Hybrid surgery with PEEK rods for lumbar degenerative diseases: a 2-year follow-up study

Background Finite element analyses and biomechanical tests have shown that PEEK rods promote fusion and prevent adjacent segment degeneration. The purpose of this study was to evaluate the effects and complications of hybrid surgery with PEEK rods in lumbar degenerative diseases. Methods From January 2015-December 2017, 28 patients who underwent lumbar posterior hybrid surgery with PEEK rods were included in the study. The patients were diagnosed with lumbar disc herniation, lumbar spinal stenosis, or degenerative grade I spondylolisthesis. Before the operation and at the last follow-up, the patients completed lumbar anteroposterior and lateral X-ray, dynamic X-ray, MRI examinations. In addition, at the last follow-up the patients also completed lumbar CT examinations. The radiographic parameters, clinical visual analog scale (VAS) score and Oswestry disability index (ODI) score were compared. Results The average age of the patients was 44.8 ± 12.6 years, and the average follow-up duration was 26.4 ± 3.6 months. The VAS score improved from 6.3 ± 1.6 to 1.0 ± 0.9, and the ODI score decreased from 38.4 ± 10.8 to 6.8 ± 4.6. The fusion rate of the fused segment was 100%. There were no significant changes in the modified Pfirrmann classifications or disc height index for the nonfused segments and the upper adjacent segments from pre- to postoperatively. No cases of screw loosening, broken screws, broken rods or other mechanical complications were found. Conclusion Hybrid surgery with PEEK rods for lumbar degenerative diseases can yield good clinical results and effectively reduce the incidence of complications such as adjacent segment diseases.

Effect of Discectomy on Dynesys Dynamic Fixation in the Treatment of Lumbar Degenerative Diseases

Objective. To compare the effect of decompression of the spinal canal with or without discectomy on the clinical efficacy of Dynesys dynamic fixation treatment in lumbar degenerative diseases. Methods. A total of 62 patients treated for single-segment lumbar degenerative disease from October 2010 to November 2017 were retrospectively analyzed. All patients underwent decompression of the spinal canal with Dynesys dynamic fixation and were divided into two groups. Twenty-seven patients in group A did not undergo discectomy, and 35 patients in group B underwent discectomy. The intervertebral height, range of motion, Pfirrmann grade of the surgical segment and the upper adjacent segment, function scores, and operation information were compared. Results. All patients were followed up for an average of 30.7 ± 11.5 months. At the final follow-up, the intervertebral height and range of motion of the surgical segment decreased significantly in both group A and B ( p < 0.05 ), the range of motion of the upper adjacent segment increased significantly ( p < 0.05 ), and the intervertebral height did not change significantly ( p < 0.05 ). The retained percentages of surgical segment intervertebral height and ROM in group A were significantly better than those in group B ( p < 0.05 ). The intervertebral height ( p > 0.05 ) and range of motion ( p < 0.05 ) of the surgical segment in group A were higher than those in group B. The surgical segment Pfirrmann grading of group A was better than that of group B ( p < 0.05 ). Conclusion. Dynesys in the treatment of lumbar degenerative diseases may lead to a good clinical effect. In selected cases without discectomy, the range of motion and intervertebral height may be better preserved, and disc degeneration may be reduced.

Associations between facet tropism and vertebral rotation in patients with degenerative lumbar disease

Background Vertebral rotation and facet tropism are very common in various lumbar degenerative diseases. Facet tropism means the presence of asymmetric angles on both sides of the facet joints. Studies have shown that facet tropism contributes to lumbar degenerative disease, and also inevitably leads to the asymmetry of movement and the imbalance of force, which may be possible to rotate the vertebral body. The aim of this study was to explore the correlation between lumbar vertebral rotation and facet tropism in patients with lumbar degenerative diseases. Methods A total of 198 patients with lumbar degenerative diseases from 2018 to 2019 were enrolled. Five hundred and seventy vertebral rotation angles and 1140 facet angles were measured. The vertebral bodies are divided into non-rotation group (Group A) and rotation group (Group B) with the vertebral rotation angle of 3° as the boundary. The information including gender, age, BMI (body mass index), bone mineral density, history of smoking, drinking, hypertension, diabetes, diagnosis, segment distribution, and degree of facet degeneration were also counted. Using inter-class correlation coefficients (ICC) to test the reliability of measurement results. Univariate and multivariate logistic regression analysis were used to analyze the relationship between vertebral rotation and facet tropism. Results The consistency of the ICC within the groups of the observers is above 0.8, with good agreement. The results of univariate analysis showed that facet tropism was significantly different between group A and group B (OR (odds ratio) = 3.30, 95% CI = 2.03–5.35, P < 0.0001). Other significant factors were included as adjustment variables into the multivariate regression model. Three models were analyzed separately (Model 1: non-adjusted. Model 2: adjust for age; facet degeneration; Model 3: adjust for age; disease distribution; segment distribution; facet degeneration). The results showed that after adjusting the confounders, the correlation between facet tropism and vertebral rotation did not change (Model 1: OR = 3.30, 95% CI = 2.03–5.35, P < 0.0001; Model 2: adjusted OR = 2.87, 95% CI = 1.66–4.97, P = 0.0002, Model 3: adjusted OR = 2.84, 95% CI = 1.56–5.17, P = 0.0006). Conclusion Current research demonstrates that there is an association between vertebral rotation and facet tropism, suggesting that vertebral rotation may also have a certain degree of correlation with lumbar degenerative diseases.

