Presence Of Spondylolisthesis Research Articles

Left-digit bias in surgical decision-making for lumbar spinal stenosis

BACKGROUND CONTEXTLeft-digit bias is a behavioral heuristic or cognitive “shortcut” in which the leftmost digit of a number, such as patient age, disproportionately influences surgical decisions. PURPOSETo determine if left-digit bias in patient age influences the decision to perform arthrodesis with instrumentation vs decompression in lumbar spinal stenosis (LSS). DESIGNRetrospective cohort. PATIENT SAMPLEPatients with an ICD-10 diagnosis of lumbar stenosis or spondylolisthesis identified in the 2017-2021 National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURESThe primary outcome was the percent of patients who underwent arthrodesis with instrumentation (AwI). Matched age group comparisons without left-digit differences (ie, 76/77 vs 78/79, 80/81 vs 82/83, etc.) were performed to isolate the effect of the heuristic. Secondary outcomes including peri-operative events and complications were also compared within AwI and decompression cohorts. METHODSUsing CPT codes, procedures were classified as either AwI or decompression. Patients were grouped into 6 cohorts based on 2-year age windows (74/75, 76/77, 78/79, 80/81, 82/83, 84/85). The cohorts were propensity matched with neighboring age groups based on the presence of spondylolisthesis, demographics, and comorbidities. The primary comparison was between those aged 78/79 vs 80/81. RESULTSAfter matching, the primary cohort consisted of two groups of 1,550 patients (aged 78/79 and 80/81). Patients aged 80/81 were less likely to undergo AwI than patients aged 78/79 (23.5% vs 27.2%, p=.021). AwI procedures occurred at similar rates between age groups with the same left digit. Within the decompression and AwI cohorts, there were no differences in secondary outcomes between patients aged 78/79 and 80/81. CONCLUSIONSLSS patients aged 80/81 are less likely to undergo AwI than patients aged 78/79, regardless of comorbidities. This was not seen when comparing patients with similar left digits in age. Until objective measures of physiologic capacity are established, left-digit bias may influence clinical decisions.

Prevalence and Characteristics of Lumbar Spondylolysis in White and Black Patients.

Retrospective case series. To the best of our knowledge, the prevalence of lumbar spondylolysis in white and black populations has never been studied using computed tomography (CT). The purpose of this study was to examine and compare the prevalence and characteristics of lumbar spondylolysis in white and black patients. This study is a cross sectional study. Patients aged 20-79 who underwent abdominal and pelvic CT for trauma screening in the New York City area and whose race was classified as "white" and "black" on the questionnaire were recruited to the study. A total of 1200 white patients (600 women, 600 men) and 1200 black patients (600 women, 600 men) were included for the analysis. The presence of lumbar spondylolysis, level, unilateral/bilateral, and the presence of spondylolisthesis at lumbar spondylolysis level were evaluated using CT. The prevalence of lumbar spondylolysis was 3.0% (n = 36) for white patients and .8% (n = 10) for black patients, with 3.3% (n = 20) and 1.0% (n = 6) for white and black females, respectively; and 2.7% (n = 16) and .7% (n = 4) for white and black males, respectively. The prevalence of lumbar spondylolysis was significantly higher in white patients compared with that in black patients (P < .0001). Lumbar spondylolysis was at L5 in 44/46 patients (95.7%) and bilateral in 41/46 patients (89.1%). Spondylolisthesis at lumbar spondylolysis level was found in 40/46 patients (87.0%). The prevalence of lumbar spondylolysis was 3.0% for white patients and .8% for black patients. The prevalence of lumbar spondylolysis was significantly higher in white patients compared with that in black patients.

