TABLE 3 - uploaded by Tetsuo Ohwada
Content may be subject to copyright.
Source publication
Object:
A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operat...
Similar publications
Objective: There has been an increasing recognition in the literature of the importance of ensuring a correct sagittal and pelvic balance after a surgical procedure in lumbar spine. Recent studys clearly demonstrated a correlation between pelvic balance and surgical outcomes. As the degenerative deformity gradually progresses there is evidence of c...
Study Design
Prospective cohort study.
Objective
Microsurgical bilateral decompression via a unilateral approach (MBDU), a minimally invasive surgical (MIS) decompression method, has been performed for numerous degenerative lumbar diseases, including degenerative lumbar scoliosis (DLS) or degenerative spondylolisthesis (DS), at our institution. In...
Adjacent segment degeneration (ASD) is a major postoperative complication associated with posterior lumbar interbody fusion (PLIF). Early-onset ASD may differ pathologically from late-onset ASD. The aim of this study was to identify risk factors for early-onset ASD at the cranial segment occurring within 2 years after surgery. A retrospective study...
Traumatic spondyloptosis of the thoracic spine is an uncommon injury. In most cases, spondyloptosis is confined to one vertebral body, whereas double-level spondyloptosis is extremely rare. Most patients who sustain traumatic spondyloptosis immediately become paraplegic, but in some cases neurological function is preserved. If this occurs, it is du...
Citations
... and DH increased by 3.4 mm (range 2.3-5.6 mm) after PLIF. 26,[48][49][50] One study added that 2-level PLIF yields better restoration of focal LL compared with 1-level PLIF. 48 Oblique lumbar interbody fusion and LLIF In 3 oblique lumbar interbody fusion (OLIF) studies (1 level III and 2 level IV) involving 194 patients (mean age range 64-76 years, female % range 46%-83%, and mean follow-up range 16-30 months), the average increase in LL was 6.7°(range 6.2°-7.5°), ...
... 26,[48][49][50] One study added that 2-level PLIF yields better restoration of focal LL compared with 1-level PLIF. 48 Oblique lumbar interbody fusion and LLIF In 3 oblique lumbar interbody fusion (OLIF) studies (1 level III and 2 level IV) involving 194 patients (mean age range 64-76 years, female % range 46%-83%, and mean follow-up range 16-30 months), the average increase in LL was 6.7°(range 6.2°-7.5°), and anterior and posterior DH increased by 6.6 mm and 1.5 mm after OLIF, respectively. ...
... Postoperative outcomes were examined in 23 studies (2 level I, 15 level III, 6 level IV) involving 2616 patients (mean age range 48-76 years, female % range 43%-83%, and mean follow-up range 6-67 months) (Table 6). 12,17,26,28,36,37,39,41,42,47,48,50,52,55,63,65,[67][68][69] Five studies examined the impact of correcting segmental and total LL on PROMs with conflicting findings. 12,17,26,28,50 Although one study found a negative correlation between total and segmental lordosis and Oswestry Disability Index (ODI) in unilateral TLIF patients, 2 other studies found no or even a positive correlation between lordosis and ODI in PLIF patients and one other study found a positive correlation between lordosis and Japanese Orthopedic Association scores. ...
BACKGROUND AND OBJECTIVES: Maintaining and restoring global and regional sagittal alignment is a wellestablished
priority that improves patient outcomes in patients with adult spinal deformity. However, the benefit of
restoring segmental (level-by-level) alignment in lumbar fusion for degenerative conditions is not widely agreed on. The
purpose of this review was to summarize intraoperative techniques to achieve segmental fixation and the impact of
segmental lordosis on patient-reported and surgical outcomes.
METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines,
PubMed, Embase, Cochrane, and Web of Science databases were queried for the literature reporting lumbar alignment
for degenerative lumbar spinal pathology. Reports were assessed for data regarding the impact of intraoperative surgical
factors on postoperative segmental sagittal alignment and patient-reported outcome measures. Included studies were
further categorized into groups related to patient positioning, fusion and fixation, and interbody device (technique,
material, angle, and augmentation).
RESULTS: A total of 885 studies were screened, of which 43 met inclusion criteria examining segmental rather
than regional or global alignment. Of these, 3 examined patient positioning, 8 examined fusion and fixation, 3
examined case parameters, 26 examined or compared different interbody fusion techniques, 5 examined
postoperative patient-reported outcomes, and 3 examined the occurrence of adjacent segment disease. The data
support a link between segmental alignment and patient positioning, surgical technique, and adjacent segment
disease but have insufficient evidence to support a relationship with patient-reported outcomes, cage subsidence,
or pseudoarthrosis.
