Lumbar Spine Disorders Research Articles

Wisconsin Spine Outcome Study–Pilot: preliminary data

Given the pragmatic difficulties in developing randomized controlled trials in patients with disorders of the spine, the Wisconsin Spine Outcome Group has adopted the use of a prospective registry design to perform comparative effectiveness research on treatments for degenerative lumbar disorders. The goal of the Wisconsin Spine Outcome Study-Pilot (WISPOS-P) was to establish a Web-based, Health Insurance Portability and Accountability Act-compliant registry and to implement a patient registration paradigm that demonstrates at least 80% compliance in collecting pre- and posttreatment data in patients with lumbar disorders, regardless of the treatment they receive. The primary outcome measures were the percentage of patients with lumbar spine disorders who completed a Web-based survey preappointment, and at 1 and 3 months postappointment; the percentage of patients receiving a physician-assigned diagnosis in the registry; and the success of electronic data transition from the Web-based interface to a locally controlled registry. The WISPOS-P uses a prospective, diagnosis-based registry design. A universally accessible and secure Internet-based data management platform was created that accrues self-entered patient data on validated disability indices, including the visual analog pain scale, Oswestry Disability Index (ODI), and the 36-Item Short Form Health Survey questionnaire. Data were obtained on patients, preappointment and at 1 and 3 months postappointment, regardless of the treatment rendered. A physician-entered diagnosis was assigned to each patient for data stratification. One hundred patients were invited into the WISPOS-P; 90 patients participated, and 10 withdrew for various reasons. Eighty-eight of 90 patients were assigned a diagnosis by the evaluating physician. Preliminary and qualitative assessment of the data shows that the major difference between patients who withdrew from the study and those who participated was the number of days between study invitation and clinic appointment (median 11 vs 20.5 days, respectively). In evaluating patients by mode of survey completion, the 2 largest groups were those who completed their intake forms electronically before their clinic appointment and those who used the paper format. The median age of patients electronically completing this survey was 14.34 years younger than those using the paper format. A significantly higher proportion of patients who completed their forms electronically had listed an email address. The 3 major diagnoses were disc disease (32 patients), stenosis (24 patients), and nonsurgical pain of spinal origin (14 patients). Patients with stenosis were older than those in the other 2 groups. Patients with nonsurgical pain of spinal origin had lower ODI scores compared with the other 2 groups. A diagnosis-based registry design is effective in collecting pretreatment data for patients with lumbar disorders. When stratified by diagnosis, comparative effectiveness analyses can be performed to identify optimum treatments for lumbar disorders given individual patient characteristics. The WISPOS-P has established a mechanism and proof of principle for the participation of patients in an outcomes registry.

A prospective randomized controlled study comparing transforaminal lumbar interbody fusion techniques for degenerative spondylolisthesis: unilateral pedicle screw and 1 cage versus bilateral pedicle screws and 2 cages

Many surgeons currently prefer to use transforaminal lumbar interbody fusion (TLIF), placing 1 unilateral pedicle screw (PS) and 1 cage. However, no study has examined whether unilateral fixation improves surgical outcome. The authors conducted a prospective randomized controlled trial with a minimum 2-year follow-up to analyze TLIF outcomes for 2 techniques: placement of a unilateral PS and a cage compared with placement of bilateral PSs and 2 cages. Fifty patients with degenerative spondylolisthesis undergoing single-level TLIF were randomly assigned to receive either unilateral or bilateral fixation. Parameters compared between the groups were surgical invasiveness, severity of intermittent claudication, pre- and postoperative visual analog scale (VAS) scores (from 0 to 10 for back pain, lower-extremity pain, and lower-extremity numbness), postoperative disability scores for lumbar spinal disorders (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire [JOABPEQ]), and fusion rates. The mean operative time for TLIF was significantly (p = 0.05) shorter and mean estimated blood loss was significantly lower in the unilateral than in the bilateral group. Intermittent claudication improved in response to each technique, but there was no significant intergroup difference. The unilateral group had a nonsignificant tendency toward less improvement in VAS score for back pain (1.5 vs 3.7 for the bilateral group) and exhibited significantly less improvement in VAS score for lower-extremity pain (2.1 vs 5.1, respectively) and numbness (1.7 vs 4.4). There were no significant differences between the groups in postsurgical scores for all 5 items of the JOABPEQ. The fusion rates were 87.5% (21 of 24 patients) in the unilateral group and 95.7% (22 of 23) in the bilateral group. Transforaminal lumbar interbody fusion involving unilateral PS fixation and a single-cage technique is less invasive than a 2-cage technique and bilateral fixation, and it improved patients' symptoms. However, it resulted in less improvement in back pain, lower-extremity pain, and lower-extremity numbness. When considering unilateral PS fixation and a single cage, the surgeon should be aware of the potential limitations of this technique. Clinical trial registration no.: UMIN000007833 (UMIN).

