Comparison of Spinal Alignment between XLIF, TLIF, PLIF, and PLF in the Treatment of Single Level Spondylolisthesis: A Retrospective Study

Background: Most lumbar spinal fusion procedures are performed to increase fusion potential, correct a deformity, and decompress spinal nerve roots. Nowadays, there are several spinal fusion techniques such as extreme lateral lumbar interbody fusion (XLIF), transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterolateral fusion (PLF). However, there are no studies directly comparing their capacity to alter lumbar lordosis, segmental lordosis, intervertebral disc height, foraminal height, and the grade of slip for treating single level spondylolisthesis in Thailand. Objective: To compare which lumbar interbody technique amongst XLIF, TLIF, PLIF, and PLF, is the most effective in restoring spinal alignment in cases such as lumbar lordosis, increased segmental lordosis, increased intervertebral disc height, increased foraminal height, and a reduced slip grade in spondylolisthesis patients. Materials and Methods: The medical records and radiographs of single level spondylolisthesis patients treated in Siriraj hospital between 2002 and 2017 were retrospectively reviewed. Clinical data and radiographic parameters such as lumbar lordosis, segmental lordosis, intervertebral disc height, foraminal height, and grade of slip, including preoperative and postoperative data were collected and analyzed. An inter-observer/ intra-observer reliability test for all parameters was also performed. Results: Two hundred forty patients including 192 females and 48 males with a mean age of 60.1 years were included in the present study. There was no statistically significant difference in demographic data except in younger patients in the PLF group and those with shorter length of stays in the XLIF group. The present study results indicated that there was a statistically significant increase in lumbar lordosis, increased foraminal height, and decreased slip grade in the XLIF group when compared to other three groups as TLIF, PLIF, and PLF. Conclusion: All spinal fusion techniques could improve lumbar spinal alignment, however, XLIF is superior to other procedures, especially in lumbar lordosis, foraminal height restoration, and slip grade. Keywords: Lumbar spondylolisthesis; Extreme lateral lumbar interbody fusion; Transforaminal lumbar interbody fusion; Posterior lumbar interbody fusion; Posterolateral fusion; Lumbar lordosis

Radiographic evaluation of lumbar intervertebral disc height index: an intra and inter-rater agreement and reliability study

Purpose: To evaluate intra- and inter-rater agreement and reliability of seven reported disc height index (DHI) measurement methods on standing lateral X-ray of lumbar spine. Methods: The adult patients who had standing lateral X-ray of lumbar spine were recruited. Seven methods were used to measure DHI of each lumbar intervertebral disc level. Bland and Altman Limits of Agreement (LOA) with standard difference were calculated to examine intra- and inter-rater agreements between two out of seven methods for DHI. Intra-class correlations (ICC) with 95% confidence intervals were calculated to assess intra- and inter-rater reliability. Results: The intra-rater reliability in DHI measurements for 288 participants were ICCs from 0.807 (0.794, 0.812) to 0.922 (0.913, 0.946) by rater 1 (SS) and from 0.827 (0.802, 0.841) to 0.918 (0.806, 0.823) by rater 2 (XC). Method 2, 3, and 5 on all segmental levels had bias (95% CI does not include zero) or/and out of the acceptable cut-off proportion (>50%). A total of 609 outliers in 9174 segmental levels LOA range. Inter-rater reliability was good-to-excellent in all but method 2 (0.736 (0.712, 0.759)) and method 5 (0.634 (0.598, 0.667)). ICCs of related lines to good-to-excellent reliability methods was excellent in all but only indirect line in method 1 and 4 (ICCs lie in the range from 0.8 to 0.9). Conclusion: Following structured protocol, intra- and inter-rater reliability was good-to-excellent for most DHI measurement methods on X-ray. However, in the presence of vertebral rotation, one should exercise caution in using complicated methods to define vertebral landmarks. Keywords: Lumbar disc herniation, discectomy, disc height, disc height index, agreement, reliability.

Comparison between intervertebral oblique lumbar interbody fusion and transforaminal lumbar interbody fusion: a multicenter study

This study aimed to perform a comparative analysis of postoperative results between lumbar degenerative spondylolisthesis (LDS) treated with oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) from the Chiba spine surgery registry database. Sixty-five patients who underwent single-level OLIF (O group) for LDS with ≥ 3 years’ follow-up were retrospectively reviewed. The control group comprised 78 patients who underwent single-level TLIF (T group). The analyzed variables included global alignment, radiological parameters of fused segments, asymptomatic and symptomatic ASD incidence, clinical outcomes at 3 years postoperatively using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire data, visual analogue scale scores for low back pain, lower extremity pain, and lower extremity numbness. There was no significant change in global alignment between the two groups. The rate of improvement in anterior intervertebral disc height was not significantly different between the groups at 1-month postoperatively. However, at the final evaluation, the anterior intervertebral disc height and incidence of asymptomatic ASD were significantly higher in the O group. There was no significant difference in symptomatic ASD, reoperation cases, or clinical results between groups. Thus, single-level OLIF can maintain the corrected disc height, but as it has no effect on global alignment, its benefit is limited.

