scholarly journals Individual Lordotic Cages Implantation and Radiographic Evaluation of Segmental and Lumbar Lordosis Correction for Patients with Adult Degenerative Scoliosis

2020 ◽  
Vol 26 (2) ◽  
pp. 71-78
Author(s):  
A. A. Denisov ◽  
D. A. Ptashnikov ◽  
D. A. Mikhaylov ◽  
S. V. Masevnin ◽  
O. A. Smekalenkov ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Fusion ◽  
Lumbar Lordosis ◽  
Radiographic Evaluation ◽  
Posterior Fixation ◽  
Degenerative Scoliosis ◽  
Custom Made ◽  
Intergroup Comparison ◽  
Significant Difference ◽  
Indirect Decompression

Relevance. The development of minimally invasive surgery has led to the development of new methods for surgical treatment of the spine. Conventional surgical technique, such as vertebrotomy is accompanied by a several number of disadvantages (high blood loss, prolonged hospital stay, long intraoperative time, postoperative neurological deficit). An alternative to improve sagittal balance in the spine is to use custom-made hyperlordotic cages, which can also be used for indirect decompression of neural structures. The objective is to compare the degree of segmental and total lumbar lordosis using hyperlordotic cages through ALIF and TLIF with posterior instrumentation.Materials and Methods. A single-center retrospective cohort study using 96 patients treated from 2018 to 2019 about degenerative spinal deformities. Comparison of two groups: group 1 (A) consisted of 30 patients who were held anterior spinal fusion with individual lordotic cages from minimally invasive anterior approach (MISS ALIF) without posterior fixation. Group 2 (B) consisted of 33 patients whom were performed spinal fusion from the posterior approach (TLIF) with Smith-Peterson Osteotomy (SPO) and transpedicular fixation. Measuring segmental and lumbar lordosis, teleradiographs were used in a standing position. For an accurate assessment, the non-commercial available Surgimap software, © Nemaris, was used.Results. Segmental lordosis were superior to preoperative ones. In the intergroup comparison, the ALIF group showed an excellent increase in the enlarged lordosis segment (L3-L4 in 8 degrees; p = 0.0005, L4-L5 in 7 degrees; p = 0.0002, L5-S1 in 7 degrees; p = 0.0001). When conducting an intergroup comparison of total lumbar lordosis in the preoperative period, there was a statistically significant difference between them (p = 0.0043). At the same time, a greater degree of correction of lordosis is shown in ALIF compared to TLIF group (29,1 in comparison with 22,5; p = 0.00005).Conclusion. The results of this study confirm that the using of custom-made lordotic cages can significantly increase segmental and total lumbar lordosis for patients with degenerative scoliosis in adults.

scholarly journals Minimally invasive lateral approach for adult degenerative scoliosis: lessons learned

2013 ◽  
Vol 35 (2) ◽  
pp. E4 ◽  
Author(s):  
Armen R. Deukmedjian ◽  
Amir Ahmadian ◽  
Konrad Bach ◽  
Alexandros Zouzias ◽  
Juan S. Uribe
Keyword(s):  
Minimally Invasive ◽  
Cobb Angle ◽  
Clinical Outcomes ◽  
Lumbar Lordosis ◽  
Traditional Approach ◽  
Lateral Approach ◽  
Lessons Learned ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
Scoliosis Correction

