scholarly journals Triangular Fixation to Prevent Proximal Screw Pullout in Adult Spinal Deformity Surgery: A Technical Note

Author(s):  
Masato Tanaka ◽  
Rahul Mehta ◽  
Taro Yamauchi ◽  
Shinya Arataki ◽  
Koji Uotani ◽  
...  

Abstract Background Adult spinal deformity (ASD) is caused by spinal malalignment and results in severe low back pain, neurological dysfunction, and severe deformity. Proximal screw back-out represents a difficult problem in minimally invasive ASD surgery. We describe a novel technique to prevent screw pullout in ASD. Methods A 71-year-old woman was referred to our hospital with severe low back pain and gait difficulty. Her daily life had been affected by severe lower back pain for more than 6 months. Standing radiograms indicated severe kyphoscoliosis. Two-stage minimally invasive corrective T10-to-pelvis fixation was performed. Results The first surgery was an L1–S1 C-arm-free oblique lumbar interbody fusion, with an operation time of 3 h 57 min and an estimated blood loss of 240 mL. After 1 week, the second percutaneous pedicle screw (PPS) fixation was performed and proximal screws were inserted under a transdiscal approach (T11) and with a lower angulation trajectory (T10) to enhance pullout strength. For this second surgery, operation time was 3 h 33 min, and estimated blood loss was 320 mL. No postoperative complications or neurological compromise was reported. In terms of clinical outcomes, Oswestry Disability Index improved from 56–24%, and visual analog scale score for lower back pain improved from 62 mm to 24 mm at the 1-year follow-up. Conclusions Minimally invasive circumferential surgery with triangular fixation is effective for preventing proximal screw back-out and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Viktor Zs. Kovari ◽  
Akos Kuti ◽  
Krisztina Konya ◽  
Istvan Szel ◽  
Anna K. Szekely ◽  
...  

Background. Comparison of single-level open and minimally invasive transforaminal lumbar interbody fusions (O-TLIF and MI-TLIF) of a single surgeon and presentation of his MI-TLIF learning curve in a retrospective observational cohort study. Methods. 27 MI-TLIF and 31 O-TLIF patients, performed between 03/01/2013 and 03/31/2018, were compared regarding the operative time, blood loss, blood transfusion frequency, postoperative length of stay (LOS), and adverse events. An overall comparison of pre- and postoperative Oswestry Disability Index (ODI) results and Visual Analog Score (VAS) results of low back and leg pain was performed in the case of the two techniques. For a learning curve presentation, the MI-TLIF cases were compared and the optimal operative time was determined. Results. The gender ratio and age did not differ in the groups. Operative time showed no difference (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P≤0.001) in the MI-TLIF group (288.9 ± 339.8 mL) than in the O-TLIF group (682.3 ± 465.4 mL) while the incidence of blood transfusion was similar (P=0.64). The MI-TLIF group had shorter LOS (2.7 ± 1.1 days vs. 5 ± 2.7, P≤0.001). The frequencies of the surgical site infections (SSI), durotomy, new motor, and sensory deficit were not significantly different (P=0.17, 0.5, 0.29, 0.92). All the ODI, the VAS low back pain, and the VAS leg pain scores improved in both groups significantly (P≤0.001, P≤0.001, and P≤0.001 in the MI-TLIF group and P≤0.001, P≤0.001, and P≤0.001 in the O-TLIF group). The comparison of the pre- and postoperative results of the ODI and VAS questionnaires of the two techniques showed no significant difference regarding the improvement of these scores (MI-TLIF versus O-TLIF pre- and postoperative ODI difference p=0.64, VAS low back pain P=0.47, and VAS leg pain P=0.21). Assessing the MI-TLIF learning curve, operative time was shortened by 63 minutes (P=0.04). After the 14th MI-TLIF case, the surgical duration became relatively constant. Comparing the 14th and previous MI-TLIF cases to the later cases, LOS showed reduction by 1.03 days (P=0.01), while the other parameters did not show significant changes. Conclusions. Similar operative time and postoperative quality of life improvement can be achieved by MI-TLIF procedure as with O-TLIF, and additionally LOS and blood loss can be reduced. When comparing parameters, MI-TLIF can be an alternative option for O-TLIF with a similar complication profile. The learning curve of MI-TLIF can be steep, although it depends on the circumstances.


2014 ◽  
Vol 4 (1_suppl) ◽  
pp. s-0034-1376724-s-0034-1376724
Author(s):  
K. Vladimirovich Tyulikov ◽  
K. Korostelev ◽  
V. Manukovsky ◽  
V. Litvinenko ◽  
V. Badalov

Author(s):  
Dr. Rangarajan B. ◽  
Dr. Muralidhara .

