Treatment Of Lumbar Degenerative Disease Research Articles

Long-term efficacy of Waveflex semi-rigid-dynamic-internal-fixation system in delaying intervertebral disc degeneration at adjacent segments and improving spinal sagittal imbalance

The Waveflex semi-rigid-dynamic-internal-fixation system shows good short-term effects in the treatment of lumbar degenerative diseases, but there are few long-term follow-up studies, especially for recovery of sagittal balance. Fifty patients with lumbar degenerative diseases treated from January 2016 to October 2017 were retrospectively analysed: 25 patients treated with Waveflex semi-rigid-dynamic-internal-fixation system (Waveflex group) and 25 patients treated with double-segment PLIF (PLIF group). Clinical efficacy was evaluated by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Imaging data before surgery and at 3 months, 1 year, and 5 years postoperatively was used for imaging indicator assessment. Local disc degeneration of the cephalic adjacent segment (including disc height index (DHI), intervertebral foramen height (IFH), and range of motion (ROM)) and overall spinal motor function (including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and |PI-LL|) were analysed. Regarding clinical efficacy, comparison of VAS and ODI scores between the Waveflex and PLIF groups showed no significant preoperative or postoperative differences. The comparison of the objective imaging indicators showed no significant differences in the DHI, IFH, LL, |PI-LL|, and SS values between the Waveflex and PLIF groups preoperatively and 3 months postoperatively (P > 0.05). These values were significantly different at 1 and 5 years postoperatively (P < 0.05), and the Waveflex group showed better ROM values than those of the PLIF group (P < 0.05). PI values were not significantly different between the groups, but PT showed a significant improvement in the Waveflex group 5 years postoperatively (P < 0.05). The Waveflex semi-rigid dynamic fixation system can effectively reduce the probability of intervertebral disc degeneration in upper adjacent segments. Simultaneously, patients in the Waveflex group showed postoperative improvements in LL, spinal sagittal imbalance, and quality of life.

Efficacy of PE-PLIF with a novel ULBD approach for lumbar degeneration diseases: a large-channel endoscopic retrospective study

PurposeThis study aims to assess the effectiveness of Percutaneous Endoscopic Posterior Lumbar Interbody Fusion (PE-PLIF) combined with a novel Unilateral Laminotomy for Bilateral Decompression (ULBD) approach using a large-channel endoscope in treating Lumbar Degenerative Diseases (LDD).MethodsThis retrospective analysis evaluates 41 LDD patients treated with PE-PLIF and ULBD from January 2021 to June 2023. A novel ULBD approach, called ‘Non-touch Over-Top’ technique, was utilized in this study. We compared preoperative and postoperative metrics such as demographic data, Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, surgical details, and radiographic changes.ResultsThe average follow-up duration was 14.41 ± 2.86 months. Notable improvements were observed postoperatively in VAS scores for back and leg pain (from 5.56 ± 0.20 and 6.95 ± 0.24 to 0.20 ± 0.06 and 0.12 ± 0.05), ODI (from 58.68 ± 0.80% to 8.10 ± 0.49%), and JOA scores (from 9.37 ± 0.37 to 25.07 ± 0.38). Radiographic measurements showed significant improvements in lumbar and segmental lordosis angles, disc height, and spinal canal area. A high fusion rate (97.56% at 6 months, 100% at 12 months) and a low cage subsidence rate (2.44%) were noted.ConclusionsPE-PLIF combined with the novel ULBD technique via a large-channel endoscope offers significant short-term benefits for LDD management. The procedure effectively expands spinal canal volume, decompresses nerve structures, improves lumbar alignment, and stabilizes the spine. Notably, it improves patients' quality of life and minimizes complications, highlighting its potential as a promising LDD treatment option.