Minimum 2-Year Follow-Up of the Mobility and Disk Changes at the Index Level Stabilized by Isobar Hybrid Stabilization

IntroductionTo test whether the application of Isobar could prevent degeneration at the index and adjacent level. Materials and MethodsTotal 27 patients underwent decompressive discectomy and stabilized with transforaminal lumbar interbody fusion (TLIF) using Isobar. The mobility and disk changes by MRI were evaluated radiologically after a minimum follow-up of 2 years. ResultsAll patients finished a mean follow-up of 39 months (range: 24 to 50 months). Clinical outcomes showed significant improvement in mean postoperative visual analog scale score by 38.3 points (p < 0.01) and Oswestry disability index by 20.9 points (p < 0.01). Disk height ratio and intervertebral angle were maintained at the index level and adjacent level (p > 0.05). Range of motion averaged 2.81° at the index level, and range of motion at the adjacent level remained unchanged (p > 0.05). The wooden score at the index level showed no statistically changes. No reoperation or screw loosening was recorded. ConclusionHybird Isobar stabilization leads to excellent clinical and radiological results in a minimum follow-up of 2 years.I confirm having declared any potential conflict of interest for all authors listed on this abstractYesDisclosure of InterestNone declaredAthiviraham A, Wali ZA, Yen D. Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis. Spine 2011;11:613–617Caputy AJ, Spence CA, Bejjani GK, et al. The role of spinal fusion in surgery for lumbar spinal stenosis: a review. Neurosurgical Focus 1997;3:e3; discussion 1 p following e4Herkowitz HN, Sidhu KS. Lumbar spine fusion in the treatment of degenerative conditions: current indications and recommendations. Journal of American Academy of Orthopedic Surgeon 1995;3:123–135Sonntag VK, Marciano FF. Is fusion indicated for lumbar spinal disorders? Spine (Phila Pa 1976) 1995;20:138S-142SBridwell KH, Sedgewick TA, O'Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. Journal of Spinal Disorder 1993;6:461–472

Minimum 2-Year Follow-Up of the Mobility and Disk Changes at the Index Level Stabilized by Isobar Hybrid Stabilization

Introduction To test whether the application of Isobar could prevent degeneration at the index and adjacent level. Materials and Methods Total 27 patients underwent decompressive discectomy and stabilized with transforaminal lumbar interbody fusion (TLIF) using Isobar. The mobility and disk changes by MRI were evaluated radiologically after a minimum follow-up of 2 years. Results All patients finished a mean follow-up of 39 months (range: 24 to 50 months). Clinical outcomes showed significant improvement in mean postoperative visual analog scale score by 38.3 points ( p &lt; 0.01) and Oswestry disability index by 20.9 points ( p &lt; 0.01). Disk height ratio and intervertebral angle were maintained at the index level and adjacent level ( p &gt; 0.05). Range of motion averaged 2.81° at the index level, and range of motion at the adjacent level remained unchanged ( p &gt; 0.05). The wooden score at the index level showed no statistically changes. No reoperation or screw loosening was recorded. Conclusion Hybird Isobar stabilization leads to excellent clinical and radiological results in a minimum follow-up of 2 years. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Athiviraham A, Wali ZA, Yen D. Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis . Spine 2011;11:613–617 Caputy AJ, Spence CA, Bejjani GK, et al. The role of spinal fusion in surgery for lumbar spinal stenosis: a review . Neurosurgical Focus 1997;3:e3; discussion 1 p following e4 Herkowitz HN, Sidhu KS. Lumbar spine fusion in the treatment of degenerative conditions: current indications and recommendations . Journal of American Academy of Orthopedic Surgeon 1995;3:123–135 Sonntag VK, Marciano FF. Is fusion indicated for lumbar spinal disorders? Spine (Phila Pa 1976) 1995;20:138S-142S Bridwell KH, Sedgewick TA, O'Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis . Journal of Spinal Disorder 1993;6:461–472