CONCLUSION: This review explores segmental correction’s impact on short-segment lumbar fusion outcomes, finding
the extent of correction to depend on patient positioning and choice of interbody cage. Notably, inadequate restoration
of lumbar lordosis is associated with adjacent segment degeneration. Nevertheless, conclusive evidence linking segmental
alignment to patient-reported outcomes, cage subsidence, or pseudoarthrosis remains limited, underscoring the
need for future research.
... El-Soufy [3] gặp 8,3% BN có rách màng cứng trong mổ, Sakaura [6] là 4,3% và Võ Tấn Sơn [1] là 2,9%. . Sakaura[6] cho thấy có 10% tổn thương thần kinh thoáng qua ở phẫu thuật 2 tầng và 2,2% ở phẫu thuật 1 tầng, có 5% phẫu thuật 2 tầng có ảnh hưởng đến vận động. Đối với rò xi măng, tác giả Waits[8] chỉ lưu ý nên giới hạn lượng xi măng bơm vào mỗi vít dưới 2,5ml để tránh biến chứng rò xi măng ra khỏi thân sống. ...
Mục tiêu: Đánh giá kết quả điều trị trượt đốt sống ở bệnh nhân loãng xương có chèn ép thần kinh được phẫu thuật cố định cột sống và hàn xương liên thân đốt lối sau kết hợp bơm xi măng qua vis rỗng. Đối tượng và phương pháp nghiên cứu: Nghiên cứu hồi cứu mô tả loạt ca tất cả các trường hợp trượt đốt sống có mất vững kèm loãng xương được phẫu thuật bằng phương pháp hàn liên thân đốt lối sau với vít rỗng chân cung có bơm xi măng sinh học tại khoa Ngoại thần kinh bệnh viện Thống Nhất, thành phố Hồ Chí Minh từ tháng 12/2016 đến tháng 12/2021. Kết quả: Trong 69 BN trượt đốt sống kèm loãng xương được phẫu thuật, chúng tôi thu được: triệu chứng đau lưng theo thang điểm VAS giảm xuống sau mổ, từ 7,2 xuống còn 2,34 điểm (p < 0,05) và đau theo rễ thần kinh giảm từ 6,3 xuống còn 1,52 điểm (p < 0,05), đi cách hồi thần kinh giảm từ 68,12% còn 7,2%, (p < 0,05). Mức độ phục hồi theo JOA ở thời điểm trước mổ từ 7,71 ± 1,78 lên 22,34 ± 3,50 ở thời điểm sau mổ (p<0,05), với sự cải thiện nhiều ở BN có tổn thương 1 và 2 tầng. Các biến chứng được ghi nhận với tỉ lệ thấp bao gồm: rò xi măng, nhiễm trùng vết mổ, rách màng cứng. Kết luận: Điều trị trượt đốt sống ở bệnh nhân loãng xương có cải thiện với phẫu thuật hàn xương liên thân đốt lối sau có bơm xi măng qua vít rỗng.
... Tuổi trung bình của BN trong nghiên cứu là 65,4. Nhóm tuổi từ 60 -69 tuổi chiếm tỷ lệ cao nhất 44,1%, cho kết quả tương tự Sakaura [7] tuổi trung bình là 68,3 (44-79) và của Nguyễn Vũ [3] tuổi trung bình 66,2. ...
... Cả 2 đều được vá kín và không ghi nhận rò. Sakaura [7] gặp biến chứng rách màng cứng trong mổ ở 4,3%. Võ Tấn Sơn [1] và cộng sự có tỉ lệ rách màng cứng là 2,9%. ...
... -Biến chứng mạch máu thần kinh: chúng tôi không có BN tổn thương rễ thần kinh. Sakaura [7] cho thấy có 10% tổn thương thần kinh thoáng qua ở phẫu thuật 2 tầng và 2,2% ở phẫu thuật 1 tầng, có 5% phẫu thuật 2 tầng có ảnh hưởng đến vận động. ...
