Postoperative Oswestry Disability Index Research Articles

Clinical outcomes of mini-invasive transforaminal lumbar interbody fusion under Quadrant system for upper lumbar disc herniation

To evaluate the treatment outcomes of mini-invasive transforaminal lumbar interbody fusion by Quadrant system for upper lumbar disc herniation. Between February 2008 and June 2011, 21 patients with upper lumbar disc herniation underwent mini-invasive transforaminal lumbar interbody fusion under Quadrant system at our institution. The relevant patient data included visual analogue scale (VAS) and Oswestry disability index (ODI) scores before and after operation 1 week, 3 months and last follow-up. And all data were collected retrospectively. No operation-related complications occurred. The mean operative duration was 2.8 (2.5-3) hours. The average blood loss volume was 430 (350-500) ml. Preoperative VAS was 7.3 ± 0.8 and 2.1 ± 0.9, 1.3 ± 0.6, 0.6 ± 0.5 after operation 1 week, 3 months and last follow-up respectively. Statistically significant differences were demonstrated between each group. Preoperative ODI was 43.7 ± 12.9 and 22.5 ± 10.4, 16.2 ± 8.5, 11.3 ± 7.2 after operation 1 week, 3 months and last follow up. Significant differences existed in preoperative and postoperative ODI scores respectively. Mini-invasive transforaminal lumbar interbody fusion using Quadrant system and special osteotome is safe and efficacious for upper lumbar disc herniation.

Functional Outcomes and Height Restoration for Patients With Multiple Myeloma-related Osteolytic Vertebral Compression Fractures Treated With Kyphoplasty

A retrospective review of pathologic vertebral fractures related to multiple myeloma. To report the functional status and height restoration of 32 patients treated with kyphoplasty for multiple myeloma-related vertebral compression fractures. Multiple myeloma can cause significant bony resorption, and vertebral involvement is extremely common. Compression fractures due to myelomatous vertebral metastases result in significant pain and can lead to kyphosis and sagittal imbalance. Nonoperative treatment can result in deformity and continued pain, and large surgical procedures have significant morbidity. Percutaneous cement augmentation (kyphoplasty and vertebroplasty) is a minimally invasive technique that can improve pain in these patients. Kyphoplasty also has the potential to provide mild deformity correction in addition to fracture stabilization. Study participants were patients with biopsy-proven multiple myeloma presenting with compression fracture treated with kyphoplasty. Data were compiled from patient charts and preoperative and postoperative radiographs. Patient self-reported functional status were obtained through the use of the Oswestry Disability Index. The degree of vertebral body collapse and deformity was evaluated using the method of Genant and analyzed using paired Student t test. Thirty-two consecutive patients who underwent kyphoplasty at a total of 76 levels for myelomatous vertebral compression fractures were identified. Sixteen fractures were at the thoracolumbar junction. The mean age was 64.3 years. The average Genant grade for the involved levels improved from 1.9 preoperative to 1.53 postoperative, which was statistically significant (P<0.0001). The postoperative Oswestry Disability Index score was obtained at a mean of 24 months, with a mean of 29.6%. Complications occurred in 12 (37.5%) patients, all consisting of minimal intraoperative cement extravasation without clinical sequelae. No changes in the neurological status were observed. The average hospital stay was 1.34 days postprocedure. Kyphoplasty for vertebral compression fractures due to multiple myeloma is a safe and effective procedure that can lead to pain relief and vertebral height restoration.

Surgical correction of post-traumatic thoracolumbar kyphotic deformity with posterior transpedicular limited osteotomy technique