A comparative study of new-type-retractor-assisted wiltse approach TLIF, MIS-TLIF and traditional PLIF in the treatment of single- level lumbar degenerative diseases

Background To compare the clinical efficacy of new-type-retractor assisted wiltse approach Transforaminal lumbar Interbody Fusion (TLIF), Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) and traditional Posterior Lumbar Interbody Fusion (PLIF)in single-level lumbar degenerative diseases. Methods A retrospective study was conducted by analyzing clinical and imaging information of consecutive patients with single-level lumbar degenerative diseases who underwent either the new-type-retractor assisted wiltse approach TLIF or the MIS-TLIF or the traditional PLIF. 87 concurrent patients with similar age ,weight and severity of the imaging and symptom between June 2016 and December 2019 were included(wiltse approach 29 cases; MIS-TLIF 28 cases; PLIF 30 cases).The three groups were compared for perioperative indicators(including intraoperative blood loss, postoperative drainage volume, operation time, intraoperative fluoroscopy time, bed time), creatine kinase (CK), Visual Analogue Scale(VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, intervertebral fusion rate, muscle atrophy and fatty infiltration(including ratio of multifidus atrophy and ratio of lean-to-total cross sectional area(CSA)). Results Intraoperative blood loss, postoperative drainage volume and bed time in MIS-TILF group and wiltse group was significantly lower than PLIF group. The operative time and intraoperative radiation time of MIS-TILF group was significantly longer than wiltse group and PLIF group. CK level in wiltse and MIS-TILF group were significantly lower than PLIF group 1 and 3 days after surgery. PLIF group back pain VAS score was higher than wiltse and MIS-TLIF group. PLIF group displayed a higher ODI and a lower JOA score than the wiltse and MIS-TLIF group 6 months and 12 months after surgery. There was no significant statistical difference in lower limb pain VAS score and intervertebral fusion rate. Ratio of multifidus atrophy in the PLIF group was significantly higher than the wiltse group and the MIS-TILF group. Ratio of lean-to-total CSA (cross-sectional area) in PLIF group was lower than wiltse group and MIS-TLIF group after surgery. There was no significant difference between wiltse group and MIS-TLIF group except that MIS-TLIF group showed longer operation time and intraoperative fluoroscopy time while lower blood loss and drainage volume. 2 cases of durotomy and 2 cases of incision fat liquefaction occurred in PLIF group, 1 case of skin edge necrosis was found in MIS-TILF group. Patients were followed up at 3 months,6moyhs,12months after surgery, The mean follow-up time of the patients was 12.14±2.78 months in wiltse group, 13.57±2.60 months in MIS-TLIF group, and 12.73±2.80 months in PLIF group, with no significant diffirence among 3 groups. (P༞0.05) Conclusion Wiltse approach TLIF assisted with the new-type retractor is a more convenient and simple minimally invasive surgical method than traditional PLIF and MIS-TLIF, which requires a long learning curve, long operation and fluoroscopy time.

