Nonfusion stabilization of the degenerative lumbar spine

2011 ◽  
Vol 15 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Alberto Maleci ◽  
Rafael Donatus Sambale ◽  
Michele Schiavone ◽  
Franz Lamp ◽  
Fahir Özer ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Donor Site ◽  
Visual Analog Scale Score ◽  
Clinical Results ◽  
Degenerative Disease ◽  
Operative Trauma ◽  
Implant Complications ◽  
Rod System ◽  
Adjacent Disc

Object The goal of this study was to assess whether a stable but nonrigid nonfusion implant can stabilize the spine in degenerative diseases and also prevent instability following decompression. Instrumented spondylodesis is a recognized surgical treatment in degenerative disease of the lumbar spine. However, pain can develop at the bone graft donor site and the operative trauma can be very stressful in elderly patients, and it is suspected that there may be increased degenerative changes in the adjacent segments. In 2002, a nonrigid but rotationally stable pedicle screw and rod system was introduced, which could be used without additional fusion (referred to hereafter as the Cosmic system). Methods A total of 139 patients with degenerative disease of the lumbar spine underwent spinal stabilization with the Cosmic system without additional spondylodesis. Seventy patients had an additional decompression. The minimum follow-up was 2 years. The perioperative course, the clinical results, and the erect anteroposterior and lateral radiographs were recorded and compared with the preoperative data. The data were obtained from 6 different spine centers in Europe and documented on an Internet platform. Results The Oswestry Disability Index score improved from 48.9% to 22.5%, and the visual analog scale score decreased from 7.3 to 2.5. Lumbar lordosis did not change, nor did the adjacent disc height. Eleven patients underwent revision, 4 of them for implant failure. Of the 139 patients, 110 assessed the result as excellent, very good, or good; 24 as fair; and 5 as poor. A total of 122 patients would undergo surgery again. There were no significant differences between patients with or without an additional decompression. Conclusions The Cosmic system is a stable but nonrigid posterior nonfusion system. Implant complications are low and the clinical outcome is good. Longer follow-up is necessary to confirm the 2-year results.

Structural Manubrium Autograft in Cervical Fusion for Patients With Cervical Tuberculosis: A Preliminary Study

2020 ◽  
Author(s):  
Shuang Xu ◽  
QING WANG ◽  
YI LING XIONG ◽  
GAOJU WANG ◽  
JIN YANG ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Posterior Instrumentation ◽  
Donor Site ◽  
Spinal Tuberculosis ◽  
Visual Analog Scale Score ◽  
Cervical Fusion ◽  
Radiographic Findings ◽  
Neurological Outcomes ◽  
Spine Tuberculosis

Abstract Background The purpose of this study was to evaluate the efficacy and safety of structural manubrium autografts in the surgical treatment of cervical spinal tuberculosis.Methods From January 2015 and December 2018, 10 patients with lower cervical spine tuberculosis (C4-C7) underwent anterior debridement, interbody fusion with structural manubrium autograft, and anterior or posterior instrumentation. The medical records and radiographic findings of the patients were reviewed.Results The surgery duration was 198.5 min and blood loss was 355.0 mL. The average preoperative kyphosis angle was 16.3 ± 8.2° and returned to -2.1 ± 2.8° two weeks postoperatively (P < 0.05 ), reaching -1.4 ± 2.5° at final follow-up (P < 0.05 vs. preoperative). The average preoperative visual analog scale score of neck pain was 4.1 ± 1.1, which decreased to 1.5 ± 0.8 one week after the surgery (P < 0.05 ) and to 0.7 ± 0.5 at final follow-up. The ESR and CRP gradually decreased postoperatively, becoming normal at final follow-up. Bony fusion was achieved in all patients by 6 months after surgery. Neurological outcomes were improved by 1–2 grades in most patients. There were no postoperative complications associated with the donor site, and there was no recurrence of tuberculosis in any patient.Conclusion Structural bone obtained from the manubrium is safe, providing a viable alternative to cervical fusion for patients with cervical spine tuberculosis. It confers the advantages of autograft fusion without the complications associated with donor site morbidities.