To evaluate the clinical outcome of surgical management for post-traumatic thoracolumbar kyphotic deformity with single-stage posterior transpedicularlimited osteotomies. From March 2007 to May 2010, 17 patients with post-traumatic thoracolumbar kyphotic deformity treated with posterior limited transpedicular osteotomy were admitted. The preoperative Cobb angle was 41°-62°(52.5° ±6.4°). Sagittal balance was evaluated by the standing lateral films measuring the C7 plumb line distance (C7 PLD) from the posterior superior corner of S1. The C7 PLD was 18-58 (41.2 ±12.4) mm in the sagittal plane. The preoperative oswestry disability index (ODI) was 42-50 (45.7 ±2.7), and the average preoperative visual analogue scale (VAS) was 8-10 (8.8 ±0.7). The American Spinal Injury Association (ASIA) impairment scale was used to assess the neurological deficits, and grade C in 1 patient, grade D in 7 and grade E in 9 patients. The operation time, blood loss, complications, post-operative Cobb angle, ODI and VAS score at the follow-up were collected and analyzed. The average duration of postoperative follow-up was 24-53 (34.5 ±7.1) months. The operation time was 180-400 (287.1 ±65.9) min, with an blood loss of 350-1 300 (838.2 ±276.4) mL. The postoperative kyphotic angle was 3°-12° (6.1° ±3.0°), and it was 7.5° ±2.6° at the final follow-up evaluation. The postoperative C7PLD was (3.6 ±3.9) mm and it was (3.4 ±2.3) mm at the final follow-up evaluation. Postoperatively, the ASIA impairment scale was grade D in 4 and grade E in 13 patients. At the final follow-up ODI and VAS were reduced to an average of 5.2 ±2.4 and 2.4 ±1.0, respectively. Cerebrospinal fluid leakage was found in 2 patients, deep wound infection in 1, and intercostal neuralgia in 2. All the complications were relieved after conservative medical therapy. One patient received additional surgery at postoperative 12 weeks due to breakage of posterior implants. Another screw pullout case was treated with reinsertion of larger screws at postoperative 4 months. Solid fusion was confirmed by plain film and CT scan in all patients within 1 year after the surgery. Single-staged posterior transpedicular limited osteotomies is safe and effective to correct post-traumatic thoracolumbar kyphotic deformity.

Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion

Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has become an increasingly popular method of lumbar arthrodesis. However, there are few published studies comparing the clinical outcomes between unilateral and bilateral instrumented MIS TLIF. Sixty-five patients with degenerative lumbar spine disease were enrolled in this study. Thirty-one patients were randomized to the unilateral group and 34 to the bilateral group. Recorded demographic data included sex, age, preoperative diagnosis, and degenerated segment. Operative time, blood loss, hospital stay length, complication rates, and fusion rates were also evaluated. The Oswestry Disability Index (ODI) score and Visual Analog Scale (VAS) pain score data were obtained. All patients were asked to follow-up at 3 and 6months after surgery, and once every 6months thereafter. The mean follow-up was 26.6months (range 18–36months). The two groups were similar in sex, age, preoperative diagnosis, and operated level. The unilateral group had significantly shorter operative time, lower blood loss, and shorter hospital time than the bilateral group. The average postoperative ODI and VAS scores improved significantly in each group. No significant differences were found between the two groups in relation to ODI and VAS. All patients showed evidence of fusion at 12months postoperatively. The total fusion rate, screw failure, and general complication rate were not significantly different. Results showed that single-level MIS TLIF with unilateral pedicle screw fixation would be sufficient in the management of preoperatively stable patients with lumbar degenerative disease. It seems that MIS TLIF with unilateral pedicle screw instrumentation is a better choice for single-level degenerative lumbar spine disease.

Minimally Invasive Versus Open Sacroiliac Joint Fusion: Are They Similarly Safe and Effective?

The sacroiliac joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, sacroiliac joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the sacroiliac joint using plates and screws is not known. We compared estimated blood loss (EBL), surgical time, length of hospital stay (LOS), and Oswestry Disability Index (ODI) between patients undergoing MIS and open sacroiliac joint fusion. We retrospectively studied 63 patients (open: 36; MIS: 27) who underwent sacroiliac joint fusion with minimum 1-year followup at our institution from 2006 to 2011. Of those, 10 in the open group had incomplete records. All patients had sacroiliac joint dysfunction confirmed by image-guided intraarticular anesthetic sacroiliac joint injection and had failed nonoperative treatment. Patients were matched via propensity score, adjusting for age, sex, BMI, history of spine fusion, and preoperative ODI scores, leaving 22 in each group. Nine patients were not matched. We reviewed patient medical records to obtain EBL, length of surgery, LOS, and pre- and postoperative ODI scores. Mean followup was 13 months (range, 11-33 months) in the open group and 15 months (range, 12-26 months) in the MIS group. Patients in the open group had a higher mean EBL (681 mL versus 41 mL, p < 0.001). Mean surgical time and LOS were shorter in the MIS group than in the open group (68 minutes versus 128 minutes and 3.3 days versus 2 days, p < 0.001 for both). With the numbers available, mean postoperative ODI scores were not different between groups (47% versus 54%, p = 0.272). EBL, surgery time, and LOS favored the MIS sacroiliac fusion group. With the numbers available, ODI scores were similar between groups, though the study size was relatively small and it is possible that the study was underpowered on this end point. Because the implants used for these procedures make assessment of fusion challenging with available imaging techniques, we do not know how many patients' sacroiliac joints successfully fused, so longer followup and critical evaluation of outcomes scores over time are called for. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Comparison of the results of MIS-TLIF and open TLIF techniques in laborers