Comparing the Efficacy and Safety of Unilateral Biportal Endoscopic Decompression with Percutaneous Endoscopic Lumbar Decompression for Lumbar Degenerative Diseases: A Meta-Analysis

Unilateral biportal endoscopic decompression (UBED) offers the advantages of minimal tissue damage, operational flexibility, and clear visualization, positioning it as an innovative, minimally invasive endoscopic technique. Nevertheless, the clinical evidence supporting the use of UBED in the treatment of degenerative lumbar diseases (DLD) is limited and conflicting. As of October 1, 2023, a comprehensive search was conducted across databases including Web of Science, PubMed, Embase, and the Cochrane Library to identify all published studies on minimally invasive UBED for the treatment of DLD. Data pertaining to patient demographics, fluoroscopy time, operative duration, intraoperative hemorrhage, hospitalization length, visual analog scale (VAS) score for back and leg pain, MacNab criteria, Oswestry Disability Index (ODI), and complication rates were extracted. The Newcastle-Ottawa scale was utilized to assess the quality. Twelve articles were included, involving 816 patients. The back VAS score (95% confidence interval [CI]: -0.09-0.07, p=0.75), MacNab criteria (95%CI: 0.52-2.3, p=0.82), fluoroscopy time (95%CI: -7.03-0.4, p=0.08), and the incidence of complications (95%CI: 0.5-1.73, p=0.82) were not significantly different, while the leg VAS score (95%CI: 0.01-0.18, p=0.03), ODI score (95%CI: -1.03-0.09, p=0.02), operation time (95%CI: 5.76-20.62, p=0.0005), hospitalization length (95%CI: 0.41-2.76, p=0.008), and intraoperative hemorrhage (95%CI: 21.92-72.44, p=0.0003) were significantly different. UBED offers superiority in ODI, flexibility, and visual field clarity. Conversely, percutaneous endoscopic lumbar decompression presents advantages in terms of operation duration, blood loss, hospitalization length, and leg VAS score. These factors should be thoroughly considered when selecting a surgical approach.

Biportal endoscopic transforaminal lumbar interbody fusion using a large cage for degenerative spondylolisthesis with stenosis.

Recently, biportal endoscopic transforaminal lumbar interbody fusion (TLIF) has been used to treat lumbar degenerative diseases, such as lumbar instability and spondylolisthesis. Biportal endoscopic TLIF may have the advantages of endoscopic spine approaches and minimally invasive lumbar fusion surgeries. In this biportal endoscopic TLIF, large cages similar to oblique lumbar interbody fusion (OLIF) cages have been used. Biportal endoscopic TLIF using a large cage can be successfully performed in the lower lumbar area. The author presents the surgical technique of biportal endoscopic TLIF using a large cage. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23231.

Lateral-PLIF for spinal arthrodesis: concept, technique, results, complications, and outcomes.

Posterior lumbar interbody fusion (PLIF) surgery represents an effective option to treat degenerative conditions in the lumbar spine. To reduce the drawbacks of the classical technique, we developed a variant, so-called Lateral-PLIF, which we then evaluated through a prospective consecutive series of patients. All adult patients treated at our institute with single or double level Lateral-PLIF for lumbar degenerative disease from January to December 2017 were prospectively collected. Exclusion criteria were patients < 18years of age, traumatic patients, active infection, or malignancy, as well as unavailability of clinical and/or radiological follow-up data. The technique consists of insert the cages bilaterally through the transition zone between the central canal and the intervertebral foramen, just above the lateral recess. Pre- and postoperative (2years) questionnaires and phone interviews (4years) assessed pain and functional outcomes. Data related to the surgical procedure, postoperative complications, and radiological findings (1year) were collected. One hundred four patients were selected for the final analysis. The median age was 58years and primary symptoms were mechanical back pain (100, 96.1%) and/or radicular pain (73, 70.2%). We found a high fusion rate (95%). A statistically significant improvement in functional outcome was also noted (ODI p < 0.001, Roland-Morris score p < 0.001). Walking distance increased from 812m ± 543m to 3443m ± 712m (p < 0.001). Complications included dural tear (6.7%), infection/wound dehiscence (4.8%), and instrument failure (1.9%) but no neurological deterioration. Lateral-PLIF is a safe and effective technique for lumbar interbody fusion and may be considered for further comparative study validation with other techniques before extensive use to treat lumbar degenerative disease.

Bibliometric analysis of interspinous device in treatment of lumbar degenerative diseases.

