scholarly journals Outcomes in cases of lumbar degenerative spondylolisthesis more than 5 years after treatment with minimally invasive decompression: examination of pre- and postoperative slippage, intervertebral disc changes, and clinical results

2016 ◽  
Vol 24 (3) ◽  
pp. 367-374 ◽  
Author(s):  
Gen Mori ◽  
Yasuo Mikami ◽  
Yuji Arai ◽  
Takumi Ikeda ◽  
Masateru Nagae ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intervertebral Disc ◽  
Disc Degeneration ◽  
Intervertebral Disc Degeneration ◽  
Degenerative Spondylolisthesis ◽  
Clinical Results ◽  
Natural Course ◽  
Disc Height ◽  
Minimally Invasive Decompression

OBJECT There are reports that fusion is the standard treatment of choice for cases of lumbar degenerative spondylolisthesis (LDS) associated with lumbar spinal canal stenosis with a large degree of slippage. The reasons why, however, have not been clarified. On the other hand, it is known that the progress of slippage decreases and restabilization occurs over the natural course of LDS. Therefore, if minimally invasive decompression could be performed, there would be little possibility of it influencing the natural course of LDS, so it would not be necessary to include preoperative percentage slip in the criteria for the selection of fusion. This study examined the course of LDS cases more than 5 years after treatment with minimally invasive decompression to determine whether pre- and postoperative slippage and disc changes influence the clinical results. METHODS A total of 51 intervertebral segments in 51 cases with the chief complaint of radicular or cauda equina symptoms due to lumbar spinal canal stenosis were examined after prospective treatment with minimally invasive decompression for LDS. The mean age of the patients at the time of surgery was 66.7 years and the mean follow-up period was 7 years 4 months. Minimally invasive decompression was performed regardless of the degree of low-back pain or percentage slip. The outcome variables were clinical results and changes in imaging findings. RESULTS Over the follow-up period, postoperative percentage slip increased and disc height decreased, but the Japanese Orthopaedic Association score improved. Regardless of the preoperative percentage slip, disc height, or degree of intervertebral disc degeneration or segmental instability, the clinical results were favorable. In the high preoperative percentage slip group, low disc height group, and progressive disc degeneration group, there was little postoperative progress of slippage. In the group with a postoperative slippage increase of more than 5%, slippage increased significantly at postoperative year 2, but no significant difference was observed at the final follow-up. CONCLUSIONS When minimally invasive decompression was performed to treat LDS, the postoperative change in slippage was no different from that during the natural course. Furthermore, regardless of the degree of preoperative slippage or intervertebral disc degeneration, the clinical results were favorable. Also, the higher the preoperative percentage slip and the more that disc degeneration progressed, the more the progress of postoperative slippage decreased. Because the postoperative progress of slippage decreased, it is believed that even after minimally invasive decompression, restabilization occurs as it would during the natural course. If minimally invasive decompression can be performed to treat LDS, it is believed that preoperative percentage slip and intervertebral disc degeneration do not have to be included in the appropriateness criteria for fusion.

scholarly journals A percutaneous, minimally invasive annulus fibrosus needle puncture model of intervertebral disc degeneration in rabbits

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901879271
Author(s):  
T David Luo ◽  
Alejandro Marquez-Lara ◽  
Zachary K Zabarsky ◽  
Jeremy B Vines ◽  
Katie C Mowry ◽  
...  
Keyword(s):  
Relaxation Time ◽  
Minimally Invasive ◽  
Intervertebral Disc ◽  
Disc Degeneration ◽  
Annulus Fibrosus ◽  
Intervertebral Disc Degeneration ◽  
Disc Height ◽  
Needle Puncture ◽  
T2 Relaxation Time ◽  
T2 Relaxation

Purpose: Various animal models have been proposed to mimic the pathophysiologic process of intervertebral disc degeneration, a leading cause of back pain. The purpose of this study is to describe a minimally invasive technique via percutaneous needle puncture of the annulus fibrosus in New Zealand white rabbits. Methods: Under fluoroscopic guidance, an 18-gauge spinal needle was inserted 2 cm lateral to the midline spinous process. The needle was slowly advanced at approximately 45° angle until it was adjacent to the L5/L6 disc space. Lateral and anteroposterior views were used to verify correct needle position before advancing into the nucleus pulposus. The rabbits underwent weekly X-rays for 4 weeks to assess disc height index. MRI T2 relaxation was evaluated at week four to assess morphological changes. Discs were histologically graded on a 12-point scale to assess degeneration and compared to discs obtained from uninjured rabbits. Results: There were no complications associated with the percutaneous needle puncture procedure. All animals survived the duration of the experiment. Four weeks after injury, the disc height had progressively narrowed to approximately 50% of baseline. MRI assessment at the 4-week time point demonstrated a mean T2 relaxation time at the L5/L6 level that was 20.9% of the T2 relaxation time at the uninjured L4/L5 disc level ( p < 0.001). Histological analysis demonstrated lamellar disorganization of the annulus and decreased cellularity and proteoglycan content within the injured nucleus compared to uninjured control discs. Conclusion: The present study demonstrated a reliable technique of inducing an annular tear via a percutaneous needle puncture. Compared to open surgical approaches, the percutaneous model produces similar progressive disc degeneration while minimizing harm to the animal subjects. Clinical Relevance: The present study establishes a technique for the introduction of novel therapeutic agents to treat disc degeneration that may translate to future clinical trials.

