scholarly journals Semi-rigid lumbar spine fixation with PEEK rods as a treatment option for mono-segmental degenerative disk disease

2020 ◽  
pp. 15
Author(s):  
Keyword(s):  
Back Pain ◽  
Invasive Procedure ◽  
Observation Time ◽  
Adjacent Segment ◽  
Rigid Fixation ◽  
Segmental Motion ◽  
Related Complication ◽  
Disc Disease ◽  
Peek Rods

Long lasting back pain due to degenerative disc disease is one of the major reasons for reduced quality of life and work incapacity. In some of these patients conservative treatment will not improve back pain significantly. Therefore fusion surgery as a surgical option is offered to these patients. The main aim of this kind of treatment is the reduction of segmental motion leading to an improvement in pain. Rigid fixation leads to high fusion rates but may also contribute to stress shielding and adjacent segment degeneration. Therefore a semi-rigid stabilization with PEEK rods may be an option because it is associated with less implant related rigidity and is a less invasive procedure. The aim of this retrospective study was to evaluate the improvement in back pain after minimally invasive semi-rigid lumbar stabilization with screws and PEEK rods in 45 patients and to identify potential implant failures during a follow up of two years. Six weeks after surgery the patients showed a significant improvement in their back pain, which persisted during the whole observation time of two years (p<0.01). All patients who were still in working life returned to their jobs without extended work incapacity. No implant related complication associated with the surgical procedure was detected. During the follow up time of two years no implant failure was observed.

Early development and progression of heterotopic ossification in cervical total disc replacement

2012 ◽  
Vol 16 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Soo Eon Lee ◽  
Chun Kee Chung ◽  
Tae Ahn Jahng
Keyword(s):  
Clinical Outcome ◽  
Heterotopic Ossification ◽  
Total Disc Replacement ◽  
Disc Replacement ◽  
Adjacent Segment ◽  
Segmental Motion ◽  
Cervical Total Disc Replacement ◽  
The Mean ◽  
Grade Iii

Object The purpose of cervical total disc replacement (TDR) is to decrease the incidence of adjacent segment disease through motion preservation. Heterotopic ossification (HO) is a well-known complication after hip and knee arthroplasties. There are few reports regarding HO in patients undergoing cervical TDR, however; and the occurrence of HO and its effects on cervical motion have rarely been reported. Moreover, temporal progression of HO has not been fully addressed. One goal of this study involved determining the incidence of HO following cervical TDR, as identified from plain radiographs, and demonstrating the progression of HO during the follow-up period. A second goal consisted of determining whether segmental motion could be preserved and identifying the relationship between HO and clinical outcomes. Methods The authors conducted a retrospective clinical and radiological study of 28 consecutive patients who underwent cervical TDR with Mobi-C prostheses (LDR Medical) between September 2006 and October 2008. Radiological outcomes were evaluated using lateral dynamic radiographs obtained preoperatively and at 1, 3, 6, 12, and 24 months postoperatively. The occurrence of HO was interpreted on lateral radiographs using the McAfee classification. Cervical range of motion (ROM) was also measured. The visual analog scale (VAS) and Neck Disability Index (NDI) were used to evaluate clinical outcome. Results The mean follow-up period was 21.6 ± 7.0 months, and the mean occurrence of HO was at 8.0 ± 6.6 months postoperatively. At the last follow-up, 18 (64.3%) of 28 patients had HO: Grade I, 6 patients; Grade II, 8 patients; Grade III, 3 patients; and Grade IV, 1 patient. Heterotopic ossification progression was proportional to the duration of follow-up; HO was present in 3 (10.7%) of 28 patients at 1 month; 7 (25.0%) of 28 patients at 3 months; 11 (42.3%) of 26 patients at 6 months; 15 (62.5%) of 24 patients at 12 months; and 17 (77.3%) of 22 patients at 24 months. Cervical ROM was preserved in Grades I and II HO but was restricted in Grades III and IV HO. Clinical improvement according to the VAS and NDI was not significantly correlated with the occurrence of HO. Conclusions The overall incidence of HO after cervical TDR was relatively high. Moreover, HO began unexpectedly to appear early after surgery. Heterotopic ossification progression was proportional to the time that had elapsed postoperatively. Grade III or IV HO can restrict the cervical ROM and may lead to spontaneous fusion; however, the occurrence of HO did not affect clinical outcome. The results of this study indicate that a high incidence of HO with the possibility of spontaneous fusion is to be expected during long-term follow-up and should be considered before performing cervical TDR.

