AbstractText: Minimally invasive lumbar spinalstenosis procedures have uncertain long-term value AbstractText: This study sought ... to model a group of 65-year-old patients with spinalstenosis who had no previous spine surgery and no contraindications to ... reasonably cost-effective initial treatment option for patients with lumbar spinalstenosis.
... effectiveness between percutaneous and open pedicle screw fixation for treating thoracolumbar fractures with spinalinjuries.A total of 105 patients with thoracolumbar fractures and spinalinjuries were divided into a percutaneous pedicle screw fixation (PPSF) group with ... measures on average compared with OPSF with respect to managing thoracolumbar fractures with spinalinjuries.
In metastatic spinetumor surgery (MSTS), previous studies investigated the influence of ABT on survival, but not on postoperative complications. We aimed to evaluate the influence of perioperative ABT on postoperative complications and infections in patients undergoing MSTS.This retrospective study included 247 patients who underwent MSTS at a single tertiary institution between 2005 and 2014.
AbstractText: Lumbar spinalstenosis (LSS) is a highly prevalent disease in older adults that causes significant limitations in walking and other daily activities. There is a lack of research into optimal nonsurgical treatment approaches for LSS AbstractText: The purpose of this qualitative study is to assess the opinions of participants in a randomized clinical trial of non-surgical LSS treatments ...
This retrospective cohort study investigated the relationship between congenital anomalies and fracture of spine, trunk, and upper and lower limbs in young people... Cases evaluated were fracture of spine and trunk (ICD-9 codes: 805-809), fracture of upper limbs (ICD-9 codes: 810-819), and fracture of lower limbs ...
AbstractText: Surgical management of complex spinalreconstructions remains a clinical challenge, as pseudoarthrosis with subsequent rod breakage ... utilize the Dual Construct for the surgical management of complex spinalreconstructions AbstractText: The purpose of this study is to review the ... fracture rates, and outcomes for the surgical management of complex spinalreconstructions AbstractText: Technique with Case Series Outcomes PATIENT SAMPLE: Patients from ...
Traumatic spineinjuries (TSIs) carry significantly high risks of morbidity, mortality, and exorbitant ... This article offers a comprehensive review on the management of spinal column injuries using the best available evidence... The initial emergency department (ED) clinical evaluation of possible spinalfractures and cord injuries, along with the definitive early management of ...
AbstractText: Fusion surgery for degenerativedisc disease (DDD) has become a standard of care, albeit not without controversy. Outcomes are inconsistent and a superiority over conservative treatment is debatable. Proper patient selection is key to clinical success, and a comprehensive understanding of prognostic tests does not currently exist AbstractText: To investigate the value of prognostic tests and sociodemographic factors in ...
Back Pain (2), Intervertebral Disc Degeneration (1), more mentions
BACKGROUND CONTEXT: The importance of surgeon volume as a quality measure has been defined for a number of surgical specialties. Meaningful procedural volume benchmarks have not been established, however, particularly with respect to lumbar spine surgery.
PURPOSE: To establish surgeon volume benchmarks for the performance of four common lumbar spine surgical procedures (discectomy, decompression, lumbar interbody fusion, lumbar posterolateral fusion).
STUDY DESIGN: Retrospective review of data in the Florida Statewide Inpatient Dataset (2011-2014).
PATIENT SAMPLE: Patients who underwent one of the four lumbar spine surgical procedures under study.
OUTCOME MEASURES: The development of a complication or hospital readmission within 90-days of the surgical procedure.
METHODS: For each specific procedure, individual surgeon volume was separately plotted against the number of complications and readmissions in a spline analysis that adjusted for co-variates. Spline cut points were used to create a categorical variable of procedure volume for each individual procedure. Log-binomial regression analysis was then separately performed using the categorical volume-outcome metric for each individual procedure and for the outcomes of 90-day complications and 90-day readmissions.
RESULTS: In all, 187,185 spine surgical procedures met inclusion criteria, performed by 5,514 different surgeons at 178 hospitals. Spline analysis determined that the procedure volume cut-point was 25 for decompressions, 40 for discectomy, 43 for interbody fusion and 35 for posterolateral fusions. For surgeons who failed to meet the volume metric, there was a 63% increase in the risk of complications following decompressions, a 56% increase in the risk of complications following discectomy, a 15% increase in the risk of complications following lumbar interbody fusions and a 47% increase in the risk of complications following posterolateral fusions. Findings were similar for readmission measures.