Mục tiêu: Đánh giá kết quả điều trị MVCSTL có chèn ép thần kinh về mặt lâm sàng, hình ảnh học và biến chứng của vít rỗng chân cung có bơm xi măng trong phẫu thuật cố định MVCSTL. Đối tượng và phương pháp nghiên cứu: Nghiên cứu hồi cứu mô tả loạt ca tất cả (59 BN) các trường hợp bị MVCSTL có loãng xương (T-score < -2.5SD) đã được phẫu thuật bằng phương pháp hàn liên thân đốt lối sau với vít rỗng chân cung có bơm xi măng sinh học tại khoa Ngoại thần kinh bệnh viện Thống Nhất, thành phố Hồ Chí Minh từ tháng 06/2015 đến tháng 06/2021. Kết quả: các triệu chứng lâm sàng trước phẫu thuật như đau lưng theo thang điểm VAS giảm từ 7,10 điểm xuống còn 2,56 điểm (giảm có ý nghĩa thống kê P < 0,05) và đau chân theo rễ thần kinh giảm từ 6,44 điểm xuống còn 1,67 điểm (giảm có ý nghĩa thống kê p < 0,05). Đi cách hồi thần kinh giảm 74,6% còn 6,8%, (giảm có ý nghĩa thống kê p < 0,05). Một số biến chứng được ghi nhận: rò xi măng, nhiễm trùng với tỉ lệ thấp. Kết quả theo thang điểm JOA: Rất tốt là 49,1%, tốt là 39%, trung bình là: 11,9%, không có trường hợp nào xấu. Tỉ lệ phục hồi theo JOA cải thiện nhiều ở BN 1 và 2 tầng và cao hơn đáng kể ở 3 tầng. Kết luận: Phương pháp bắt vít rỗng kèm bơm xi măng sinh học qua cuống có hiệu quả trong điều trị BN MVCSTL có loãng xương.
... 21 concluded that the clinical outcomes in two years of follow-up in patients who had lumbar spinal stenosis, with or without concomitant degenerative spondylolisthesis, were not better than those of patients only submitted to decompression surgery. Better surgical outcomes have been reported for one-level fusion than two-level fusion, 22 which is similar to our results. ...
Objectives The relevance of spinopelvic parameters in the patients' clinical and functional outcomes has been widely studied in long spinal fusion. Yet, the importance of the spinopelvic parameters in short-segment fusion surgeries needs further investigation. We analyzed the spinopelvic parameters and surgical outcomes of patients undergoing short-segment lumbar interbody fusion.
Materials and Methods An observational, prospective study was conducted between January and June 2021. We selected 25 patients with lumbar stenosis, with or without concomitant spondylolisthesis, undergoing transforaminal lumbar interbody fusion. Variables related to the patient, diagnosis, and surgery were collected. The clinical and functional outcomes were assessed using the Visual Analogue Scale for low-back and leg pain and the Oswestry Disability Index (ODI). The surgical outcomes and spinopelvic parameters were analyzed pre- and postoperatively.
Results There was a significant clinical and functional improvement after surgery ( p < 0.001), with a mean ODI decrease of 63.6%. The variables of obesity, concomitant spondylolisthesis, absence of osteotomy, and two-level fusion were all associated with lower levels of improvement after surgery ( p < 0.05). Pelvic incidence minus lumbar lordosis (PI-LL) was the only parameter that significantly changed regarding the pre- and postoperative periods ( p < 0.05). Before surgery, PI-LL < −10° correlates with less low-back pain after surgery (r = 0.435; p < 0.05). Postoperatively, no correlation was found between surgical outcomes and all the spinopelvic parameters analyzed.
Conclusions The clinical and functional outcomes significantly improved with the surgical intervention but did not correlate with the change in spinopelvic parameters. Patients with preoperative PI-LL < −10° seem to benefit the most from surgery, showing greater improvement in back pain.
... A seven-year follow-up study of short-segment fusion surgery had shown around a 25% subsequent ASD incidence, where 5.6% of the cases required additional operation [14]. There is a correlation between ASD incidence and the elongation of fusion systems over the three segments, which may be due to overloading on adjacent disks and hypermobility [9,[15][16][17][18]. ...
Objective
Adjacent segment disease is a controversial process after spine stabilization. The two important factors discussed are natural aging and hypermobility in incidental segmental fusion anomalies; patients have two or more fused vertebrae from birth, which are the results of spinal movement restriction due to the fusion of some spinal units. This article’s main purpose is to determine the degree of relationship of hypermobility and the aging process in the deterioration of the disks adjacent to fusion.
Methods
In this study, the degenerative process developed by hypermobility in the adjacent segment due to incidental segmental fusion was evaluated. The MRI images of 52 adjacent and nonadjacent disks of 45 patients in total were analyzed according to the Pfirrmann grading systems. The average Pfirrmann rating of the disks just above and below the fused segment and the distant first, second, and third non-neighboring levels were evaluated and calculated, respectively.
Results
The highest rate of incidental fusion is determined on the cervical area with 51.9%, followed by the thoracal area with 32.7%, and the lumbar area with 15.4%. Damage to the adjacent segment disks in cases with incidental fusion can still be seen at any age, with fusion, indicating that the hypermobility effect plays a more prominent role. The evidence of hypermobility without aging is that the segments adjacent to fusion undergo more degeneration than the distant disks.
