Treatment Of Degenerative Spine Disease Research Articles

Is Less Surgical Treatment Possible in the Treatment of Degenerative Spine Diseases? Four-Year Follow-up Results of Foraminal Epidural and Facet Joint Injection Treatments

In this article, I would like to share my opinions about the article named 'Is Less Surgical Treatment Possible in the Treatment of Degenerative Spine Diseases? Four-Year Follow-up Results of Foraminal Epidural and Facet Joint Injection Treatments' (1). First of all, I would like to thank the authors. I will especially try to contribute to this article from the perspective of a physical medicine and rehabilitation physician.

Safety and efficacy of autologous bone marrow clot as a multifunctional bioscaffold for instrumental posterior lumbar fusion: a 1-year follow-up pilot study.

Bone marrow aspirate (BMA), when combined with graft substitutes, has long been introduced as a promising alternative to iliac crest bone graft in spinal fusion. However, the use of BMA is limited by the absence of a standardized procedure, a structural texture, and the potential for diffusion away from the implant site. Recently, the potential use of a new formulation of BMA, named BMA clot, has been preclinically described. In this report, we present the results of a prospective pilot clinical study aimed at evaluating the safety and efficacy of autologous vertebral BMA (vBMA) clot as a three-dimensional and multifunctional bioscaffold in instrumented posterior lumbar fusion. Ten consecutive patients with an indication of multilevel (≤5) posterior spinal fusion due to lumbar spine degenerative diseases were included in the study and treated with vBMA. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and EuroQoL-5L (EQ-5L) preoperatively and at 3 months and 12 months after spinal fusion. Bone fusion quality was evaluated at the 12-month follow-up using the Brantigan classification on radiography (XR) imaging. Bone density was measured on computed tomography (CT) scans at 6 and 12 months of follow-up visits at the intervertebral arches and intervertebral joint areas and expressed in Hounsfield unit (HU). The results indicate a successful posterolateral fusion rate of approximately 100% (considering levels with C, D, and E grades according to the Brantigan classification) at the 12-month follow-up, along with an increase in bone density from 6 to 12 months of follow-up. An improvement in the quality of life and health status following surgery, as assessed by clinical scores (ODI, VAS, and EQ-5L), was also observed as early as 3 months postsurgery. No adverse events related to the vBMA clot were reported. This prospective pilot study demonstrates the effectiveness and safety profile of vBMA clot as an advanced bioscaffold capable of achieving posterior lumbar fusion in the treatment of degenerative spine diseases. This lays the groundwork for a larger randomized clinical study.

Calcium phosphate ceramics combined with rhBMP6 within autologous blood coagulum promote posterolateral lumbar fusion in sheep

Posterolateral spinal fusion (PLF) is a procedure used for the treatment of degenerative spine disease. In this study we evaluated Osteogrow-C, a novel osteoinductive device comprised of recombinant human Bone morphogenetic protein 6 (rhBMP6) dispersed in autologous blood coagulum with synthetic ceramic particles, in the sheep PLF model. Osteogrow-C implants containing 74–420 or 1000–1700 µm ceramic particles (TCP/HA 80/20) were implanted between L4–L5 transverse processes in sheep (Ovis Aries, Merinolaandschaf breed). In the first experiment (n = 9 sheep; rhBMP6 dose 800 µg) the follow-up period was 27 weeks while in the second experiment (n = 12 sheep; rhBMP6 dose 500 µg) spinal fusion was assessed by in vivo CT after 9 weeks and at the end of the experiment after 14 (n = 6 sheep) and 40 (n = 6 sheep) weeks. Methods of evaluation included microCT, histological analyses and biomechanical testing. Osteogrow-C implants containing both 74–420 and 1000–1700 µm ceramic particles induced radiographic solid fusion 9 weeks following implantation. Ex-vivo microCT and histological analyses revealed complete osseointegration of newly formed bone with adjacent transverse processes. Biomechanical testing confirmed that fusion between transverse processes was complete and successful. Osteogrow-C implants induced spinal fusion in sheep PLF model and therefore represent a novel therapeutic solution for patients with degenerative disc disease.

Avoiding Surgery: Successful Weight Loss as an Alternative Treatment for Degenerative Spine Disease

Avoiding Surgery: Successful Weight Loss as an Alternative Treatment for Degenerative Spine Disease

Advanced technologies for lumbar spondylolisthesis

Technological advancements in the treatment of lumbar spondylolisthesis aim to match the efficacy of conventional methods with reduced surgical morbidity and faster postoperative recovery. Endoscopic surgery, anesthesia enabling awake surgery, enhanced recovery after surgery protocols, and activity monitoring are prime examples of these technologies. Endoscopy for decompression and interbody fusion decreases soft tissue disruption and operative time. Awake surgery eliminates many of the harmful effects associated with general anesthesia. Enhanced recovery after surgery protocols optimizes patient factors in the preoperative, intraoperative, and postoperative periods to reduce pain, reduce morbidity, and speed postoperative recovery. Activity monitoring provides an objective, reliable, and reproducible method of outcome assessment. This chapter reviews each of these innovations, and the profound impact each will have on the treatment of degenerative spine diseases in years to come.