The Relationship between Spondylolisthesis and Modic Changes: An MRI Study

Aim: We aimed to investigate the relationship between the presence of spondylolisthesis and Modic changes (MCs) by using lumbar magnetic resonance imaging (MRI).&#x0D; Methods: The study included 139 adult patients aged 18-65 years with lumbar spondylolisthesis detected on lumbar MRI. Demographic characteristics such as age, gender, and levels and grades of spondylolisthesis, and presence of lumbar MCs/types were recorded. The findings were compared between two groups including grade 1 and grade 2 spondylolisthesis.&#x0D; Results: Grade 1 and 2 spondylolisthesis groups were similar for age (p=0.787), sex (p=0.076), listhesis' level (p=0.268) and direction (p=0.280). The presences of pars spondylolysis, disc space narrowing, and MCs were significantly higher in patients with grade 2 spondylolisthesis than those with grade 1 (94.4% vs 64.1%), (97.2% vs 83.5%), and (100% vs 83.5%), respectively (all p

Risk factors for ninety-day readmissions following full-endoscopic transforaminal lumbar discectomy for 1542 patients in the biggest spine institutes in Korea.

Endoscopic techniques are becoming popular among spine surgeons because of their advantages. Though the advantages of endoscopic spine surgery are evident and patients can be discharged home within hours of surgery, readmissions can be sought for incomplete relief of leg pain, recurrent disc herniation, and recurrent leg pain. We aim to find out the factors related to the readmission of patients treated for lumbar pathologies. This is a retrospective analysis of the data between the time duration of 2012 and 2022. Patients in the age group of 18-85years, with lumbar disc herniation treated by transforaminal endoscopic lumbar procedures, were included. The patients who were readmitted within 90days were included in the R Group and those who were not were included in the NR group. Univariable and multivariable logistic regression analyses were used to find the risk factors for 90-day readmission. There were a total of 1542 patients enrolled in this study. Sex, number of episodes before admission, hypertension, smoking, BMI, migration, disc height, disc height index, spondylolisthesis, instability, pelvic tilt (PT), and disc cross-sectional area (CSA) were found significant on univariable analysis. Age, spondylolisthesis, instability and muscle CSA were the only variables that were found to be statistically significant on multivariable analysis. This study shows that the elderly age group, presence of spondylolisthesis, segmental instability and decreased muscle cross-sectional area are independent risk factors for 90-day hospital readmissions. Patients having the above risk factors should be carefully counseled regarding the possibility of readmission in the future.

Clinical outcomes, MRI evaluation and predictive factors of indirect decompression with lateral transpsoas approach for lumbar interbody fusion: a multicenter experience.

Evaluating the effects of indirect decompression obtained through lateral lumbar interbody fusion (LLIF) by clinical improvements and radiological parameters on MRI scans. Identifying predictors of better decompression and clinical outcome. From 2016 to 2019, patients who underwent single- or double-level indirect decompression LLIF were consecutively reviewed. Radiological signs of indirect decompression were evaluated in preoperative and follow-up MRI studies and were subsequently correlated to clinical data, expressed as axial/radicular pain (VAS back/leg), index of disability (Oswestry Disability Index) and clinical severity of lumbar stenosis (Swiss Spinal Stenosis Questionnaire). 72 patients were enrolled. The mean follow-up was 24 months. Differences in vertebral canal area (p < 0.001), height of the foramina (p < 0.001), thickness of the yellow ligament (p = 0.001) and anterior height of the interbody space (p = 0.02) were observed. Older age (p = 0.042), presence of spondylolisthesis (p = 0.042), presence of intra-articular facet effusion (p = 0.003) and posterior height of the implanted cage (p = 0.020) positively affected the increase of the canal area. Change in root canal area (p < 0.001), height of the implanted cage (p = 0.020) and younger age (p = 0.035) were predictive factors of root pain relief, while increased vertebral canal area (p = 0.020) and height of the interbody fusion cage (p = 0.023) positively affected the severity of clinical stenosis. LLIF indirect decompression showed both clinical and radiological improvements. Presence and degree of spondylolisthesis, presence of intra-articular facet effusion, age of the patient and height of the cage were predictive factors of major clinical improvements.

Prevalence and Risk Factors of Degenerative Spondylolisthesis and Retrolisthesis in the Thoracolumbar and Lumbar Spine - An EOS Study Using Updated Radiographic Parameters.