Objective: To compare clinical outcomes in laborers who have undergone open transforaminal interbody fusion (TLIF) and minimally invasive transforaminal interbody fusion (MIS TLIF). Methods: 78 patients were submitted to lumbar arthrodesis by the same two spine surgeons partners from January 2008 to December 2012. Forty-one were submitted to traditional open arthrodesis and 37 to the minimally invasive procedure. Three patients were not included because they had already retired from work. The analyzed variables were length of hospitalization, length of follow-up, type of access (TILF or MIS TLIF), need for blood transfusion, percentage of improvement or worsening after surgery, pre- and postoperative VAS scale, time off work, pre-and postoperative Oswestry disability index, and general aspects of the laborers such as age, education, profession, working time, amount of daily weight carried at work, and use or not of personal protective equipment. Results: Time off work was longer in the TLIF group (average of 9.84 months) compared with the MIS TLIF group (average of 3.20 months). Significant improvement in postoperative VAS and Oswestry was achieved in both groups. Average length of hospitalization was 5.73 days for the TLIF group and 2.76 days for the MIS TLIF group. Conclusions: Minimally invasive transforaminal lumbar interbody fusion presents similar results when compared to open TLIF, but has the benefits of less postoperative morbidity, shorter hospitalization times, and faster rehabilitation in laborer patients.

Elderly Patients Have Similar Outcomes Compared to Younger Patients After Minimally Invasive Surgery for Spinal Stenosis

Older patients undergo surgery for lumbar spinal stenosis in great numbers, but as a result of substantial diagnostic and surgical heterogeneity, the impact of age on results after surgery is poorly defined. We compared groups of patients younger and older than 70 years with relative clinical and surgical homogeneity to determine differences in (1) interval improvement in Oswestry Disability Index (ODI) at 6 weeks, 6 months, and 12 months postoperatively and (2) perioperative adverse events. We performed a subgroup analysis of an ongoing prospective observational study. Patients were divided based primarily on age (younger than 70 years [n = 68] and 70 years or older [n = 41]) and secondarily on procedure (minimally invasive decompression alone or decompression and instrumented fusion). With the exception of age and American Society of Anesthesiologists status, the two age groups were similar (p > 0.3) in baseline demographics and ODI. Mean pre- and postoperative ODI were compared between groups at 6 weeks, 6 months, and 12 months. Perioperative adverse events were also compared. At all time intervals, both younger and older patients demonstrated (p = 0.05 to < 0.001) improvements in ODI. At the 1-year mark, no differences in ODI were demonstrated between the younger and older patients for decompression only (21 versus 26 [p = 0.29]) or decompression and fusion (19 versus 18 [p = 0.97]). Interval improvement in ODI was not different between younger and older patients at any time point for decompression only (6 weeks: -18 versus -20 [p = 0.66]; 6 months: -21 versus -17 [p = 0.41]; 12 months: -21 versus -15 [p = 0.29]) or decompression and fusion (6 weeks: -11 versus -12 [p = 0.58]; 6 months: -21 versus -22 [p = 0.69]; 12 months: -23 versus -27 [p = 0.97]). There were no differences in perioperative adverse events between groups (p = 0.67). When clinical and surgical heterogeneity is minimized, improvements in terms of disability as measured by the ODI and the frequency of adverse events after surgery in elderly patients with lumbar spinal stenosis are comparable to those of younger patients. For patients with focal lumbar spinal stenosis, age alone should not dissuade us from considering surgical intervention if otherwise indicated. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Early results of stand-alone anterior lumbar interbody fusion in iatrogenic spondylolisthesis patients