Diurnal variation in aviation significant gravity-dependent and gravity-independent anthropometric parameters

Introduction: Anthropometric parameters need to be accurately measured because of their direct implications in selection of aircrew, aircrew-cockpit compatibility, and cockpit workspace design. Some of these parameters have significant diurnal variation, hence, measurement of these parameters in particular time of day becomes important. Quantification of these diurnal variations among some of the aviation significant parameters was the desired objective of the study. Material and Methods: In a prospective repeated measure design, anthropometric parameters of a total of 35 volunteers were measured in the standard defined protocol from 0800h to 1600h, at an interval of every 2h, using Institute of Aerospace Medicine (IAM) Anthropometry Platform. The data were analyzed to observe and quantify changes in diurnal variations in both gravity-dependent and gravity-independent parameters. A maximum value of 0.4 cm was taken as intraobserver variations based on the results of a pilot study. Results: There was a statistically significant decrement in the values of gravity-dependent anthropometric parameters from morning to evening; the difference being more after 1200h. Most of the gravity-independent parameters did not show any significant changes from 0800h to 1600h, except leg length, which showed a decrement overtime, the difference being statistically significant after 1200h. Conclusion: The study revealed a statistically significant variation of gravity-dependent anthropometric parameters from the baseline which could be because of the effect of erect posture on the intervertebral disc height and axial compressive loads on the spine. This became practically significant after 1200h. However, most of the gravity-independent parameters did not show any significant variations. Based on the results of this study, anthropometric measurements should be done in the morning hours preferably before 1200h.

Lumbar intervertebral disks: morphometric parameters and indices

An important element of evidence-based medicine is to take into account the individual variability of the indicators of the norm of intervertebral discs, which is undoubtedly the basis for early preclinical detection of their pathology. Mathematical modeling and comprehensive assessment of the parameters of the intervertebral discs can not only predict and determine the early manifestations of pathological changes, but also help to correct them in advance. The aim of the study was to calculate and evaluate the variability of absolute, calculated and relative metric parameters of intervertebral discs in the norm with the subsequent possibility of modeling standards based on individual linear dimensions of intervertebral discs of the lumbar spine and general anthropometric characteristics (body length and weight) in young men and men of the first period of adulthood (17-28 years), both in separate age groups and in the combined group. The series of MRI scans obtained on a Phillips Achieva 1.5T scanner measured the anterior, middle and posterior vertical dimensions, maximum sagittal and frontal dimensions of the intervertebral discs L1-L2, L2-L3, L3-L4, L4-L5 segments of the spine (IVDL1-L2, IVDL2-L3, IVDL3-L4, IVDL4- L5). We calculated the average height of the intervertebral discs, cross-sectional area and volume of intervertebral discs, as well as relative indicators - the ratio of the sum of sagittal and transverse dimensions, the sum of three dimensions, cross-sectional area and volume of intervertebral discs to the average intervertebral disc height. Statistical analysis of the obtained morphometric parameters was performed in the license package “STATISTICA 6.1”. The distribution of variation series indicators, their average values and standard errors, coefficients of variation and asymmetry were evaluated. It was determined that the sums of the transverse and sagittal sizes and the sums of the three sizes increase proportionally in the caudal direction, have a distribution of indicators as close as possible to normal, and their coefficients of variation are many times smaller than for cross-sectional areas and volumes. Indicators of the ratio of the sum of the sagittal and transverse size and the sum of the three sizes to the average height of the intervertebral discs have a variability of less than 10% and correspond to the characteristics of the general population. Body weight and length have significantly higher correlation coefficients with the sums of sagittal and transverse dimensions, the sums of three dimensions and cross-sectional areas than with the partial dimensions of the intervertebral discs.