Object Lateral minimally invasive thoracolumbar instrumentation techniques are playing an increasing role in the treatment of adult degenerative scoliosis. However, there is a paucity of data in determining the ideal candidate for a lateral versus a traditional approach, and versus a hybrid construct. The objective of this study is to present a method for utilizing the lateral minimally invasive surgery (MIS) approach for adult spinal deformity, provide clinical outcomes to validate our experience, and determine the limitations of lateral MIS for adult degenerative scoliosis correction. Methods Radiographic and clinical data were collected for patients who underwent surgical correction of adult degenerative scoliosis between 2007 and 2012. Patients were retrospectively classified by degree of deformity based on coronal Cobb angle, central sacral vertical line (CSVL), pelvic incidence, lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), presence of comorbidities, bone quality, and curve flexibility. Patients were placed into 1 of 3 groups according to the severity of deformity: “green” (mild), “yellow” (moderate), and “red” (severe). Clinical outcomes were determined by a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results Of 256 patients with adult degenerative scoliosis, 174 underwent a variant of the lateral approach. Of these 174 patients, 27 fit the strict inclusion/exclusion criteria (n = 9 in each of the 3 groups). Surgery in 17 patients was dictated by their category, and 10 were treated with surgery outside of their classification. The average age was 61 years old and the mean follow-up duration was 17 months. The green and yellow groups experienced a reduction in coronal Cobb angle (12° and 11°, respectively), and slight changes in CSVL, SVA, and PT, and LL. In the green group, the VAS and ODI improved by 35 and 17 points, respectively, while in the yellow group they improved by 36 and 33 points, respectively. The red subgroup showed a 22° decrease in coronal Cobb angle, 15° increase in LL, and slight changes in PT and SVA. Three patients placed in the yellow subgroup had “green” surgery, and experienced a coronal Cobb angle and LL decrease by 17° and 10°, respectively, and an SVA and PT increase by 1.3 cm and 5°, respectively. Seven patients placed in the red group who underwent “yellow” or “green” surgery had a reduction in coronal Cobb angle of 16°, CSVL of 0.1 cm, SVA of 2.8 cm, PT of 4°, VAS of 28 points, and ODI of 12 points; lumbar lordosis increased by 15°. Perioperative complications included 1 wound infection, transient postoperative thigh numbness in 2 cases, and transient groin pain in 1 patient. Conclusions Careful patient selection is important for the application of lateral minimally invasive techniques for adult degenerative scoliosis. Isolated lateral interbody fusion with or without instrumentation is suitable for patients with preserved spinopelvic harmony. Moderate sagittal deformity (compensated with pelvic retroversion) may be addressed with advanced derivatives of the lateral approach, such as releasing the anterior longitudinal ligament. For patients with severe deformity, the lateral approach may be used for anterior column support and to augment arthrodesis.

Anterior Longitudinal Ligament Release From the Minimally Invasive Lateral Retroperitoneal Transpsoas Approach: Technical Note

2016 ◽  
Vol 12 (3) ◽  
pp. 214-221 ◽  
Author(s):  
Joshua M Beckman ◽  
Nicola Marengo ◽  
Gisela Murray ◽  
Konrad Bach ◽  
Juan S Uribe
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Vascular Complications ◽  
Deformity Correction ◽  
Anterior Longitudinal Ligament ◽  
Global Improvement ◽  
Transpsoas Approach ◽  
Indirect Decompression

Abstract BACKGROUND The technique for minimally invasive anterior longitudinal ligament release is a major advancement in lateral access surgery. This method provides hypermobility of lumbar segments to allow for aggressive lordosis restoration while maintaining the benefits of indirect decompression and minimally invasive access. OBJECTIVE To provide video demonstration of the lateral retroperitoneal transpsoas approach with anterior longitudinal ligament sectioning. METHODS A detailed surgical technique of the minimally invasive anterior column release is described and illustrated in an elderly patient with adult spinal deformity and low back pain (visual analog scale, 8 of 10) refractory to conservative measures. The 3-foot standing radiographs demonstrated a lumbar lordosis of 54.4°, pelvic incidence of 63.7°, and pelvic tilt of 17.5°. Computed tomography and magnetic resonance imaging showed generalized lumbar spondylosis and degenerative disc changes from L2 to L5. RESULTS The patient underwent a multilevel minimally invasive deformity correction with an anterior longitudinal ligament release at the L3/L4 level through the lateral retroperitoneal transpsoas approach. Lumbar lordosis increased from 54.4° to 77° with a global improvement in sagittal vertical axis from 4.37 cm to 0 cm. Total blood loss was less than 25 mL, and there were no major neurological or vascular complications. CONCLUSION The anterior longitudinal ligament release using the minimally invasive lateral approach allows for deformity correction without the morbidity and blood loss encountered by traditional open posterior approaches. However, the risk of major vascular/visceral complication warrants only experts in minimally invasive lateral surgery to attempt this technique.

scholarly journals Minimally invasive transforaminal lumbosacral interbody fusion