Two-year follow-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease

2013 ◽  
Vol 20 (3) ◽  
pp. 394-399 ◽  
Author(s):  
Zhonghai Li ◽  
Fengning Li ◽  
Shunzhi Yu ◽  
Hui Ma ◽  
Zhaohui Chen ◽  
...  
Keyword(s):  
Degenerative Disease ◽  
Lumbar Degenerative Disease ◽  
Rod System ◽  
Rigid Rod

scholarly journals Minimum Two-Year Follow-Up of Cases with Recurrent Disc Herniation Treated with Microdiscectomy and Posterior Dynamic Transpedicular Stabilisation

2010 ◽  
Vol 4 (1) ◽  
pp. 120-125 ◽  
Author(s):  
Tuncay Kaner ◽  
Mehdi Sasani ◽  
Tunc Oktenoglu ◽  
Ahmet Levent Aydin ◽  
Ali Fahir Ozer
Keyword(s):  
Disc Herniation ◽  
Clinical Results ◽  
Prospective Clinical Study ◽  
Low Back ◽  
Failed Back Syndrome ◽  
Recurrent Disc Herniation ◽  
Rod System ◽  
Disc Herniations ◽  
Vas Scores

The objective of this article is to evaluate two-year clinical and radiological follow-up results for patients who were treated with microdiscectomy and posterior dynamic transpedicular stabilisation (PDTS) due to recurrent disc herniation. This article is a prospective clinical study. We conducted microdiscectomy and PDTS (using a cosmic dynamic screw-rod system) in 40 cases (23 males, 17 females) with a diagnosis of recurrent disc herniation. Mean age of included patients was 48.92 ± 12.18 years (range: 21-73 years). Patients were clinically and radiologically evaluated for follow-up for at least two years. Patients’ postoperative clinical results and radiological outcomes were evaluated during the 3rd, 12th, and 24th months after surgery. Forty patients who underwent microdiscectomy and PDTS were followed for a mean of 41 months (range: 24-63 months). Both the Oswestry and VAS scores showed significant improvements two years postoperatively in comparison to preoperative scores (p<0.01). There were no significant differences between any of the three measured radiological parameters (α, LL, IVS) after two years of follow-up (p > 0.05). New recurrent disc herniations were not observed during follow-up in any of the patients. We observed complications in two patients. Performing microdiscectomy and PDTS after recurrent disc herniation can decrease the risk of postoperative segmental instability. This approach reduces the frequency of failed back syndrome with low back pain and sciatica.

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 Posterior dynamic stabilization of the lumbar spine with the Accuflex rod system as a stand-alone device: experience in 20 patients with 2-year follow-up

2010 ◽  
Vol 19 (12) ◽  
pp. 2164-2170 ◽  
Author(s):  
Alejandro Reyes-Sánchez ◽  
Barón Zárate-Kalfópulos ◽  
Isabel Ramírez-Mora ◽  
Luis Miguel Rosales-Olivarez ◽  
Armando Alpizar-Aguirre ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Dynamic Stabilization ◽  
Rod System ◽  
Posterior Dynamic Stabilization

Autogeneic Fat Transplants in the Epidural Space in Routine Lumbar Spine Surgery

Neurosurgery ◽  
1983 ◽  
Vol 13 (4) ◽  
pp. 351-366 ◽  
Author(s):  
Michael S. Bryant ◽  
Alfonso M. Bremer ◽  
Tai Q. Nguyen
Keyword(s):  
Lumbar Spine ◽  
Dura Mater ◽  
Donor Site ◽  
Ct Scanning ◽  
Fat Graft ◽  
Lumbar Spine Surgery ◽  
Computed Tomographic ◽  
Short And Long Term