In recent years, with the introduction of the concept of lumbar non-fusion, the interspinous device has emerged. The purpose of this study is to bibliometrically analyze the state, areas of interest, and emerging trends in the usage of interspinous devices for the treatment of lumbar degeneration disease, as well as related research fields. Between January 1, 2000 and June 14, 2023, a comprehensive collection of publications on the topic of interspinous devices in the treatment of lumbar degenerative disease (IDTLDD) was procured from the Web of Science. A bibliometric analysis and visualization were subsequently conducted, utilizing various tools including HisCite, VOSviewer, CiteSpace, and bibliometrix package. This process involved the gathering of data on the country, institution, author, journal, reference, and keywords. A comprehensive analysis of 401 publications sourced from 149 journals was conducted, with 1718 authors affiliated with 1188 institutes across 240 countries/regions. Notably, the United States emerged as the leading contributor with 134 published articles on interspinous devices in the treatment of lumbar degenerative disease (33.42%). The most productive institution was Capital Medical University, with (10, 2.49%) publications. The author with the highest publication output was Block, Jon E, with 10 publications. European Spine Journal demonstrated the highest level of productivity, with a publication of (n = 39, 9.73%). The term "X-Stop" was the most frequently utilized keyword, followed by "Lumbar spinal stenosis." The study identified various topics of current interest, such as "Invasive decompression" and "Coflex." The present study provides a comprehensive survey of research trends and developments in the application of interspinous device for the treatment of lumbar degenerative diseases, including relevant research findings and collaborative efforts among authors, institutions, and countries.

Clinical study of lumbar stability after unilateral biportal endoscopy in the treatment of degenerative lumbar diseases

Objectives: To investigate the clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of degenerative lumbar disease (DLD) and its impact on postoperative lumbar stability. Methods: This is a retrospective case series study. A total of 109 cases of DLD treated with UBE in the Department of Orthopaedic, Beijing Chaoyang Hospital Affiliated to Capital Medical University from July 2020 to June 2022 were analyzed retrospectively. There were 47 males and 62 females, aged (53.3±8.2) years (range: 21 to 80 years). The surgical segments were single segment in 80 cases, two segments in 25 cases, and three segments in 4 cases. The low back pain and leg pain of visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were evaluated before and after operation. The modified MacNab criteria were used for evaluation of the clinical consequences. Postoperative three-dimensional lumbar CT was performed to observe the preservation of the facet joints and the angle of the medial surface of the facetectomy(β angle). At 12 months after surgery, X ray of the flexion and extension lumbar spine were reviewed. The comparison and analysis of the data were conducted using paired sample t tests or generalized estimation equations. Results: All 109 patients underwent operative procedures successfully. The operation time was (94.5±37.1) minutes (range:56 to 245 minutes), the times of X ray was 6.8±4.0 (range:4 to 16 times), and the days of hospitalization was (5.3±3.7) days (range:4 to 14 days). Complications included dural tears in 4 cases, transient lower limb numbness in 4 cases, epidural hematoma in 2 case. The follow-up time was (19.6±7.2) months (range:12 to 36 months). The postoperative low back pain VAS, leg pain VAS, JOA score and ODI were significantly improved(all P<0.05). According to the modified MacNab criteria, the excellent and good rate was 88.99%(97/109) at 12 months after surgery. One case underwent revision surgery because of recurrent lumbar disc herniation. In term of radiographic evaluation, the area of the surgical side facet joints after UBE surgery was reserved more than 60%. The β angle was less than 90° in all patients. After 12 months of surgery, there was no surgical segment instability or spondylolisthesis by the X-ray of the flexion and extension lumbar spine. Conclusion: UBE can achieve satisfactory clinical efficacy in the treatment of DLD, and maintain the stability of the lumbar spine.

Development of End-to-End Artificial Intelligence Models for Surgical Planning in Transforaminal Lumbar Interbody Fusion.

Transforaminal lumbar interbody fusion (TLIF) is a commonly used technique for treating lumbar degenerative diseases. In this study, we developed a fully computer-supported pipeline to predict both the cage height and the degree of lumbar lordosis subtraction from the pelvic incidence (PI-LL) after TLIF surgery, utilizing preoperative X-ray images. The automated pipeline comprised two primary stages. First, the pretrained BiLuNet deep learning model was employed to extract essential features from X-ray images. Subsequently, five machine learning algorithms were trained using a five-fold cross-validation technique on a dataset of 311 patients to identify the optimal models to predict interbody cage height and postoperative PI-LL. LASSO regression and support vector regression demonstrated superior performance in predicting interbody cage height and postoperative PI-LL, respectively. For cage height prediction, the root mean square error (RMSE) was calculated as 1.01, and the model achieved the highest accuracy at a height of 12 mm, with exact prediction achieved in 54.43% (43/79) of cases. In most of the remaining cases, the prediction error of the model was within 1 mm. Additionally, the model demonstrated satisfactory performance in predicting PI-LL, with an RMSE of 5.19 and an accuracy of 0.81 for PI-LL stratification. In conclusion, our results indicate that machine learning models can reliably predict interbody cage height and postoperative PI-LL.