2016 ◽  
Vol 41 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
Peng-Yuan Chang ◽  
Michael Y. Wang
Keyword(s):  
Minimally Invasive ◽  
Spinal Fusion ◽  
Interbody Fusion ◽  
Standard Approach ◽  
Neural Structure ◽  
Fusion Surgery ◽  
Plain Radiographs ◽  
Spinal Fusion Surgery ◽  
Indirect Decompression ◽  
Single Approach

In minimally invasive spinal fusion surgery, transforaminal lumbar (sacral) interbody fusion (TLIF) is one of the most common procedures that provides both anterior and posterior column support without retraction or violation to the neural structure. Direct and indirect decompression can be done through this single approach. Preoperative plain radiographs and MR scan should be carefully evaluated. This video demonstrates a standard approach for how to perform a minimally invasive transforaminal lumbosacral interbody fusion.The video can be found here: https://youtu.be/bhEeafKJ370.

scholarly journals Minimally Invasive Interlaminar Decompression with a 10-mm Endoscope and Microscope in Cases of Adult Degenerative Scoliosis

2021 ◽  
Vol 24 (6) ◽  
pp. E867-E875
Keyword(s):  
Minimally Invasive ◽  
De Novo ◽  
Leg Pain ◽  
Lumbar Stenosis ◽  
Degenerative Scoliosis ◽  
Invasive Treatment ◽  
Japanese Orthopedic Association ◽  
Adult Degenerative Scoliosis ◽  
Significant Difference ◽  
The Mean

BACKGROUND: Adult degenerative (de novo) scoliosis (ADS) usually occurs due to degenerative changes and is accompanied by progressive low-back pain and/or symptomatic lumbar stenosis. Interlaminar decompression is considered an effective treatment of lumbar stenosis, but some surgical contraindications to traditional open surgery limit its application in elderly patients with many disorders. A 10-mm endoscope has been used in the treatment of stenosis in individuals with ADS and its safety and efficacy should be assessed. OBJECTIVE: The objective was to conduct a retrospective analysis to compare interlaminar decompression with a 10-mm endoscope versus a microscope. STUDY DESIGN: Retrospective study. SETTING: This study took place at the First Affiliated Hospital of Harbin Medical University. METHODS: The data of 34 ADS patients treated in our hospital from January 2018 to December 2019, who underwent decompression with a 10-mm endoscope (ES group, 19 patients) or microscope (MS group, 15 patients) were retrospectively reviewed. The two methods were compared using the visual analog scale (VAS), Japanese orthopedic association (JOA) scale, and Oswestry disability index (ODI). Lumbar stability was also evaluated by the progression of scoliosis. RESULTS: There were no significant differences between the 2 groups in demographic or clinical characteristics. The mean preoperative Cobb angle of all patients was 23.34° ± 6.44°, which indicated degenerative scoliosis. The mean JOA and ODI scores were 8.09 ± 1.44 and 55.47 ± 11.91. The mean preoperative pelvic incidence (PI) and lumbar lordosis (LL) angles were 51.02° ± 7.21 and 38.26° ± 6.98 and the mean PI-LL mismatch was 12.76° ± 5.63. There was no significant difference in the VAS scores for back/leg pain between the groups at 1 week after the operation, but the scores of the ES group were significantly higher than those of the MS group at 3 months and 12 months. There were no significant differences of mean JOA and ODI between the ES and MS groups preoperatively, at 3 months, or at 12 months, but the JOA and ODI scores of the ES group were significantly higher than those of the MS group 1 week after the operation. LIMITATIONS: The study showed that a novel method for the minimally invasive treatment of ADS is feasible; the safety and outcomes of this method should be verified with more cases. CONCLUSIONS: Minimally invasive decompression with a 10-mm endoscope was suggested to be a safe and effective method, as expected, for the treatment of lumbar stenosis in ADS patients. KEY WORDS: Adult degenerative scoliosis, endoscope, lumbar stability, microscopic decompression, minimally invasive

Feasibility of a custom made retrieval modification in minimally invasive transapical aortic valve implantation

2010 ◽  
Vol 58 (S 01) ◽  
Author(s):  
J Blumenstein ◽  
J Kempfert ◽  
S Lehmann ◽  
A van Linden ◽  
D Merk ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Minimally Invasive ◽  
Custom Made ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Comparison of the Effects of Fenugreek Vaginal Cream and Ultra Low- Dose Estrogen on Atrophic Vaginitis

