosclerosis can aggravate degenerative changes at the adjacent segments of the lumbar spine after PLIF.

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Is the Goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion?

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20238 ◽

2020 ◽

pp. 1-6

Author(s):

Ping-Guo Duan ◽

Praveen V. Mummaneni ◽

Jeremy M. V. Guinn ◽

Joshua Rivera ◽

Sigurd H. Berven ◽

...

Keyword(s):

Revision Surgery ◽

Demographic Data ◽

Degenerative Spondylolisthesis ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Fat Infiltration ◽

Single Level ◽

Goutallier Classification ◽

Spinopelvic Parameter

OBJECTIVEThe aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.METHODSA total of 178 patients undergoing single-level L4–5 TLIF for spondylolisthesis (2006 to 2016) were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, preoperative MR images and radiographs, and single-level L4–5 TLIF for degenerative spondylolisthesis. Twenty-three patients underwent revision surgery for ASD during the follow-up. Another 23 patients without ASD were matched with the patients with ASD. Demographic data, Roussouly curvature type, and spinopelvic parameter data were collected. The fat infiltration of the LM muscle (L3, L4, and L5) was evaluated on preoperative MRI using the Goutallier classification system.RESULTSA total of 46 patients were evaluated. There were no differences in age, sex, BMI, or spinopelvic parameters with regard to patients with and those without ASD (p > 0.05). Fat infiltration of the LM was significantly greater in the patients with ASD than in those without ASD (p = 0.029). Fat infiltration was most significant at L3 in patients with ASD than in patients without ASD (p = 0.017). At L4 and L5, there was an increasing trend of fat infiltration in the patients with ASD than in those without ASD, but the difference was not statistically significant (p = 0.354 for L4 and p = 0.077 for L5).CONCLUSIONSFat infiltration of the LM may be associated with ASD after L4–5 TLIF for spondylolisthesis. Fat infiltration at L3 may also be associated with ASD at L3–4 after L4–5 TLIF.

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Analysis of Risk Factors for Adjacent Segment Degeneration Occurring More than 5 Years after Fusion with Pedicle Screw Fixation for Degenerative Lumbar Spine

Asian Spine Journal ◽

10.4184/asj.2013.7.4.273 ◽

2013 ◽

Vol 7 (4) ◽

pp. 273 ◽

Cited By ~ 28

Author(s):

Jaewan Soh ◽

Jae Chul Lee ◽

Byung Joon Shin

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Pedicle Screw ◽

Screw Fixation ◽

Adjacent Segment Degeneration ◽

Pedicle Screw Fixation ◽

Adjacent Segment ◽

Degenerative Lumbar Spine

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A retrospective study analysis of success rate following endonasal dacryocystorhinostomy with stents

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191620 ◽

2019 ◽

Vol 5 (3) ◽

pp. 568

Author(s):

Ritesh Mahajan ◽

T. M. Nagaraj

Keyword(s):

Success Rate ◽

Revision Surgery ◽

Objective Evaluation ◽

Subjective Assessment ◽

Nasolacrimal Duct ◽

Success Rates ◽

Endoscopic Endonasal ◽

Persistent Symptoms ◽

Primary Surgery ◽

Single Centre Study

Background: Endoscopic endonasal dacryocystorhinostomy (EN DCR) has now become a procedure of choice for nasolacrimal duct obstruction or in chronic dacryocystitis. Lots of debate is still going on regarding stent placement following surgery. The purpose of this study is to analyse the subjective and objective success following EN DCR with stents.Methods: In this single centre study, 30 patients underwent EN DCR surgery from May 2011 to March 2013, out of those 20 eligible patients with 26 nasolacrimal duct obstructions underwent EN DCR with stents, and they were included in the study. Success rates were determined with subjective assessment of the patient symptoms and objective evaluation by lacrimal syringing. Results: 80.7% patients underwent primary surgery and 19.2% patient’s revision surgery, overall success rates was 88.4% out of which 95.2% success rate for primary surgery and 60% success rates of revision surgery. 11.5% of patients complained of persistent symptoms and success rate of ENDCR with stents was observed in 95.2% of patients after primary surgery and in 60% of patient’s after revision surgery. Stent removal was done on 4-6 weeks (mean duration- 5 weeks) and patients follow up time was 6 months.Conclusions: Whether to stent or to not still remain a topic of debate in EN DCR surgery, however ENDCR with stents represents the procedure of choice for treating nasolacrimal duct obstructions.

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Capturing Three-Dimensional In Vivo Lumbar Intervertebral Joint Kinematics Using Dynamic Stereo-X-Ray Imaging

Journal of Biomechanical Engineering ◽

10.1115/1.4025793 ◽

2013 ◽

Vol 136 (1) ◽

Cited By ~ 29

Author(s):

Ameet K. Aiyangar ◽

Liying Zheng ◽

Scott Tashman ◽

William J. Anderst ◽

Xudong Zhang

Keyword(s):

Lumbar Spine ◽

Three Dimensional ◽

Lumbar Vertebrae ◽

Lumbar Vertebra ◽

Weight Lifting ◽

Data Set ◽

X Ray ◽

Biomechanical Models ◽

Lifting Task

Availability of accurate three-dimensional (3D) kinematics of lumbar vertebrae is necessary to understand normal and pathological biomechanics of the lumbar spine. Due to the technical challenges of imaging the lumbar spine motion in vivo, it has been difficult to obtain comprehensive, 3D lumbar kinematics during dynamic functional tasks. The present study demonstrates a recently developed technique to acquire true 3D lumbar vertebral kinematics, in vivo, during a functional load-lifting task. The technique uses a high-speed dynamic stereo-radiography (DSX) system coupled with a volumetric model-based bone tracking procedure. Eight asymptomatic male participants performed weight-lifting tasks, while dynamic X-ray images of their lumbar spines were acquired at 30 fps. A custom-designed radiation attenuator reduced the radiation white-out effect and enhanced the image quality. High resolution CT scans of participants' lumbar spines were obtained to create 3D bone models, which were used to track the X-ray images via a volumetric bone tracking procedure. Continuous 3D intervertebral kinematics from the second lumbar vertebra (L2) to the sacrum (S1) were derived. Results revealed motions occurring simultaneously in all the segments. Differences in contributions to overall lumbar motion from individual segments, particularly L2–L3, L3–L4, and L4–L5, were not statistically significant. However, a reduced contribution from the L5–S1 segment was observed. Segmental extension was nominally linear in the middle range (20%–80%) of motion during the lifting task, but exhibited nonlinear behavior at the beginning and end of the motion. L5–S1 extension exhibited the greatest nonlinearity and variability across participants. Substantial AP translations occurred in all segments (5.0 ± 0.3 mm) and exhibited more scatter and deviation from a nominally linear path compared to segmental extension. Maximum out-of-plane rotations (<1.91 deg) and translations (<0.94 mm) were small compared to the dominant motion in the sagittal plane. The demonstrated success in capturing continuous 3D in vivo lumbar intervertebral kinematics during functional tasks affords the possibility to create a baseline data set for evaluating the lumbar spinal function. The technique can be used to address the gaps in knowledge of lumbar kinematics, to improve the accuracy of the kinematic input into biomechanical models, and to support development of new disk replacement designs more closely replicating the natural lumbar biomechanics.

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