“Dynamic Fusion” in Degenerative Lumbar Spine Disorders

Introduction Dynamic stabilization in lumbar degenerative disorders has become very popular in the last few years. The basic concept of pedicle-screw-based systems is to reduce stiffness of the implants to allow load sharing between instrumentation system and functional spine (movement) unit to prevent adjacent segment syndrome. Basic biomechanical requirements for this philosophy are as follows: (a) a predicable load distribution to the intervertebral disk, (b) the limitation (control) of range of motion, and (c) to maintain and/or to restore the sagittal (sacral) balance. Disk degeneration results in loss of disk height and increase of axial compression loading in the posterior spine elements, probably accompanied with accelerated facet degeneration (arthrosis). Challenged by G. Perrinás reports in the late 1990s we started in 2002 with dynamic (semirigid) transpedicular stabilization systems in degenerative lumbar spine disorders using Isolock device, later using Isobar and AladynR device also. Materials and Methods This paper presents an inhomogene case presentation of 26 patients with different perception of degenerative lumbar disorders. Patients underwent a so called “Dynamic Fusion” between 2003 and 2007 using PLIF or TLIF added by posterior transpedicular dynamic (semirigid) stabilization. The case presentation presents preoperative, postoperative radiographs, and maximally follow-up radiographs to show a perfect bony healing in anterior elements. Definition of Dynamic Fusion Semirigid pedicle screw systems allow an increased anterior column load-sharing leading to favor osteogenesis with enhanced interbody fusion. This physical phenomenon is related to Wolffás Law. Lavaste and Perrin validated in 1993 in a finite element model of the lumbar spine that semirigid posterior instrumentation increases compared to rigid instrumentation of the load transmission through the anterior column. This observation and the publication by Goel et al confirmed that dynamic stabilization systems enable more load through the anterior column and the interbody graft compared to rigid systems without compromising stability, led to changing philosophy. We started to combine PLIF/TLIF with posterior transpedicular semirigid stabilization over the instrumented segment. Results No loosening signs of the PLIF/TLIF implants have been followed-up in this patient cohort. The evaluated pain relief is depended on many factors but all patients had a pain level degree in the VAS (25%). Conclusion The PLIF/TLIF in degenerative lumbar spine disorders showed in combination with posterior semirigid stabilization good clinical and radiographical results. No implant loosening has been followed up. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Perrin G: Treatment of lumbar spondylolisthesis and related unstable spinal lesions: the usefulness of PLIF with cages and dynamic interpedicular posterior fixation for circumferential arthrodesis and prevention of adjacent level degeneration. presented at the 3rd World Spine Meeting, Rio de Janeiro, 2005 Goel VK, Lim Th, Gwon J, et al. Effects of rigidity of an internal fixation device. A comprehensive biomechanical investigation. Spine 1991;16:155–161

“Dynamic Fusion” in Degenerative Lumbar Spine Disorders

“Dynamic Fusion” in Degenerative Lumbar Spine Disorders

Commentary: Is the hip bone connected to the spine bone?

Prather H, Van Dillen LR, Kymes SM, et al. Impact of coexistent lumbar spine disorders on clinical outcomes and physician charges associated with total hip arthroplasty. Spine J 2012;12:363-9 (in this issue).