Conclusion
Adjacent segment disease is under the influence of many factors. Our findings suggest that its incidence is increasing with the pathological processes initiated by hypermobility. It seems that, at least, it carries equal importance as compared to age. Fusion surgeries damage the adjacent segments under the influence of the passage of time beyond the physiological aging of the patient.
... Surgical interbody fusion of the degenerative lumbar spine can improve the patient's low back or lower leg pain and disability. Evidence supporting good clinical outcomes after PLIF has already been reported [9][10][11]. ...
... PLIF is a common general procedure for degenerative lumbar disease. The clinical outcome of PLIFs is widely recognized to be satisfactory [9][10][11]. Liu reported that a PLIF alone improved clinical satisfaction and decreased complications [9]. ...
Background
In several previous studies, Charlson comorbidity index (CCI) score was associated with postoperative complications, mortality, and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF.
Methods
Three hundred sixty-six patients who underwent an elective primary single-level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1, and 2+). JOA improvement rate, length of stay (LOS), and direct cost were compared between each group. Postoperative complications were also investigated.
Results
There was a weak negative relationship between CCI score and JOA improvement rate ( r = − 0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of group 0 and group 1 was significantly higher than group 2+. LOS and direct cost were also significantly different between group 0 and group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities.
Conclusions
A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.
... Surgical interbody fusion of the degenerative lumbar spine can improve the patient's low back or lower leg pain and disability. Evidence supporting good clinical outcomes after PLIF has already been reported [9][10][11]. ...
... PLIF is a common general procedure for degenerative lumbar disease. The clinical outcome of PLIFs is widely recognized to be satisfactory [9][10][11]. Liu reported that a PLIF alone improved clinical satisfaction and decreased complications [9]. ...
Background. In several previous studies Charlson comorbidity Index (CCI) score was associated with postoperative complications, mortality and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF.
Methods. 366 patients who underwent an elective primary single level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1 and 2+). JOA improvement rate, length of stay (LOS) and direct cost were compared between each group. Postoperative complications were also investigated.
Results. There was a weak negative relationship between CCI score and JOA improvement rate (r = -0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of Group 0 and Group 1 was significantly higher than Group 2+. LOS and direct cost were also significantly different etween Group 0 and Group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities.
Conclusions. A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.
... [10] The outcome of JOA scores has been published by other studies in the literature. [7,[11][12][13][14][15][16] Also, the average recovery rate in this study was 63%, which is considered by the authors as a good outcome when compared to another study [15] although the duration of follow-up were different. ...
... [10] The outcome of JOA scores has been published by other studies in the literature. [7,[11][12][13][14][15][16] Also, the average recovery rate in this study was 63%, which is considered by the authors as a good outcome when compared to another study [15] although the duration of follow-up were different. ...
Introduction: Posterior lumbar interbody fusion (PLIF) is one of the options for the management of lumbar spine instability and is being increasingly used in Nigeria. The aim of the study is to assess the outcome of cases managed with PLIF in Enugu, Nigeria. Methods: Retrospective analysis of all patients that had PLIF for degenerative lumbar spine spondylolisthesis from the year 2016 to 2019 at a single centre the interbody fusion device was polyetheretherketone cage loaded with autologous bone graft. All patients presented with severe low back pain. Patients operated for traumatic spondylolisthesis and those managed with pedicle screw fixation alone were excluded. Patients were followed up for at least one year. The outcome was assessed using Japanese Orthopedic Association (JOA) scoring for back pain, visual analog score (VAS), fusion rate, and the 5-point patient-reported improvement scale. Results: A total of 57 patients were analyzed. The mean age was 56.5 ± 7.4 years and the mean duration of back pain was three years (1–15 years). The mean preoperative VAS was 7.9 ± 1.1, while the postoperative VAS score was 3.3 ± 1.7. The JOA scores before surgery and at least 12 months post-surgery were 12.9 ± 2.8 and 22.9 ± 4.9, respectively. The patient recovery rate was 63.3%. A satisfactory outcome was noted in 82.8% of patients, post-surgery. The average fusion rate postsurgery was 88%. The most common postoperative complication was cerebrospinal fluid leak (8.8%). Four obese patients had implant-related complications. Conclusion: PLIF for degenerative spine disease is associated with significant improvement in preoperative back pain and neurological outcome. It is also associated with good fusion, recovery, and patient-reported improvement.