Comparison of instrumented and stand-alone lateral lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis

BackgroundBoth instrumented and stand-alone lateral lumbar interbody fusion (LLIF) have been widely used to treat lumbar degenerative disease. However, it remains controversial as whether posterior internal fixation is required when LLIF is performed. This meta-analysis aims to compare the radiographic and clinical results between instrumented and stand-alone LLIF.MethodsPubMed, EMBASE and Cochrane Collaboration Library up to March 2023 were searched for studies that compared instrumented and stand-alone LLIF in the treatment of lumbar degenerative disease. The following outcomes were extracted for comparison: interbody fusion rate, cage subsidence rate, reoperation rate, restoration of disc height, segmental lordosis, lumbar lordosis, visual analog scale (VAS) scores of low-back and leg pain and Oswestry Disability Index (ODI) scores.Results13 studies involving 1063 patients were included. The pooled results showed that instrumented LLIF had higher fusion rate (OR 2.09; 95% CI 1.16–3.75; P = 0.01), lower cage subsidence (OR 0.50; 95% CI 0.37–0.68; P < 0.001) and reoperation rate (OR 0.28; 95% CI 0.10–0.79; P = 0.02), and more restoration of disc height (MD 0.85; 95% CI 0.18–1.53; P = 0.01) than stand-alone LLIF. The ODI and VAS scores were similar between instrumented and stand-alone LLIF at the last follow-up.ConclusionsBased on this meta-analysis, instrumented LLIF is associated with higher rate of fusion, lower rate of cage subsidence and reoperation, and more restoration of disc height than stand-alone LLIF. For patients with high risk factors of cage subsidence, instrumented LLIF should be applied to reduce postoperative complications.

Effect of Lateral Surgery Compared with Posterior Surgery on Lumbar Degenerative Disease: A Meta-Analysis of 41 Cohort Studies

PurposeThe purpose of this study was to compare the efficacy of the lateral approach and posterior approach in the treatment of lumbar degenerative diseases. MethodsThrough a systematic search of relevant articles published on or before July 20, 2023, in the Embase, PubMed and Cochrane libraries, the two authors independently extracted data and used the Newcastle‒Ottawa scale (NOS) to evaluate the quality of the included studies. Using Stata16 software, the continuous variables were presented as the standard mean deviation (SMD), and the bipartite variables were analyzed using the pooled odds ratio (ORs) with 95% confidence interval (CIs). ResultsA total of 13,892 articles were screened, and 10,908 studies were identified after deleting duplicates, of which 41 met the criteria and were included in the meta-analysis. The meta-analysis showed that the lateral approach was superior to the posterior approach in reducing blood loss, operation time and hospital stay. At the same time, compared with the posterior approach, the lateral approach has more advantages in the long-term JOA score and ODI score, adjusting mid-term and long-term LL and short-term and long-term DH. ConclusionLateral and posterior surgery have similar clinical effects in the treatment of lumbar degenerative diseases and can significantly reduce pain and improve postoperative SL. At the same time, the lateral approach has more advantages in improving long-term quality of life, reducing the long-term disability index, adjusting mid-term and long-term LL and short-term and long-term DH.

Biomechanical Analysis of a Newly Proposed Surgical Combination (MIS Screw-Rod System for Indirect Decompression+ Interspinous Fusion System for long Term Spinal Stability) in Treatment of Lumbar Degenerative Diseases