Lumbar Spine Capsule Strain After Total Disc Replacement

2010 ◽  
Author(s):  
Tomoyuki Takigawa ◽  
Alejandro A. Espinoza Orías ◽  
Howard S. An ◽  
Peter Simon ◽  
Keizo Sugisaki ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Facet Joint ◽  
Total Disc Replacement ◽  
Clinical Results ◽  
Disc Replacement ◽  
Segmental Motion ◽  
Low Back ◽  
Disc Disease ◽  
Poor Outcomes

Degenerative disc disease is a common cause for low back pain, and sometimes requires surgical treatment. Total disc replacement (TDR) is one such surgical option performed to remove the painful disc and preserve segmental motion. However, TDR clinical results are not always satisfactory. Altered kinematics and residual low back pain have been reported as frequent poor outcomes. The facet joint is a pure articular joint and can be a pain generator. Although the effect of TDR on ROMs (ranges of motion) and facet contact force is relatively well studied, the influence of TDR on facet capsules has not been clarified yet. The purpose of this study was to evaluate the effect of TDR on facet joint capsule strain.

scholarly journals Retrospective Review of Procedural Parameters and Outcomes of Percutaneous Vertebroplasty in 673 Patients

2014 ◽  
Vol 20 (5) ◽  
pp. 564-575 ◽  
Author(s):  
Benny S. Kim ◽  
Barbara Hum ◽  
Jung Cheol Park ◽  
In Sup Choi
Keyword(s):  
Back Pain ◽  
Percutaneous Vertebroplasty ◽  
Lumbar Vertebrae ◽  
Invasive Procedure ◽  
Vertebral Compression Fractures ◽  
Thoracic Vertebrae ◽  
Pain Outcomes ◽  
Pain Outcome ◽  
Cement Extravasation

Percutaneous vertebroplasty (PVP) is a minimally invasive procedure to treat back pain secondary to osteoporotic vertebral compression fractures (VCF). This study aims to review our techniques and outcomes in patients with VCF. Outcomes of all patients who underwent PVP at our institution from 1998 to 2014 were retrospectively collected from medical records and follow-up telephone interviews. 1174 PVP procedures for VCF in 673 patients were identified to have complete follow-up data. Patients with inadequate data were excluded from the analysis. Procedural aspects such as unipedicular or bipedicular access, vertebral region treated, amount of cement injected into vertebrae, number of levels treated at a single session, refracture rates and location, presence of a necrotic cavity, and pain outcomes were examined. Excellent rates of improvement of back pain for both single level and multilevel PVP were achieved in 92% of patients. Unipedicular or bipedicular approach, cement volume, vertebral region treated, cement extravasation, and presence of a necrotic cavity did not affect pain outcomes or refracture rates. Fractures that did develop after PVP were often adjacent and occurred earlier than distant level fractures. Lumbar vertebrae required more cement than thoracic vertebrae. PVP provides excellent rates of pain relief in both single and multilevel procedures. The procedural aspects evaluated did not affect pain outcome or refracture rates. Adjacent refractures tended to occur sooner than distant ones.

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.

scholarly journals Hybrid surgery with PEEK rods for lumbar degenerative diseases: a 2-year follow-up study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Yao Zhao ◽  
Beiyu Xu ◽  
Longtao Qi ◽  
Chunde Li ◽  
Lei Yue ◽  
...  
Keyword(s):  
Lumbar Disc ◽  
Clinical Results ◽  
Adjacent Segment ◽  
Degenerative Diseases ◽  
Hybrid Surgery ◽  
X Ray ◽  
Vas Score ◽  
Peek Rods ◽  
Lumbar Degenerative Diseases

