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Application of polyetheretherketone cages through minimally invasive oblique retroperitoneal approach for the treatment of lumbar polymicrobial spondylodiscitis: A STROBE-compliant retrospective study with 7 cases.
Luo, W, Zhu, Y, Zhao, ZH, Ou, YS
Medicine. 2020;(17):e18594
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Abstract
Despite the plethora of evidence in support of the use of structural osseous autograft in lumbar spondylodiscitis, attention has recently been turned to the addition of synthetic materials such as polyetheretherketone (PEEK) to restore anterior vertebral column support.From January 2015 to April 2017, 7 patients with lumbar polymicrobial spondylodiscitis were surgically treated with a minimally invasive oblique retroperitoneal approach to the infected focus. The patients underwent a standard lateral minimally invasive oblique retroperitoneal approach using direct lateral interbody fusion system. The PEEK cages were loaded with autologous bone graft. All the patients underwent posterior fixation with percutaneous pedicle screw instrumentation. Lumbar function was measured using Oswestry Disability Index, and pain was measured with visual analog scale. Fusion and subsidence were also recorded.The study included 5 female and 2 male patients. The median age was 58.9 years. The duration of follow-up was 31.8 ± 6.1 months (range: 24-47). All patients recovered from the infection without relapse within 24-month follow-up. Visual analog scale significantly declined from 7.57 ± 0.53 before surgery to 1.57 ± 0.53 at 12-month follow-up. Mean Oswestry Disability Index decreased from 72.14 ± 6.82 before surgery to 22.28 ± 2.13 after surgery. All patients had solid fusion at 2-year follow-up. Fusion occurred at 6 to 15 months (mean 9.8 months).The specific use of PEEK cages in lumbar polymicrobial spondylodiscitis suggests reliable outcome in terms of clinical and imaging outcomes in our limited cases.
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Vitamin D Receptor gene polymorphisms and plasma levels are associated with lumbar disc degeneration.
Yang, Q, Liu, Y, Guan, Y, Zhan, X, Xiao, Z, Jiang, H, Wei, Q
Scientific reports. 2019;(1):7829
Abstract
The purpose of this study was to investigate the association of Vitamin D Receptor (VDR) gene polymorphisms and VDR levels with lumbar disc degeneration (LDD). TaqMan SNP Genotyping Assay was utilized to probe VDR gene polymorphisms including the FokI (rs2228570), ApaI (rs7975232) and TaqI (rs731236) in 454 patients with LDD and 485 controls. Enzyme-Linked Immunosorbent Assay (ELISA) was used to detect plasma VDR levels. The patients with LDD were divided into three subgroups (subgroup 1: lumbar disc herniation; subgroup 2: lumbar spinal stenosis; subgroup 3: lumbar spondylolisthesis) to further probe the association of plasma VDR levels and VDR gene polymorphisms and LDD. Moreover, immunohistochemistry (IHC) was implemented to evaluate VDR expression in lumbar degenerated disc and normal disc. Allele and genotype frequency of TaqI (rs731236) were significantly different in patients with LDD and controls (all P < 0.05). For TaqI polymorphism, the frequencies of T allele were significantly higher in the LDD patients compared with controls (OR = 1.319; 95%CI 1.091 to 1.595; P = 0.004, adjusted (OR = 1.319; 95%CI 1.091 to 1.595; P = 0.004, adjusted OR = 1.383; 95%CI 1.135 to 1.684; P = 0.016). Furthermore, the allele distribution showed a higher frequency of the T allele in the patients with lumbar disc herniation in subgroup 1 (OR = 1.384; 95% CI 1.105 to 1.732; P = 0.004, adjusted OR = 1.319; 95%CI 1.091 to 1.595; P = 0.016). Plasma VDR levels and VDR expression were significantly lower in patients with LDD compared with controls (all P < 0.05). Moreover, the TT genotype of TaqI polymorphism was significantly associated with lower plasma VDR levels in patients with LDD (P = 0.002). TaqI (rs731236) polymorphism was associated with a predisposition to LDD. Plasma VDR and VDR expression levels may be the marker for the occurrence and development of LDD.
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Clinical experiences with a PEEK-based dynamic instrumentation device in lumbar spinal surgery: 2 years and no more.