Instrumented Posterior Arthrodesis of the Lumbar Spine: Prospective Study Evaluating Fusion Outcomes in Patients Receiving an Interspinous Fixation Device for the Treatment of Degenerative Spine Diseases.

Prospective evaluation of radiographic fusion outcomes in patients receiving instrumented posterior arthrodesis of the lumbar spine using a minimally invasive interspinous fixation device. All patients (n = 110) from a single US physician's practice who received instrumented posterior arthrodesis of the lumbar spine with a minimally invasive interspinous fixation device in the calendar year 2020 were invited to return for a follow-up CT scan to radiographically assess fusion. Forty-three patients, representing 69 total treated levels, consented to participate and received a lumbar CT scan at a mean of 459 days post-surgery (177 to 652). The interspinous/interlaminar fusion was assessed by 3 independent radiologists using a novel grading scale. Spinous process fractures were also assessed. 92.8% of the assessed levels were considered fused. There were no intraoperative spinous process fractures. There were 4 spinous process fractures (5.8%) identified on CT imaging, all of which were asymptomatic and healed without subsequent intervention. There were no instances of device mechanical failure or device-related reoperation. Instrumented posterior arthrodesis of the lumbar spine using a minimally invasive interspinous fixation device provides clinically meaningful fusion rates with no reoperations and a low risk of spinous process fracture or other device-related complications.

Iatrogenic contralateral foraminal stenosis following lumbar spine fusion surgery: illustrative cases.

Lumbar spine fusion is the mainstay treatment for degenerative spine disease. Multiple potential complications of spinal fusion have been found. Acute contralateral radiculopathy postoperatively has been reported in previous literature, with unclear underlying pathology. Few articles reported the incidence of contralateral iatrogenic foraminal stenosis after lumbar fusion surgery. The aim of current article is to explore the possible causes and prevention of this complication. The authors present 4 cases in which patients developed acute postoperative contralateral radiculopathy requiring revision surgery. In addition, we present a fourth case in which preventive measures have been applied. The aim of this article was to explore the possible causes and prevention to this complication. Iatrogenic foraminal stenosis of the lumbar spine is a common complication; preoperative evaluation and middle intervertebral cage positioning are needed to prevent this complication.

Projections From Surgical Use Models in Germany Suggest a Rising Number of Spinal Fusions in Patients 75 Years and Older Will Challenge Healthcare Systems Worldwide.

Spinal fusion is a well-established procedure in the treatment of degenerative spinal diseases. Previous research shows that the use of this operative treatment has been growing in recent decades in industrialized countries and has become one of the most cost-intensive surgical procedures. It seems that in some countries such as Germany-with its large, industrialized, European population-this increase is mainly driven by demographic changes with low fertility rates, increasing life expectancy, and an aging population. Based on current projections, however, Germany faces a population trend that many other countries are likely to follow within a few decades. An increasingly shrinking and aging working population may eventually put the healthcare system under enormous pressure, with greater demands for spinal fusions and associated higher costs. Thus, we aimed to provide reliable projections regarding the future demand for posterior spinal fusion procedures including age- and gender-related trends up to 2060, which will be necessary for future resource planning and possible improvements in actual treatment strategies. (1) How is the use of posterior spinal fusions in Germany expected to change from 2019 through 2060, if currents trends continue? (2) How is the use of posterior spinal fusions in Germany expected to change depending on patients' age and gender during this time period? Comprehensive nationwide data provided by the Federal Statistical Office, the official institution for documenting all data on operations and procedures performed in Germany, were used to quantify posterior spinal fusion rates as a function of calendar year, age, and gender. Because there is a lack of evidence regarding future trends in the use of posterior spinal fusions, an autoregressive integrated moving average model on historical procedure rates from 2005 to 2019 in relation to official population projections from 2020 to 2060 was chosen to forecast future absolute numbers and incidence rates of this procedure in Germany. Long-term forecasting is more prone to unexpected disruptions than forecasting over short-term periods; however, longer spans facilitate estimates of how trends may challenge future healthcare systems if those trends continue, and thus are useful for research and planning. The incidence rate of posterior spinal fusion was projected to increase by approximately 83% (95% CI 28% to 139%) to 102% per 100,000 inhabitants (95% CI 71% to 133%) in 2060, with a 1.3-fold higher rate of women undergoing surgery in terms of absolute numbers. The highest increase identified by the model occurred in patients 75 years and older with 38,974 (95% CI 27,294 to 50,653) posterior spinal fusions in 2060, compared with 14,657 in 2019. This trend applied for both women and men, with a 246% (95% CI 138% to 355%) increase in the total number of posterior spinal fusions for women 75 years and older and a 296% (95% CI 222% to 370%) increase for men 75 years and older. At the same time, posterior spinal fusions in all age groups younger than 55 years were projected to follow a constant or even negative trend up to 2060. Our findings suggest that increasing use of posterior spinal fusion, particularly in patients 75 years and older, will challenge healthcare systems worldwide if current trends persist. This study may serve as a model for many other industrialized countries facing similar demographic and procedure-specific developments in the future. This emphasizes the need to focus on frailty research as well as appropriate financial and human resource management. Effective perioperative medical management, multidisciplinary treatment, and interinstitutional protocols are warranted, especially in older patients as we attempt to manage these trends in the future. Level III, economic and decision analysis.