Abstract This report presents our experience with the use of autogeneic fat patch grafts to protect the exposed dura mater during lumbar spine operations. A total of 44 consecutive surgical procedures was performed primarily for discogenic or spondylotic disease from 1979 to 1982. Prophylactic antibiotics were used in 21 (48%) cases. The autogeneic fat transplants were well accepted by all recipients during 10.4 (1 to 32) months of follow-up. Fat grafts, greater than 1 cm in thickness, were easily identified on subsequent computed tomographic (CT) scans. There were no postoperative wound infections. However, 1 patient developed a large subcutaneous sterile fluid accumulation at the fat donor site, which required surgical intervention. Our results, both short and long term, indicate that autogeneic fat transplants may be well tolerated in the lumbar spine area. The fat graft viability as demonstrated by CT scanning and histological examination supports the contention that autogeneic fat interposed between dura mater and overlying musculature may serve as a barrier limiting the growth of cicatrix into the spinal canal.

Semi-rigid minimally invasive transpedicular fixation in the treatment of degenerative diseases of the lumbar spine

2018 ◽  
Vol 20 (3) ◽  
pp. 19-30
Author(s):  
A. V. Bulatov ◽  
D. A. Rzayev ◽  
V. S. Klimov ◽  
A. V. Evsyukov
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Clinical Results ◽  
Intervertebral Discs ◽  
Minimal Invasive ◽  
Low Back ◽  
Degenerative Diseases ◽  
Study Objective

The study objective is to analyze the effectiveness of the use of minimal invasive polyetheretherketone (PEEK) rod systems in the treatment of lumbar spine degenerative diseases.Materials and methods. The minimal invasive semi-rigid stabilization using PEEK rod systems was performed in 24 patients (4 (17 %) male and 20 (83 %) female) patients (mean age 46.3 ± 8.4, ranging from 32 to 63). The average follow-up duration was 15 months. Inclusion criteria: mechanical low back pain, White–Panjabi instability: 5 points, degenerative changes of the disc by C. Pfirrmann scale: II–IV grade. Follow-up at the 6 and 12 months postoperatively.Results. In the postoperative period, the majority of patients had a complete or significant regression of pain (on average, from 6.3 to 1.8 points on the visual analog scale). The Oswestry disability index decreased from 64/66 [64; 68] to 33/34 [32; 36] in 6 months (p <0.001) and 18/17 [16; 18] in 12 months (p <0.001). Before surgery, the height of the operated disk was 0.96 cm, after 1 year decreased to 0.91 cm. Range of rotary motion in the operated segment in all cases did not exceed 6°.Conclusion. The PEEK rod fixation in patients with mechanical low back pain provides good and excellent clinical results on the I. Macnab scale in 83.4 % of cases. Within 12 months, the minimal volume of movements on the operated segment remains, without signs of continued degeneration of adjacent intervertebral discs.

P42. Posterior Dynamic Stabilization of the Lumbar Spine with the Accuflex Rod System as a Stand-Alone Device. Experience in 20 Patients with Two Year Follow-Up

2009 ◽  
Vol 9 (10) ◽  
pp. 135S-136S
Author(s):  
Alejandro Reyes Sanchez ◽  
Barón Zárate-Kalfópulos ◽  
Luis Miguel Rosales-Olivarez ◽  
Isabel Ramirez-Mora ◽  
Armando Alpizar-Aguirre ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Dynamic Stabilization ◽  
Rod System ◽  
Posterior Dynamic Stabilization

Mid-term and long-term follow-up data after placement of the Graf stabilization system for lumbar degenerative disorders

2006 ◽  
Vol 5 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Akira Onda ◽  
Koji Otani ◽  
Shinichi Konno ◽  
Shinichi Kikuchi
Keyword(s):  
Japanese Orthopaedic Association ◽  
Degenerative Spondylolisthesis ◽  
Clinical Results ◽  
Significant Inhibition ◽  
Degenerative Disease ◽  
Disc Height ◽  
Three Dimensions ◽  
Lumbar Degenerative Disease ◽  
Radiographic Measurements