Oikonomidis, S, Ashqar, G, Kaulhausen, T, Herren, C, Siewe, J, Sobottke, R
Journal of orthopaedic surgery and research. 2018;(1):196
Abstract
BACKGROUND Dynamic spine implants were developed to prevent adjacent segment degeneration (ASD) and adjacent segment disease (ASDi). Purpose of this study was to investigate the clinical and radiological outcomes of "topping off" devices following lumbar spinal fusion procedure using a PEEK-based dynamic rod system. Moreover, this study focused on the hypothesis that "topping off" devices can prevent ASD. METHODS This prospective nonrandomized study included patients with indication for single-level lumbar fusion and radiological signs of ASD without instability. The exclusion criteria were previous lumbar spine surgery and no sign of disc degeneration in the adjacent segment according to magnetic resonance imaging. All patients were treated with single-level lumbar interbody fusion and dynamic stabilization of the cranial adjacent segment. Patients underwent a clinical examination and radiographs preoperatively and at 1 and 2 years after surgery. Analyses were performed on clinical data collected with the German Spine Registry using the core outcome measure index (COMI) and visual analogue scale (VAS) scores for back and leg pain. RESULTS A total of 22 patients (6 male and 16 female) with an average age of 57.6 years were included in the study; 20 patients completed the follow-up (FU). The average COMI score was 9.0 preoperatively, 4.2 at the 1-year FU, and 4.7 at the 2-year FU. The average preoperative VAS scores for back and leg pain were 7.7 and 7.1, respectively. At the 1-year FU, the scores were 4.25 for back pain and 2.2 for leg pain, and at the 2-year FU, the scores were 4.7 for back pain and 2.3 for leg pain. At FU, failure of the dynamic topping off implant material was verified in four cases, and ASD of the segment cranial to the topping off was confirmed in three cases. CONCLUSIONS These results demonstrate significant improvements in clinical outcomes and pain reduction after lumbar spinal fusion with topping off at 2 years after surgery. However, the implant failed due to the high rate of implant failure and the development of ASD in the segment cranial to the dynamic stabilized segment.
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Differences in lumbar spine and lower extremity kinematics in people with and without low back pain during a step-up task: a cross-sectional study.
Mitchell, K, Porter, M, Anderson, L, Phillips, C, Arceo, G, Montz, B, Levy, S, Gombatto, SP
BMC musculoskeletal disorders. 2017;(1):369
Abstract
BACKGROUND Low back pain (LBP) affects more than one third of the population at any given time, and chronic LBP is responsible for increased medical costs, functional limitations and decreased quality of life. A clear etiology is often difficult to identify, but aberrant posture and movement are considered contributing factors to chronic LBP that are addressed during physiotherapy intervention. Information about aberrant movement during functional activities in people with LBP can help inform more effective interventions. The purpose of this study was to determine if there are differences in lumbar spine and lower extremity kinematics in people with and without LBP during a step-up task. METHODS A convenience sample of 37 participants included 19 with LBP and 18 without a history of LBP. All participants were between the ages of 18 and 65, and controls were matched to participants with LBP based on age, gender and BMI. A motion capture system was used to record spine and lower extremity kinematics during the step-up task. ANOVA tests were used to determine differences in three-dimensional kinematics between groups. RESULTS Participants with LBP displayed less lower lumbar motion in the sagittal plane (P = 0.001), more knee motion in the coronal plane (P = 0.001), and more lower extremity motion in the axial plane (P = 0.002) than controls. CONCLUSIONS People with LBP display less lower lumbar spine motion in the sagittal plane and more out-of-plane lower extremity motion. Clinically, the step-up task can be used to identify these aberrant movements to develop more focused functional interventions for patients with LBP. TRIAL REGISTRATION Not applicable.
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Refined Phenotyping of Modic Changes: Imaging Biomarkers of Prolonged Severe Low Back Pain and Disability.