Temporary Segmental Distraction in a Dog with Degenerative Lumbosacral Stenosis

2018 ◽  
Vol 31 (04) ◽  
pp. 298-303 ◽  
Author(s):  
Nicole Willems ◽  
Roel Kersten ◽  
Steven van Gaalen ◽  
F. Öner ◽  
Gustav Strijkers ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Pedicle Screw ◽  
Disc Degeneration ◽  
Intervertebral Disc Degeneration ◽  
Clinical Signs ◽  
Disc Height ◽  
Lumbosacral Junction ◽  
Initial Value ◽  
Distraction Device

Objectives Degenerative lumbosacral stenosis (DLSS) is characterized by intervertebral disc degeneration and causes lower back pain in dogs. Temporary distraction in rabbit models with induced intervertebral disc degeneration showed signs of intervertebral disc repair. In the present study, we assessed safety and efficacy of temporary segmental distraction in a dog with clinical signs of DLSS. Methods Distraction of the lumbosacral junction by pedicle screw–rod fixation was applied in a 5-year-old Greyhound with DLSS and evaluated by radiography, magnetic resonance imaging, and force plate analysis before and after distraction. Results Safe distraction of the lumbosacral junction was demonstrated, with improvement of clinical signs after removal of the distraction device. Signal intensity of the intervertebral disc showed no changes over time. T2 value was highest directly after removal of the distraction device but decreased by 10% of the preoperative value at 9 months of follow-up. Disc height decreased (8%) immediately after removal of the distraction device, but recovered to the initial value. A decrease in the pelvic/thoracic propulsive force during pedicle screw–rod fixation and distraction was demonstrated, which slowly increased by 4% compared with the initial value. Clinical significance Temporary pedicle screw–rod fixation in combination with distraction in a dog with DLSS was safe, improved clinical signs and retained disc height at 9 months of follow-up.

scholarly journals Denosumab Alleviates Intervertebral Disc Degeneration Adjacent to a Lumbar Fusion by Inhibiting Endplate Osteochondral Remodeling and Vertebral Osteoporosis in Ovariectomized Rats

2020 ◽  
Author(s):  
Qi Sun ◽  
Fa-Ming Tian ◽  
Fang Liu ◽  
Jia-Kang Fang ◽  
Yun-Peng Hu ◽  
...  
Keyword(s):  
Bone Formation ◽  
Intervertebral Disc ◽  
Disc Degeneration ◽  
Intervertebral Disc Degeneration ◽  
Lumbar Fusion ◽  
Biomechanical Properties ◽  
Disc Height ◽  
X Ray ◽  
Manual Palpation ◽  
Trap Staining

Abstract Background: Although adjacent segmental intervertebral disc degeneration (ASDD) is one of the most common complications after lumbar fusion, its exact mechanism remains unclear. As an antibody to RANKL, denosumab (Dmab) effectively reduces bone resorption and stimulates bone formation, which can increase bone mineral density (BMD) and improve osteoporosis. However, it has not been confirmed whether Dmab has a reversing or retarding effect on ASDD. Methods: Three-month-old female Sprague-Dawley rats that underwent L4–L5 posterolateral lumbar fusion (PLF) with spinous-process wire fixation four weeks after OVX surgery were given Dmab four weeks after PLF surgery (OVX+PLF+Dmab group). In addition, the following control groups were defined: Sham, OVX, PLF, and OVX+PLF (n=12 each).Then, manual palpation and X-ray were used to evaluate the state of lumbar fusion. The bone microstructure in the lumbar vertebra and endplate as well as the disc height index (DHI) of the L5/6 were evaluated by microcomputed tomography (μCT). The characteristic alterations of ASDD were identified via Safranin-O green staining staining. Osteoclasts were detected using tartrate-resistant acid phosphatase (TRAP) staining and the biomechanical properties of vertebra were evaluated. Aggrecan (Agg), metalloproteinase-13 (MMP-13), a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4) expression in the intervertebral disc were detected by immunohistochemistry and real-time polymerase chain reaction (RT-PCR) analysis.Results: Manual palpation showed clear evidence of the fused segment’s immobility. Compared to the OVX+PLF group, more new bone formation was observed by X-ray examination in the OVX+PLF+Dmab group. Dmab significantly alleviated ASDD by retaining disc height index (DHI), decreasing porosity of endplate, and increasing the biomechanical properties and BMD of vertebra. TRAP staining results showed a significantly decreased number after Dmab treatment, especially in subchondral bone and cartilaginous endplate. Moreover, the results of protein and mRNA expression in intervertebral disc (IVD) showed that Dmab not only inhibited matrix degradation by decreasing MMP-13 and ADAMTS-4 but also promoted matrix synthesis by increasing Agg. Conclusions: These results suggest that Dmab may be a novel therapeutic target for the treatment of ASDD.

