scholarly journals Clinical efficacy and radiographic K-Rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis

2020 ◽  
Author(s):  
Chaohua Fu ◽  
Tianju Chen ◽  
Yuhao Yang ◽  
Hua Yang ◽  
Maohui Diao ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Lordosis ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Rigid System ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal ◽  
Rigid Group

Abstract Background: This study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS). Methods: A total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n=25) and rigid systems (n=15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system. Results: JOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system. Conclusions: Compared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.

scholarly journals Clinical efficacy and radiographic K-Rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis

2020 ◽  
Author(s):  
Chaohua Fu ◽  
Tianju Chen ◽  
Yuhao Yang ◽  
Hua Yang ◽  
Maohui Diao ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Lordosis ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Rigid System ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal ◽  
Rigid Group

Abstract Background: This study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS).Methods: A total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n=25) and rigid systems (n=15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system. Results: JOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system. Conclusions: Compared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.

scholarly journals Outcomes of Revision Surgery Following Instrumented Posterolateral Fusion in Degenerative Lumbar Spinal Stenosis: A Comparative Analysis between Pseudarthrosis and Adjacent Segment Disease

2017 ◽  
Vol 11 (3) ◽  
pp. 463-471 ◽  
Author(s):  
Seung-Pyo Suh ◽  
Young-Hoon Jo ◽  
Hae Won Jeong ◽  
Won Rak Choi ◽  
Chang-Nam Kang
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Revision Surgery ◽  
Adjacent Segment Disease ◽  
Posterolateral Fusion ◽  
Adjacent Segment ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Group A ◽  
Lumbar Spinal

<sec><title>Study Design</title><p>Retrospective study.</p></sec><sec><title>Purpose</title><p>We examined the clinical and radiological outcomes of patients who received revision surgery for pseudarthrosis or adjacent segment disease (ASD) following decompression and instrumented posterolateral fusion (PLF).</p></sec><sec><title>Overview of Literature</title><p>At present, information regarding the outcomes of revision surgery for complications such as pseudarthrosis and ASD following instrumented PLF is limited.</p></sec><sec><title>Methods</title><p>This study examined 60 patients who received PLF for degenerative lumbar spinal stenosis and subsequently developed pseudarthrosis or ASD leading to revision surgery. Subjects were divided into a group of 21 patients who received revision surgery for pseudarthrosis (Group P) and a group of 39 patients who received revision surgery for ASD (Group A). Clinical outcomes were evaluated using the visual analogue scales for back pain (VAS-BP) and leg pain (VAS-LP), the Korean Oswestry disability index (K-ODI), and each patient's subjective satisfaction. Radiological outcomes were evaluated from the extent of bone union, and complications in the two groups were compared.</p></sec><sec><title>Results</title><p>VAS-LP at final follow-up was not statistically different between the two groups (<italic>p</italic> =0.353), although VAS-BP and K-ODI at final follow-up were significantly worse in Group P than in Group A (all <italic>p</italic> &lt;0.05), and only 52% of the patients in Group P felt that their overall well-being had improved following revision surgery. Fusion rates after the first revision surgery were 71% (15/21) in Group P and 95% (37/39) in Group A (<italic>p</italic> =0.018). The rate of reoperation was significantly higher in Group P (29%) than in Group A (5%) (<italic>p</italic> =0.021) due to complications.</p></sec><sec><title>Conclusions</title><p>Clinical and radiological outcomes were worse in patients who had received revision surgery for pseudarthrosis than in those who had revision surgery for ASD. Elderly patients should be carefully advised of the risks and benefits before planning revision surgery for pseudarthrosis.</p></sec>

scholarly journals PEEK versus Silicon Interspinous Spacer for Reduction of Supradjacent Segment Degeneration following Decompression and Short-Segment Instrumentation for Degenerative Lumbar Spinal Stenosis

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Panagiotis Korovessis ◽  
Vasileios Syrimpeis ◽  
Vasileios Tsekouras ◽  
Konstantinos Vardakastanis ◽  
Peter Fennema
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Interspinous Spacer ◽  
Additional Surgery ◽  
Spinopelvic Balance ◽  
Lumbar Spinal

Purpose. A retrospective study that aims to report Adjacent Segment Degeneration (ASD) incidence and spinopelvic balance in short lumbosacral instrumentation for degenerative lumbar spinal stenosis. Although ASD is a common complication following lumbar fusion, the effect of an interspinous spacer (IS) in the supradjacent segment in short lumbosacral instrumented fusion and its interaction with spinopelvic balance has not been studied adequately. Methods. From 55 consecutive age-, diagnosis-, and gender-matched patients aged 60±11 years, 17 (Group R) received PEEK IS; 18 (Group S) received Silicon IS compared with 20 controls (Group C) without receiving any IS. The functional outcome was evaluated with VAS and ODI. Spinopelvic balance was evaluated using SVA, T12-S1 LL, SS, PT, PI, and supradjacent segment disc heights. All spines were preoperatively balanced (SVA<40 mm). Results. The follow-up averaged out to 56±11 months. VAS and ODI scores improved postoperatively in all 3 groups. SS and anterior disc height in the supradjacent free segment increased postoperatively compensatory to spinal alterations. Although 6, 4, and 5 patients from Groups R, S, and C, respectively, showed radiological progression of the preoperative degeneration grade in the supradjacent disc, only 2, 1, and 2 patients in Groups R, S, and C, respectively, developed symptomatic ASD in the 1st supradjacent segment solely. No additional surgery was required in any patient. Conclusion. ASD incidence in the supradjacent segment following short lumbar fusion did not statistically significantly differ between PEEK and Silicon IS. There was a trend towards lower ASD incidence in Silicon IS. IS reduced ASD in both 1st and 2nd supradjacent segments. The authors speculate that soft stabilization provided by IS may be more advantageous for preventing ASD. This trial is registered with ClinicalTrials.govNCT03477955.