Abstract Background Finite element analyses and biomechanical tests have shown that PEEK rods promote fusion and prevent adjacent segment degeneration. The purpose of this study was to evaluate the effects and complications of hybrid surgery with PEEK rods in lumbar degenerative diseases. Methods From January 2015-December 2017, 28 patients who underwent lumbar posterior hybrid surgery with PEEK rods were included in the study. The patients were diagnosed with lumbar disc herniation, lumbar spinal stenosis, or degenerative grade I spondylolisthesis. Before the operation and at the last follow-up, the patients completed lumbar anteroposterior and lateral X-ray, dynamic X-ray, MRI examinations. In addition, at the last follow-up the patients also completed lumbar CT examinations. The radiographic parameters, clinical visual analog scale (VAS) score and Oswestry disability index (ODI) score were compared. Results The average age of the patients was 44.8 ± 12.6 years, and the average follow-up duration was 26.4 ± 3.6 months. The VAS score improved from 6.3 ± 1.6 to 1.0 ± 0.9, and the ODI score decreased from 38.4 ± 10.8 to 6.8 ± 4.6. The fusion rate of the fused segment was 100%. There were no significant changes in the modified Pfirrmann classifications or disc height index for the nonfused segments and the upper adjacent segments from pre- to postoperatively. No cases of screw loosening, broken screws, broken rods or other mechanical complications were found. Conclusion Hybrid surgery with PEEK rods for lumbar degenerative diseases can yield good clinical results and effectively reduce the incidence of complications such as adjacent segment diseases.

A Computational Biomechanical Investigation of Posterior Dynamic Instrumentation: Combination of Dynamic Rod and Hinged (Dynamic) Screw

2014 ◽  
Vol 136 (5) ◽  
Author(s):  
Deniz U. Erbulut ◽  
Ali Kiapour ◽  
Tunc Oktenoglu ◽  
Ali F. Ozer ◽  
Vijay K. Goel
Keyword(s):  
Peak Stress ◽  
Adjacent Segment Degeneration ◽  
Dynamic Stabilization ◽  
Adjacent Segment ◽  
Fe Model ◽  
Rigid Fixation ◽  
Segmental Motion ◽  
Rigid Rod ◽  
Adjacent Segments

Currently, rigid fixation systems are the gold standard for degenerative disk disease treatment. Dynamic fixation systems have been proposed as alternatives for the treatment of a variety of spinal disorders. These systems address the main drawbacks of traditional rigid fixation systems, such as adjacent segment degeneration and instrumentation failure. Pedicle-screw-based dynamic stabilization (PDS) is one type of these alternative systems. The aim of this study was to simulate the biomechanical effect of a novel posterior dynamic stabilization system, which is comprised of dynamic (hinged) screws interconnected with a coiled, spring-based dynamic rod (DSDR), and compare it to semirigid (DSRR and RSRR) and rigid stabilization (RSRR) systems. A validated finite element (FE) model of L1-S1 was used to quantify the biomechanical parameters of the spine, such as range of motion, intradiskal pressure, stresses and facet loads after single-level instrumentation with different posterior stabilization systems. The results obtained from in vitro experimental intact and instrumented spines were used to validate the FE model, and the validated model was then used to compare the biomechanical effects of different fixation and stabilization constructs with intact under a hybrid loading protocol. The segmental motion at L4–L5 increased by 9.5% and 16.3% in flexion and left rotation, respectively, in DSDR with respect to the intact spine, whereas it was reduced by 6.4% and 10.9% in extension and left-bending loads, respectively. After instrumentation-induced intradiskal pressure at adjacent segments, L3-L4 and L5-S1 became less than the intact in dynamic rod constructs (DSDR and RSDR) except in the RSDR model in extension where the motion was higher than intact by 9.7% at L3-L4 and 11.3% at L5-S1. The facet loads were insignificant, not exceeding 12N in any of the instrumented cases in flexion. In extension, the facet load in DSDR case was similar to that in intact spine. The dynamic rod constructions (DSDR and RSDR) led to a lesser peak stress at screws compared with rigid rod constructions (DSRR and RSRR) in all loading cases. A dynamic construct consisting of a dynamic rod and a dynamic screw did protect the adjacent level from excessive motion.

scholarly journals One decade follow up after nucleoplasty in the management of degenerative disc disease causing low back pain and radiculopathy