Single centre, cross-sectional study. The objective is to report the prevalence of spondylolisthesis and retrolisthesis, analyse both conditions in terms of the affected levels and severity, as well as identify their risk factors. A review of clinical data and radiographic images of consecutive spine patients seen in outpatient clinics over a 1-month period is performed. Images are obtained using the EOS® technology under standardised protocol, and radiographic measurements were performed by 2 independent, blinded spine surgeons. The prevalence of both conditions were shown and categorised based on the spinal level involvement and severity. Associated risk factors were identified. A total of 256 subjects (46.1% males) with 2304 discs from T9/10 to L5/S1 were studied. Their mean age was 52.2(± 18.7) years. The overall prevalence of spondylolisthesis and retrolisthesis was 25.9% and 17.1% respectively. Spondylolisthesis occurs frequently at L4/5(16.3%), and retrolisthesis at L3/4(6.8%). Majority of the patients with spondylolisthesis had a Grade I slip (84.3%), while those with retrolisthesis had a Grade I slip. The presence of spondylolisthesis was found associated with increased age (P < .001), female gender (OR: 2.310; P = .005), predominantly sitting occupations (OR:2.421; P = .008), higher American Society of Anaesthesiology grades (P = .001), and lower limb radiculopathy (OR: 2.175; P = .007). Patients with spondylolisthesis had larger Pelvic Incidence (P < .001), Pelvic Tilt (P < .001) and Knee alignment angle (P = .011), but smaller Thoracolumbar junctional angle (P = .008), Spinocoxa angle (P = .007). Retrolisthesis was associated with a larger Thoracolumbar junctional angle (P =.039). This is the first study that details the prevalence of spondylolisthesis and retrolisthesis simultaneously, using the EOS technology and updated sagittal radiographic parameters. It allows better understanding of both conditions, their mutual relationship, and associated clinical and radiographic risk factors.

Predictive factors for successful non-operative treatment and achieving MCID improvement in health-related quality of life in adult spinal deformity

BackgroundAdult spinal deformity is a spectrum of degenerative spinal diseases with increasing prevalence and healthcare burden worldwide. Identification of patients who are more likely to improve through conservative management may reduce cost and potentially prevent surgery and its associated costs and complications. This study aims to identify predictive factors for MCID in improvement of ODI and SRS-22r questionnaires in patients with adult spinal deformity treated with conservative treatment.MethodsA prospective, observational cohort study of 46 patients was conducted at a spine specialist clinic. Inclusion criteria were 30–80 years of age, diagnosis of neglected adolescent idiopathic scoliosis, de-novo scoliosis, degenerative spondylolisthesis, and sagittal plane deformities (thoracic hypokyphosis, lumbar hypolordosis), presenting with mechanical back pain with or without radicular leg pain. All patients received conservative management including medication and physiotherapy. Radiological and clinical parameters were measured at baseline and at 1-year follow-up. Primary outcomes were ODI and SRS-22r scores. Secondary outcomes were EQ-5D-5L scores and requiring spine surgery during conservative treatment. Predictors for MCID improvement in ODI and SRS-22r were identified using multivariate regressions and receiver operating characteristic (ROC) analyses.ResultsAt baseline, patients who reached MCID in ODI and/or SRS-22r showed less comorbidities (diabetes mellitus, hypertension, ischemic heart disease, osteoarthritis, cancer), smaller range of lateral spinal flexion, larger trunk shift, larger pelvic incidence, a higher EQ-5D-5L anxiety/depression dimension score, a lower SRS-22r total score, and presence of spondylolisthesis. Lateral flexion range < 25 degrees, trunk shift > 14 mm, pelvic incidence > 50 degrees, EQ-5D-5L anxiety/depression dimension score > 1, and SRS-22r total score < 3.5 were the cut-off values generated by ROC analysis.ConclusionsBoth radiological and clinical predictive factors for MCID improvement in health-related quality of life were identified. Future research should identify subgroups of patients who are responsive to specific conservative treatment modalities, so as to provide information for personalized medicine.Level of evidenceII

Case Series of Tubular Retractor Assisted Minimally Invasive Extraforaminal L5/S1 Microdiskectomy