... Between (January 2017 and April 2018), 15 patients were evaluated in this study (12 female (80%) and 3 male (20%) mean age is 56.2 (from 50 y To 70 y) similar to Rashid Khan study (11) which was 55,3 ranged from ( 20 to 70 years ) while the mean age of Sears W study (12) was 65.1 years ranged from (35 to 82 years)the mean age of HiroykHyashi study (13) . was61.8 years ranged from ( 26 to77 years ), the mean age of Okuyama, Koichiro study (14) was 60, The mean age of Hironobu Sakaurastudy (15) was 68.3 years range from (44 to79 years). (131) this study patient age was close to Raship Khan study and Okuyama, Koichiro study this confirm that degenerative spondylolithesis is one of the diseases of elderly. ...
... (131) this study patient age was close to Raship Khan study and Okuyama, Koichiro study this confirm that degenerative spondylolithesis is one of the diseases of elderly. In our study, 15 patients (12 females and 3 males), 53 patients(45 females and 8 males)were in Rashid Khan study (11) ,37 patients (16 males and 21 females) were in Hiroyuki Hayashi et al study (13) , 28 patients (10 males and 18 females)were in Okuyama, Koichiro study (14) 20patients (6 males and 14 females) were in Hironobu Sakaura study ( 15) . so that The reason for higher female to male ratio in our study may be due to the increased incidence of postmenopausal osteoporosis and increased incidence of obesity among elderly females . ...
... Reoperation was required in 3 patients (8.1%) due to intolerable symptoms in their lower extremities caused by adjacent segment degeneration. Re operated 76 months later .and in Hironobu Sakaura study (15) the postoperative complications rate was 14.6% in the form of epidural hematoma ,mild deep wound infection and Symptomatic ASD was found patients of the 2-level PLIF .In comparison with Farhaan Altaf study (16) the complication rate was 8.9% in the form of ASD and superficial wound infection in PLF group and complication rate in PLIF group was 13.8% in the form of deep wound infection, ASD and dural tear. So that the complication rate of in PLIF surgery is high than PLF surgery and near to TLIF surgery. ...
... Although several studies have described ASD after lumbar arthrodesis, ASD incidence, and time period were affected by patient numbers and follow-up period. [1][2][3][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] In the previous report, the largest study reported 1069 cases, with an average follow-up of 4 years, and the incidence and time period of symptomatic ASD with additional operation were 2.6% and 4.4 years, 14 while the longest follow-up study had an average follow-up of 12.6 years, and included 111 cases; the radiological ASD incidence was 15%, with no information about the ASD time period. 15 With respect to clinical features of ASD, previous reports described that cranial fusion segment was often observed. ...
... In terms of risk factors for ASD, preexisting disc and facet joint degenerations was often reported as the morphological features, while segmental lordosis, sagittal imbalance, and excessive disc height distraction as the surgical features. [1][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] In the present study, such risk factor analysis was not done; however, patients with early-onset ASD might have some risk factors for ASD. ...
... Many reports have described the contribution of fusion length and aging to ASD. 6,[9][10][11][12][13][21][22][23] From clinical and biomechanical aspects, fusion length was well reported the contribution to ASD. Similarly, Lee reported that patients older than 60 years were 2.5 times more likely to undergo revision operation than those younger than 60 years. ...
Study Design
Retrospective study.
Objective
There have been few reports of adjacent segment disease (ASD) after posterior lumbar interbody fusion (PLIF) with large numbers and long follow-up. The purpose of this study was to investigate (1) ASD incidence and time periods after primary PLIF, (2) repeat ASD incidence and time periods, and (3) ASD incidence and time periods by fusion length, age, and preoperative pathologies.
Methods
A total of 1000 patients (average age 67 years, average follow-up 8.3 years) who underwent PLIF for degenerative lumbar disorders were reviewed. ASD was defined as a symptomatic condition in which revision surgery was required.
Results
The overall ASD rate was 9.0%, and the average ASD period was 4.7 years after primary surgery. With respect to clinical features of ASD, degenerative spondylolisthesis at the cranial fusion segment was the most frequent. In terms of repeat ASD, second and third ASD incidences were 1.1% and 0.4%, respectively. As for ASD by fusion length, age, and preoperative pathologies, ASD incidence was increased by fusion length, while the time period to ASD was significantly shorter in elderly patients and those with degenerative lumbar scoliosis.
Conclusions
In the present study, the overall ASD incidence was 9.0%, and the average ASD period was 4.7 years after primary operation. Second and third ASD incidences were 1.1% and 0.4%, respectively. Fusion length affected the ASD incidence, while aging factor and preoperative pathology affected the ASD time period.
