lumbar spinal fusion Dotaz Zobrazit nápovědu
BACKGROUND: Midline lumbar fusion (MIDLF) is one promising new surgical technique that has been developed to minimize perioperative damage to the paravertebral stabilizing musculotendinous system. The aim of this study was to assess long-term clinical and radiological effects of MIDLF. METHODS: This prospective cohort study evaluated patients who underwent MIDLF for degenerative spinal instability. Clinical and radiological examinations were performed before and after surgery. Perioperative and postoperative complications were recorded. Follow-up was 2 years. P ≤ 0.05 was considered statistically significant. RESULTS: The study included 64 patients (mean age 58.9 ± 10.7 years; 41 women [64.1%]). The most frequent indication for MIDLF was degenerative spondylolisthesis grade I (28 cases [43.8%]); the prevalent spinal segment to be fused was L4-L5 (35 cases [54.7%]). Mean duration of surgery was 148.2 ± 28.9 minutes. Relief of low back pain and leg pain was significant and stable in the postoperative period as assessed by visual analog scale (P < 0.001). Of patients, 86.9% reported fair, good, or excellent outcomes in terms of pain relief based on MacNab score 2 years after surgery. Patients' level of function in activities of daily living improved significantly based on Oswestry Disability Index score: from 66.8 ± 9.8 before surgery to 33.9 ± 16.5 2 years after surgery (P < 0.001). X-rays and computed tomography at 12 months showed interbody fusion in 46 cases (73.4%), inconclusive results in 13 cases (20.3%), and no fusion in 4 cases (6.3%). No damage to neural or vascular structures and no failure of hardware or screw loosening were recorded. CONCLUSIONS: MIDLF is a safe, efficient method for surgical treatment of lumbar spine instability. Its limited invasiveness contributes to better preservation of paravertebral muscles and enhanced postoperative spinal stability.
- Klíčová slova
- Czech Republic, MIDLF, Midline lumbar fusion, Spinal fusion, Spinal instability, Spinal stabilization,
- MeSH
- bederní obratle diagnostické zobrazování patologie chirurgie MeSH
- degenerace meziobratlové ploténky diagnostické zobrazování patologie chirurgie MeSH
- dospělí MeSH
- fúze páteře * MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy. CLINICAL RATIONALE FOR THE STUDY: MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies. MATERIAL AND METHODS: This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05. RESULTS: The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference -3.3mm, p = 0.02) and the inferior adjacent segment (-7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes.
- Klíčová slova
- cortical bone trajectory, midline lumbar fusion, multifidus muscles, spinal fusion, spinal instability, spinal stabilisation,
- MeSH
- bederní obratle * chirurgie MeSH
- dospělí MeSH
- fúze páteře * škodlivé účinky metody MeSH
- hluboké zádové svaly * diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- pedikulární šrouby škodlivé účinky MeSH
- retrospektivní studie MeSH
- senioři MeSH
- spondylolistéza * chirurgie MeSH
- svalová atrofie * etiologie diagnostické zobrazování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Spinal fusion is a surgical procedure used to join two or more vertebrae to prevent movement between them. This surgical procedure is considered in patients suffering from a wide range of degenerative spinal diseases or vertebral fractures. The success rate of spinal fusion is frequently evaluated subjectively using X-ray computed tomography. The pig was chosen as an animal model for spinal fusion, since its spinal structure is similar to the human spine. Our paper presents an automatic approach for pig's spinal fusion evaluation in 3D. The proposed approach is based on the determination of the vertebral fused area, which reflects the fusion quality. The approach was applied and tested on microCT (μCT) data of fused porcine vertebrae ex-vivo. In our study, three types of implants were used to perform spinal fusion: the iliac crest bone graft used as the gold standard, and two types of novel scaffold implants based on the polymer/ceramic porous foam involving either growth factors or polyphosphates. The evaluation worked automatically for all three types of used implants, and the fusion quality was determined quantitatively. The calculation is based on the detection of the fused area and area of facies intervertebralis, so the percentual representation of the vertebral joint can be determined. Since this approach is versatile and is described in detail as a guide for image processing the data of vertebrae fusion, this methodology has the potential to establish a standard approach for evaluating the fusion quality in ex-vivo samples that can be tested on clinical data.