Doing Good, Feeling Good, and Having More: Resources Mediate the Health Benefits of Altruism Differently for Males and Females with Lumbar Spine Disorders

We evaluated whether resources mediate and/or moderate the relationship between altruism and health outcomes in adults with lumbar spine disorders. Hierarchical regression modeling on 243 persons with lumbar spine disorders evaluated gender differences and whether physical, emotional, and economic resources mediated or moderated the relationship between altruism (Schwartz Altruism) and health (Rand-36, PROMIS Pain Impact). Men and women had similar altruism subscale scores, but there were gender differences in the altruism-health relationships. Both men and women had better mental health with higher levels of Community Connection, after adjusting for Community Pressure, and this effect was mediated by emotional resources. Women evidenced better physical health and less pain impact when they endorsed higher levels of Community Connection and/or General Helping aspects of altruism. Physical and economic resources partially but did not fully mediate women’s altruism-physical health link. The altruism-pain impact link was not significant after adjusting for covariates. Men and women report similar levels of altruism but enjoy different benefits. Emotional resources explained the altruism-mental health link in both genders, but women experienced a physical health benefit of altruism that was not mediated by resources. Future research should test causal relationships.

Differences in Damage to CGRP Immunoreactive Sensory Nerves After Two Lumbar Surgical Approaches

Immunohistochemical study. To evaluate invasive surgical approaches by analyzing the number of sensory nerve fibers at 2 back muscle sites in rats and humans and the number of injured nerve fibers innervating these 2 sites after muscle injury in rats. SUMMARY OF BACKGROUND DATA.: Several minimally invasive approaches have recently become popular in the treatment of lumbar spine disorders. Minimally invasive surgery (MIS) is not invasive to back muscle and is thought to reduce low back pain. Muscle damage has been generally evaluated by magnetic resonance imaging (MRI); however, damage to sensory nerve fibers in and around back muscle that is directly related to pain has apparently not been explored. Human muscle at L4-L5 was obtained from the paraspinous process (during a midline approach) and from paraspinal back muscle (during a Wiltse paraspinal approach) (n = 10 each). The muscle was sectioned and immunostained for calcitonin gene-related peptide (CGRP). To detect dorsal root ganglion (DRG) neurons innervating back muscle in rats, Fluoro-Gold (FG) was applied to the same 2 sites on the lower back muscle at L4-L5 (only application, n = 12; application of FG + muscle injury, n = 12). DRGs were harvested and immunostained for CGRP and activating transcription factor-3 (ATF-3: marker for nerve injury). The numbers of FG-labeled CGRP-immunoreactive or FG-labeled ATF-3-immunoreactive DRG neurons innervating the 2 sites were counted and compared. CGRP-immunoreactive sensory nerve fibers were found at the 2 sites. The average number of CGRP-immunoreactive sensory nerve fibers in muscle obtained in a midline approach was significantly higher than that in muscle obtained in a Wiltse paraspinal approach (P < 0.01). The numbers of FG-labeled CGRP- and ATF-3-immunoreactive DRG neurons innervating paraspinous process muscle were significantly greater than those innervating paraspinal back muscle in rats (P < 0.01). There are more CGRP-immunoreactive sensory nerve fibers and DRG neurons innervating muscle in the midline approach area than in the Wiltse paraspinal approach area in humans and rats. There are more ATF-3-immunoreactive DRG neurons innervating muscle in the midline approach area than in the Wiltse paraspinal approach area after muscle injury in rats. This result may show the differences in sensory nerve injury during the 2 surgical approaches.

