scholarly journals The surgical outcome of decompression alone versus decompression with limited fusion for degenerative lumbar scoliosis

2018 ◽  
Vol 29 (3) ◽  
pp. 259-264 ◽  
Author(s):  
Kenji Masuda ◽  
Takayuki Higashi ◽  
Katsutaka Yamada ◽  
Tatsuhiro Sekiya ◽  
Tomoyuki Saito
Keyword(s):  
Decision Making ◽  
Cobb Angle ◽  
Japanese Orthopaedic Association ◽  
Spinal Instability ◽  
Degenerative Lumbar Scoliosis ◽  
Surgical Decision ◽  
Lumbar Scoliosis ◽  
Radiological Parameters ◽  
Surgical Decision Making

OBJECTIVEThe aim of this study was to assess the usefulness of radiological parameters for surgical decision-making in patients with degenerative lumbar scoliosis (DLS) by comparing the clinical and radiological results after decompression or decompression and fusion surgery.METHODSThe authors prospectively planned surgical treatment for 298 patients with degenerative lumbar disease between September 2005 and March 2013. The surgical method used at their institution to address intervertebral instability is precisely defined based on radiological parameters. Among 64 patients with a Cobb angle ranging from 10° to 25°, 57 patients who underwent follow-up for more than 2 years postoperatively were evaluated. These patients were divided into 2 groups: those in the decompression group underwent decompression alone (n = 25), and those in the fusion group underwent decompression and short segmental fusion (n = 32). Surgical outcomes were reviewed, including preoperative and postoperative Cobb angles, lumbar lordosis based on radiological parameters, and Japanese Orthopaedic Association (JOA) scores.RESULTSThe JOA scores of the decompression group and fusion group improved from 5.9 ± 1.6 to 10.0 ± 2.8 and from 7.2 ± 2.0 to 11.3 ± 2.8, respectively, which was not significantly different between the groups. At the final follow-up, the postoperative Cobb angle in the decompression group changed from 14° ± 2.9° to 14.3° ± 6.4° and remained stable, while the Cobb angle in the fusion group decreased from 14.8° ± 4.0° to 10.0° ± 8.5° after surgery.CONCLUSIONSThe patients in both groups demonstrated improved JOA scores and preserved Cobb angles after surgery. The improvement in JOA scores and preservation of Cobb angles in both groups show that the evaluation of spinal instability using radiological parameters is appropriate for surgical decision-making.

The influence of approach side on facet preservation in microscopic bilateral decompression via a unilateral approach for degenerative lumbar scoliosis

2010 ◽  
Vol 13 (6) ◽  
pp. 758-765 ◽  
Author(s):  
Akira Matsumura ◽  
Takashi Namikawa ◽  
Hidetomi Terai ◽  
Tadao Tsujio ◽  
Akinobu Suzuki ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Recovery Rate ◽  
Japanese Orthopaedic Association ◽  
Spinal Instability ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Unilateral Approach ◽  
Scale Scores ◽  
The Mean

Object The authors compared the clinical outcomes of microscopic bilateral decompression via a unilateral approach (MBDU) for the treatment of degenerative lumbar scoliosis (DLS) and for lumbar canal stenosis (LCS) without instability. The authors also compared postoperative spinal instability in terms of different approach sides (concave or convex) following the procedure. Methods The authors retrospectively reviewed data obtained in 50 consecutive patients (25 in the DLS group and 25 in the LCS group) who underwent MBDU; the minimum follow-up period was 2 years. Patients with DLS were divided into 2 subgroups according to the surgical approach side: a concave group (23 segment) and a convex group (17 segments). The Japanese Orthopaedic Association Scale scores for the assessment of low-back pain were evaluated before surgery and at final follow-up. The Japanese Orthopaedic Association Scale scores and recovery rates were compared between the DLS and LCS groups, and between the convex and concave groups. Cobb angle and scoliotic wedging angle (SWA) were evaluated on standing radiographs before surgery and at final follow-up. Facet joint preservation (the percentage of preservation) was assessed on pre- and postoperative CT scans, compared between the LCS and DLS groups, and compared between the concave and convex groups. The influence of approach side on postoperative progression of segmental instability was also examined in the DLS group. Results The mean recovery rate was 58.7% in the DLS and 62.0% in the LCS group. The mean recovery rate was 58.6% in the convex group and 60.6% in the concave group. There were no significant differences in recovery rates between the LCS and DLS groups, or between the DLS subgroups. The mean Cobb angles in the DLS group were significantly increased from 12.7° preoperatively to 14.1° postoperatively (p < 0.05), and mean preoperative SWAs increased significantly from 6.2° at L3–4 and 4.1° at L4–5 preoperatively to 7.4° and 4.9°, respectively, at final follow-up (p < 0.05). There was no significant difference in percentage of preservation between the DLS and LCS groups. The mean percentages of preservation on the approach side in the DLS group at L3–4 and L4–5 were 89.0% and 83.1% in the convex group, and those in the concave group were 67.3% and 77.6%, respectively. The percentage of preservation at L3–4 was significantly higher in the convex than the concave group. The mean SWA had increased in the concave group (p = 0.01) but not the convex group (p = 0.15) at final follow-up. Conclusions The MBDU can reduce postoperative segmental spinal instability and achieve good postoperative clinical outcomes in patients with DLS. The convex approach provides surgeons with good visibility and improves preservation of facet joints.