2020 ◽  
Vol 17 (9) ◽  
pp. 815-822
Author(s):  
Maryam Safary ◽  
Sevil Hakimi ◽  
Noushin Mobaraki-Asl ◽  
Paria Amiri ◽  
Habib Tvassoli ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Low Dose ◽  
Intervention Group ◽  
Clinical Signs ◽  
Control Group ◽  
Conjugated Estrogens ◽  
Atrophic Vaginitis ◽  
Vaginal Cream ◽  
Intergroup Comparison ◽  
Significant Difference

Introduction: Atrophic vaginitis is a common problem in postmenopausal women and results from decreased levels of blood estrogen. It is associated with symptoms of itching, burning, dyspareunia, and postmenopausal bleeding. The present study evaluated the effects of fenugreek extract on atrophic vaginitis. Materials and Methods: This randomized controlled clinical trial was performed on 60 postmenopausal women in Ardabil, Iran, in 2018. The participants were selected using block randomization with the allocation ratio 1:1. Those in the intervention group received 0.5g (the applicator filled to the half-full mark) fenugreek vaginal cream 5% twice a week for 12 weeks. The control group received conjugated estrogens vaginal cream at the dose of 0.625 mg (the applicator filled to the half-full mark) containing 0.3 mg of conjugated estrogens. Atrophic vaginitis was evaluated before and after the treatment through clinical examination, clinical signs, and measurement of Vaginal Maturation Index (VMI). Findings: After the 12-week intervention and modification of the baseline score, the mean (standard error) score for atrophic vaginitis signs was 3.100 (1.43-4.75). This difference was statistically significant in intragroup comparison and in favor of the control group in intergroup comparison (p=0.001). VMI was less than 49% in 86.7% and 46.7% of the participants in the intervention and control groups, respectively. This was a significant difference in favor of the control group (p=0.001). Conclusion: The results of this study showed that total fenugreek extract could be effective in treating signs of atrophic vaginitis, but it was not as effective as ultra-low-dose estrogen.

scholarly journals Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mohamed I. Refaat ◽  
Amr K. Elsamman ◽  
Adham Rabea ◽  
Mohamed I. A. Hewaidy
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Decompression Surgery ◽  
Microsurgical Decompression ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

scholarly journals Clinical effect of minimally invasive surgery for inguinal cryptorchidism

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yunjin Wang ◽  
Liu Chen ◽  
Xu Cui ◽  
Chaoming Zhou ◽  
Qing Zhou ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Clinical Effect ◽  
Testicular Atrophy ◽  
Surgery Group ◽  
Significant Difference ◽  
Good Cosmetic ◽  
Scrotal Hematoma

Abstract Background The purpose of this study was to investigate the clinical effect of minimally invasive surgery for inguinal cryptorchidism. Methods The patients were divided into the minimally invasive surgery group (n = 100) and the traditional surgery group (n = 58). In the minimally invasive surgery group, patients with low inguinal cryptorchidism (n = 54) underwent surgery with a transscrotal incision, and patients with high inguinal cryptorchidism (n = 46) underwent laparoscopic surgery. Results There was no difference in the hospital stay duration or cost between the minimally invasive surgery group and the traditional surgery group (P > 0.05). As for the operative time, minimally invasive surgery of low inguinal cryptorchidism was shorter than traditional surgery (P = 0.033), while minimally invasive surgery of high inguinal cryptorchidism was comparable to traditional surgery (P = 0.658). Additionally, there were no cases of testicular atrophy, testicular retraction, inguinal hernia or hydrocele in either group. There was no significant difference in the incidence of poor wound healing between the two groups (P > 0.05). Although there was no significant difference in the incidence of scrotal hematoma between the two groups (P > 0.05), the incidence in the minimally invasive surgery group was higher than that in the traditional surgery group. Conclusions Minimally invasive surgery including a transscrotal incision for low inguinal cryptorchidism and laparoscopic surgery for high inguinal cryptorchidism is as safe and effective as traditional surgery, and could also provide a good cosmetic effect for children.

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