CONCLUSIONS: The results of this work allow us to identify meaningful volume-based benchmarks for the performance of common lumbar spine surgical procedures including decompression, discectomy and fusion-based procedures. Based on our determinations readily achievable goals for individual surgeons would approximate an average of four discectomy and lumbar interbody fusion procedures per month, three posterolateral lumbar fusions per month and at least one decompression surgery every other week.
BACKGROUND: Changes in the dimensions of the cervical neural foramina (CNF) are considered to be a key factor in nerve root compression and development of cervical radiculopathy. However, to what extent foraminal geometry differs between patients who underwent anterior cervical discectomy and fusion (ACDF) and those who underwent total disc arthroplasty with an artificial disc (AD) during physiological motion is largely unknown.
PURPOSE: The objective of this study is to compare compare CNF dimensions during physiological neck motion between ACDF and AD.
STUDY DESIGN/SETTING: This is a retrospective comparative analysis of prospectively collected, consecutive, non-randomized series of patients at a single institution.
PATIENT SAMPLE: A total of 16 single-level C5-6 ACDF (4M, 12F; 28-71 years) and 7 single-level C5-6 cervical arthroplasty patients (3M, 4F; 38-57 years), at least 12 months after surgery (23.6 ± 6.8 months) were included.
OUTCOME MEASURES: Patient demographics, pre-operative MRI based measurements of cervical spine degeneration and 2-year post-operative measurements of dynamic foraminal geometry.
METHODS: Biplane x-ray images were acquired during axial neck rotation and neck extension. A CT scan was also acquired from C3 to the first thoracic vertebrae. The subaxial cervical vertebrae (C3 to C7) were reconstructed into 3D bone models for use with model-based tracking. Foraminal height (FH) was calculated as the 3D distance between the superior point of the inferior pedicle and the inferior point of the superior pedicle using custom software. Foraminal width (FW) was similarly calculated as the 3D distance between the anterolateral aspect of the superior vertebral body inferior notch, and the posterolateral aspect of the inferior vertebral body superior notch. Dynamic foraminal dimensions were quantified as the minimum (FH.Min, FW.Min), the range (FH.Range, FW.Range) and the median (FH.Med, FW.Med) of each trial and then averaged over trials. Mixed model ANOVA framework was used to examine the differences between ACDF and AD groups. The initial severity of disc degeneration as determined from pre-operative MRI images was introduced as covariates in the models. There were no study-specific biases related to conflicts of interest.
RESULTS: At the operated level (C5-6), FH.Med and FH.Range were smaller in ACDF than in AD during axial rotation and neck extension (p<0.003 to p<0.05). At the superior adjacent level (C4-5), no significant difference was found. At the inferior adjacent level (C6-7), FW.Range was greater in ACDF than in AD during axial rotation and extension (p<0.05). At the nonadjacent level (C3-4), FW.Range was greater in ACDF than in AD during extension (p<0.008).
CONCLUSIONS: This study demonstrated decreases in foraminal dimensions and their range for ACDF compared to AD at the operated level. In contrast, it demonstrated increases in the range of foraminal dimensions during motion for ACDF compared to AD at the nonoperated segments. Together, these data support the notion that increased mobility at the nonoperated segments after ACDF may contribute to a greater risk for adjacent segment degeneration. Due to the significant presence of Range variables in the findings, the current data also indicate that a dynamic evaluation is likely more appropriate for evaluation of the differences in foramina between ACDF and AD than a static evaluation.
BACKGROUND CONTEXT: Conventional laminoplasty is useful for expanding a stenotic spinal canal. However, it has limited use for the decompression of accompanying neural foraminal stenosis. As such, an additional posterior foraminotomy could be simultaneously applied, although this procedure carries a risk of segmental kyphosis and instability.
PURPOSE: The aim was to elucidate the long-term surgical outcomes of additional posterior foraminotomy with a laminoplasty for cervical spondylotic myelopathy (CSM) with radiculopathy.
STUDY DESIGN/SETTING: Retrospective comparative study.
PATIENT SAMPLE: Ninety-eight consecutive patients who underwent laminoplasty for CSM with radiculopathy between January 2006 and December 2012 were screened for eligibility. This study included 66 patients, who were treated with a laminoplasty of two or more levels and followed more than two years after surgery.
OUTCOME MEASURES: The Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores, JOA recovery rates, and Visual Analog Scale (VAS) were used to evaluate clinical outcomes. The C2-C7 sagittal vertical axis distance, cervical lordosis, range of motion (ROM), and angulation and vertebral slippage at the foraminotomy level were used to measure radiological outcomes using the whole spine anteroposterior/lateral and dynamic lateral radiographs.