scholarly journals Coflex Interspinous Process Dynamic Stabilization for Lumbar Spinal Stenosis: Long-term Follow-up

2020 ◽  
Author(s):  
Mingrui Du ◽  
Fei-Long Wei ◽  
Kai-Long Zhu ◽  
Cheng-Pei Zhou ◽  
Ji-Xian Qian
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Dynamic Stabilization ◽  
Adjacent Segment ◽  
Imaging Data ◽  
Process Dynamic ◽  
The Difference ◽  
Lumbar Spinal

Abstract [Objective]To evaluate the long-term efficacy of Coflex interspinous process dynamic stabilization device in the treatment of lumbar spinal stenosis.[Methods]The clinical and imaging data of 73 patients undergoing Coflex interspinous process dynamic stabilization surgery from July 2008 to June 2012 were retrospectively analyzed. Clinical data include: visual analogue scale of pain (VAS), Owestry disability index(ODI) and Japanese Orthopedic Association Scores(JOA) of preoperation, 6 months after surgery, and last follow-up; complications; reoperation rates and incidence of adjacent segment degeneration(ASD). Imaging data including: lumbar range of motion(ROM), intervertebral space height(ISH) and intervertebral foramen height (IFH) of operative and adjacent segment at preoperative, 6 months after operation and the last follow-up.[Results]56 patients were followed up. The follow-up time was 107.6 ± 13.3 months, the operation time was 10.0 ± 3.1 minutes, the intraoperative blood loss was 153.9 ± 80.6 ml, and the hospitalization time was 10.2 ± 3.2 days. The VAS, ODI and JOA scores improved significantly after surgery. At 6 months after surgery and the last follow-up, ROM was significantly lower than that before surgery with statistical significance (P < 0.001). ROM was slightly increased at the last follow-up compared with that 6 months after operation, but the difference was not statistically significant (P > 0.05). The ROM of adjacent segments increased at 6 months and at the last follow-up compared with that before surgery, but the difference was not statistically significant (P > 0.05). At 6 months after surgery, ISH and IFH of implanted segment was significantly higher than that before surgery, and the difference was statistically significant (P < 0.05). At the last follow-up, there was a decrease in ISH and IFH, with no statistical difference compared with that before the operation. During the follow-up period, a total of 11 patients (19.6%) experienced complications and 6 patients (10.7%) underwent secondary surgery.[Conclusion]Coflex interspinous process dynamic stabilization is effective in the treatment of lumbar spinal stenosis in the long term. The surgical segment retains a small range of motion. The incidence of complications and reoperation is low. However, the ISH and IFH of implanted segment can only be maintained for a short period of time.

Endoscopic posterior decompression under local anesthesia for degenerative lumbar spinal stenosis

2018 ◽  
Vol 29 (6) ◽  
pp. 661-666 ◽  
Author(s):  
Myung Soo Youn ◽  
Jong Ki Shin ◽  
Tae Sik Goh ◽  
Seung Min Son ◽  
Jung Sub Lee
Keyword(s):  
Spinal Stenosis ◽  
Local Anesthesia ◽  
Lumbar Spinal Stenosis ◽  
Short Form ◽  
Posterior Decompression ◽  
Mean Values ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Sf 36 ◽  
Lumbar Spinal

OBJECTIVEVarious minimally invasive techniques have been described for the decompression of lumbar spinal stenosis (LSS). However, few reports have described the results of endoscopic posterior decompression (EPD) with laminectomy performed under local anesthesia. This study aimed to evaluate the clinical and radiological outcomes of EPD performed under local anesthesia in patients with LSS and to compare the procedural outcomes in patients with and without preoperative spondylolisthesis.METHODSFifty patients (28 female and 22 male) who underwent EPD under local anesthesia were included in this study. Patients were assessed before surgery and were followed up with regular outpatient visits (at 1, 3, 6, 12, and 24 months postoperatively). Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and the 36-Item Short Form Survey (SF-36) outcome questionnaire. Radiological outcomes were assessed by measuring lumbar lordosis, disc-wedging angle, percentage of vertebral slippage, and disc height index on plain standing radiographs.RESULTSThe VAS, ODI, and SF-36 scores were significantly improved at 1 month after surgery compared to the baseline mean values, and the improved scores were maintained over the 2-year follow-up period. Radiological progression was found in 2 patients during the follow-up period. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical and radiological outcomes.CONCLUSIONSEPD performed under local anesthesia is effective for LSS treatment. Similar favorable outcomes can be obtained in patients with and without preoperative spondylolisthesis using this approach.

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