A Novel Capsule Lumbar Interbody Fusion (CLIF) in Treating Foot Drop due to Lumbar Degenerative Diseases: a Prospective, Observational Study

Objective. This present study aimed to explore the clinical effects of a novel capsule lumbar interbody fusion (CLIF) on foot drop due to lumbar degenerative diseases. Methods. Between June 2018 and January 2019, a total of 27 patients admitted to our department with lumbar degenerative diseases with associated foot drop were prospectively enrolled. Given the selection of surgical technique, patients were divided into traditional TLIF group and CLIF group. We assessed patients’ neurological status using JOA and VAS score, tibialis anterior muscle strength using MMT score, diameter and hemodynamic parameters of the L5 nerve root using intraoperative ultrasonography (IoUS), and related radiological parameters of the lumbar spine. Operation time, blood loss, and surgery-associated complications were also recorded. Results. The median duration of follow-up was 150 (6–1460) months. At the final follow-up, all patients acquired satisfactory improvement of neurological function. However, patients in the CLIF group showed better early recovery of foot drop three months after operation than those in the TLIF group, with 75% excellent rate. In addition, IoUS suggested that the diameter and hemodynamic parameters of the L5 nerve root were improved better in the CLIF group, which may suggest the correlation between the recovery of foot drop and the status of L5 nerve root. No severe complications were encountered with CLIF. Conclusions. Our preliminary study revealed that the axial tension of L5 nerve root may be involved in the pathological mechanism of foot drop. The novel technique of CLIF can shorten the lumbar spine and can be effective and safe for the treatment of foot drop due to lumbar degeneration-related diseases.

Bending rod is unnecessary in single-level posterior internal fixation and fusion in treatment of lumbar degenerative diseases

Background Bending rod is a routine in lumbar fusion and fixation surgery, but there is no study investigating whether bending rod in one level is necessary. Methods Patients receiving 1 level lumbar fixation and fusion between May 2018 and September 2020 were included with a minimum 6-month follow-up. The routine of bending rod was omitted during fixation. Preoperative and postoperative radiological parameters were compared. Results There were 67 patients included in the study. Segment lordosis angle increased obviously from 10° (1–39°) to 14° (2–30°) immediately after operation (p = 0.000). T5-T12 increased from 22.97 ± 12.31° to 25.52 ± 11.83° by the 3rd months after surgery (p = 0.011). SS decreased from 35.45 ± 10.47 to 32.19 ± 11.37 in 6-month follow-up (p = 0.038), and PI dropped from 56.97 ± 14.24 to 53.19 ± 12.84 (p = 0.016). ROM of SLA decreased from 4.13 ± 3.14° to 1.93 ± 1.87° at that time point (p = 0.028). Those changes were not seen at 12-month follow-up. No evidence of adjacent vertebral disc degeneration was observed at any time point. Conclusions No sagittal imbalance, dynamic instability or adjacent vertebral degeneration was observed by the 12th month after single-segment posterior lumbar fusion with the use of unbent rods. Bending rod could be omitted in 1-level lumbar fusion to simplify the procedure and reduce operating time.

Oblique Lateral Interbody Fusion Combined with Lateral Plate VS. Combined with Posterior Pedicle Screw Fixation in Lumbar Degenerative Diseases

Background The oblique lateral interbody fusion (OLIF) is a minimally invasive indirect decompression technique for the treatment of degenerative spinal disease. OLIF with posterior pedicle screws fixation frequently is performed, whereas it requires much more surgery time and blood loss. The purpose of this study was to compare the oblique lateral interbody fusion (OLIF) combined with lateral plate (LP) vs. OLIF combined with posterior pedicle screw (PS) fixation for the treatment of lumbar degenerative diseases.Methods The clinical data of 53 patients with lumbar degenerative diseases who underwent OLIF from January 2020 to September 2020 were retrospectively analyzed，24 in OLIF combined with lateral plate (OLIF+LP) group and 29 in OLIF combined with pedicle screw (OLIF+PS) group. All patients completed a minimum 1-year follow-up. The duration of operation, blood loss, fusion rate and complications were recorded. The visual analog scale (VAS) score, Oswestry Disability Index (ODI), disc height (DH), foraminal height (FH) and cross-sectional area (CSA) were also evaluated.Results The operation time was 75.41±11.53 min in the OLIF+LP group, which shorter than that in OLIF+PS group(127.05±5.62min, P<0.01). Also, the blood loss was significantly less in the OLIF+LP group (39.55±5.32 ml ) than in the OLIF+PS group (89.81±9.62, P<0.01). The VAS and ODI scores both significantly reduced after operation in OLIF+LP group. There was no difference either in VAS or ODI scores by 1 year after surgery between two groups (P>0.01). The DH, FH, and CSA parameters were all improved significantly after operation in both groups, however, there was no significant difference at the any follow-up point between the two groups. The total complication rate was 13.21% (7/53) in this study, and there was no siginificant difference between the two groups. The fusion rate was 91.67% in the OLIF+LP group and 93.10% in the OLIF+PS group (P =0.69).Conclusions OLIF+LP fixation seems to be a valuable surgical option for single-segmental lumbar degenerative disease, it can achieve much better clinical outcomes than OLIF+PS group.