METHODS: Sixty-six patients with CSM with radiculopathy involving two or more levels were consecutively treated with laminoplasty and followed up for more than two years after surgery. The first 26 patients underwent laminoplasty alone (LA group), while the next 40 patients underwent an additional posterior foraminotomy at stenotic neural foramens with radiating symptoms in addition to laminoplasty (LF group). In the LF group, the foraminotomy with less resection than 50% of facet joint to avoid segmental kyphosis and instability was performed at 78 segments (unilateral:bilateral = 57:21) and 99 sites. Clinical and radiographic data were assessed preoperatively and at two-year follow-up and compared between the groups.
RESULTS: NDI, JOA scores, JOA recovery rates, and VAS for neck/arm pain were improved significantly in both groups after surgery. The improvement in the VAS for arm pain was significantly greater in the LF group (from 5.55 ± 2.52 to 1.85 ± 2.39) than the LA group (from 5.48 ± 2.42 to 3.40 ± 2.68) (P < 0.001). Although cervical lordosis and ROM decreased postoperatively in both groups, there were no significant differences in the degree of reduction between the LF and LA groups. Although the postoperative focal angulation and slippage were slightly increased in the LF group, this was not to a significant degree. Furthermore, segmental kyphosis and instability were not observed in the LF group, regardless of whether the patient underwent a unilateral or bilateral foraminotomy.
CONCLUSIONS: Additional posterior foraminotomy with laminoplasty is likely to improve arm pain more significantly than laminoplasty alone by decompressing nerve roots. Also, performing posterior foraminotomy via multiple or bilateral did not significantly affect segmental malalignment and instability. Therefore, when a laminoplasty is performed for CSM with radiculopathy, an additional posterior foraminotomy could be an efficient and safe treatment that improves both myelopathy symptoms and radicular arm pain.
Muscular and Skeletal Diseases (1) Radiculopathy (6), Kyphosis (4), Spinal Cord Diseases (4), more mentions
Background Foraminal and extraforaminal lumbar disc herniations are uncommon. The main presentation is radicular pain related to the exiting nerve root at the affected level. Different approaches for surgical intervention have been described. Purpose To evaluate the clinical outcome, complications recurrence and reoperation rate of extraforaminal microscopic assisted percutaneous nucleotomy with literature review focusing on complications and recurrence rate Study Design Prospective cohort study done in a high flow spine center in Germany Patient Sample Between October 2012 and October 2015, 76 patients (35 females and 41 males) with foraminal or extraforaminal lumbar disc prolapse were operated upon. Outcome Measures • Self-report measures: Visual Analogue Scale (VAS) for leg pain and back pain. • Physiologic measures: standing plain x-rays (antero-posterior, lateral, and dynamic views) • Functional measures: Oswestry Disability Index (ODI) (validated German version) and Odom's criteria Methods All patients were operated upon with Trans-tubular Extraforaminal Microscopic-assisted Percutaneous (EF-MAPN) technique. Preoperative clinical and neurological evaluation were done. The mean follow up period was 38 months (range 12 - 54). The study hasn't received funding for research from any organisation. All authors do not have any conflict of interest. Results The mean age was 54 years. The most commonly affected level was L4/5 (34 patients). The mean preoperative VAS for leg pain was 7.6 (3-10), improved to 1.4 (0-4) postoperatively. The average operative time was 57.5 minutes. There were no intraoperative complications. One patient had temporary postoperative quadriceps weakness (L4 radiculopathy) that was completely improved at 3 months follow up. Another patient had deep venous thrombosis after discharge. Two patients had recurrences that necessitated another operation within the first 6 months postoperatively. Both were followed up for one year without a second recurrence. Conclusion Trans-tubular percutaneous extra-foraminal microscopic-assisted nucleotomy is effective for foraminal and extra-foraminal disc herniations. It is a muscle splitting minimal-invasive approach with minimal morbidity. Complications, recurrence and reoperation rate is not different compared with microsurgical open or endoscopic techniques.
Prolapse (2), Deep Vein Thrombosis (1), Sciatica (1), more mentions
Two patients of the complete 35 patients cohort underwent a secondary operation AbstractText: Satisfactory clinical results and good prosthesis survival can be achieved in the long term. Lumbar TDR surgeries also have the potential to reduce the incidence of adjacent segment disease Keyword: Adjacent segment. Keyword: Degenerativedisc disease. Keyword: Long-term results. Keyword: Lumbar spine.