Iatrogenic spondylolisthesis is a challenging condition for spinal surgeons. Posterior surgery in these cases is complicated by poor anatomical landmarks, scar tissue adhesion of muscle and dural structures and difficult access to the intervertebral disc. Anterior interbody fusion provides an alternative treatment method, allowing indirect foraminal decompression, reliable disc clearance and implantation of large surface area implants. A retrospective chart review of patients with iatrogenic spondylolisthesis including pre- and post-operative Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores was performed. Imaging criteria were pelvic incidence, overall lumbar lordosis and segmental lordosis. In addition, the fusion rate was investigated after 6 months. Six consecutive patients treated between 2008 and 2011 (4 female, 2 male, mean age 61 ± 7.1 years) were identified. The initially performed surgeries included decompression with or without discectomy; posterior instrumented and non-instrumented fusion. The olisthetic level was in all cases at the decompressed level. All patients were revised with stand-alone anterior interbody fusion devices at the olisthetic level filled with BMP 2. Average ODI dropped from 49 ± 11 % pre-operatively to 26.0 ± 4.0 at 24 months follow-up. VAS average dropped from 7 ± 1 to 2 ± 0. Mean total lordosis of 39.8 ± 2.8° increased to 48.5 ± 4.9° at pelvic incidences of 48.8 ± 6.8° pre-operatively. Mean segmental lordosis at L4/5 improved from 10.5 ± 6.7° to 19.0 ± 4.9° at 24 months. Mean segmental lordosis in L5/S1 increased from 15.1 ± 7.4° to 23.2 ± 5.6°. Cage subsidence due to severe osteoporosis occurred in one case after 5 months, and hence there was no further follow-up. Fusion was confirmed in all other patients. Anterior interbody fusion offers good stabilisation and restoration of lordosis in iatrogenic spondylolisthesis and avoids the well-known problems associated with reentering the spinal canal for revision fusions. In this group, ODI and VAS scores were improved.

Provocative discography screening improves surgical outcome

The objective of this study was to compare the surgical outcomes of patients operated on, with or without discography prior to operation. The study was designed as a randomized controlled trial, using power analysis with McNemar's test on two correlated proportions. The study comprised of 310 patients divided into trial (207) and control (103) groups. Inclusion criteria were low back pain resistant to nonsurgical treatment for more than 6 months and conventional radiological findings showing degenerative changes without a clear generator of pain. Exclusion criteria were red flags (tumor, trauma, and infection). After standard radiological diagnostic imaging (X-ray, CT, and MR), patients filled in the Oswestry Disability Index (ODI), SF-36, Zung, and MSP questionnaires. Depending on their radiological findings, patients were included and randomly placed in the trial or control group. At the 1-year follow-up examination, patients filled in the ODI, SF-36, and Likert scale questionnaires. The difference between preoperative and postoperative ODI in the control group degenerative disc disease (DDD) subgroup was 22.07%. The difference between preoperative and postoperative ODI in the trial group DDD subgroup was 35.04%. Differences between preoperative and postoperative ODI in the control group other indications subgroup was 26.13%. Differences between preoperative and postoperative ODI in the trial group other indications subgroup was 28.42%. DDD treated surgically without discography did not reach the clinically significant improvement of 15 ODI points for the patients treated with fusion. Provocative discography screening with psychological testing in the trial group made improvement following fusion clinically significant.

Minimally Invasive Unilateral Pedicle Screw Fixation and Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Disease

Minimally invasive unilateral pedicle screw fixation for the treatment of degenerative lumbar diseases has won the support of many surgeons. However, few data are available regarding clinical research on unilateral pedicle screw fixation associated with minimally invasive techniques for the treatment of lumbar spinal diseases. The purpose of this study was to evaluate clinical outcomes in a selected series of patients with lumbar degenerative diseases treated with minimally invasive unilateral vs classic bilateral pedicle screw fixation and lumbar interbody fusion. Patients in the unilateral group (n=43) underwent minimally invasive unilateral pedicle screw fixation with the Quadrant system (Medtronic, Memphis, Tennessee). The bilateral group (n=42) underwent bilateral instrumentation via the classic approach. Visual analog scale pain scores, Oswestry Disability Index scores, fusion rate, operative time, blood loss, and complications were analyzed. Mean operative time was 75 minutes in the unilateral group and 95 minutes in the bilateral group. Mean blood loss was 220 mL in the unilateral group and 450 mL in the bilateral group. Mean postoperative visual analog scale pain score was 3.10±0.16 in the unilateral group and 3.30±1.10 in the bilateral group. Mean postoperative Oswestry Disability Index score was 15.67±2.3 in the unilateral group and 14.93±2.6 in the bilateral group. Successful fusion was achieved in 92.34% of patients in the unilateral group and 93.56% of patients in the bilateral group. Minimally invasive unilateral pedicle screw fixation is an effective and reliable option for the surgical treatment of lumbar degenerative disease. It causes less blood loss, requires less operative time, and has a fusion rate comparable with that of conventional bilateral fixation.