scholarly journals Superior Facet Joint Violations during Single Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Preliminary Retrospective Clinical Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Long Jia ◽  
Yan Yu ◽  
Kamran Khan ◽  
Fuping Li ◽  
Rui Zhu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intervertebral Disc ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Intervertebral Disc Height ◽  
Group A

Background. Facet joint violation (FV) was reported as variable iatrogenic damage that can be a crucial risk factor leading to the adjacent segment degeneration (ASD). “Blind” screw placement technique in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) contributes to the increasing incidence of FV that can be influenced by several potential factors. Many controversies about these factors and clinical outcomes of different types of FV patients exist, yet they have not been analyzed. Methods. 99 cases undergoing single-segment MIS-TLIF from July 2013 to December 2015 were retrospectively analyzed. Computed tomography (CT) was applied to determine the incidence of FV, and then the correlation between FV and relevant factors, including gender, age, body mass index (BMI), top-screw level, and decompression, was analyzed. A total of 53 cases were followed up after one year, 31 cases in noninjury (A group) and 22 patients in FV injury (B group). Results. The incidence of FV was 39. 39% (39/99) in the patients and 23.23% (46/198) in the screws. Logistic regression analysis showed that screw at L5 in patients with BMI > 30 kg/m2 was vulnerable to FV (P<0.05). Moreover, postoperative average intervertebral disc height (AIDH) of fusion segment, visual analog scale (VAS), and Oswestry disability index (ODI) scores improved significantly in group A and B when compared with preoperative data (P<0.05). Adjacent superior average intervertebral disc height (ASAIDH) presented decrease, but adjacent superior intervertebral disc Cobb angle (ASIDCA) appeared to increase in the two groups at the final follow-up compared with postoperative 3 days (P<0.05). Low back VAS and ODI scores in group A (31 cases) were lower than those in group B (22 cases) in the final follow-up (P<0.05). Conclusion. MIS-TLIF is an effective treatment for lumbar degenerative disease, but FV occurred at a higher incidence. Facet joints should be protected in MIS-TLIF to avoid FV.

scholarly journals Effects of Endplate Healing Morphology on Intervertebral Disc Degeneration after Pedicle Screw Fixation for Thoracolumbar Fractures

2020 ◽  
Author(s):  
Yunshan Su ◽  
Dong Ren ◽  
Dehang Liu ◽  
Junfei Li ◽  
Tianci Wang ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Pedicle Screw ◽  
Disc Degeneration ◽  
Intervertebral Disc Degeneration ◽  
Clinical Decision Making ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fractures ◽  
Cartilage Endplate

Abstract Background: The cartilage endplate plays an important role in the stress distribution and nutrition metabolism of intervertebral disc. The healing morphology of the endplate after spinal fracture and its effect on the intervertebral disc degeneration are still unclear. Methods: 51 patients with single-level thoracolumbar fractures underwent posterior open reduction and pedicle screw fixation. Combined with the initial CT and MRI images, the endplate injury was defined as three types, which are unilateral endplate injury, bilateral endplate injury and no endplate injury. According to the location of the injury in the endplate, it was further divided into endplate central injury and endplate peripheral injury. The degree of post-traumatic disc lesions and disc degeneration during follow-up were classified based on the Sander classification and the Pfirrmann classification, respectively. According to the T1 image of MRI in the final follow-up, the healing morphology of endplates was classified into three types including the increased endplate curvature, the irregular healing and the traumatic Schmorl nodes. Results: Cartilage endplate fractures are closely related to the degree of degeneration of the intervertebral disc (P=0.003). Injuries in different parts of the endplate have no significant effect on the intervertebral disc degeneration (P=0.204). The healing morphology after endplate fracture significantly affected the degree of intervertebral disc degeneration (P=0.001). The comparison of groups showed that the effects of irregular healing and traumatic Schmorl nodes on disc degeneration were not statistically different, but were significantly different from those with increased curvature. Conclusions: Increased endplate curvature, irregular healing and traumatic Schmorl nodes are three common forms of healing. The irregular healing and the traumatic Schmorl nodes are closely related to intervertebral disc degeneration. The existence and severity of the endplate injury can provide valuable information for individualized clinical decision-making processes.