Gridhrasi (Sciatica) is a disorder in which low back pain is found, that spreads through the hip, to the back of the thigh and down the inside of the leg. Mechanical low back pain (LBP) remains the second most common symptom related reason for seeing a physician. 85% of total population will experience an episode of mechanical LBP at some point during their lifetime. Fortunately, the LBP resolves for the vast majority within 2-4 weeks. There are many causes for low back pain, however true sciatica is a symptom of inflammation or compression of the sciatica nerve. The sciatica nerve carries impulses between nerve roots in the lower back and the muscles and nerve of the buttocks, thighs and lower legs. Compression of a nerve root often occurs as a result of damage to one of the discs between the vertebrae. In some cases, sciatic pain radiate from other nerves in the body. This is called referred pain. Pain associated with sciatica often is severe, sharp and shooting. It may be accompanied by other symptom, such as numbness, tingling, weakness and sensitivity to touch. There is only conservative treatment giving short term relief in pain or surgical intervention with side effect. But these are not successful and therefore those who are suffering from this are always in search of result oriented remedy. Walking distance and SLR test were taken for assessment parameter, VAS score was adopted for pain. Before treatment patient was not able to walk even 4 to 5 steps due to severe pain, was brought on stretcher and his SLR was 30° of right side. After 22 days of treatment he was able to walk up to 500 meters without any difficulty, SLR was changed to 60° and patient had got 80 % relief in pain. This case report showed that Ayurvedic protocol is potent and safe in the treatment of Gridhrasi.


2017 ◽  
Vol 20 (01) ◽  
pp. 1750005 ◽  
Author(s):  
Ghorbanali Mohammadi

Low back pain (LBP) is one of the most frequent occupational health problems and accounts for a large number of losses in working days and disability for workers in modern industrialized countries. The aim of this paper was to investigate the prevalence of lower back problem and to associate risk factors among high school teachers. A cross-sectional study was conducted among high school teachers using self-administered questionnaires, which were distributed to randomly selected school teachers of 7 boys’ and 10 girls’ high schools across the city of Kerman and collected between October and November 2010. A total of 296 teachers returned completed questionnaires, yielding a response rate of 78.9%. The 12-month prevalence of LBP was 68.8%, which reporting with moderate disability. The results of multiple logistic regression analysis revealed that females [odds ratio (OR): 1.85, 95% confidence interval (CI): 1.51–2.00] were positively correlated to LBP. Awkward arm posture (OR: 1.81, 95% CI: 1.24–2.62) and awkward body posture (OR: 1.23, 95% CI: 0.87–1.49) were significantly associated with LBP. Psychosocial job demands and job dissatisfaction were also significantly associated with LBP. Smoking cigarette was three times more likely to develop lower back pain when compared with non-smokers. The prevalence of LBP was high among high school teachers. A wide variety of LBP risk factors were identified in the current study. The present study indicates that the high prevalence of lower back pain may lose difficulty to teachers in getting to work and “performing” the work required of them, resulting in work absenteeism, which may decrease work productivity.


2021 ◽  
Vol 15 (11) ◽  
pp. 3219-3221
Author(s):  
Maryam Liaquat ◽  
Wajida Perveen ◽  
Danish Hassan ◽  
Misbah Amanat Ali ◽  
Muhammad Akhtar ◽  
...  

Lower back pain is one of the most common problems in adults all over the world, and chances of having back pain increases with the age. Objectives: To determine the effect of tailored motor control rehabilitation versus standard exercise program in chronic nonspecific lower back pain. Study Design: Non randomized clinical study. Methodology: A non randomized clinical study was conducted in six-month during 2018 after ethical approval. 40 patients were enrolled through non-probability purposive sampling technique and allocated into two groups (Group A & B). Informed consent was obtained. Individuals between twenty to forty years with chronic nonspecific low back pain with intensity at least 3 on a 10cm visual analog scale (VAS) were included and individuals with past history of trauma of the spine and hip and with any red flags were excluded. Outcomes were measures by Modified Oswestry Disability Index (MODI) and Visual Analogue Scale (VAS). Statistical analysis: Data was analyzed by SPSS software, version 19 as qualitative variables were expressed as mean ± SD. Independent sample T test was also applied. Results: The mean age Group A was 29.05±8.58 and Group B, was 32.05±6.53 years. The result shows that there was a significant difference in outcomes among tailored motorcontrol rehabilitation (Group A) and standard exercise program (Group B). Conclusion: We concluded that motor control rehabilitation was more effective than standard exercise program in decreasing low back pain and improving quality of life. Key Words: Low Back Pain, Tailored Motor Control Rehabilitation, Standard Exercise Program and Modified Oswastry Disability Index.