We present the largest series of tubular assisted minimally invasive extraforaminal L5/S1 microdiskectomy and describe the operative nuances. An extraforaminal L5/S1 disk herniation poses a surgical challenge as a result of limited access from a high iliac crest, the sacral ala, and the large transverse process of L5 necessitating oblique working angles. This is a case series of 28 consecutive patients who underwent tubular retractor-assisted minimally invasive extraforaminal L5/S1 microdiskectomy between 2017 and 2020 for L5 radiculopathy. Preoperative variables include demographics (age, gender); imaging characteristics (presence of spondylolisthesis, grade and presence of dynamic instability); and patient-reported measures of pain and function. Postoperatively, any complications, pain, and function were documented at 1-day, 3-month, and 12-months follow-up. Statistical analysis involved descriptive analysis of measured variables. Patients (13 females and 15 males) had a median age of 62 years (range: 32-92). One patient demonstrated grade I spondylolisthesis with no dynamic instability. Twenty-six patients (93%) achieved complete pain resolution during the follow-up period. Two patients had persistent or recurrent radicular pain, 1 of whom resolved completely with a redo tubular retractor-assisted minimally invasive microdiskectomy. No other complications were noted during the postoperative follow-up. Tubular retractor-assisted minimally invasive extraforaminal L5/S1 microdiskectomy is an effective approach. Good surgical outcomes are achieved while avoiding the complications associated with more invasive options such as open surgery or fusion.

Functional outcomes are preserved in adult acetabular dysplasia with radiographic evidence of lumbosacral spine anomalies: an investigation in hip-spine syndrome

PurposeAcetabular dysplasia (AD) is a debilitating condition which results in impaired hip function, leading to hip-spine syndrome with anomalies identifiable on plain radiographs. However, no study to date has investigated the association between radiographic spine anomalies and functional outcomes in AD. We hypothesize that AD patients with radiographic evidence of lumbar spine anomalies are associated with decreased function in comparison to those without such radiographic findings.Patients and methodsOne hundred thirty-five hips underwent a full four-view hip radiograph series, and two observers analyzed hip and spine variables using standard radiographs and obtained Castellvi grade, assessment of spondylolisthesis, and L4-S1 interpedicular distance. A comprehensive hip questionnaire was administered which included Harris Hip Score (HHS) and Hip Disability and Osteoarthritis Outcome Score (HOOS) to assess patient function. Correlations between HHS and HOOS and radiographic spinal measurements were calculated, and p-values were corrected for multiple comparison using the Holm’s method.ResultsOut of 135 patients, 119 were female (88.1%) and 16 were male (11.9%). Average age of presentation was 34.2 years, and average BMI was 26. There was no statistically significant correlation between Castellvi grade, presence of spondylolisthesis, or L4-S1 interpedicular distance and the patient-reported outcome measures HHS or HOOS. Conversely, a significant correlation was observed between Femoro-Epiphyseal Acetabular Roof (FEAR) index and HOOS of the contralateral hip (correlation coefficient = 0.38, adjusted p = 0.03) and Tönnis angle of AD severity and HHS of the contralateral hip (correlation coefficient = − 0.33, adjusted p = 0.04).ConclusionSeverity of spinal anomalies measured by Castellvi grade and spondylolisthesis in patients with AD was not associated with decreased patient function in the ipsilateral diseased hip. To our knowledge, this is the first study to date to report the relationship between radiographically identifiable lumbosacral abnormalities and hip function in AD.

Radiographic analysis of neuroforaminal and central canal decompression following lateral lumbar interbody fusion

BackgroundLateral lumbar interbody fusion (LLIF) is a minimally invasive surgical option for treating symptomatic degenerative lumbar spinal stenosis (DLSS) in select patients. However, the efficacy of LLIF for indirectly decompressing the lumbar spine in DLSS, as well as the best radiographic metrics for evaluating such changes, are incompletely understood. MethodsA single-institutional cohort of patients who underwent LLIF for DLSS between 5/2015 – 12/2019 was retrospectively reviewed. Diameter, area, and stenosis grades were measured for the central canal (CC) and neural foramina (NF) at each LLIF level based on preoperative and postoperative T2-weighted MRI. Baseline facet joint (FJ) space, degree of FJ osteoarthritis, presence of spondylolisthesis, interbody graft position, and posterior disc height were analyzed as potential predictors of radiographic outcomes. Changes to all metrics after LLIF were analyzed and compared across lumbar levels. Preoperative and intraoperative predictors of decompression were then assessed using multivariate linear regression. ResultsA total of 102 patients comprising 153 fused levels were analyzed. Pairwise linear regression of stenosis grade to diameter and area revealed significant correlations for both the CC and NF. All metrics except CC area were significantly improved after LLIF (p < 0.05, 2-tailed t-test). Worse FJ osteoarthritis ipsilateral to the surgical approach was predictive of greater post-operative CC and NF stenosis grade (p < 0.05, univariate and multivariate ordinary least squares linear regression). Lumbar levels L3-5 had significantly higher absolute postoperative CC stenosis grades while relative change in CC stenosis at the L2-3 was significantly greater than other lumbar levels (p < 0.05, one-way ANOVA). There were no baseline or postoperative differences in NF stenosis grade across lumbar levels. ConclusionsRadiographically, LLIF is effective at indirect compression of the CC and NF at all lumbar levels, though worse FJ osteoarthritis predicted higher degrees of post-operative stenosis.