ObjectiveThe aim of this study is to analyze the biomechanical stability of a newly proposed surgical combination (minimally invasive surgery of screw-rod system for indirect decompression+ interspinous fusion system for long term spinal stability) in treatment of lumbar degenerative diseases Materials and methodsThe three-dimensional CT image data of an adult healthy male volunteer was selected. An intact model of L4/5 was further established and validated by using Mimic and 3-matic, 3D slicer, abaqus, Python. Four surgical models were constructed. The biomechanical stability among these surgical modes was compared and analyzed using finite element analysis. ResultsThe maximum von mises on fixation system in surgical models 2 and 3 exhibited comparable values. This finding suggested that the increase in interspinous fusion did not result in a significant elevation in maximum von mises on fixation system. Compared with the third surgical model, the fourth model, which received less average von mises experienced by the screw in contact with both cancellous and cortical bone. The findings indicated that the inclusion of facet joint fusion in surgical procedures might not be necessary to increase the average von Mises stress experienced by the screw in contact with both cancellous and cortical bone. ConclusionThe biomechanical stability of the newly proposed surgical combination (MIS screw-rod for indirect decompression + interspinous fusion for long term spinal stability technique) was not lower than that of the other surgical combination groups, and it might not be necessary to perform facet joint fusion during the surgery.

The Effect of Unintended Facet Arthrodesis on the Treatment Outcome of Dynamic Neutralization System for Lumbar Degenerative Diseases.

This study aimed to examine the influence of unintended facet arthrodesis on the therapeutic effectiveness of the dynamic neutralization system (Dynesys). This retrospective study enrolled consecutive patients who underwent posterior decompression and dynamic stabilization for lumbar spondylosis or spinal stenosis. Follow-up assessments included lumbar radiography, lumbar vertebral computerized tomography (CT), visual analog scale (VAS), and Oswestry disability index (ODI). Patients were classified into the facet fusion and non-fusion groups. The differences in the VAS scores for back pain and leg pain, ODI, intervertebral range of motion (ROM) at the surgical segments, and upper adjacent segments were assessed before and after treatment. A total of 49 patients (29 males and 20 females) aged 31-65years were enrolled and followed-up for over 40months. Among the patients, 16 (32.7%) experienced unintended facet arthrodesis and were assigned to the fusion group, whereas the remaining patients were assigned to the non-fusion group. There was a significant increase in the incidence of facet arthrodesis in the surgical segments over time post-surgery (χ2 = 6.2, p < 0.05). The ROM of the surgical and upper adjacent segments, VAS scores for back pain and leg pain, and ODI were all significantly different before and after the operation (p < 0.05), but not between the fusion and non-fusion groups (p > 0.05). Although unintended facet arthrodesis is common after Dynesys procedure, the presence of facet arthrodesis does not significantly affect the efficacy of Dynesys in treating lumbar degenerative diseases.

Clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion and modified posterior lumbar interbody fusion in the treatment of lumbar degenerative disease

BackgroundTo compare the early clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and modified posterior lumbar interbody fusion (MPLIF) in the treatment of lumbar degenerative disease (LDD).MethodsA total of 37 patients who underwent PE-PLIF and 58 patients who underwent MPLIF from March 2019 to January 2022 were retrospectively reviewed. The operation time, intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were recorded. The visual analogue scale (VAS) scores of leg pain and low back pain, Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI) scores were evaluated and compared before the operation, 3 days after the operation, 1 week after the operation, 1 month after the operation, 6 months after the operation and at the last follow-up. The modified MacNab’s criteria were applied at the last follow-up. The fusion rate and surgical-related complications during follow-up were recorded.ResultsThe average operation time in the PE-PLIF group was highly significant longer than that in the MPLIF group (P < 0.01). The intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were significantly less in the PE-PLIF group than those in the MPLIF group (P < 0.01). There were highly significant differences in VAS scores of leg pain, VAS scores of low back pain, JOA scores, ODI scores at the last follow-up compared with those before the operation in the two groups (P < 0.01). Three days after the operation and 1 week after the operation, the VAS scores for low back pain and ODI were highly significant less in the PE-PLIF group than that in the MPLIF group (P < 0.01). Three days after the operation, the JOA scores were highly significant higher in the PE-PLIF group than that in the MPLIF group (P < 0.01). All patients showed intervertebral fusion at 6 months after the operation. Two patients (5.4%) in the PE-PLIF group experienced complications.ConclusionBoth PE-PLIF and MPLIF surgery were clinically effective and safe for patients with single-segment LDD. PE-PLIF surgery is a promising technique that can be used as an alternative treatment for single-segment LDD.