A Scoring System for Anterior Longitudinal Ligament Ossification of the Lumbar Spine in Diffuse Idiopathic Skeletal Hyperostosis: Relationship Between the Extent of Ligament Ossification and the Range of Motion

Study Design: Retrospective observational study. Objective: To investigate the relationship between the extent of ligament ossification and the range of motion (ROM) of the lumbar spine and develop a new scoring system. Methods: Forty-three patients (30 men and 13 women) with lumbar spinal canal stenosis who underwent decompression from January to December 2018. Ligament ossification at L1/2 to L5/S was assessed on plain X-ray (Xp) and computed tomography (CT) using a modified Mata scoring system (0 point: no ossification, 1 point: ossification of less than half of the intervertebral disc height, 2 points: ossification of half or more of the intervertebral disc height, 3 points: complete bridging), and the intra-rater and inter-rater reliability of the scoring was assessed. The relationship of the scores with postoperative lumbar ROM was investigated. Result: Intra-rater reliability was high (Cronbach’s α was 0.74 for L5/S on Xp but 0.8 or above for other sections), as was inter-rater reliability (Cronbach’s α was 0.8 or above for all the segments). ROM significantly decreased as the score increased (scores 1 to 2, and 2 to 3). A significant moderate negative correlation was found between the sum of the scores at L1/2-L5/S and the ROM at L1-S (ρ = − 0.4493, P = 0.025). Conclusion: Our scoring system reflects lumbar mobility and is reproducible. It is effective for assessing DISH in fractures and spinal conditions, and monitoring effects on treatment outcomes and changes over time.

ZERO-PROFILE ANCHORED SPACER SYSTEM IN THE TREATMENT OF CERVICAL DEGENERATIVE DISEASE WITH A FOLLOW-UP OF 1 YEAROUR EXPERIENCE .

Objects: Anterior cervical plating decreases the risk of pseudarthrosis, increases rate of fusion following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-prole, stand-alone interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. We are reporting our ndings in term of clinico-radiological outcomes following the use of such devices in the treatment of cervical spine degenerative diseases with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia. The authors conducted a prospective analysis of all Methods: patients who had undergone ACDF between December 2018 and December 2019. All patients received a Zero-P implant (DePuy Synthes Spine).The Neck Disability Index (NDI),Modied Japanese Orthopaedic Association Score(mJOA) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, intervertebral disc height were assessed as well. The nal outcome was assessed with Odom's criteria. Total 30 patients Results: were studied prospectively, and data were collected and analyzed. 17 male and 13 female consecutive patients, with a mean age of 48.28 ± 8.17 years, underwent ACDF with Zero-Prole spacer (42 total operated levels) in the dened study period. There were signicant improvements in neck and arm VAS scores, the NDI and mJOA scores following surgery at last follow up. The neck VAS score improved from a mean 7.34 ±1.87 to 1.04 ± 0.09 (p<0.01) . The arm VAS score improved from 7.22±2.03 to1.03±0.10 at latest follow up. NDI score improved signicantly from preoperative 31.94±6.73 to 12.87±5.24 and mJOAscore improved from preoperative 9.53±1.98 to 15.6±1.26 at last follow up. Immediate postoperative dysphagia was experienced by 36.67% of all patients. Complete resolution of dysphagia was demonstrated at the latest follow-up. Prevertebral soft-tissue thickness at postoperative 48 hrs decreased across all levels from a mean of 15.87 ±0.69 to 11.81 ± 0.53 mm at last follow up. Cervical alignment and intervertebral disc height were also improved signicantly after surgery. Radiographic fusion was achieved in 100% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score. Majority of the patients had excellent outcomes in odom's criteria. Conclusions: Zero-Prole device is a safe and effective alternative for the treatment of cervical degenerative diseases. Chronic dysphagia rates are comparable to or better than those for previously published case series.

Effects of oophorectomy on the lumbar spine of Wistar rats submitted to vibratory platform treatment

Introduction: This study evaluated the effect of the vibratory platform on the lumbar spine morphology of Wistar rats submitted to hormonal deprivation by oophorectomy. Material and method: Twenty rats were divided into four groups: Pseudo-oophorectomy (GP), Pseudo-oophorectomy Treated (GPT), Oophorectomy (GO), Oophorectomy Treated (GOT). After 60 days of postoperative, the treated groups started exercises on a vibratory platform in the frequency parameters of 60 Hz, alternating vibration with amplitude of 2 mm, acceleration of 57.6 m/s² and time of 10 minutes, three times in the during the four week period. Following the euthanasia of the animals, the lumbar spine was dissected and processed for analysis of the anterior and posterior longitudinal ligaments, intervertebral disc height (IVD), nucleus pulposus (NP) height, radiographic density of the lumbar vertebrae and IVD morphology. Results: The results showed a decrease in the height of the NP associated to the GO and morphological alterations such as lamellar disorganization and presence of rifts in the fibrous ring, alterations of the structural limits and decrease of the NP cavity; while the other groups presented organized lamellae, peripheral and nuclear region well delimited and wide cavity of the nucleus. Conclusion: In this way, it can be concluded that the oophorectomy protocol promoted a decrease in the height of the NP of the IVD and that the exercise in the vibratory platform did not generate lesions in the analyzed tissues, as well as preserved the structural organization of the IVD and the height of the NP of oophorectomized rats.