Scoliosis (1), Lordosis (1), Intervertebral Disc Degeneration (1), more mentions
... may be a useful imaging study for detecting dynamic changes in the degree of olisthesis during axial loading to the lumbar spine related to the narrowing of the spinal canal and the severity of clinical symptoms in the assessment of patients with DS Keyword: axial loading. Keyword: degenerative spondylolisthesis. Keyword: lumbar spine. Keyword: magnetic resonance imaging. Keyword: spinal canal stenosis.
Spondylolisthesis (3), Pathologic Constriction (1), more mentions
AbstractText: Emergency management of upper cervical spineinjuries often requires cervical spine immobilisation and some critical patients also ... cervical spine immobilisation in the presence of unstable upper cervical spineinjury such as atlanto-occipital dislocation or type II odontoid fracture ... cervical collar application on cadaveric models of unstable upper cervical spineinjury such as atlanto-occipital dislocation or type II odontoid fracture ...
OBJECTIVE: To assess the effectiveness of exercise programs on disease activity and function in ankylosing spondylitis (AS) by a systematic review and meta-analysis of randomized controlled trials (RCTs).
DATA SOURCES: Medline via PubMed and Cochrane Library.
STUDY SELECTION: Reports of RCTs examining the effectiveness of exercise programs for AS published up to May 2017.
DATA EXTRACTION: Outcomes were evolution of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) after the completion of exercise programs. Modalities of exercise were compared and the use of biologic therapy was reported.
DATA SYNTHESIS: After screening 190 abstracts, we selected 26 reports for detailed evaluation and finally investigated 8 trials that assessed a home-based exercise program (2/8), swimming (1/8), Pilates training (1/8) or supervised exercises (4/8), for 331 AS patients. Four trials included patients receiving anti-TNF therapy. All trials except one showed a decrease in BASDAI and BASFI, with exercise. The weighted mean difference (95% confidence interval) was -0.90 (-1.52, -0.27) (I(2)=69%, p=0.005) for the BASDAI and -0.72 (-1.03, -0.40) (I(2)= 0%, p<0.00001) for the BASFI in favor of exercise programs.
CONCLUSIONS: Despite the small number of patients and the heterogeneity of exercise programs in the RCTs included in this meta-analysis, its results support the potential of exercise programs to improve disease activity and body function in AS.
BACKGROUND: Many studies suggest that impairment of motor control is the mechanical component of the pathogenesis of painful disorders in the lumbo-sacral region; however, this theory is still unproven and the results and recommendations for intervention remain questionable. The need for a force to compress both innominate bones against the sacrum is the basis for treatment of pregnancy-related pelvic girdle pain (PGP). Therefore, it is advised to use a pelvic belt and do exercises to enhance contraction of the muscles which provide this compression. However, our clinical experience is that contraction of those muscles appears to be excessive in PGP. Therefore, in patients with long-lasting pregnancy-related posterior PGP, there is a need to investigate the contraction pattern of an important muscle that provides a compressive force, i.e. the transverse abdominal muscle (TrA), during a load transfer test, such as active straight leg raising (ASLR).
METHODS: TrA thickness was measured by means of ultrasound imaging at rest and during ASLR in 43 non-pregnant women with ongoing posterior PGP that started during a pregnancy or delivery, and in 39 women of the same age group who had delivered at least once and had no current PGP (healthy controls).
RESULTS: In participants with PGP, the median TrA thickness increase with respect to rest during ipsilateral and contralateral ASLR was 31% (SD 46%) and 31% (SD 57%), respectively. In healthy controls, these values were 11% (SD 25%) and 13% (SD 22%), respectively.
CONCLUSIONS: Significant excessive contraction of the TrA is present during ASLR in patients with long-lasting pregnancy-related posterior PGP. The present findings do not support the idea that contraction of the TrA is decreased in long-lasting pregnancy-related PGP. This implies that there is no rationale for the prescription of exercises to enhance contraction of TrA in patients with long-lasting pregnancy-related PGP.
Only one patient also had a cervical spinefracture which was not clinically significant. When compared to the established rate of cervical spineinjury of 2.4%, the absolute risk reduction (ARR) was 0.35% (95% CI, - 1.06 to 1.75%) and the number needed to treat (NNT) was 290.In the case ...
A 21-year-old male military academy cadet developed acute posterior neck pain after performing multiple sets of overhead shoulder presses and resting the bar on his lower neck and shoulders. He presented to a direct-access physical therapy clinic. Due to the acute onset and focal nature of pain in the setting of repetitive weightlifting, the physical therapist ordered radiographs of the cervical spine, which revealed a C6 spinous process fracture. J Orthop Sports Phys Ther 2017;47(8):578. doi:10.2519/jospt.2017.7277.