- Klíčová slova
- Computed tomography, Image processing, Lumbar spinal surgery, Regenerative medicine, Spinal fusion, Vertebrae fusion,
- MeSH
- bederní obratle diagnostické zobrazování chirurgie MeSH
- fúze páteře * MeSH
- lidé MeSH
- lumbosakrální krajina MeSH
- nemoci páteře * MeSH
- prasata MeSH
- rentgenová mikrotomografie MeSH
- rentgenové záření MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Experimental spinal cord transection injuries followed by spinal cord destruction and gentle resection of the destructed cord tissue necessarily lead to a gap between both of the cord stumps. For any attempts to reconstruct the cord or to bridge this gap by transplantation it may be useful to narrow or close the gap. This can be done by vertebral resection. The technique of upper lumbar vertebra resection in cats and rabbits with and without spinal cord lesion is presented. The spine is shortened by approximately 20 mm by spondylectomy. This length exceeds the 10-14 mm long gap in the spinal cord which is created by a spinal cord crush injury using haemostatic forceps and the subsequent destruction zone resection which is performed seven days later. The upper lumbar vertebra is resected by the posterior approach and the spinal cord is sufficiently exposed to perform spinal cord reconstruction experiments.
INTRODUCTION AND PURPOSE: With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD). MATERIAL AND METHODS: This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery. RESULTS: During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work. CONCLUSION: Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04876586.
- Klíčová slova
- Axial pain, Degenerative disc disease, Low back pain, SPECT, Spinal fusion,
- MeSH
- bederní obratle diagnostické zobrazování chirurgie MeSH
- degenerace meziobratlové ploténky * diagnostické zobrazování chirurgie MeSH
- fúze páteře * metody MeSH
- jednofotonová emisní výpočetní tomografie MeSH
- lidé MeSH
- lumbalgie * diagnostické zobrazování etiologie chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
AIM: The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF). METHODS: Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure. RESULTS: SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative. CONCLUSION: This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
- Klíčová slova
- interbody fusion, lumbar spine, sympathectomy, thermography,
- MeSH
- bederní obratle chirurgie MeSH
- dospělí MeSH
- fúze páteře škodlivé účinky metody MeSH
- hypohidróza etiologie MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurologické vyšetření metody MeSH
- pooperační komplikace etiologie MeSH
- poranění nervového systému etiologie MeSH
- retrospektivní studie MeSH
- sympatický nervový systém zranění MeSH
- tělesná teplota fyziologie MeSH
- termografie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
PURPOSE: Extraforaminal lumbar interbody fusion as with other methods that involve the mechanism of indirect decompression, the discussion not only focuses on the benefit of minimizing the risk of thecal sac injury and postoperative scarring, but also on the risk of insufficient decompression in the affected neural structures during the reduction of the affected segment. METHODS: Eighty-two patients presenting with degenerative lumbar disease with segmental instability underwent ELIF combined with transpedicular fixation and circumferential fusion. Clinical and radiographic evaluations were performed. RESULTS: The mean ODI significantly improved from 63.4 preoperatively to 32.3 1 year postoperatively. The mean VAS back pain significantly improved from 5.95 to 2.63 postoperatively and VAS (leg pain) improved from 6.04 to 2.44. The mean CSA increased from 103 mm2 preoperatively to 169 mm2 postoperatively. The median extension ratio of CSA was 33%. Disc height, segmental disc angle, and lumbar lordosis also improved significantly. Only three (3.7%) patients were revised using direct central decompression due to neurologic deterioration. CONCLUSION: Spinal stenosis was resolved successfully by indirect decompression through extraforaminal interbody fusion via a transmuscular limited approach.
BACKGROUND CONTEXT: Spondylodesis in the operative management of lumbar spine diseases has been the subject of numerous studies over several decades. The posterolateral fusion (PLF) with pedicle screw fixation is a commonly used procedure. PURPOSE: To determine whether the addition of bone marrow concentrate (BMC) to allograft bone increases fusion rate after instrumented posterior lumbar fusion. STUDY DESIGN: The study was prospective, randomized, controlled, and blinded. METHODS: Eighty patients with degenerative disease of the lumbar spine underwent instrumented lumbar or lumbosacral PLF (22 men, 58 women; body mass index less than 35 for a good visualization of the PLF in the X-rays). In 40 cases, the PLF was done with spongious allograft chips alone (Group I, age 62.7 years in average, range 47-77 years, level of fusion 1-2). In another 40 cases, spongious allograft chips were mixed with BMC (Group II, age 58.5 years in average, range 42-80, level of fusion 1-3), including the mesenchymal stem cells (MSCs). Patients were scheduled for anteroposterior and lateral radiographs 12 and 24 months after the surgery and for computed tomography scanning 24 months after the surgery. Fusion status and the degree of mineralization of the fusion mass were evaluated separately by two radiologists blinded to patient group affiliation. The bony mass was judged as fused if there was uninterrupted bridging of well-mineralized bone between the transverse processes or sacrum, with trabeculation indicating bone maturation on least at one side of the spines. RESULTS: In Group I at 12 months, the bone graft mass was assessed in X-rays as fused in no cases (0%) and at 24 months in four cases (10%). In Group II, 6 cases (15%) achieved fusion at 12 months and 14 cases (35%) at 24 months. The statistically significant difference between both groups was proven for complete fusion at both 12 (p=.041) and 24 months (p=.011). Computed tomography scans showed that 16 cases (40%) in Group I and 32 cases (80%) in Group II had evidence of at least unilateral continuous bridging bone between neighboring vertebrae at 24 months (p<.05). CONCLUSIONS: We have confirmed the hypothesis that the autologous BMC together with the allograft is a better alternative for PLF than the allograft alone. The use of autologous MSCs in form of BMC in combination with allograft is an effective option to enhance the PLF healing.
