Differentiating Hip Pathology From Lumbar Spine Pathology

2017 ◽  
Vol 25 (2) ◽  
pp. e23-e34 ◽  
Author(s):  
Aaron J. Buckland ◽  
Ryan Miyamoto ◽  
Rakesh D. Patel ◽  
James Slover ◽  
Afshin E. Razi
Keyword(s):  
Lumbar Spine ◽  
Spine Pathology

scholarly journals Do Orthopedic Surgeons or Neurosurgeons Detect More Hip Disorders in Patients with Hip-Spine Syndrome? A Nationwide Database Study

2021 ◽  
Vol 11 (4) ◽  
pp. 485
Author(s):  
Tsung-Cheng Yin ◽  
Adam M. Wegner ◽  
Meng-Ling Lu ◽  
Yao-Hsu Yang ◽  
Yao-Chin Wang ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Hip Surgery ◽  
Lumbar Spine Surgery ◽  
Research Database ◽  
X Rays ◽  
Replacement Surgery ◽  
Orthopedic Surgeons ◽  
Spine Pathology ◽  
Sh Group

Background: Disorders of the hip and lumbar spine can create similar patterns of pain and dysfunction. It is unknown whether all surgeons, regardless of orthopedic or neurosurgery training, investigate and diagnose concurrent hip and spine pathology at the same rate. Methods: Data were retrieved from Taiwan’s National Health Insurance Research Database (NHIRD). Enrolled patients were stratified into hip and spine surgery at the same admission (Both), hip surgery before spine surgery (HS), or spine surgery before hip surgery (SH). The SH group was further subdivided based on whether spine surgery was performed by an orthopedic surgeon (OS) or neurosurgeon (NS), and differences in preoperative radiographic examinations and diagnoses were collected and analyzed. Results: In total, 1824 patients received lumbar spine surgery within 1 year before or after hip replacement surgery. Of these, 103 patients had spine and hip surgery in the same admission (Both), 1290 patients had spine surgery before hip surgery (SH), and 431 patients had hip surgery before spine surgery (HS). In the SH group, patients were categorized into spine surgery by orthopedic surgeons (OS) (n = 679) or neurosurgeons (NS) (n = 522). In the SH group, orthopedic surgeons investigated hip pathology with X-rays more often (52.6% vs. 38.1%, p < 0.001) and diagnosed more cases of hip disease (43.6% vs. 28.9%, p < 0.001) than neurosurgeons. Conclusions: Of patients in Taiwan’s NHIRD who had concurrent surgical degenerative hip and lumbar spine disorders who had spine surgery before hip surgery, orthopedic surgeons obtained hip images and made hip-related diagnoses more frequently than did neurosurgeons.

scholarly journals Cajas intersomáticas lumbares: ¿medios de fusión o solo espaciadores?

10.15417/211 ◽  
2013 ◽  
Vol 78 (2) ◽  
pp. 74
Author(s):  
Diego Nicolas Flores Kanter ◽  
Alberto Javier Jabif ◽  
Pablo Nicolás Ortiz
Keyword(s):  
Computed Tomography ◽  
Lumbar Spine ◽  
Lumbar Fusion ◽  
Pedicle Screws ◽  
Fusion Rate ◽  
Title Page ◽  
Anterior Fusion ◽  
Surgical Fusion ◽  
Circumferential Fusion ◽  
Spine Pathology