Impact of coexistent lumbar spine disorders on clinical outcomes and physician charges associated with total hip arthroplasty

Despite the common prevalence of lumbar spine and degenerative hip disorders, there are few descriptions of patients with coexisting hip disorders and lumbar spine disorders (LSDs). The independent economic burden of each disorder is substantial, but the financial burden when the disorders are coexisting is unknown. To determine the prevalence of coexisting hip disorders and LSDs in a large cohort of patients with hip osteoarthritis (OA) treated with total hip arthroplasty (THA) as well as the impact on pain and functional THA outcomes and physician charges. This is a retrospective study performed at a tertiary university. Three thousand two hundred six patients underwent total hip replacement from 1996 to 2008. Self-report measures: visual analog scale. Functional measures: modified Harris Hip Score (mHHS) and University of California Los Angeles (UCLA) hip questionnaire. Economic impact measures: physician medical charges. International Classification of Diseases, Version 9, billing codes related to LSDs were cross-referenced with the 3,206 patients who had undergone a THA to determine which patients were also evaluated by a spine specialist. Demographic, hip clinical outcomes, and physician charges for patients with THA alone (THA alone) were compared with patients treated with THA and diagnosed with an LSD (THA+LSD). Of 3,206 patients who underwent THA, 566 (18%) were also evaluated by a spine specialist. Of those with an LSD, 334 (59%) were women with an older average age (64.5 ± 13.3 years) compared with patients treated with THA alone (51%, 58.5 ± 15.5 years, p = .0001). Patients in the THA alone group as compared with the THA+LSD group had greater improvement in the mHHS (p=.0001), UCLA score (p=.0001), and pain (p=.0001). Patients in the THA+LSD group incurred on average $2,668 more in charges per episode of care as compared with patients in the THA alone group (p<.001). Patients in the THA+LSD group had more days per episode of care (p=.001). Patients undergoing THA alone had greater improvement in function and pain relief with fewer medical charges as compared with patients undergoing a THA and treatment for an LSD. The prevalence of coexisting hip disorders and spine disorders is likely higher than currently documented. Further study is needed to improve therapeutic recommendations and determine the potential for reduction in medical expenses associated with concurrent treatment of hip OA and LSDs.

A diagnostic classification for lumbar spine registry development

Low back pain (LBP) is a symptom, not a diagnosis. The failure to differentiate underlying diagnoses in patients complaining of LBP is one of the primary reasons that studies examining treatments for LBP have yielded inconsistent results. To design a lumbar spine registry such that the accumulated data provide applicable guidance for clinical treatment, the incorporation of a functional diagnostic matrix is critical. To propose a clinically relevant diagnostic classification scheme, simple enough for use in clinical practice but granular enough to differentiate characteristics that impact clinical outcome. Case-based development, feasibility, and reliability testing of a classification scheme. Thirty case histories were compiled. Each case consisted of a brief clinical history with physical examination findings as well as pertinent radiographic images, including computed tomography scan and magnetic resonance image when available. Kappa values for inter- and intrarater reliability. Thirty-six physicians were asked to provide a three-digit diagnostic code, specifying Symptoms, Structural Pathology, and Compressive Pathology for each case. The cases were then randomly rearranged and sent back to the physicians 2 weeks later for a second review. Inter- and intraobserver reliability was calculated using Randolph's free-marginal multirater kappa. Symptoms are classified differentiating between patients with back or leg pain dominance and those with equal back and leg pain; symptoms are also divided as acute versus chronic. Additional categories denote neurogenic claudication and cauda equina. Structural Pathology includes an option for age appropriate changes. Additional options include disc pathology with and without disc space collapse; spondylolisthesis or spondylolysis without olisthesis; and regional spinal deformity, either scoliosis or kyphosis. The remaining structural categories are primary facet pathology and nonunion after attempted fusion. Compressive Pathology includes a category indicating the absence of any study on which to judge compressive pathology and a category indicating an available study, but the lack of any clinically relevant compressive pathology. Additional options are for either central compression or lateral recess/foraminal/extraforaminal compressive pathology of any etiology. There is also a category for combined central and lateral compression. The final category is recurrent compression, central, lateral, or combined compression after surgical treatment at the involved level. It is important to emphasize that the intention is only to categorize Structural and Compressive Pathology that is relevant to the patient's symptom complex. When more than one relevant structural or compressive lesion exists, the provider should select the most clinically relevant finding. The interrater agreement was substantial for Symptoms (κ=0.70) and moderate for Structural Pathology (κ=0.58) and Compressive Pathology (κ=0.53). The intrarater agreement was substantial for Symptoms (κ=0.78), Structural Pathology (κ=0.70), or Compressive Pathology (κ=0.67). This study demonstrates that improved diagnostic stratification of lumbar spine disorders is a feasible goal. The diagnostic coding matrix, based on clinically relevant descriptors, yielded substantial interrater consistency for symptoms, moderate interrater consistency for structural and compressive pathology, and substantial intrarater consistency for all elements.