- Klíčová slova
- Allograft, Bone marrow concentrate, Fusion rate, Lumbar spine, Mesenchymal stem cells, Posterolateral fusion,
- MeSH
- bederní obratle diagnostické zobrazování chirurgie MeSH
- dospělí MeSH
- fúze páteře metody MeSH
- homologní transplantace MeSH
- křížová kost diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci páteře diagnostické zobrazování chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transplantace kostní dřeně metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
OBJECTIVE: Retrograde ejaculation (RE) is a known complication of anterior lumbar interbody fusion (ALIF) and results from injury to the superior hypogastric plexus (SHP) during intervertebral disc exposure. Yet, there has been no recommendation for SHP mobilization. Thus, the aim of this study was to describe the anatomy of the SHP and vessels at the L5-S1 level, and to evaluate the possibility of SHP mobilization and its retraction to the side. METHODS: Twelve formaldehyde-embalmed cadavers (6 female and 6 male; mean age 65.5 years [range 60-77 years]) were dissected. Distances from the SHP and middle sacral vessels to the midline were measured at the L5-S1 level. The relationship of the great vessel bifurcations and common iliac vessels to the SHP were noted. The extent of lateral retraction of the SHP following mobilization was measured in relation to the midline. Moreover, the positions of the SHP and middle sacral vessels relative to the midline at the L5-S1 level were determined. RESULTS: The SHP formed below the aortic bifurcation and was present at the L5-S1 level in all cases. The SHP overlaid the midline with a left-sided shift. There were 4 cases (33.3%) in which lateral retraction was not achievable because the plexus divided into hypogastric nerves at the L5-S1 level or was too wide for safe mobilization. In the remaining cases, retraction on the left side was achievable up to 15.3 mm from the midline, while retraction to the right side was limited to 5.3 mm from the midline. The types of SHP morphological arrangement included single cord (41.7%), plexiform (41.7%), and fiber (16.6%). CONCLUSIONS: Based on the more extensive left-sided shift of the SHP at the L5-S1 level and frequent presence of the third left splanchnic lumbar nerve, attempting retraction to the left side is recommended. If it is not feasible, the SHP should be split at the midline, with both components mobilized laterally.
- Klíčová slova
- ALIF, anatomy, anterior lumbar interbody fusion, retrograde ejaculation, sexual dysfunction, spinal fusion, superior hypogastric plexus,
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The mini-invasive open posterior lumbar fusion procedure (mini PLIF) procedure is an alternative to standard open procedure (open PLIF) and is intended to reduce surgery-related trauma. The measuring of suitable biochemical factors enables objective comparison of the invasiveness of spinal surgery procedures. METHODS: Prospectively collected data on myoglobin, creatine kinase, interleukin-6, C-reactive protein levels and intensity of low back pain and radicular pain in one-level mini PLIF and open PLIF procedures were analysed. The mini PLIF and the open PLIF groups included 27 and 23 patients, respectively. The collection of blood samples and clinical data were performed preoperatively and on postoperative days 1, 3 and 7. The non-paired t-test was used for statistical evaluation. RESULTS: We did not found any statistically significant differences of myoglobin and creatine kinase levels between the groups. In the open PLIF group the IL-6 levels were significantly higher than in the mini PLIF group on postoperative day 3. CRP levels showed significant lower stress response in favour of the mini PLIF group on postoperative days 3 and 7. Levels of post-op low back pain on day 3 were significantly lower in mini PLIF group. Also intensity of radicular pain on day 1 and 3 were lower also mini PLIF group. CONCLUSION: The extent of myonecrosis was comparable in both techniques. The analysis of the IL-6 and CRP levels showed significantly lower systemic inflammatory response in mini PLIF technique. The mini PLIF technique provides transiently lower postoperative pain levels.
- Klíčová slova
- Creatine kinase, Interleukin-6, Lumbar interbody fusion, Minimally invasive approach, Myoglobin,
- MeSH
- bederní obratle chirurgie MeSH
- C-reaktivní protein MeSH
- fúze páteře metody MeSH
- hodnocení výsledků zdravotní péče * MeSH
- interleukin-6 krev MeSH
- kreatinkinasa krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie krev patofyziologie MeSH
- miniinvazivní chirurgické výkony metody MeSH
- myoglobin krev MeSH
- pooperační komplikace krev patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Názvy látek
- C-reaktivní protein MeSH
- interleukin-6 MeSH
- kreatinkinasa MeSH
- myoglobin MeSH