Revision surgery for lumbar pseudarthrosis

Background contextRevision surgery for pseudarthrosis after a lumbar spinal fusion has unpredictable functional results. PurposeThe aim of this study was to determine the clinical outcomes of revision surgery to fuse the pseudarthrosis site based on the two most common diagnoses (degenerative disc disease [DDD] vs. spondylolisthesis). Study designPatients who had a revision surgery between 1995 and 2004 for lumbar pseudarthrosis after short segment lumbar spinal fusion were identified through the institution's Spine Center surgery database. A retrospective chart review of clinical, hospital, and anesthesia records was then performed. Patient sampleSixty-six patients were included in the study (28 patients with DDD and 38 patients with spondylolisthesis). Inclusion criteria were a surgical diagnosis of pseudarthrosis with a prior fusion of one or two motion segments, minimum 24 months of follow-up, and a diagnosis of either symptomatic DDD or spondylolisthesis as the primary indication for the index fusion surgery. Outcome measuresThe Oswestry disability index (ODI) and a self-assessment questionnaire were used to evaluate clinical outcomes. MethodsA retrospective chart and radiographic review was performed. Statistical analysis was done using Student t test for ODI scores and chi-square test for discrete variables from the outcome questionnaires. ResultsFollow-up radiographs were available for 64 patients (97%), and a fusion rate of 100% was found in both groups for the radiographs examined. The mean postoperative ODI score was 53.3 (30–84.4) for DDD patients and 37.2 (2.5–76) for the spondylolisthesis group (p<.01). Only 50% of the patients in the DDD group felt that their overall well-being had improved since the surgery. In the spondylolisthesis group, 64% of patients stated that their overall well-being had improved since their revision surgery. ConclusionsThe clinical outcomes after revision surgery for pseudarthrosis are worse in patients with DDD compared with spondylolisthesis despite successful repair of nonunion. Risks and benefits should be well discussed with the patients before deciding on surgical treatment for the management of pseudarthrosis, especially in patients with previous short-segment fusions done for DDD.

Clinical Outcomes of Discectomy in Octogenarian Patients With Lumbar Disc Herniation

A retrospective clinical study. To investigate the efficacy and safety of surgery for lumbar disc herniation in octogenarian patients. Lumbar disc protrusion in the very elderly becomes more common with the aging of the general population, but few patients undergo surgical treatment because the chronological age of 80 years or more has long been considered a contraindication to elective spine surgery. Thus, there is little information about acute and long-term outcomes of lumbar discectomy in octogenarians, and the influence of age on outcome after surgery still remains controversial. Sixty-four octogenarian patients with lumbar disc herniation underwent unilateral laminectomy and discectomy between January 2004 and June 2010. Operative time (OT), intraoperative estimated blood loss (EBL), length of hospital stay (LOS), and complication rate (CR) were used to assess the safety of surgery. The visual analog scale (VAS), the Oswestry disability index (ODI), and the North American Spine Society Outcome Questionnaire were used to evaluate clinical effectiveness. Significant differences were found between the very elderly and the middle-aged group in LOS (P<0.001) but not in OT, EBL, and CR (all P>0.05). The preoperative, postoperative, and final follow-up VAS and ODI scores were not significantly different between the 2 groups (each P>0.05). However, the VAS and ODI scores significantly improved after surgery and at final follow-up compared with those before surgery (all P<0.001). Satisfaction with outcome was expressed by 57 (89.1%) of 64 very elderly patients. Discectomy through hemilaminectomy is a feasible, safe, and effective treatment procedure in octogenarian patients with lumbar disc herniation. Disc resection in octogenarian patients usually gives good or excellent results. Careful examination of the surgical indications and attentive perioperative management should be considered for this patient population.

Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis

The object of this study was to compare minimally invasive surgery (MIS) with open surgery in a severely affected subgroup of degenerative spondylolisthetic patients with severe stenosis (SDS) and high-grade facet osteoarthritis (FJO). From January 2009 to February 2010, 49 patients with severe SDS and high-grade FJO were treated using either MIS or open TLIF. Intraoperative and diagnostic data, including perioperative complications and length of hospital stay (LOS), were collected, using retrospective chart review. Surgical short- and long-term outcomes were assessed according to the Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain. Comparing MIS and open surgery, the MIS group had lesser blood loss, significantly lesser need for transfusion (p = 0.02), more rapid improvement of postoperative back pain in the first 6 weeks of follow-up and a shorter LOS. On the other hand, we experienced in the MIS group a longer operative time. The distribution on the postoperative ODI (p = 0.841), VAS leg (p = 0.943) and back pain (p = 0.735) scores after a mean follow-up of 2 years were similar. The overall proportion of complications showed no significant difference between the groups (29% in the MIS group vs. 28% in the open group, p = 0.999). Minimally invasive surgery for severe SDS leads to adequate and safe decompression of lumbar stenosis and results in a faster recovery of symptoms and disability in the early postoperative period.

Does Correction of Preoperative Coronal Imbalance Make a Difference in Outcomes of Adult Patients With Deformity?

Retrospective study with prospectively collected outcomes data. Determine the significance of coronal balance on spinal deformity surgery outcomes. Sagittal balance has been confirmed as an important radiographic parameter correlating with adult deformity treatment outcomes. The significance of coronal balance on functional outcomes is less clear. Eighty-five patients with more than 4 cm of coronal imbalance who underwent reconstructive spinal surgery were evaluated to determine the significance of coronal balance on functional outcomes as measured with the Oswestry Disability Index (ODI) and Scoliosis Research Society outcomes questionnaires. Sixty-two patients had combined coronal (>4 cm) and sagittal imbalance (>5 cm), while 23 patients had coronal imbalance alone. Postoperatively, 85% of patients demonstrated improved coronal balance. The mean improvement in the coronal C7 plumb line was 26 mm for a mean correction of 42%. The mean preoperative sagittal C7 plumb line in patients with combined coronal and sagittal imbalance was 118 mm (range, 50-310 mm) and improved to a mean 49 mm. The mean preoperative and postoperative ODI scores were 42 (range, 0-90) and 27 (range, 0-78), for a mean improvement of 15 (36%) (P = 0.00001; 95% CI, 12-20). The mean Scoliosis Research Society scores improved by 17 points (29%) (P = 0.00). Younger age (P = 0.008) and improvement in sagittal balance (P = 0.014) were positive predictors for improved ODI scores. Improvement in sagittal balance (P = 0.010) was a positive predictor for improved Scoliosis Research Society scores. In patients with combined coronal and sagittal imbalance, improvement in sagittal balance was the most significant predictor for improved ODI scores (P = 0.009). In patients with preoperative coronal imbalance alone, improvement in coronal balance trended toward, but was not a significant predictor for improved ODI (P = 0.092). Sagittal balance improvement is the strongest predictor of improved outcomes in patients with combined coronal and sagittal imbalance. In patients with coronal imbalance alone, improvement in coronal balance was not a factor for predicting improved functional outcomes.

Intervertebral Disc Rehydration after Lumbar Dynamic Stabilization: Magnetic Resonance Image Evaluation with a Mean Followup of Four Years

Objective. To compare the clinical and radiographic outcomes in patients of different ages who underwent the Dynesys stabilization. Methods. This retrospective study included 72 patients (mean age 61.4 years) with one- or two-level lumbar spinal stenosis who underwent laminectomy and the Dynesys (Zimmer Spine, Minneapolis) dynamic stabilization system. Thirty-seven patients were younger than 65-year old while the other 35 were older. Mean followup was 46.7 months. Pre- and postoperative radiographic and clinical evaluations were analyzed. Results. The mean calibrated disc signal (CDS) at the index level was significantly improved from 60.2 ± 25.2 preoperatively to 66.9 ± 26.0 postoperatively (P > 0.001). Screw loosening occurred in 22.2% of patients and 5.1% of screws. The improvement in CDS at index level was seen to be significant in younger patients but not in older patients. Overall, the mean visual analogue scale (VAS) of back pain, VAS of leg pain, and the Oswestry disability index (ODI) scores improved significantly after operation. There were no significant differences in pre- and postoperative VAS and ODI and screw loosening rates between the younger and older patients. Conclusions. There is significant clinical improvement after laminectomy and dynamic stabilization for symptomatic lumbar spinal stenosis. Intervertebral disc rehydration was seen in younger patients.