Effects of Viewing an Evidence-Based Video Decision Aid on Patientsʼ Treatment Preferences for Spine Surgery

Secondary analysis within a large clinical trial. To evaluate the changes in treatment preference before and after watching a video decision aid as part of an informed consent process. A randomized trial with a similar decision aid in herniated disc patients had shown decreased rate of surgery in the video group, but the effect of the video on expressed preferences is not known. Subjects enrolling in the Spine Patient Outcomes Research Trial (SPORT) with intervertebral disc herniation, spinal stenosis, or degenerative spondylolisthesis at 13 multidisciplinary spine centers across the United States were given an evidence-based videotape decision aid viewed prior to enrollment as part of informed consent. Of the 2505 patients, 86% (n = 2151) watched the video and 14% (n = 354) did not. Watchers shifted their preference more often than nonwatchers (37.9% vs. 20.8%, P < 0.0001) and more often demonstrated a strengthened preference (26.2% vs. 11.1%, P < 0.0001). Among the 806 patients whose preference shifted after watching the video, 55% shifted toward surgery (P = 0.003). Among the 617 who started with no preference, after the video 27% preferred nonoperative care, 22% preferred surgery, and 51% remained uncertain. After watching the evidence-based patient decision aid (video) used in SPORT, patients with specific lumbar spine disorders formed and/or strengthened their treatment preferences in a balanced way that did not appear biased toward or away from surgery.

Motion-preserving technologies for degenerative lumbar spine: The past, present, and future horizons

Over the past few decades, remarkable advancements in the understanding of the origin of low-back pain and lumbar spinal disorders have been achieved. Spinal fusion is generally considered the “gold standard” in the treatment of low-back pain; however, fusion is also associated with accelerated degeneration of adjacent levels. Spinal arthroplasty and dynamic stabilization technologies, as well as the continuous improvement in diagnosis and surgical interventions, have opened a new era of treatment options. Recent advancements in nonfusion technologies such as motion-preservation devices and posterior dynamic stabilization may change the gold standard. These devices are designed with the intent to provide stabilization and eliminate pain while preserving motion of the functional spinal unit. The adaption of nonfusion technologies by the surgical community and payers for the treatment of degenerative spinal conditions will depend on the long-term clinical outcome of controlled randomized clinical studies. Although the development of nonfusion technology has just started and the adoption is very slow, it may be considered a viable option for motion preservation in coming years. This review article provides technical and surgical views from the past and from the present, as well as a glance at the future endeavors and challenges in instrumentation development for lumbar spinal disorders.

Commentary on an article by Rick Delamarter, MD, et al.

For nearly as long as spinal arthrodesis has been used to treat lumbar spine disorders, concerns have been raised regarding the long-term biomechanical and anatomic ramifications of successful fusion, particularly adjacent-segment disc degeneration and loss of lumbar range of motion. In many ways, the specter of adjacent-segment disc degeneration has been most concerning as it can lead to a deterioration in function that was gained following the initial procedure as well as to symptoms that may require further surgery. As a result, new surgical devices and procedures are being developed with the intention of treating lumbar degenerative conditions while maintaining near-normal biomechanical and anatomic parameters. Without question, the total disc replacement is one such “motion-sparing” device that has received substantial attention within the spine surgery community. Despite the fact that total disc replacement has been performed in Europe since the mid-1980s, there have been few scientifically rigorous investigations capable of providing high-grade evidence regarding optimal indications, effectiveness, and longevity1,2. Recently, randomized prospective studies on the short-term benefits of single-level total disc replacement have demonstrated that the beneficial results of this procedure have been maintained for up to five years following surgery1,2. Yet, until now, no comparable investigation was available regarding the use of total disc replacement as treatment for lumbar degenerative disorders at two contiguous levels. The authors of the present study are to …