2015 ◽  
Vol 10 (1) ◽  
pp. 21 ◽  
Author(s):  
Amit Agrawal ◽  
Rafael Cincu ◽  
Francisco Lorente ◽  
Joaquin Gomez ◽  
Jose Eiras
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Degenerative Disc Disease ◽  
Low Back ◽  
Disc Disease ◽  
Degenerative Disc

scholarly journals Five-Level Unilateral Laminectomy Bilateral Decompression (ULBD) by Two-Stage Unilateral Biportal Endoscopy (UBE)

2021 ◽  
Author(s):  
Wenlong Wang ◽  
Zheng Liu
Keyword(s):  
Back Pain ◽  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Fusion ◽  
Invasive Procedure ◽  
Rigid Fixation ◽  
Minimally Invasive Procedure ◽  
Two Stage ◽  
Lumbar Spinal

Abstract Background Unilateral biportal endoscopy (UBE) is a relatively new yet common minimally invasive procedure in spine surgery, capable of achieving adequate decompression for lumbar spinal stenosis through unilateral laminectomy bilateral decompression (ULBD). Neither additional fusion nor rigid fixation is required, as UBE-ULBD rarely causes iatrogenic lumbar instability. However, to our knowledge, five-level ULBD via two-stage UBE without lumbar fusion has been yet to be reported in the treatment of multilevel lumbar spinal stenosis.Case description We present a case of an 80-year-old female patient who developed progressive paralysis of the lower extremities. Radiographic examinations showed multilevel degenerative lumbar spinal stenosis and extensive compression of the dural sac and nerve roots from L1-2 to L5-S1. The patient underwent five-level ULBD through two-stage UBE without lumbar fusion or fixation. One week after the final procedure, the patient could ambulate with walking aids and braces. Moreover, no back pain or limited lumbar motion was observed at the 6-month follow-up.Conclusions Multilevel ULBD through UBE may provide elderly patients with an alternative, minimally invasive procedure for treating spinal stenosis. This procedure could be achieved by staging surgeries. In this case, we reported complaints of little back pain, despite not needing to perform lumbar fusion or fixation.

Direct surgical repair of spondylolysis in athletes: indications, techniques, and outcomes

2011 ◽  
Vol 31 (5) ◽  
pp. E9 ◽  
Author(s):  
Doniel Drazin ◽  
Ali Shirzadi ◽  
Sunil Jeswani ◽  
Harry Ching ◽  
Jack Rosner ◽  
...  
Keyword(s):  
Back Pain ◽  
Surgical Techniques ◽  
Young Athlete ◽  
Axial Loading ◽  
Fracture Repair ◽  
Common Symptom ◽  
Disc Disease ◽  
Number Of Patients ◽  
Few Data

Object Athletes present with back pain as a common symptom. Various sports involve repetitive hyperextension of the spine along with axial loading and appear to predispose athletes to the spinal pathology spondylolysis. Many athletes with acute back pain require nonsurgical treatment methods; however, persistent recurrent back pain may indicate degenerative disc disease or spondylolysis. Young athletes have a greater incidence of spondylolysis. Surgical solutions are many, and yet there are relatively few data in the literature on both the techniques and outcomes of spondylolytic repair in athletes. In this study, the authors undertook a review of the surgical techniques and outcomes in the treatment of symptomatic spondylolysis in athletes. Methods A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 1950 and 2011: “spondylolysis,” “pars fracture,” “repair,” “athlete,” and/or “sport.” Papers on both athletes and nonathletes were included in the review. Articles were read for data on methodology (retrospective vs prospective), type of treatment, number of patients, mean patient age, and mean follow-up. Results Eighteen articles were included in the review. Eighty-four athletes and 279 nonathletes with a mean age of 20 and 21 years, respectively, composed the population under review. Most of the fractures occurred at L-5 in both patient groups, specifically 96% and 92%, respectively. The average follow-up period was 26 months for athletes and 86 months for nonathletes. According to the modified Henderson criteria, 84% (71 of 84) of the athletes returned to their sports activities. The time intervals until their return ranged from 5 to 12 months. Conclusions For a young athlete with a symptomatic pars defect, any of the described techniques of repair would probably produce acceptable results. An appropriate preoperative workup is important. The ideal candidate is younger than 20 years with minimal or no listhesis and no degenerative changes of the disc. Limited participation in sports can be expected from 5 to 12 months postoperatively.

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