2016 ◽  
Author(s):  
Vikram B Patel

Lumbar or lower back pain is a very debilitating condition that affects  almost one fifth of the adult population during a given year. Almost everyone walking on two feet is bound to suffer from some back pain during their lifetime. The health care burden for treating low back pain is enormous, especially if the lost work hours are combined with the amount used in diagnosing and treating low back pain. Lumbar facet (zygapophysial) joints are one of the major components involved in causing lower back pain. Diagnosing the pain generator is more of an art than a science. Combining various parameters in the patient’s history, physical examination, and diagnostic studies is not much different from solving a murder mystery. Although facet joint pain may be accompanied by other pain generators, that is, lumbar intervertebral disks, nerve roots, and vertebral bodies, once treated, the relief in pain is more helpful in performing proper rehabilitation and improving further deterioration in low back pain. Muscles are almost always painful due to myofascial pain syndrome that accompanies the facet joint–related pain. Treating one without addressing the other leads to failure in management and optimization of patient’s pain and function. Several treatments are available for treatment of facet joint–mediated pain, including steroid injections using a miniscule amount and radiofrequency ablation of the nerves supplying the facet joints (medial branches of the dorsal primary ramus of the lumbar nerve root). With proper diagnosis and treatment, a patient’s pain and function can be optimized to a level where it may not impact the day-to-day activities or even resumption of the patient’s routine job function. The following review describes the anatomy, pathophysiology, diagnosis, and treatment of lumbar facet joint–mediated pain.   Key words: facet joint pain, facet joint syndrome, low back pain, medial branch radiofrequency, spondylolisthesis


2021 ◽  
Vol Special issue (3) ◽  
pp. 30-34
Author(s):  
Dilrabo Jalilovna Khalimova ◽  

In the polyclinics of the city of Bukhara and the Bukhara region, in the polyclinics of the city of Navoi and the Navoi region of the Republic of Uzbekistan, in the period for 2019, they were selectively interviewed using a questionnaire developed in the Bukhara Medical Institute of the Republic of Uzbekistan to determine the characteristics of LBP (for a patient). According to a survey on this questionnaire, specific characteristics of LBP were identified in patients living in urban and rural conditions


2021 ◽  
Vol 9 (11) ◽  
pp. 2909-2913
Author(s):  
Kavita Kavita ◽  
Suresh N Hakkandi ◽  
Manjunath Akki

Lower Back Pain can have causes that aren’t due to underlying diseases and this pain refers to the pain that usual- ly begins in the lower back region, radiating to the sacroiliac regions and buttocks.[1] People with chronic pain often find it difficult to cope with work, family and social activities which is the significant cause of disability worldwide. Eighty percent of the population is affected by this symptom sometimes in life.[2] Increased preva- lence of low back pain and temporary and reduced success rates in invasive contemporary treatment measures has drawn considerable attention towards alternative, effective, non-invasive treatment modalities. Katishoola, a Vata vyadhi diagnosed with cardinal symptoms as Pain in Kati Pradesha. In Ayurveda, a holistic approach has been adopted that includes the use of oral Ayurvedic formulations, Panchakarma procedures like Snehana karma (unc- tion therapy), Swedana karma (sudation therapy) etc. [3] Here In this article a case of low Back Pain treated with Kati Pichu with Masha taila with good outcomes are reported. Keywords: Katishoola, Low Back Pain, Masha Taila, Kati Pichu


2021 ◽  
Vol 13 (3) ◽  
pp. 107-112
Author(s):  
V. A. Golovacheva ◽  
A. A. Golovacheva ◽  
T. G. Fateyeva

Low back pain (LBP) is one of the most common reasons for a neurologist visit. In 90–95% of cases, LBP is nonspecific (musculoskeletal). The diagnosis of nonspecific LBP based on symptoms, somatic and neurological examination data, the absence of «red flags» (symptoms and signs characteristic of specific causes of back pain, discogenic radiculopathy, or lumbar stenosis). We review the modern principles of acute, subacute, and chronic nonspecific LBP treatment. We also discuss interventional and non-interventional treatment approaches, emphasizing the importance of combination therapy and an interdisciplinary approach.


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