<div class="page" title="Page 1"><div class="layoutArea"><div class="column"><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p>RESUMEN</p><p><span>Introducción: </span><span>La fusión quirúrgica de la columna lumbar es un método muy utilizado para el tratamiento de la inestabilidad segmentaria lumbar dolorosa. En la actualidad, las dos técnicas de fusión instrumentada más utilizadas son la fusión posterolateral con tornillos pediculares y la fusión circunferencial mediante asociación de caja intersomática. Si bien hay evidencia de que la asociación de dispositivos intersomáticos aumenta la tasa de fusión, la mayoría de los estudios no discriminan si esta se produce solo de forma posterolateral o si se asocia una fusión anterior. El objetivo de este trabajo es determinar si existe fusión ósea real a nivel de las cajas intersomáticas o si estas actúan solo como espaciadores.</span></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Materiales y métodos: </span><span>Se analizaron 28 pacientes con patología de la columna lumbar sometidos a artrodesis lumbar circunferencial en un solo nivel entre mayo de 2007 y enero de 2012, mediante tomografía computarizada posquirúrgica para valorar la presencia o no de artrodesis anterior. Se efectuó un estudio de valor terapéutico, descriptivo, de observación (nivel de evidencia IV); mediante evaluación estadística se realizó un análisis de frecuencias para describir la proporción de casos con fusión anterior.</span></p></div></div><div class="layoutArea"><div class="column"><p><span>Resultados: </span><span>Se detectó una tasa de fusión del 92,86% y falta de fusión radiológica anterior en el 7,14% de los pacientes.</span></p><p><span>Conclusiones: </span><span>Hay una alta tasa de fusión anterior a nivel de las cajas intersomáticas; de este modo, se demuestra que dichos dispositivos actúan como medios de fusión y no solo como espaciadores.</span></p><div class="layoutArea"><div class="column"><p>PALABRAS CLAVE: Cajas intersomáticas. Fusión lumbar intersomática transforaminal. Tomografía computarizada.</p><p> </p><p>LUMBAR INTERBODY CAGES: FUSING MEANS OR ONLY SPACERS?</p></div></div><div class="layoutArea"><div class="column"><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Background: </span><span>Surgical fusion of the lumbar spine is a frequently used method for the treatment of painful lumbar segmental instability; currently the two instrumented fusion techniques most commonly used are posterolateral fusion with pedicle screws, and circumferential fusion by association of interbody cages. Although evidence shows that the association of intersomatic devices increases the fusion rate, most studies do not discriminate if this fusion occurs only posterolaterally, or an anterior fusion also occurs. The aim of this study is to determine if there is a true bone fusion at the level of interbody cages or if they act only as spacers.</span></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Methods: </span><span>We analyzed 28 patients with lumbar spine pathology surgically treated with one level circumferential lumbar fusion from May 2007 to January 2012, using post-surgical computed tomography, to assess the presence or absence of anterior arthrodesis. A therapeutic value, descriptive, observational study was conducted (evidence level IV); by statistical evaluation, frequency analysis was performed to describe the proportion of cases with anterior fusion.</span></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Results: </span><span>The fusion rate reached 92.86%; while there was no anterior radiological fusion in 7.14% of patients. </span></p><p><span>Conclusions: </span><span>There is a high rate of anterior fusion at the level of the interbody cages, thus demonstrating that these devices act as fusing means and not only as anterior spacers.</span></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>KEY WORDS: Interbody cages; Transforaminal lumbsar interbody fusion. Computed tomography. </span></p></div></div></div><p><span><br /></span></p></div></div></div><p><span><br /></span></p></div></div></div><p><span><br /></span></p></div></div></div><p> </p></div></div><p><span><br /></span></p></div></div></div><p><span><br /></span></p></div></div></div><p> </p></div></div></div>

scholarly journals Instability in Patients with Lumbar Spine Disease or Fusion Undergoing Posterior Approach vs. Lateral Approach Primary Total Hip Arthroplasty

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Amritdev Parihar ◽  
Evan R. Deckard ◽  
Leonard T. Buller ◽  
R. Michael Meneghini
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Spine Pathology ◽  
Direct Lateral Approach ◽  
Postoperative Dislocation ◽  
Spine Disease

Background and Hypothesis:  Dislocation rates after total hip arthroplasty (THA) in patients with fixed spinopelvic motion due to lumbar spine disease or fusion have been reported as high as 20%. Few studies exist that compare dislocation rates in patients with spine pathology undergoing THA via different surgical approaches. The purpose of this study was to compare postoperative dislocation rates in patients with lumbar spine disease or fusion between those undergoing a primary THA using a posterior versus direct lateral surgical approach.    Experimental Design or Project Methods:  With IRB approval, 1,205 primary THAs performed by two surgeons were retrospectively reviewed. One surgeon routinely performs THAs with a posterior approach while the other surgeon routinely uses a direct lateral approach. Chart review from the electronic medical record was conducted to identify patients who have lumbar spine disease or a lumbar spine fusion. Dislocations for patients with and without lumbar spine disease were compared by posterior approach and direct lateral approach.    Results:   767 posterior approach and 431 direct lateral approach THAs were available for analysis.  43.6% of all THAs had lumbar spine pathology (337/767 posterior and 185/431 direct lateral). The overall dislocation rate was 1.26% (15/1195).  The main predictors of dislocation in binary logistic regression were the presence of lumbar spine pathology (OR 5.24, 95% CI: 1.47–18.69, p=0.018) and posterior surgical approach (OR 7.93, 95% CI: 1.04–60.6, p=0.046).  The dislocation rate for direct lateral approach THAs with lumbar spine pathology was significantly lower compared to posterior approach THAs with lumbar spine pathology (0.0% vs 3.6%, p=0.011).    Conclusion and Potential Impact:   Although there were few dislocations, the study results suggest a direct lateral approach for primary THA may be beneficial to reduce postoperative dislocation for patients with limited spinopelvic motion due to lumbar spine pathology. 