Pre-operative prognostic factors for walking capacity after surgery for lumbar spinal stenosis: a systematic review

Lumbar spinal stenosis (LSS) reduces walking and quality of life. It is the main indication for spinal surgery in older people yet 40% report walking disability post-operatively. Identifying the prognostic factors of post-operative walking capacity could aid clinical decision-making, guide rehabilitation and optimise health outcomes. To synthesise the evidence for pre-operative mutable and immutable prognostic factors for post-operative walking in adults with LSS. Systematic review with narrative synthesis. Electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, OpenGrey) were searched for observational studies, evaluating factors associated with walking after surgery in adults receiving surgery for LSS from database inception to January 2020. Two reviewers independently evaluated studies for eligibility, extracted data and assessed risk of bias (Quality in Prognosis Studies). The Grading of Recommendations Assessment, Development and Evaluation method was used to determine level of evidence for each factor. 5526 studies were screened for eligibility. Thirty-four studies (20 cohorts, 9,973 participants, 26 high, 2 moderate, 6 low risk of bias) were included. Forty variables (12 mutable) were identified. There was moderate quality of evidence that pre-operative walking capacity was positively associated with post-operative walking capacity. The presence of spondylolisthesis and the severity of stenosis were not associated with post-operative walking capacity. All other factors investigated had low/very low level of evidence. Greater pre-operative walking is associated with greater post-operative walking capacity but not spondylolisthesis or severity of stenosis. Few studies have investigated mutable prognostic factors that could be potentially targeted to optimise surgical outcomes.

Transpedicular Screw Fixation for Microinstability in Recurrent Lumbar Disc

Background: Microinstability represents the first phase of the degenerative cascade and has specific pathoanatomical and clinical characteristics (low back pain) in the interested vertebral segment, without the presence of spondylolisthesis it is more prominent in recurrent lumbar disc. Objective: The objective of this study is to evaluate the surgical outcome of trans-pedicular screw fixation for microinstability in recurrent lumbar disc herniation with ipsilateral or bilateral transpedicular screw fixation, with highlights on lumbosacral instability classification. Patients and Methods: Two hundred patients with recurrent lumbar disc herniation were managed surgically by discectomy, curettage and unilateral transpedicular screw fixation at the offending side (100 patients among 200 patients of recurrent lumbar disc), or discectomy with endplate curettage and bilateral transpedicular screw fixation (100 patients among 200 patients of recurrent lumbar disc). Results: No significant difference was reported between both groups regarding patient age, gender, level of the disc. Surgery was on left side in 120 patients. The clinical outcome at the last follow up visit revealed that, recurrence and dural tears were confined to group A (unilateral) (each was reported in 1 patient), while root injury and spinal instability were confined to group B (Bilateral) (one patient for each. The recovery rate was 0.888 for group A and 0.807 for group B, with statistically significant difference. Conclusion: unilateral transpedicular screw fixation for recurrent lumbar disc provides slightly better outcome than bilateral approach, especially for recovery rate.