Entrapment of the Medial Branch of the Superior Cluneal Nerve – a Previously Unrecognized Cause of Lower Back Pain in Cricket Fast Bowlers

Cricket fast bowlers have a high incidence of injury and are prone to back problems that can become debilitating and foreshorten their careers. We present a case of superior cluneal nerve (SCN) entrapment neuropathy as a previously unrecognized etiology of lower back pain in a professional cricket fast bowler, often misdiagnosed as a lumbar spine disorder. We believe that the SCN may be susceptible to compression related to repetitive contraction of the back musculature, in particular the Thoraco-lumbar erector spinae (TLES) and Latissimus dorsi which contribute to a fibro-osseous tunnel through which the SCN runs. The problem can be readily treated with surgical decompression and patients can expect a return to near full function. Clinicians should be aware of this diagnosis when investigating athletes for chronic lower back pain. J Med Cases. 2011;2(3):101-103 doi: https://doi.org/10.4021/jmc167w

Relevance of Lifestyle and Attitudinal Factors to Spine Surgery Outcomes: Empirical Results on a Heterogeneous Sample

Background Context: Patient demographic and medical indicators influence the well-being of spine surgery patients. It may, however, be worthwhile to evaluate other lifestyle and attitudinal factors. We hypothesized that such factors would explain at least as much variance in outcome as more commonly considered covariates. Purpose: To compare explained variance in outcome of lifestyle and attitudinal factors as compared to standard demographic and medical covariates. Study Design/Setting: Cross-sectional observational study of patients drawn from an active clinic and internet-based support group. Patient Sample: A heterogeneous sample of 376 patients was recruited, comprised of people with diagnoses of cervical (n = 80), lumbar (n = 228), and scoliosis (n = 68) spine disorders. Outcome Measures: Quality of Life (QOL) outcomes were measured using the Oswestry Disability Index, Neck Disability Index, Rand-36, PROMIS Pain Impact, NRS Back and Leg Pain, Scoliosis Research Society-22r, and Global Health. Methods: This study compared explained variance in QOL outcomes in demographic and medical versus lifestyle and attitudinal factors. Demographic and medical factors included age, gender, body mass index, and co-morbidities. Lifestyle factors included exercise and commuting practice. Attitudinal factors related to social connectedness: giving and receiving emotional support, feeling overwhelmed by others’ needs, helping orientation, and general helping behaviors. Regression analyses estimated explained variance. Patient groups differed in most factors evaluated, so the regression analyses were computed separately by group. R2 statistics were characterized as null, small (0.02), medium (0.15), and large (0.35) effect sizes (ES), and proportions were compared for the medical/demographic versus lifestyle/attitudinal factors by group. Results: Similar proportions of variance were explained by demographic/medical and lifestyle/attitudinal covariates across groups, with half of effect sizes being small in magnitude and 6% being medium. Lumbar patients tended to have more small effect sizes among lifestyle and attitudinal covariates than among medical/demographic covariates (z = – 1.29, p < 0.10). Similar patterns were found for both generic and disease-specific outcomes. Conclusions: Spine surgery outcome research should investigate lifestyle and attitudinal factors to enhance the personal and salutogenic relevance of the research. Time spent commuting, exercise practice, and social connectedness appear to be relevant factors. A pre-operative evaluation of overweight and smoking status, limited social connectedness, and long daily commutes could alert the surgeon to delay or avoid performing procedures on these patients to avoid poor outcomes.