Määttä, JH, Karppinen, J, Paananen, M, Bow, C, Luk, KDK, Cheung, KMC, Samartzis, D
Medicine. 2016;(22):e3495
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Abstract
Low back pain (LBP) is the world's most disabling condition. Modic changes (MC) are vertebral bone marrow changes adjacent to the endplates as noted on magnetic resonance imaging. The associations of specific MC types and patterns with prolonged, severe LBP and disability remain speculative. This study assessed the relationship of prolonged, severe LBP and back-related disability, with the presence and morphology of lumbar MC in a large cross-sectional population-based study of Southern Chinese.We addressed the topographical and morphological dimensions of MC along with other magnetic resonance imaging phenotypes (eg, disc degeneration and displacement) on the basis of axial T1 and sagittal T2-weighted imaging of L1-S1. Prolonged severe LBP was defined as LBP lasting ≥30 days during the past year, and a visual analog scale severest pain intensity of at least 6/10. An Oswestry Disability Index score of 15% was regarded as significant disability. We also assessed subject demographics, occupation, and lifestyle factors.In total, 1142 subjects (63% females, mean age 53 years) were assessed. Of these, 282 (24.7%) had MC (7.1% type I, 17.6% type II). MC subjects were older (P = 0.003), had more frequent disc displacements (P < 0.001) and greater degree of disc degeneration (P < 0.001) than non-MC subjects. In adjusted models, any MC (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.01-2.18), MC affecting whole anterior-posterior length (OR 1.62, 95% CI 1.04-2.51), and MC affecting 2/3 posterior length (OR 2.79, 95% CI 1.17-6.65) were associated with prolonged severe LBP. Type I MC tended to associate with pain more strongly than type II MC (OR 1.80, 95% CI 0.94-3.44 vs OR 1.36, 95% CI 0.88-2.09, respectively). Any MC (OR 1.47, 95% CI 1.04-2.10), type II MC (OR 1.56, 95% CI 1.06-2.31), MC affecting 2/3 posterior length (OR 2.96, 95% CI 1.27-6.89), and extensive MC (OR 1.95, 95% CI 1.21-3.15) were associated with disability. The strength of the associations increased with the number of MC.This large-scale study is the first to definitively note MC types and specific morphologies to be independently associated with prolonged severe LBP and back-related disability. This proposed refined MC phenotype may have direct implications in clinical decision-making as to the development and management of LBP. Understanding of these imaging biomarkers can lead to new preventative and personalized therapeutics related to LBP.
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Indirect effects of decompression surgery on glycemic homeostasis in patients with type 2 diabetes mellitus and lumbar spinal stenosis.
Kim, HJ, Lee, KW, Cho, HG, Kang, KT, Chang, BS, Lee, CK, Yeom, JS
The spine journal : official journal of the North American Spine Society. 2015;(1):25-33
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) patients with diabetes mellitus (DM) are presumed to experience difficulty when performing regular daily exercise, although such exercise is of paramount importance for glucose homeostasis and control. Therefore, decompression surgery, which can help patients perform regular physical activity, would have indirect positive effects on blood glucose control in LSS patients with DM. PURPOSE To evaluate the indirect effects of spinal surgery on hemoglobin A(1c) (HbA(1c)) levels in the patient with Type 2 DM and LSS. STUDY DESIGN Prospectively collected observational cohort data. PATIENT SAMPLE Patients with degenerative LSS and DM. OUTCOME MEASURES The fasting total cholesterol (TC), fasting blood glucose (FBG), and HbA1c levels and visual analog scale (VAS) for back pain, VAS for leg pain, and Oswestry Disability Index (ODI). METHODS According to the treatment methods, 31 and 37 patients were allocated to the surgical and conservative treatment groups, respectively. The HbA(1c), TC, and FBG levels and the ODI and VAS for back/leg pain were recorded for all patients before surgical and conservative treatments. At the first and second follow-up assessments after surgical or conservative treatment, the data were reassessed for all patients. RESULTS In both groups, the VAS for back/leg pain and the ODI scores significantly decreased after surgical or conservative treatment. In the surgical treatment group, the HbA(1c) levels were significantly decreased at the first and second assessments after surgery, whereas the conservative treatment group did not show significant reductions in HbA(1c) levels at the first and second follow-up assessments. In both groups, the FBG levels did not differ between the initial and follow-up assessments. The TC levels were significantly decreased at the second follow-up assessment, only in the surgical treatment group. The amount of ODI score reduction correlated positively with the degree of HbA(1c) level reduction at the first follow-up assessment. CONCLUSIONS The present study demonstrates the reduction in HbA(1c) level in patients with DM and LSS after decompression surgery with or without fusion. We believe this reduction in the HbA(1c) level may be a result of increased physical activity, subsequent to successful surgical decompression of the cauda equina.
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Predictions of the length of lumbar puncture needles.