scholarly journals Platelet-Derived Biomaterials Exert Chondroprotective and Chondroregenerative Effects on Diabetes Mellitus-Induced Intervertebral Disc Degeneration

Life ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1054
Author(s):  
Wen-Cheng Lo ◽  
Chun-Chao Chang ◽  
Chun-Hao Chan ◽  
Abhinay Kumar Singh ◽  
Yue-Hua Deng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Growth Factor ◽  
Intervertebral Disc ◽  
Disc Degeneration ◽  
Intervertebral Disc Degeneration ◽  
Transforming Growth Factor ◽  
Disc Height ◽  
Therapeutic Effects

Complications of diabetes mellitus (DM) range from acute to chronic conditions, leading to multiorgan disorders such as nephropathy, retinopathy, and neuropathy. However, little is known about the influence of DM on intervertebral disc degeneration (IVDD). Moreover, traditional surgical outcomes in DM patients have been found poor, and to date, no definitive alternative treatment exists for DM-induced IVDD. Recently, among various novel approaches in regenerative medicine, the concentrated platelet-derived biomaterials (PDB), which is comprised of transforming growth factor-β1 (TGF-β1), platelet-derived growth factor (PDGF), etc., have been reported as safe, biocompatible, and efficacious alternatives for various disorders. Therefore, we initially investigated the correlations between DM and IVDD, through establishing in vitro and in vivo DM models, and further evaluated the therapeutic effects of PDB in this comorbid pathology. In vitro model was established by culturing immortalized human nucleus pulposus cells (ihNPs) in high-glucose medium, whereas in vivo DM model was developed by administering streptozotocin, nicotinamide and high-fat diet to the mice. Our results revealed that DM deteriorates both ihNPs and IVD tissues, by elevating reactive oxygen species (ROS)-induced oxidative stress, inhibiting chondrogenic markers and disc height. Contrarily, PDB ameliorated IVDD by restoring cellular growth, chondrogenic markers and disc height, possibly through suppressing ROS levels. These data imply that PDB may serve as a potential chondroprotective and chondroregenerative candidate for DM-induced IVDD.

Radiologic Analysis of Causes of Early Recurrence after Percutaneous Endoscopic Transforaminal Discectomy

2021 ◽  
Author(s):  
Zepeng Li ◽  
Lulu Liu ◽  
Hao Liu ◽  
Jinghua Tan ◽  
Xuelin Li ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Disc Degeneration ◽  
Lumbar Disc Herniation ◽  
Annulus Fibrosus ◽  
Intervertebral Disc Degeneration ◽  
Lumbar Disc ◽  
Early Recurrence ◽  
Tear Size ◽  
Base Width

Abstract Objective: To retrospectively analyze causes of, and factors influencing, early recurrence after percutaneous endoscopic transforaminal discectomy (PETD) used to treat lumbar-disc herniation. Methods: We included 285 patients with single-segment lumbar-disc herniation, treated using PETD from January 2017 to December 2019 in the First Affiliated Hospital of the University of South China. Patients were classified into early recurrence and non-early recurrence groups based on clinical symptoms and MRI reexamination. Differences in disc-height index (DHI), sagittal range of motion (sROM), base-width of intervertebral disc degeneration, and postoperative intervertebral annulus-fibrosus tear size were compared using independent-sample t test. Differences in degree of intervertebral disc degeneration and herniation sites were analyzed using rank-sum and chi-square tests. Logistic regression was used for multivariate analysis of factors associated with early recurrence after PETD. Results: Two hundred and eighty five patients completed surgery and underwent clinical follow-up. Mean follow-up duration was 15.5 months (12–24 months). During follow-up, 19 patients relapsed within 6 months post-surgery. Early recurrence rate was 6.7%, and mean recurrence duration was 73.4 days (3–168 days). Differences in DHI, base-width, postoperative annulus-fibrosus tear size, degree of intervertebral disc degeneration, and herniation sites between early recurrence and non-early recurrence groups were statistically significant (P<0.05). Herniation site and base-width of herniation were significantly correlated with early recurrence after PETD. Conclusions: DHI, postoperative annulus-fibrosus tear size, and degree of intervertebral disc degeneration were associated with early recurrence after PETD. Increased base-width of herniation was a risk factor for early recurrence after PETD. Central-herniation patients with were more prone to postoperative early recurrence than paracentral-herniation patients.

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.

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