Lateral intramuscular planar approach to the lumbar spine and sacrum

2007 ◽  
Vol 7 (2) ◽  
pp. 270-273 ◽  
Author(s):  
Edgar Newman Weaver
Keyword(s):  
Lumbar Spine ◽  
Pedicle Screw ◽  
Clinical Experience ◽  
Erector Spinae ◽  
Lateral Aspect ◽  
Multifidus Muscle ◽  
Less Invasive ◽  
Invasive Method ◽  
Planar Approach ◽  
Lateral Fusion

✓The goal of this study was to establish a much less invasive method for access to the lateral lumbar spine for posterolateral fusion and pedicle screw (PS) placement. The technique was developed through knowledge of the anatomy literature and the author's clinical experience in more than 90 completed cases. The lateral intramuscular planar approach provides a much less invasive access to the lateral aspect of the lumbar spine and sacrum. An invariant intramuscular plane, poorly described in the anatomical literature, is ideal for postero-lateral fusion and/or PS placement from L-3 caudally. The approach requires essentially no resection of the multifidus muscle, or of the pars thoracis of the erector spinae.

scholarly journals Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion

2021 ◽  
pp. 219256822110107
Author(s):  
Robert J. Owen ◽  
Noah Quinlan ◽  
Addisyn Poduska ◽  
William Ryan Spiker ◽  
Nicholas T. Spina ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Lumbar Fusion ◽  
Spine Fusion ◽  
Erector Spinae ◽  
Control Group ◽  
Block Group ◽  
Opioid Use ◽  
Lumbar Spine Fusion ◽  
Delivery Technique

Study Design: Retrospective review. Objective: To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. Methods: A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student’s t-test ( P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. Results: There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use ( P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. Conclusions: ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.

scholarly journals Development of Injectable Polydactyly-Derived Chondrocyte Sheets

2021 ◽  
Vol 22 (6) ◽  
pp. 3198
Author(s):  
Shiho Wasai ◽  
Eriko Toyoda ◽  
Takumi Takahashi ◽  
Miki Maehara ◽  
Eri Okada ◽  
...  
Keyword(s):  
Cell Viability ◽  
Cartilage Damage ◽  
Enzyme Linked Immunosorbent Assay ◽  
Invasive Treatment ◽  
Experimental Conditions ◽  
Humoral Factors ◽  
Less Invasive ◽  
Cell Counts ◽  
Invasive Method ◽  
Injection Control

We are conducting a clinical study of the use of allogeneic polydactyly-derived chondrocyte sheets (PD sheets) for the repair of articular cartilage damage caused by osteoarthritis. However, the transplantation of PD sheets requires highly invasive surgery. To establish a less invasive treatment, we are currently developing injectable fragments of PD sheets (PD sheets-mini). Polydactyly-derived chondrocytes were seeded in RepCell™ or conventional temperature-responsive inserts and cultured. Cell counts and viability, histology, enzyme-linked immunosorbent assay (ELISA), quantitative real-time polymerase chain reaction (qPCR), and flow cytometry were used to characterize PD sheets-mini and PD sheets collected from each culture. To examine the effects of injection on cell viability, PD sheets-mini were tested in four experimental conditions: non-injection control, 18 gauge (G) needle, 23G needle, and syringe only. PD sheets-mini produced similar amounts of humoral factors as PD sheets. No histological differences were observed between PD sheets and PD sheets-mini. Except for COL2A1, expression of cartilage-related genes did not differ between the two types of PD sheet. No significant differences were observed between injection conditions. PD sheets-mini have characteristics that resemble PD sheets. The cell viability of PD sheets-mini was not significantly affected by needle gauge size. Intra-articular injection may be a feasible, less invasive method to transplant PD sheets-mini.

CE FEATURE: Part 2: Pedicle Screw Fixation in the Lumbar Spine

1990 ◽  
Vol 9 (6) ◽  
pp. 22-32
Author(s):  
Hannah Brosnan ◽  
Pam Berda
Keyword(s):  
Lumbar Spine ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation

scholarly journals Architectural Analysis and Intraoperative Measurements Demonstrate the Unique Design of the Multifidus Muscle for Lumbar Spine Stability

2009 ◽  
Vol 91 (1) ◽  
pp. 176-185 ◽  
Author(s):  
Samuel R Ward ◽  
Choll W Kim ◽  
Carolyn M Eng ◽  
Lionel J Gottschalk ◽  
Akihito Tomiya ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Multifidus Muscle ◽  
Spine Stability ◽  
Architectural Analysis

Use of Kinetic and Kinematic Data to Evaluate Load Transfer as a Mechanism for Flexion Relaxation in the Lumbar Spine

2013 ◽  
Vol 135 (10) ◽  
Author(s):  
Samuel J. Howarth ◽  
Paul Mastragostino
Keyword(s):  
Lumbar Spine ◽  
Body Mass ◽  
Full Range ◽  
Added Mass ◽  
Erector Spinae ◽  
Lower Limbs ◽  
Upper Body ◽  
Low Back ◽  
Kinematic Data ◽  
Flexion Relaxation

Flexion relaxation (FR) in the low back occurs when load is transferred from the spine's extensor musculature to its passive structures. This study investigated the influence of added upper body mass on low back kinetics and kinematics at the FR onset. Sixteen participants (eight male, eight female) performed standing full forward spine flexion with 0%, 15%, and 30% of their estimated upper body mass added to their shoulders. Electromyographic data were obtained from the lumbar erector spinae. Ground reaction forces and kinematic data from the lower limbs, pelvis, and spine were recorded. Extensor reaction moments (determined using a bottom-up linked segment model) and flexion angles at the FR onset were documented along with the maximum spine flexion. The angle at the FR onset increased significantly with added mass (p < 0.05). Expressing the FR onset angle as a percent of the full range of trunk flexion motion for that condition negated any differences between the added mass conditions. These findings demonstrate that low back kinetics play a role in mediating FR in the lumbar spine.

scholarly journals Biomechanical Evaluation of Pedicle Screw-Based Dynamic Stabilization Devices for the Lumbar Spine: A Systematic Review

2008 ◽  
Vol 2 (4) ◽  
pp. 159-170 ◽  
Author(s):  
Cédric Y. Barrey ◽  
Ravi K. Ponnappan ◽  
Jason Song ◽  
Alexander R. Vaccaro
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Pedicle Screw ◽  
Dynamic Stabilization ◽  
Biomechanical Evaluation
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