Comparative study of posterior lumbar interbody fusion by strut laminar autograft versus cage in degenerative lumbar spine diseases

Abstract Background Degenerative spondylolisthesis and lumbar disk degeneration are common degenerative diseases of the spine that may lead to lower back pain and radicular leg pain. The perfect surgical treatment remains a point of debate; interbody fusion has been recognized as having a ‘golden role’ in the treatment of lumbar degenerative diseases, but spinal interbody fusion with polyetheretherketone (PEEK) cage surgery often incurs numerous complications such as cage retropulsion, nonunion, and high cost. We hypothesize that the autologous strut laminar graft will show clinical and radiological results similar to those obtained using a PEEK cage. Objective To compare the primary outcome (clinical pain relief) and the secondary outcome (radiological signs of union and rate of fusion) when using strut laminar graft versus PEEK cage in posterior lumbar interbody fusion (PLIF) technique in the surgical management of degenerative lumbar diseases. Patients and methods Forty patients with single-level lumbar degenerative disk disease and/or degenerative spondylolisthesis grades 1 or 2 underwent PLIF surgery between November 2017 and December 2020. All patients were randomly divided into two groups according to the method of fusion (group A: laminar strut graft and group B: PEEK cage). Single-level PLIF was performed in all patients. Clinical, radiological, functional, and perioperative data were recorded and compared. Results The mean follow-up was 22 ± 6 months. Clinical improvement and radiological fusion were significantly documented in each group (P&gt;0.05). However, no significant difference existed between the two groups regarding demographic, radiological, and functional outcomes. Conclusions The results suggest that the laminar strut graft when used instead of the cage seems to be an equally safe and low-priced method of interbody fusion.

Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study.

Although several studies have reported successful fusion rates after oblique lumbar interbody fusion (OLIF) using allografts or dimerized bone matrix (DBM) instead of autografts, whether OLIF can achieve satisfactory solid fusion without the use of autografts remains unclear. This study investigated the real fusion rates after OLIF using allografts and DBM, which were evaluated using both dynamic radiographs and computed tomography scans. We enrolled 79 consecutive patients who underwent minimally invasive OLIF followed by percutaneous pedicle screw fixation. All patients were treated with OLIF between L2 and L5 and underwent radiographic and clinical follow-ups at 12, 18, and 24 months after surgery. Radiographic assessment of fusion was performed using the modified BrantigaSteffee-Fraser (mBSF) scale, which was categorized as follows: grades I (radiographic pseudoarthrosis), II (indeterminate fusion), and III (solid radiographic fusion). Other radiologic and clinical outcomes were evaluated using the following parameters: vertebral slippage distance, disc height, subsidence, Oswestry Disability Index (ODI), and visual analogue scale (VAS). Clinical outcomes demonstrated significant improvements in the VAS scores for back pain, leg pain, and ODI after surgery. Subsidence was present in 34 cases (35.4%) at 12 months postoperatively, which increased to 47.9% and reached 50.0% at 1.5 years and 2 years after surgery, respectively. The solid fusion rate after OLIF was 32.3% at 1 year, increased to 58.3% at 1.5 years, and reached 72.9% at 2 years. Radiographic pseudoarthrosis was 24.0% at 1 year, which decreased to 6.3% at 1.5 years and 3.1% at 2 years. OLIF is a safe and effective surgical procedure for the treatment of degenerative lumbar diseases. The mBSF scale, which simultaneously evaluates both dynamic angles and bone bridge formation, offers great reliability for the radiological assessment of fusion. Moreover, OLIF using allografts and DBM, which is performed on one or 2 levels at L2-5, can achieve satisfactory fusion rates within 2 years after surgery.

Biomechanical characteristics of a novel interspinous distraction fusion device in the treatment of lumbar degenerative diseases: a finite element analysis