Radiologic prognostic factors of curve progression in early degenerative lumbar scoliosis

2021 ◽  
pp. 1-7
Author(s):  
Jin-Sung Park ◽  
Se-Jun Park ◽  
Chong-Suh Lee ◽  
Tae-hoon Yum ◽  
Bo-Taek Kim
Keyword(s):  
Cobb Angle ◽  
Curve Progression ◽  
Degenerative Lumbar Scoliosis ◽  
Disc Space ◽  
Lumbar Scoliosis ◽  
Radiological Parameters ◽  
Lateral Subluxation ◽  
Lower Disc ◽  
The Mean

OBJECTIVESeveral radiological parameters related to the aging spine have been reported as progression factors of early degenerative lumbar scoliosis (DLS). However, it has not been determined which factors are the most important. In this study the authors aimed to determine the risk factors associated with curve progression in early DLS.METHODSFifty-one patients with early DLS and Cobb angles of 5°–15° were investigated. In total, 7 men and 44 women (mean age 61.6 years) were observed for a mean period of 13.7 years. The subjects were divided into two groups according to Cobb angle progression (≥ 15° or < 15°) at the final follow-up, and radiological parameters were compared. The direction of scoliosis, apical vertebral level and rotational grade, lateral subluxation, disc space difference, osteophyte difference, upper and lower disc wedging angles, and relationship between the intercrest line and L5 vertebra were evaluated.RESULTSDuring the follow-up period, the mean curve progression increased from 8.8° ± 3.2° to 19.4° ± 8.9°. The Cobb angle had progressed by ≥ 15° in 17 patients (33.3%) at the final follow-up. In these patients the mean Cobb angle increased from 9.4° ± 3.4° to 28.8° ± 7.5°, and in the 34 remaining patients it increased from 8.5° ± 3.1° to 14.7° ± 4.8°. The baseline lateral subluxation, disc space difference, and upper and lower disc wedging angles significantly differed between the groups. In multivariate logistic regression analysis, only the upper and lower disc wedging angles were significantly correlated with curve progression (OR 1.55, p = 0.035, and OR 1.89, p = 0.004, respectively).CONCLUSIONSAsymmetrical degenerative change in the lower apical vertebral disc, which leads to upper and lower disc wedging angles, is the most substantial factor in predicting early DLS progression.

scholarly journals P.128 The clinical utility of the spinal instability neoplastic score (SINS) and its role in surgical management of patients with spinal metastatic disease

2016 ◽  
Vol 43 (S2) ◽  
pp. S49-S49
Author(s):  
A Dakson ◽  
E Leck ◽  
M Butler ◽  
G Thibault-Halman ◽  
S Christie
Keyword(s):  
Decision Making ◽  
Metastatic Disease ◽  
Clinical Utility ◽  
Spinal Metastasis ◽  
Intervention Group ◽  
Spinal Instability ◽  
Vertebral Augmentation ◽  
Mechanical Instability ◽  
Surgical Decision ◽  
Surgical Decision Making

Background: The Spinal Instability Neoplastic Score (SINS) is used to assess mechanical instability based on radiographic and clinical factors. We conducted this study to evaluate the clinical utility of SINS in surgical decision-making in spinal metastasis and its association with metastatic epidural spinal cord compression (MESCC). Methods: We allocated 285 patients with spinal metastatic disease through a retrospective review. SINS was calculated using good-quality computed tomography. The degree of MESCC was assessed using 0 to 3 grading system. Results: Based on SINS, patients were categorized into stable (35.1%), potentially unstable (52.3%) and unstable (12.6%) groups. In the surgical intervention group, there was 69.5% treated with decompression and instrumented fusion, 17% with decompression alone, 8.5% with percutaneous vertebral augmentation and 5% with instrumented vertebral augmentation. A significantly higher proportion of patients with stable SINS (63.6%) were treated surgically without instrumentation (X2=10.6, P=0.005), whereas instrumentation was utilized in 87.5% of patients with unstable SINS. Grade 3 MESCC occurred in 65.5% of patients with unstable SINS, whereas 71.4% of patients with stable SINS had grade 0 MESCC (X2=42.1, P<0.001). Conclusions: SINS is associated with higher degrees of MESCC and plays an important role in surgical decision-making, facilitating assessment and recognition of spinal instability in need of urgent appropriate surgical interventions.