Efficacy of Posterior Lumbar Interbody Fusion using PEEK Cage and Pedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders - Minimum 3 Years Follow up Results -

Study Design: A retrospective study. Objectives: To evaluate the three-plus year follow-up results of patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease. Summary of Literature Review: There are few previous reports addressing posterior lumbar interbody fusion using PEEK cage with mid-term follow up periods. Materials and Methods: 260 patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease were enrolled. We classified patients into three groups according to their fusion level: group A (n=151) had one-level fusion, and group B (n=91) had two-level fusion, and group C (n=18) had three-level fusion. Clinical outcomes were evaluated by pre- and post-operative Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), and complication and reoperation rates. Radiologic outcomes were measured by the fusion rate, sagittal alignment, disc height and changes. Results: VAS (pre-operative to final follow-up) changed from 7.62±2.03 (5-10) to 3.19±1.94 (1-8) in group A, from 6.83±2.28(4-9) to 4.51±2.18(2-9) in group B and from 7.17±2.46 (5-10) to 4.63±1.97(1-9) in group C. Final follow-up ODI also decreased in group A (17.6±8.56%), group B (15.4±5.46%) and group C (24.7±7.46%). This corresponds to scores of 94.7% in group A, 92.3% in group B and 94.4% in group C. There were significant differences between preoperative, post-operative and final follow-up lumbar lordosis [p=0.042(group A), 0.036(group B), 0.045(group C)], segmental lordosis [p=0.036(group A), 0.039(group B), 0.047(group C)]. Reoperation was performed in patients 8 group A, 4 group B, and 1 group C, and there is no significant diffrence between groups. Adjacent segmental change was found in all reoperation patients, but showed no correlation with clinical results. Conclusions: Posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation in lumbar degenerative disease showed excellent clinical results and fusion rates, regardless of patient fusion levels.

Short Term Outcomes of Intervertebral Spike (IS®) Cage for Degenerative Lumbar Spinal Disorders

Korean J Spine 8(3) September 2011 183 ● Received: May 30, 2011 ● Revised: July 26, 2011 ● Accepted: September 21, 2011 Corresponding Author: Ho Yeol Zhang, MD, PhD Department of Neurosurgery, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, 1232 Baekseok-dong, Ilsandong-gu, Goyang 410-719, Korea Tel: +82-31-900-0256, Fax: +82-31-900-0588 E-mail: hoyeolzhang@gmail.com Short Term Outcomes of Intervertebral Spike (ISR) Cage for

Comparative Study of Posterior Lumbar Interbody Fusion with Posterolateral Fusion in Degenerative Lumbar Spinal Disorders

Comparative Study of Posterior Lumbar Interbody Fusion with Posterolateral Fusion in Degenerative Lumbar Spinal Disorders

Auto-tracking system for human lumbar motion analysis

Previous lumbar motion analyses suggest the usefulness of quantitatively characterizing spine motion. However, the application of such measurements is still limited by the lack of user-friendly automatic spine motion analysis systems. This paper describes an automatic analysis system to measure lumbar spine disorders that consists of a spine motion guidance device, an X-ray imaging modality to acquire digitized video fluoroscopy (DVF) sequences and an automated tracking module with a graphical user interface (GUI). DVF sequences of the lumbar spine are recorded during flexion-extension under a guidance device. The automatic tracking software utilizing a particle filter locates the vertebra-of-interest in every frame of the sequence, and the tracking result is displayed on the GUI. Kinematic parameters are also extracted from the tracking results for motion analysis. We observed that, in a bone model test, the maximum fiducial error was 3.7%, and the maximum repeatability error in translation and rotation was 1.2% and 2.6%, respectively. In our simulated DVF sequence study, the automatic tracking was not successful when the noise intensity was greater than 0.50. In a noisy situation, the maximal difference was 1.3 mm in translation and 1° in the rotation angle. The errors were calculated in translation (fiducial error: 2.4%, repeatability error: 0.5%) and in the rotation angle (fiducial error: 1.0%, repeatability error: 0.7%). However, the automatic tracking software could successfully track simulated sequences contaminated by noise at a density ≤ 0.5 with very high accuracy, providing good reliability and robustness. A clinical trial with 10 healthy subjects and 2 lumbar spondylolisthesis patients were enrolled in this study. The measurement with auto-tacking of DVF provided some information not seen in the conventional X-ray. The results proposed the potential use of the proposed system for clinical applications.