Weight-Bearing MRI of the Lumbosacral Spine: Difference between Supine and Weight Bearing Positions and Additional Value in Patients with Low Back Pain

Objective: To study the difference of magnetic resonance imaging (MRI) parameters of the lumbosacral spine between weight-bearing and supine positions, and evaluate whether there is additional value in patients with low back pain. Materials and Methods: Eight-six patients with low back pain with or without leg pain who underwent MRI of the lumbosacral spine in weight-bearing and supine positions were included in the present retrospective study. The patients’ characteristics and MRI parameters were measured. The data were analyzed to find significant differences between these two positions. Results: MRI parameters which significantly increased in weight-bearing position compared to supine position (p&lt;0.05) included lumbar lordotic angle, lumbosacral angle, presence of spondylolisthesis (at L4/L5 level), and presence of nerve root compression (at L3/L4, L4/L5, and L5/S1 levels). Parameters or findings that significantly decreased were spinal canal diameter (at L2/L3, L4/L5, and L5/S1 levels), and intervertebral disk height (at L2/L3, L4/L5, and L5/S1 levels). Older age group (mean age of 54.3 years versus 45.6 years as younger group) showed a significant change in number of nerve root compression. Forty-three percent of patients with radiating symptom showed a changed number of nerve root compression but this was not statistically significant. Conclusion: Multiple MRI parameters of the lumbosacral spine show significant change in weight-bearing compared to supine position. Increased presence of spondylolisthesis and nerve root compression might be beneficial in patients with radiating symptom unexplained by conventional MR studies in supine position. Older age group showed a significant change in number of nerve root compression. Keywords: Weight-bearing, MRI, Lumbar spine, Back pain

223. Development and validation of a novel scoring tool for predicting facility discharge after elective posterior lumbar fusion

223. Development and validation of a novel scoring tool for predicting facility discharge after elective posterior lumbar fusion

The impact of multijoint symptoms on patient-reported disability following surgery for lumbar spine osteoarthritis

Background ContextIn the lumbar spine osteoarthritis (LS-OA) population having surgery for lumbar spinal stenosis (LSS) symptoms, a significant proportion of patients experience limited benefit following the intervention. Thus, identifying contributing factors to this is important. Individuals with OA often have multiple joint symptoms, yet this has received limited attention in this population. PurposeDocument the occurrence of joint symptoms among patients undergoing surgery for LS-OA, and investigate the influence of these symptoms on disability postsurgery. DesignProspective study of consecutive patients followed to 12-month postsurgery. Patient SamplePatients undergoing surgery (decompression surgery, with or without fusion) for neurogenic claudication with or without back pain due to LSS with a primary pathology diagnosis of LS-OA. Outcomes MeasuresPatient self-reported: Oswestry Disability Index (ODI), completed pre- and 12-month postsurgery; and, completed presurgery, age, sex, education, smoking, comorbid conditions, opioid use, short/long-term disability, depression and anxiety symptoms, back and leg pain intensity, presence of spondylolisthesis, procedure, prior spine surgery, and joints with arthritis and “pain/stiffness/swelling most days of the month” indicated on a homunculus (a joint site count was derived). Assessments: Height and weight, used to calculate body mass index; timed-up-and-go performance-based test. MethodsOutcome of interest was achieving a clinically important improvement (CII) in ODI by 12-month postsurgery (yes/no). The association between joint site count and achieving a CII was examined by multivariable logistic regression analyses, adjusted for other measures. ResultsIn all, 165 patients were included. The mean age was 67 years (range: 44–90) and 47% were female. Seventy-seven percent reported 1+ joint site other than the back, 62% reported 2+, and 25% reported 4+. Among those achieving a CII, 21% had 4+ joint sites, compared with 31% among those not achieving a CII. Adjusted analyses: Increasing joint site count was associated with increasing risk (odds ratio [OR]: 1.32, 95% confidence interval [CI]: 1.05, 1.66) of not achieving a CII; for those with 4+ joints, adjusted probability of not achieving a CII exceeded 50%. Also associated with an increased risk of not achieving a CII was presurgery anxiety (OR: 2.97, 95% CI: 1.02, 8.65), opioid use (OR: 2.89, 95% CI: 1.07, 7.82), and worse back pain intensity score (OR: 1.27, 95% CI: 1.05, 1.53). ConclusionsMultijoint involvement was highly prevalent in this LS-OA surgical sample. Its association with poorer postsurgery outcome supports a comprehensive approach to OA management and care. Knowledge of multijoint symptoms should inform patient education, shared decision-making, and recommendations for postsurgical rehabilitation and self-management strategies.