Object The Graf pedicle screw and ligament device is designed to provide flexible stabilization to prevent abnormal spinal movement. The purpose of this study was to investigate radiographic and clinical outcomes during a minimal 5-year follow-up period. Methods Between 1991 and 1997, 43 consecutive patients (whose mean age was 61 years) with lumbar degenerative disease underwent decompression and stabilization in which the Graf system was placed. Data were available for 31 patients who attended follow up for the minimal 5-year period. In a retrospective review, the authors assessed measurements on radiographs, clinical results (using Japanese Orthopaedic Association [JOA] Scale scores), and low-back pain (using a visual analog scale [VAS] score), preoperatively and postoperatively at 1, 3, 5, and/or 10 years. Radiographic measurements included sagittal and frontal range of motion (ROM), regional lordosis, and posterior disc height as well as the extent of degenerative spondylolisthesis. Final follow-up JOA and VAS scores were significantly better than preoperative scores. Sagittal and frontal ROM was significantly reduced at 1 and 5 years, respectively, compared with preoperative values, and a gradual reduction persisted throughout the follow-up period. Compared with its preoperative status, the disc height ratio (adjacent segments to the operated level) was reduced 5 years after surgery. A significant inhibition of the vertebral slippage was detected only in the flexion position. Conclusions Analysis of these data indicated that the Graf system eventually leads to successful fusion, suggesting the presence of stability in all three dimensions. The use of the Graf system should continue to be evaluated as an alternative device in the treatment of lumbar degenerative disease.

scholarly journals Operative Treatment of Degenerative Lumbar Spine Spondylolisthesis/ Оперативен Третман На Лумбосакрална Дегенреативна Спондилолистеза

PRILOZI ◽  
2015 ◽  
Vol 36 (1) ◽  
pp. 129-135
Author(s):  
Igor Kaftandziev ◽  
Simon Trpeski ◽  
Venko Filipce ◽  
Oliver Arsovski ◽  
Ilir Hasani ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Functional Outcome ◽  
Spinal Stenosis ◽  
Operative Treatment ◽  
Degenerative Spondylolisthesis ◽  
Clinical Results ◽  
Grade Ii ◽  
Functional Outcome Measures ◽  
Lumbosacral Spondylolisthesis

Abstract Introduction: Management of degenerative lumbosacral spondylolisthesis with spinal stenosis is still controversial. Surgery is widely used, as well as non-surgical treatment. Aim: To evaluate the clinical results and functional outcome after operative treatment in Grade II and III lumbar spine spondylolisthesis. Material and methods: Twelve patients with symptoms and image-confirmed degenerative spondylolisthesis entered the study. Mean patient age was 57 years. Spondylolisthesis Grade II or III, segment L4-L5 or L5-S1 were evaluated. All patients underwent similar protocols. Operative treatment was decompressive laminectomy, posterior one segment fixation, and fusion with autologous bone grafting. Functional outcome measures were Visual Analog Scale (VAS, 10-point scale) and Oswestry Disability Index (ODI, 100-percent scale) after 6 and 12 months. Results: Patient follow-up was 12 months. Preoperatively, 7 patients had severe disability according to ODI, 4 had moderate disability. VAS measured 6 and 7 points in 6 patients, lowest score of 4 points and the highest score of 9. After 6 months, ODI showed 5 patients had minimal and 7 had moderate disability; 2 patients had 0 points on the VAS, 2 had a score of 1, 4 had a score of 2, highest score of 4 points. Treatment outcome effects after 1 year were 9 patients with minimal disability, 3 with moderate; VAS - 2 patients with O points, 3 with 1 point, 4 with 2 points. Conclusion: Patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and functional outcome during a period of 1 year.

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