Clinical assessment of a CMC/PEO gel to inhibit postoperative epidural adhesion formation after lumbar discectomy: a randomized, control study

To evaluate effectiveness of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel in improving clinical outcomes after the first-time lumbar discectomy. Ninety-three patients with herniated lumbar disc at L4-L5 or L5-S1 were enrolled and randomized into two groups: CMC/PEO gel treatment group and control group. All the patients underwent laminotomy and discectomy by posterior approach. The preoperative and postoperative Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores for lower-back pain and leg pain were analyzed and compared between two groups at 30- and 60-day time points. No patient presented with any clinically measurable adverse event during surgery. There were no significant differences between the treated group and the control group on the preoperative ODI and VAS scores. In general, the ODI and VAS scores decreased in both groups at all the time points. At the 30-day time point, the VAS scores for back pain and leg pain and the ODI scores in treatment group were lower by 9.9% (P=0.0302), 27.0% (P=0.0002) and 16.3% (P=0.0007) than those in control group. And at the 60-day time point, the ODI and VAS scores further decreased in both groups. The VAS scores for leg pain in treatment group were lower by 4.5% than that in the control group (P=0.0149). However, no significant difference was detected between two groups on the ODI and VAS scores for back pain. The results demonstrated that CMC/PEO gel is effective in reducing posterior dural adhesions in the spine with no apparent safety issues. It can improve patients' postoperative clinical outcome.

ProDisc-L learning curve: 24-Month clinical and radiographic outcomes in 44 consecutive cases

BackgroundTotal disc replacement (TDR) promises preservation of spine biomechanics in the treatment of degenerative disc disease but requires more careful device placement than tradition fusion and potentially has a more challenging learning curve. MethodsA cohort of 44 consecutive patients had 1-level lumbar disc replacement surgery at a single institution by a single surgeon. Patients were followed up clinically and radiographically for 24 months. Patients were divided into 2 groups of 22 sequential cases each. Clinically, preoperative and postoperative Oswestry Disability Index, visual analog scale, Short Form 12 (SF-12) Mental and Physical Components, and postoperative satisfaction were measured. Radiographically, preoperative and postoperative range of motion (ROM) dimensions, prosthesis deviation from the midline, and disc height were measured. TDR-related complications were noted. Logarithmic curve–fit regression analysis was used to assess the learning curve. ResultsOperative time decreased as cases progressed, with an asymptote after 22 cases. The operative time for the later group was significantly lower (P < .0005), but hospital stay was significantly longer (P = .03). There was no significant difference in amount of blood loss (P = .10) or prosthesis midline deviation (P = .86). Clinically, there was no significant difference in postoperative scores between groups in Oswestry Disability Index (P = .63), visual analog scale (P = .45), SF-12 Mental Component (P = .66), SF-12 Physical Component (P = .75), or postoperative satisfaction (P = .92) at 24 months. Radiographically, there was no significant difference in improvement between groups in ROM (P = .67) or disc height (P = .87 for anterior and P = .13 for posterior) at 24 months. For both groups, there was significant improvement for all clinical outcomes and disc height over preoperative values. One patient in the later group had device failure with subluxation of the polyethylene, which required revision. Conclusions/level of evidenceEarly experience can quickly reduce operative time but does not affect clinical outcomes or ROM significantly (level IV case series). Clinical relevanceLumbar TDR is a rapidly learnable technique in treatment of degenerative disc disease.

Transpedicular closing wedge osteotomy in the treatment of thoracic and lumbar kyphotic deformity with different etiologies

Transpedicular closing wedge osteotomy (CWO) has become popular in correcting thoracic and lumbar kyphotic deformity (TLKD). Our study aims to evaluate the efficacy of CWO in treating TLKD of different etiologies. CWO was performed on 25 patients with thoracic and lumbar kyphosis, of whom 10 had ankylosing spondylitis, 10 had post-traumatic thoracolumbar fractures, and 5 had tuberculosis. Mean follow-up period was 24 months. Pre- and postoperative kyphotic Cobb angles and the horizontal distance between C7 and S1 in the lateral view were measured. Back pain and disability were assessed by visual analog score (VAS) and oswestry disability index (ODI). Postoperative complications were also recorded. Kyphotic deformity was successfully corrected, and 100% osteotomic site fusion was obtained in all cases. Average operative duration was 255.6 min and blood loss was 1,675.6 ml. Average correction angels were 37.6°. The horizontal distance between C7 and S1 was 88.28 mm before the operation and 20.84 mm after the operation. Pre- and postoperative mean VAS of back pain in all cases was 7.6 and 2.6 respectively. Pre- and postoperative mean ODI was 61.8 and 27.32 receptively. Six complications were registered in six patients. Pedicle subtraction osteotomy is an effective and safe surgical method to correct thoracic and lumbar kyphosis of different etiologies.

Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis in patients with significant obesity

Comparative studies evaluating efficacy and safety of minimally invasive spinal fusion between patients with significant obesity (body mass index [BMI]⩾35kg/m2) and those of normal weight are scarce. We examined complication rates and outcomes for minimally invasive transforaminal lumbar interbody fusion (MITLIF) in patients with significant obesity and those of normal weight undergoing treatment for symptomatic spondylolisthesis. Patients with a BMI⩾35kg/m2 or <25kg/m2 undergoing elective MITLIF for symptomatic spondylolisthesis for the period 2006–09 were identified. Of the 16 patients identified, nine patients with a mean BMI of 37.4kg/m2 were included in the obese group, while seven patients with a mean BMI of 23.4kg/m2 comprised the normal weight group. Estimated blood loss (EBL), operative time, complication rate, length of hospital stay, and clinical outcomes were assessed. Outcome measures included patient-reported visual analog scale (VAS) score for pain and the Oswestry Disability Index (ODI) questionnaire completed by the patient. No significant differences were found in blood loss (p=0.436), hospital stay (p=0.606), or number of surgical complications (p=0.920) between the two groups. Mean follow-up intervals were 15.0months for patients with obesity, and 18.6months for those of normal weight. Both groups had significant improvements in VAS (obese, p=0.003; normal, p=0.016) and ODI (obese, p=0.020; normal, p=0.034) scores. There were no statistically significant differences between normal weight and obese groups in postoperative VAS (p=0.728) and ODI (p=0.886) scores. Patients with significant obesity experienced clinical improvement similar to that of patients with normal weight, suggesting that obesity does not impact MITLIF outcomes. In addition, both groups experienced similar complication rates, operative times, EBL, and length of hospital stay.

Changes in Vitamin D Status After Surgery in Female Patients With Lumbar Spinal Stenosis and Its Clinical Significance

A prospective cohort study. To demonstrate the changes in vitamin D status after surgery in female patients with lumbar spinal stenosis (LSS), and its correlation with surgical outcomes. In patients with LSS, general health including walking ability and nutritional status can be markedly improved by decompressive surgery. It can be hypothesized that such improvement may have a positive effect on their vitamin D status. In total, 31 female patients who underwent decompression and instrumented posterolateral fusion for LSS were enrolled. Serum 25-hydroxyvitamin D (25-OHD) level was measured before the surgery and at 1 year postoperative visit. According to serum 25-OHD level, patients were classified into 3 groups: (1) deficient group, when 25-OHD level was less than 20 ng/mL (< 50 nmol/L); (2) insufficient group, when 25-OHD level was between 20 to 30 ng/mL (50 nmol/L ≤ 25-OHD < 75 nmol/L); (3) and normal group, when 25-OHD level was 30 ng/mL or more (≥ 75 nmol/L). The Oswestry Disability Index (ODI) score and health-related quality of life (EQ-5D) were compared according to the level of 25-OHD at 1 year postoperatively. Preoperatively, there were 20 patients in the deficient group, 11 patients in the insufficient group and no patient in the normal group. There were no differences in age, body mass index, preoperative ODI scores, preoperative EQ-5D index scores, and EQ-5D visual analogue scale scores between the 2 groups. Mean preoperative 25-OHD level was 15.8 ng/mL (range, 5.2-29.4 ng/mL) and increased to 19.5 ng/mL (range, 6.3-47.7 ng/mL) 1 year after surgery (P = 0.075). Significant increase of 25-OHD was noted only in the deficient group (P = 0.017). Postoperatively, there were 18 patients in the deficient group, 8 patients in the insufficient group, and 5 patients in the normal group. In the postoperative deficient group, postoperative ODI scores and EQ-5D index scores showed significantly worse outcomes than those in the other groups. The changes in serum 25-OHD level were significantly correlated with the changes in ODI scores (r = -0.580; P = 0.001) and with the changes in EQ-5D index scores (r = 0.379; P = 0.035). In all the groups, postoperative ODI scores (r = -0.665; P < 0.001) and EQ-5D index scores (r = 0.601; P < 0.001) were significantly correlated with postoperative 25-OHD level. Vitamin D deficiency was common in patients with LSS. However, vitamin D status was improved after decompressive surgery, and postoperative 25-OHD level was significantly correlated with surgical outcomes.