scholarly journals Surgical treatment of lower lumbar spine pathology in children and adolescents

2018 ◽  
Vol 6 (4) ◽  
pp. 37-47 ◽  
Author(s):  
Aleksandr V. Krutko ◽  
Abdugafur J. Sanginov ◽  
Morgan B. Giers ◽  
Alina А. Alshevskaya ◽  
Andrei V. Moskalev
Keyword(s):  
Physical Activity ◽  
Surgical Treatment ◽  
Lumbar Spine ◽  
Children And Adolescents ◽  
Posterior Approach ◽  
Intervertebral Discs ◽  
Neurosurgical Department ◽  
Lower Lumbar Spine ◽  
Spine Pathology ◽  
Lower Lumbar

Introduction. Analysis of the modern literature shows that the number of children complaining of low back pain of varying intensity in the spine increases annually. Publications on the surgical treatment of juvenile osteochondrosis were scarce. Currently, there are no algorithms for choosing a surgical treatment for children and adolescents with lumbar spine pathology, particularly high-grade listhesis, methods and terms of surgical treatment, and the use of reduction maneuvers remain debatable. There are no high-quality evidence studies. Aim. This study aimed to summarize the experience of treatment of children and adolescents with pathology of the lower lumbar spine. Material and methods. We performed a retrospective analysis of the treatment outcomes in patients with lower lumbar spine pathology who were younger than 18 years and who underwent surgery in the Neurosurgical Department No. 2 of the Tsiv’yan Novosibirsk Research Institute of Traumatology and Orthopedics between 2008 and 2018. The mean age of the patients was 15.5 years. We structured pathologies and interventions in children and adolescents and evaluated the clinical and radiological outcomes of treatment and the rate of intraoperative and postoperative complications. Results and discussion. From 2008 to 2018, 11,428 patients with degenerative spine disease and isthmic/dysplastic spondylolisthesis underwent surgery at the Neurosurgical Department No. 2. Of these, 55 (0.5%) patients were younger than 18 years. In all patients, surgical treatment led to pain relief and physical activity recovery. Decompression/stabilization surgery through the posterior approach enabled formation of an artificial block in 100% of cases. The rate of surgical treatment complications was 8.6% and 28.6% in children and adolescents with herniated lumbar intervertebral discs and spondylolisthesis, respectively. Conclusion. Surgical treatment of children and adolescents with pathology of the lower lumbar spine demonstrated an excellent clinical outcome. Disc herniation did not recur 4.9 years after decompression surgery for herniated lumbar intervertebral discs. Decompression/stabilization surgery through the posterior approach in children and adolescents with spondylolisthesis facilitated abolition of pain, regression of neurological disorders, full recovery of physical activity, and formation of a reliable artificial block. Potential complications were resolved without consequences and did not downplay the importance of surgical techniques in the treatment of this group of patients.

scholarly journals MIS Fusion of the SI Joint: Does Prior Lumbar Spinal Fusion Affect Patient Outcomes?

2013 ◽  
Vol 7 (1) ◽  
pp. 163-168 ◽  
Author(s):  
Leonard Rudolf
Keyword(s):  
Lumbar Spine ◽  
Spinal Fusion ◽  
Spine Fusion ◽  
Lumbar Spinal Fusion ◽  
Lumbar Spine Fusion ◽  
Spine Pathology ◽  
History Of ◽  
Lumbar Spinal ◽  
Si Joint