BackgroundA novel interspinous distraction fusion (ISDF) device has been used to treat lumbar degenerative diseases. As a minimally invasive technique, ISDF differs from the traditional interspinous process distraction devices. Currently, biomechanical studies on ISDF are rare.ObjectiveTo investigate the biomechanical properties of the ISDF device (BacFuse) which is used to treat lumbar degenerative diseases.MethodsThree-dimensional L3-L5 models were created. The models were divided into four groups: intact (M1), local decompression alone (M2), internal fixation alone (M3) and local decompression combined with internal fixation (M4), based on different surgical procedures. Local laminectomy was performed to resect the lower part of the L4 lamina and the upper part of the L5 lamina at the right lamina of L4/5 in the M2 and M4 groups. After meshing the models elements, Abaqus were used to perform the finite element (FE) analysis. The intervertebral range of motion (ROM) was measured during flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation under a follower load of 400 N with a 7.5Nm moment. The distributions of disc and facet joint stresses were observed and recorded. Spinal vertebral stress was compared, and internal fixation device stress was observed.ResultsThe ROM of L4/5 in M2 increased in flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation compared with that in M1. In all motion directions, the ROM at L4/5 decreased, and the ROM at L3/4 increased after implantation of the ISDF device in M3 and M4 groups. The disc stress and facet joint stresses in the instrumented segment decreased after implantation of the ISDF device. The spinous process loaded a certain amount of stress in M3 and M4 groups. The spikes of the internal fixation device were loaded with the maximum stress.ConclusionBacFuse exhibited a reduction in intervertebral ROM, as well as decreased stress on the intervertebral disc and facet joint, while also demonstrating a discernible impact on the upper adjacent segment.

Oblique lateral internal fusion combined with percutaneous pedicle screw fixation in severe lumbar spinal stenosis: clinical and radiographic outcome

BackgroundOblique lumbar interbody fusion (OLIF) has been a popular technique for treating lumbar degenerative diseases. Previous studies have shown its efficiency in lumbar spinal stenosis; yet, only a few studies have investigated its application to severe lumbar spinal stenosis. Herein, we investigated the clinical and radiographic outcome of OLIF with percutaneous pedicle screws in the treatment of severe lumbar spinal stenosis.MethodsA total of 15 patients who underwent OLIF with percutaneous pedicle screws were retrospectively analysed. All patients were diagnosed with severe lumbar stenosis (Schizas grade C or D) through preoperative magnetic resonance image (MRI) and received OLIF combined with percutaneous pedicle screw surgery. Clinical outcomes, including visual analogue scale (VAS)-back and VAS-leg scores, and Oswestry Disability Index (ODI), as well as mean disc height (DH), mean foraminal height (FH), segmental lumbar lordosis (SLL) and cross-sectional area (CSA) of the spinal canal, were analysed before and after surgery and at the last follow-up. Intraoperative data, complications and fusion rate were also investigated.ResultsOLIF combined with percutaneous pedicle screws was performed on 18 segments in 15 patients. Mean follow-up was 23.1 ± 4.6 months (range 15–29 months). VAS-back, VAS-leg, and ODI scores were significantly improved at the last follow-up. DH increased from 8.86 ± 3.06 mm before surgery to 13.31 ± 2.14 mm after; at the last follow-up, DH was 11.69 ± 1.87 mm. FH increased from 17.85 ± 2.26 mm before surgery to 22.09 ± 1.36 mm after; at the last follow-up, FH was 20.41 ± 0.99 mm. CSA of the spinal canal increased from 30.83 ± 21.15 mm2 before surgery to 74.99 ± 33.65 mm2 after the operation and 81.22 ± 35.53 mm2 at the last follow-up. The segmental LL before surgery, after surgery and at last follow-up was 20.27 ± 6.25 degrees, 20.83 ± 6.52 degrees and 19.75 ± 5.87 degrees, respectively. All patients have gained fusion at the last follow-up.ConclusionOLIF with percutaneous pedicle screws could achieve satisfactory clinical and radiographic effects through indirect compression by increasing DH, FH and CSA of the spinal canal in severe lumbar stenosis patients.

Treatment of Lumbar Degenerative Disease with a Novel Interlaminar Screw Elastic Spacer Technique: A Finite Element Analysis.

A novel interlaminar elastic screw spacer technique was designed to maintain lumbar mobility in treating lumbar degenerative diseases. A validated finite element model of L4/5 was used to establish an ISES-1/2 model and an ISES-1/3 model based on different insertion points, a unilateral fixation model and a bilateral fixed model based on different fixation methods, and a Coflex-F model based on different implants. The elastic rods were used to fix screws. Under the same mechanical conditions, we compared the biomechanical characteristics to investigate the optimal entry point for ISES technology, demonstrate the effectiveness of unilateral fixation, and validate the feasibility of the ISES technique. Compared to ISES-1/3, the ISES-1/2 model had lower intradiscal pressure, facet cartilage stress, and posterior structural stress. Compared to the ISES-BF model, the ISES-UF model had lower intervertebral pressure, larger mobility, and smaller stress on the posterior structures. The ISES model had a similar intervertebral pressure and limitation of extension as the Coflex-F model. The ISES model retained greater mobility and reduced the stress on the facet cartilage and posterior structure compared with the Coflex-F model. Our study suggests that the ISES technique is a promising treatment of lumbar degenerative diseases, especially those with osteoporosis.