Visualization of the Cervicothoracic Junction With EOS Imaging Is Superior to Conventional Lateral Cervical Radiographs.

Study Design:Single-center retrospective review.Objectives:The cervicothoracic junction (CTJ) is typically difficult to visualize using traditional radiographs. Whole-body stereoradiography (EOS) allows for imaging of the entire axial skeleton in a weightbearing position without parallax error and with lower radiation doses. In this study we sought to compare the visibility of the vertebra of the CTJ on lateral EOS images to that of conventional cervical lateral radiographs.Methods:Two fellowship-trained spine surgeons evaluated the images of 50 patients who had both lateral cervical radiographs and EOS images acquired within a 12-month period. The number of visible cortices of the vertebral bodies of C6-T2 were scored 0-4. Patient body mass index and the presence of spondylolisthesis >2 mm at each level was recorded. The incidence of insufficient visibility to detect spondylolisthesis at each level was also calculated for both modalities.Results:On average, there were more visible cortices with EOS versus XR at T1 and T2, whereas visible cortices were equal at C6 and C7. Patient body mass index was inversely correlated with cortical visibility on XR at T2 and on EOS at T1 and T2. There was a significant difference in the incidence of insufficient visibility to detect spondylolisthesis on EOS versus XR at C7-T1 and T1-2, but not at C6-7.Conclusions:EOS imaging is superior at imaging the vertebra of the CTJ. EOS imaging deserves further consideration as a diagnostic tool in the evaluation of patients with cervical deformity given its ability to produce high-quality images of the CTJ with less radiation exposure.

Risk factors for persistent numbness following decompression surgery for lumbar spinal stenosis

ObjectiveDecompression surgery is a mainstay of surgical treatment for lumbar spinal stenosis (LSS). However, up to 30% of patients have low satisfaction due to residual symptoms. In the clinical setting, improvements in leg pain are more significant than those in leg numbness. Residual numbness could be related to the relatively low satisfaction rate. However, few studies have focused on numbness; thus, elucidating the risk factors and rate of residual numbness would benefit surgeons and patients. This study aimed to clarify the risk factors for and rate of residual numbness after decompression surgery. Patients and MethodsWe retrospectively reviewed prospectively collected data from consecutive patients who underwent lumbar decompression without fusion for LSS at a single institution between January 2014 and March 2016. Patients were included if preoperative and final follow-up questionnaires and radiographs were available. A minimum one-year follow-up was required. We evaluated the Numeric Rating Scale (NRS) scores of low back pain, leg pain, and leg numbness preoperatively and at the final follow-up visit. Residual numbness was defined as a postoperative NRS ≥ 1, whereas persistent numbness was defined as a postoperative NRS ≥ 5. We compared the clinical data of patients with or without residual numbness to those of patients with or without persistent numbness. Multivariate logistic regression analysis was performed to identify risk factors for residual and persistent numbness. ResultsA total of 116 patients (73 men, 43 women) were included. Of them, 60% had residual numbness with a mean follow-up period of 25 months. Only durotomy differed significantly between patients with and those without residual numbness. However, the significance did not persist after logistic regression analysis. A total of 16% had persistent numbness. Diabetes mellitus, intraoperative durotomy, and preoperative NRS of numbness were identified as risk factors. There were no differences in smoking status, presence of spondylolisthesis or scoliosis, or severity of stenosis. ConclusionsWe found three risk factors for persistent numbness following decompression surgery for LSS; diabetes mellitus and durotomy were modifiable, whereas preoperative numbness was not. Our findings would help surgeons minimize the incidence of persistent numbness by adequately controlling diabetes and avoiding durotomy during surgery. Providing information about the potential for residual numbness during the informed consent process is important to ensuring realistic patient expectations.