Ma, HP, Hung, YF, Tsai, SH, Ou, JC
Computational and mathematical methods in medicine. 2014;:732694
Abstract
INTRODUCTION The lumbar puncture is a well-known neurological procedure. The purpose of this study is to build an accurate mathematical formula to estimate the appropriate depth for inserting a lumbar puncture needle for a beginner. METHODS This is a retrospective study of patients who underwent magnetic resonance imaging (MRI) of the L-spine. The depth from the skin to the posterior and anterior margin of the spinal canal at the level of L4-L5 and L3-L4 interspaces of the spine was estimated using MRI. RESULTS Three hundred sixty-eight patients aged between 20 and 89 years were studied. The optimal puncture depths of the lumbar puncture needle were moderately strongly related to weight and BMI. The most accurate models with the highest coefficient of determination were 1.27 + 0.18 × BMI and 1.68 + 0.067 × weight (kg) for man and woman, respectively. CONCLUSION The best formula for men and women provides the most accurate estimates for adults based on the MRI of the L-spine.
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Depressive burden is associated with a poorer surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study.
Pakarinen, M, Vanhanen, S, Sinikallio, S, Aalto, T, Lehto, SM, Airaksinen, O, Viinamäki, H
The spine journal : official journal of the North American Spine Society. 2014;(10):2392-6
Abstract
BACKGROUND CONTEXT In lumbar spinal stenosis (LSS), conservative treatment is usually the first choice of treatment. If conservative treatment fails, surgery is indicated. Psychological factors such as depression and anxiety are known to affect the outcome of surgery. Previous studies on depression and surgery outcome using long follow-up times are scarce. PURPOSE The purpose of this study was to investigate the effect of depressive symptoms on the surgical outcome during a 5-year follow-up among patients with LSS. STUDY DESIGN A prospective observational study. PATIENT SAMPLE Patient sample included 102 LSS patients who needed surgical treatment. OUTCOME MEASURES The outcome of surgery was evaluated with the Oswestry Disability Index (ODI), visual analog scale pain assessment, and self-reported walking capacity. METHODS The patients completed a set of questionnaires preoperatively and 3 and 6 months, as well as 1, 2, and 5 years after the surgery. Depressive symptoms were assessed with the Beck Depression Inventory. The depressive burden was estimated by summing all individual Beck Depression Inventory scores. Statistical analyses included cross-sectional group comparisons and linear regression analyses. No conflicts of interest. RESULTS On 5-year follow-up, a high depressive burden associated with a poorer outcome of surgery when assessed with the ODI. In linear regression analysis, a high depressive burden associated with higher ODI score. CONCLUSIONS Even slightly elevated long-term depressive symptoms in LSS patients are associated with an increased risk of a poorer functional ability after decompressive surgery.
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Changes in lumbar disk morphology associated with prolonged sitting assessed by magnetic resonance imaging.
Billy, GG, Lemieux, SK, Chow, MX
PM & R : the journal of injury, function, and rehabilitation. 2014;(9):790-5
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Abstract
OBJECTIVE To determine what if any changes occur to the lumbar disks in the spine after prolonged sitting with and without intermittent breaks during a 4-hour period. DESIGN A prospective observational study. SETTING An academic outpatient clinic. METHODS The measurement of lumbar disk changes was performed with 12 subjects after an analysis of a mid sagittal lumbar magnetic resonance image, which measured lumbar disk height and disk diameter. Scanning and analysis were done over a 2-day period: day 1 at the start of the work day and 4 hours later after continuous sitting; at the start of work day 2 and after four hours after a change in position and stretching protocol every 15 minutes. RESULTS For this study, we first evaluated each level of the lumbar spine for any changes after prolonged sitting for 4 hours over the 2 days. Multiple comparisons bias was eliminated by a Bonferroni correction to limit the overall experiment-wise error rate to .05. The comparison was conducted by using a paired t-test when the normality condition was satisfied and by using a Wilcoxon signed rank test when normality was not satisfied. To test for normality, a Shapiro-Wilk test was used. We found that, for disk height, L4-5 was significantly decreased at the end of the sitting for day 1 but not for day 2. There were no significant height changes for the other lumbar disks. In addition, for disk diameter, there were no significant differences present for any of the disks. CONCLUSIONS Analysis of the data shows that the greatest change in disk height is at the L4-5 level after prolonged sitting without intermittent breaks. The other levels did not show a significant change in their height. The findings also showed that the L4-5 height changes were not significant with brief positional changes every 15 minutes. Fewer changes in disk height may correlate with an improvement in low back pain and disability.