Background: Sacroiliac (SI) joint pain is a challenging condition to manage as it can mimic discogenic or radicular low back pain, and present as low back, hip, groin and/or buttock pain. Patients may present with a combination of lumbar spine and SI joint symptoms, further complicating the diagnosis and treatment algorithm [1-3]. SI joint pain after lumbar spinal fusion has been reported in the literature. Both clinical and biomechanical studies show the SI joint to be susceptible to increased motion and stress at the articular surface with up to 40-75% of patients developing significant SI joint degeneration after 5 years. In a recent case series study of 50 patients who underwent minimally invasive SI joint arthrodesis, 50% had undergone previous lumbar spinal fusion and 18% had symptomatic lumbar spine pathology treated conservatively [4]. The purpose of this study is to determine if history of previous lumbar fusion or lumbar pathology affects patient outcomes after MIS SI joint fusion surgery. Methods: We report on 40 patients with 24 month follow up treated with MIS SI joint fusion using a series of triangular porous plasma coated titanium implants (iFuse, SI-Bone, Inc. San Jose, CA). Outcomes using a numerical rating scale (NRS) for pain were obtained at 3-, 6-, 12- and 24 month follow up intervals. Additionally, patient satisfaction was collected at the latest follow up interval. Patients were separated into 3 cohorts: 1) underwent prior lumbar spine fusion (PF), 2) no history of previous lumbar spine fusion (NF), 3) no history of previous lumbar spine fusion with symptomatic lumbar spine pathology treated conservatively (LP). A repeated measures analysis of variance (rANOVA) was used to determine if the change in NRS pain scores differed across timepoints and subgroups. A decrease in NRS by 2 points was deemed clinically significant [5]. Results: Mean age was 54 (±13) years and varied slightly but not statistically between groups. All subgroups experienced a clinically and statistically significant reduction in pain at all time points (mean change >2 points, p<0.001). There was a statistically significant effect of cohort (p=0.045), with the NF cohort (no prior lumbar spinal fusion) having a somewhat greater decrease in pain (by approximately 1 point) compared to the other 2 groups (PF and LP).Patient reported satisfaction by cohort was: 89% (NF), 92% (PF) and 63% (LP).Overall satisfaction rate was 87%. Discussion and Conclusion: Patients with SI joint pain, regardless of prior lumbar spine fusion history, show significant improvement in pain after minimally invasive SI joint fusion. The presence of symptomatic lumbar spine pathology potentially confounds the treatment affect, as patients may not be able to discriminate between symptoms arising from the SI joint and the lumbar spine. These patients expressed a lower satisfaction with surgery. Patients without other confounding lumbar spine pathology and who have not undergone previous spine surgery tend to be younger and experience a greater reduction in pain.

scholarly journals Increased Fibrogenic Gene Expression in Multifidus Muscles of Patients With Chronic Versus Acute Lumbar Spine Pathology

Spine ◽  
2020 ◽  
Vol 45 (4) ◽  
pp. E189-E195 ◽  
Author(s):  
Bahar Shahidi ◽  
Kathleen M. Fisch ◽  
Michael C. Gibbons ◽  
Samuel R. Ward
Keyword(s):  
Gene Expression ◽  
Lumbar Spine ◽  
Spine Pathology

scholarly journals Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Padwal ◽  
David B. Berry ◽  
James C. Hubbard ◽  
Vinko Zlomislic ◽  
R. Todd Allen ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Muscle Activation ◽  
Spinous Process ◽  
Cross Sectional Area ◽  
Degenerative Changes ◽  
Sectional Area ◽  
Cross Sectional ◽  
Spine Stabilization ◽  
Spine Pathology ◽  
Deep Region

Abstract Background Due to its unique arrangement, the deep and superficial fibers of the multifidus may have differential roles for maintaining spine stabilization and lumbar posture; the superficial multifidus is responsible for lumbar extension and the deep multifidus for intersegmental stability. In patients with chronic lumbar spine pathology, muscle activation patterns have been shown to be attenuated or delayed in the deep, but not superficial, multifidus. This has been interpreted as pain differentially influencing the deep region. However, it is unclear if degenerative changes affecting the composition and function of the multifidus differs between the superficial and deep regions, an alternative explanation for these electrophysiological changes. Therefore, the goal of this study was to investigate macrostructural and microstructural differences between the superficial and deep regions of the multifidus muscle in patients with lumbar spine pathology. Methods In 16 patients undergoing lumbar spinal surgery for degenerative conditions, multifidus biopsies were acquired at two distinct locations: 1) the most superficial portion of muscle adjacent to the spinous process and 2) approximately 1 cm lateral to the spinous process and deeper at the spinolaminar border of the affected vertebral level. Structural features related to muscle function were histologically compared between these superficial and deep regions, including tissue composition, fat fraction, fiber cross sectional area, fiber type, regeneration, degeneration, vascularity and inflammation. Results No significant differences in fat signal fraction, muscle area, fiber cross sectional area, muscle regeneration, muscle degeneration, or vascularization were found between the superficial and deep regions of the multifidus. Total collagen content between the two regions was the same. However, the superficial region of the multifidus was found to have less loose and more dense collagen than the deep region. Conclusions The results of our study did not support that the deep region of the multifidus is more degenerated in patients with lumbar spine pathology, as gross degenerative changes in muscle microstructure and macrostructure were the same in the superficial and deep regions of the multifidus. In these patients, the multifidus is not protected in order to maintain mobility and structural stability of the spine.

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