scholarly journals Role of sciatic nerve stiffness in surgical decision making and follow up in patients with deep gluteal syndrome

2018 ◽  
Author(s):  
Sava Stajic ◽  
Aleksandar Vojvodic ◽  
Luis Perez Carro ◽  
Jelena Mihailovic ◽  
Milos Gasic ◽  
...  
Keyword(s):  
Decision Making ◽  
Sciatic Nerve ◽  
Knee Flexion ◽  
Acoustic Radiation Force Impulse ◽  
Stiffness Ratio ◽  
Surgical Decision ◽  
Strain Elastography ◽  
Deep Gluteal Syndrome ◽  
Surgical Decision Making

AbstractThe study shows the relevance of sciatic nerve stiffness assessed by strain elastography using ARFI (Acoustic Radiation Force Impulse) for surgical decision making and the follow up of patients with deep gluteal syndrome (DGS). The research focuses on nerve stiffness associated with knee movements in order to determine the degree of nerve entrapment. Neurological examination, MRI of pelvis and electromyography (EMG) were performed as well. The sciatic nerve was scanned by ARFI (strain) elastography during knee movements in patients with DGS (143). In 54 patients surgical treatment was indicated, while 24 of them underwent surgery. The results were based on tissue response to ARFI by color elastogram and stiffness ratio. Diameters of the sciatic nerve in patients with DGS during knee flexion were statistically significantly lower than during extension movement (p<0.01). In patients with DGS (in ones without indication and the ones scheduled for surgery) sciatic nerve stiffness ratio was significantly increased (p<0.01) during knee flexion. Patients scheduled for surgery confirmed increased sciatic nerve stiffness during knee movements, compared with those without indications for surgery (p<0.05). Sciatic nerve recovery after surgery by diameter and stiffness ratio was marked (r=0.881). The correlation between MRI and EMG findings and ARFI nerve stiffness values in patients scheduled for surgery was high (r=0.963). The overall specificity of method was 93.5%, sensitivity was 88.9% with accuracy of 90.6%. ARFI elastography (by strain) is a diagnostic procedure based on nerve stiffness assessment and a useful tool in decision making for surgery and the follow up.

scholarly journals Management of idiopathic pediatric syringohydromyelia

2015 ◽  
Vol 16 (4) ◽  
pp. 452-457 ◽  
Author(s):  
Analiz Rodriguez ◽  
Elizabeth N. Kuhn ◽  
Aravind Somasundaram ◽  
Daniel E. Couture
Keyword(s):  
Decision Making ◽  
Clinical Course ◽  
Inclusion Criteria ◽  
Single Institution ◽  
Surgical Decision ◽  
Spinal Imaging ◽  
Spinal Mri ◽  
Surgical Decision Making ◽  
Median Maximum

OBJECT Syringohydromyelia is frequently identified on spinal imaging. The literature provides little guidance to decision making regarding the need for follow-up or treatment. The purpose of this study was to review the authors' experience in managing pediatric syringohydromyelia of unknown cause. METHODS A single-institution retrospective review of all cases involving pediatric patients who underwent spinal MRI from 2002 to 2012 was conducted. Patients with idiopathic syringohydromyelia (IS) were identified and categorized into 2 subgroups: uncomplicated idiopathic syrinx and IS associated with scoliosis. Clinical and radiological course were analyzed. RESULTS Ninety-eight patients (50 female, 48 male) met the inclusion criteria. Median age at diagnosis of syrinx was 11.9 years. Median maximum syrinx size was 2 mm (range 0.5–17 mm) and spanned 5 vertebral levels (range 1–20 vertebral levels). Thirty-seven patients had scoliosis. The most common presenting complaint was back pain (26%). Clinical follow-up was available for 78 patients (80%), with a median follow-up of 20.5 months (range 1–143 months). A neurological deficit existed at presentation in 36% of the patients; this was either stable or improved at last follow-up in 64% of cases. Radiological follow-up was available for 38 patients (39%), with a median duration of 13 months (range 2–83 months). There was no change in syrinx size in 76% of patients, while 16% had a decrease and 8% had an increase in syrinx size. Thirty-six patients had both clinical and radiological follow-up. There was concordance between clinical and radiological course in 14 patients (39%), with 11 patients (31%) showing no change and 3 patients (8%) showing clinical and radiological improvement. No patients had concurrent deterioration in clinical and radiological course. One patient with scoliosis and muscular dystrophy underwent direct surgical treatment of the syrinx and subsequently had a deteriorated clinical course and decreased syrinx size. CONCLUSIONS There remains a paucity of data regarding the management of pediatric IS. IS in association with scoliosis can complicate neurosurgical decision making. There was no concordance between radiological syrinx size increase and clinical deterioration in this cohort, indicating that surgical decision making should reflect clinical course as opposed to radiological course.

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