Instrumented lumbar fusion in patients over 75 years of age: is it worthwhile?-a comparative study of the improvement in quality of life between elderly and young patients.

Surgical treatment of degenerative lumbar disease in the elderly is controversial. Elderly patients have an increased risk for medical and surgical complications commensurate with their comorbidities, and concerns over complications have led to frequent cases of insufficient decompression to avoid the need for instrumentation. The purpose of this study was to evaluate clinical outcome between older and younger patients undergoing lumbar instrumented arthrodesis. This is a retrospective, comparative study of prospectively collected outcomes. One hundred and fifty-four patients underwent 1- or 2-level posterolateral lumbar fusion. Patients were divided into two groups. Group 1: 87 patients ≤65 years of age who underwent decompression and posterolateral instrumented fusion; Group 2: 67 patients ≥75 years of age who underwent the same procedures with polymethylmethacrylate (PMMA) pedicle-screw augmentation. Mean follow-up 27.47 months (range, 76-24 months). Mean age was 49.1 years old (range, 24-65) for the younger group and 77.8 (range, 75-86) in the elderly group. Patients ≥75 years of age showed higher preoperative comorbidity (American Society of Anesthesiology, ASA: 1.7 vs. 2.4), and ≥2 systemic diseases with greater frequency (12.5% vs. 44.7%). No significant differences were found between the two groups in terms of postoperative complications, fusion, or revision rate. During follow-up, adjacent disc disease and adjacent fracture occurred significantly more in Group 2 (P<0.05). At the end of follow-up, there were no significant differences between the two groups in any of the clinical and health-related quality of life scores or satisfaction with treatment received. Osteoporosis represents a major consideration before performing spine surgery. Despite an obvious increased risk of complications in elderly patients, PMMA-augmented fenestrated pedicle screw instrumentation in spine fusion represents a safe and effective surgical treatment option to elderly patients with poor bone quality. Age itself should not be considered a contraindication in otherwise appropriately selected patients.

Comparison of the mid-term clinical efficacy of different fixtaion methods combined with oblique lumbar interbody fusion in treating lumbar degenerative diseases.

To compare the mid-term follow-up clinical efficacy among three treatment approaches for lumbar degenerative diseases (LDD): standalone oblique lumbar interbody fusion (SF), oblique lumbar interbody fusion combined with lateral screw fixation (LF), and oblique lumbar interbody fusion combined with posterior screw fixation (PF). This retrospective study included a total of 71 cases of single level LDD that underwent OLIF in Hospital of Chengdu University of Traditional Chinese Medicine were retrospectively collected between March 2016 and September 2017. Patients were divided into three groups: 24 cases in the SF group, 24 cases in the LF group and 23 cases in the PF group. Various parameters, such as operation time, hospitalization time, and complications, were recorded. The fusion condition was assessed at last follow up. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) from pre-operation to 5years post-surgery. Significantly lower mean operation time and hospitalization time were observed in the SF and LF groups compared to the PF group (p < .05). However, no significant difference in fusion rate was found among the three groups. Regarding clinical outcomes, there was no statistically significant difference in VAS scores between the three groups during all follow-up periods. At the 6th month and 1st year after surgery, the SF and LF groups had significantly lower Oswestry Disability Index (ODI) scores compared to the PF group (p < .05). There was no significant difference in perioperative complication rates among the three groups (p > .05). In the LF group, one case of instrument displacement and urethra injury were reported, while in the SF, LF, and PF groups, 10, 9, and 3 cases of cage subsidence were reported, respectively. The study findings suggest that oblique lumbar interbody fusion (OLIF) is a safe and effective treatment for mid-term management of lumbar degenerative diseases (LDD). Compared to the posterior screw fixation (PF) group, both the standalone OLIF (SF) and OLIF combined with lateral screw fixation (LF) groups showed advantages in terms of reduced operation time, shorter hospitalization, and faster symptom alleviation in the short-term. However, OLIF combined with PF demonstrated comparable symptom relief in the mid-term and had the additional benefit of lower cage subsidence rates while improving fusion rates as well.