Interlaminar decompression for patients with degenerative lumbar stenosis. Literature review and results of a prospective study

The study objective is to assess the effectiveness of interlaminar decompression in patients with degenerative lumbar stenosis.Materials and methods. A prospective study was conducted among 100 patients with degenerative lumbar stenosis. All patients were operated, interlaminar decompression of the symptomatic side was made. Outcomes were assessed by using a visual analogue scale and Oswestry questionnaire 1 and 2 years after surgery. Among patients with an unsatisfactory result, the cause of the unsatisfactory outcome was studied.Results. One year after surgery a satisfactory result was noted in 71 patients, and 2 years after surgery a satisfactory result was noted in 67 patients. The following causes of unsatisfactory outcome were found in 33 patients: 9 – spinal canal restenosis, 2 – herniated disc at the operation level, 4 – the facet syndrome, 4 – development of clinical instability, 3 – pain in the opposite leg (there was no pain before the operation), 2 – development of delayed radiculopathy, 9 – decompensation of concomitant diseases (4 – coxarthrosis, 3 – gonarthrosis, 2 – chronic ischemia of the lower extremities). Among the risk factors for restenosis, statistically significant relationship was found only with the presence of spondylolisthesis.Conclusion. Interlaminar decompression is an effective surgical option in patients with degenerative lumbar stenosis. The presence of spondylolisthesis is a risk factor for the inefficiency of this operation.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study

Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis

BackgroundRecent demographic changes have led to a large population of older adults, many of whom experience degenerative disc diseases. Degenerative lumbar spinal stenosis (DLSS) is associated with considerable discomfort and limitations in activities of daily living (ADL). Symptomatic DLSS is one of the most frequent indications for spinal surgery. The aim of this study was to identify sociodemographic variables, morphological markers, depression as well as fear of movement that predict ADL performance and participation in social life in patients with DLSS.MethodsSixty-seven patients with DLSS (mean age 62.5 years [11.7], 50.7% females) participated in the study. Predictor variables were age, gender, duration of disease, three morphological markers (severity of the lumbar stenosis, the number of affected segments and presence of spondylolisthesis) as well as self-reported depression and fear of movement. Dependent variables were pain interference with the performance of ADLs, ADLs and participation in social life. Correlations between predictor and dependent variables were calculated before stepwise, linear regression analyses. Only significant correlations were included in the linear regression analyses.ResultsVariance explained by the predictor variables ranged between 12% (R2 = .12; pain interference-physical) and 40% (R2 = .40; ADL requiring lower extremity functioning; participation). Depression and fear of movement were the most powerful predictors for all dependent variables. Among the morphological markers only stenosis severity contributed to the prediction of ADLs requiring lower extremity functioning.ConclusionDepression and fear of movement were more important predictors of the execution of ADLs and participation in social life compared to morphological markers. Elevated depressive symptoms and fear of movement might indicate limited adaptation and coping regarding the disease and its consequences. Early monitoring of these predictors should therefore be conducted in every spine centre. Future studies should investigate whether psychological screening or a preoperative psychological consultation helps to avoid operations and enables better patient outcomes.

Risk Factors Associated With Femoral Ring Allograft Breakage in ALIF.

Study design:This is a retrospective chart review.Objectives:To identify the incidence of, and variables correlated with, femoral ring allograft (FRA) fracture following anterior lumbar interbody fusion (ALIF).Methods:All patients who underwent ALIF using FRAs at an academic institution over 10 years were included. Postoperative radiographs were reviewed by both the primary and senior authors; fracture and no-fracture groups were created for comparison. Patient and surgical characteristics were extracted from electronic medical records. Frequency data comparisons were performed using contingency table analysis; comparisons of means were analyzed for continuous variables. A multivariate linear regression model was developed using screw use, graft height <12 mm, index level, and weight as variables.Results:A total of 76 FRAs in 59 patients were identified, 13 (17%) of which fractured. Age, sex, smoking status, use of buttress screws, weight, index level, and presence of spondylolisthesis were not correlated with incidence of fracture (P > .05). There was a significant correlation between the height of FRA and incidence of fracture; 2% (1/52) of grafts ≥12 mm and 50% (12/24) of grafts <12 mm fractured (P < .0001). Using ordinary least-squares regression, this result was independent of patient weight, use of screws, and index level. Of 10 patients, 9 did not require revision surgery to achieve fusion.Conclusions:Graft height was the only variable correlated with incidence of FRA fracture. Graft height <12 mm is an independent risk factor for FRA fracture in patients undergoing ALIF, and their use should be avoided in ALIF procedures.