Concentration-Dependent Efficacy of Recombinant Human Bone Morphogenetic Protein-2 Using a HA/β-TCP Hydrogel Carrier in a Mini-Pig Vertebral Oblique Lateral Interbody Fusion Model.

Bone morphogenetic protein-2 (BMP-2) is used in the treatment of degenerative spinal disease and vertebral fractures, spine fusion, dental surgery, and facial surgery. However, high doses are associated with side effects such as inflammation and osteophytes. In this study, we performed spinal fusion surgery on mini-pigs using BMP-2 and a HA/β-TCP hydrogel carrier, and evaluated the degree of fusion and osteophyte growth according to time and dosage. Increasing the dose of BMP-2 led to a significantly higher fusion rate than was observed in the control group, and there was no significant difference between the 8-week and 16-week samples. We also found that the HA + β-TCP hydrogel combination helped maintain the rate of BMP-2 release. In conclusion, the BMP-2-loaded HA/β-TCP hydrogel carrier used in this study overcame the drawback of potentially causing side effects when used at high concentrations by enabling the sustained release of BMP-2. This method is also highly efficient, since it provides mineral matter to accelerate the fusion rate of the spine and improve bone quality.

Complications of injections in conservative treatment of degenerative spine disease: a prospective unicentric study

BackgroundSpinal injection has been an accepted part of conservative therapy for degenerative diseases. The drugs used can cause side effects and severe complications. The aim of this study was to determine the occurrence of general side effects (GSE) and complications when performing consecutive different types of spinal injections and to evaluate pain reduction.MethodsProspective data evaluation of patients with degenerative spine disease at hospital admission, discharge, and six and 12 weeks after discharge. All patients received a specific injection protocol depending on their symptoms and radiological findings. The injections performed were dorsal sacroiliac joint injections, perineural injections, epidural interlaminar and epidural periradicular injections, and facet joint injections. Potential complications were categorized and recorded as GSE and complications. In addition, the Numerical Analog Scale (NAS) for pain, the Oswestry Disability Index (ODI) were evaluated.ResultsForty-eight patients were enrolled. There were 282 spinal injections performed. A total of 131 common treatment-related events were recorded. Depending on the type of injection, transient pain at the injection site (32.4–73.5%), radiating pain (9.4–34.7%), and nerve root irritation (2–18.4%) were the most common. One complication with postpuncture syndrome occurred with epidural-interlaminar injection. No persistent neurologic deficits occurred. The highest rate of GSE was observed with periradicular injections (relative frequency (RF) = 0.8), followed by epidural-interlaminar injections (RF = 0.65), least frequently with FJ injections (RF = 0.32). From the time of admission to discharge, NAS scores were significantly decreased and ODI score significantly improved at discharge (p < 0.001), but relapse occurred at the 12-week follow-up.ConclusionsVarious consecutive spinal injections for conservative treatment of degenerative spine diseases are safe and lead to a decrease in pain and improvement in quality of life. GSE are common, but not persistent. Although complications are rare, they can have serious consequences for the patient.

Ceramic bone graft substitute (Mg-HA) in spinal fusion: A prospective pilot study.

Background: Iliac crest bone graft (ICBG) is considered the gold standard for spine surgical procedures to achieve a successful fusion due to its known osteoinductive and osteoconductive properties. However, complications related to harvesting procedure and donor site morbidity have been largely reported in the literature, favoring the development of a wide range of alternative products to be used as bone graft extenders or substitutes for spine fusion. Among all, ceramic-based biomaterials have been widely studied and employed in the last years as bone graft substitutes. Methods: We report here the results of a prospective pilot study aimed to evaluating the grade of ossification obtained by the use of an Mg-doped hydroxyapatite (HA) product to achieve postero-lateral fusion in degenerative spine diseases. Results: Results show a successful degree of fusion of about 62% at the 12-month follow-up and an improvement of quality of life and health status following surgery, as evaluated by clinical scores (ODI, VAS, and EQ-5L). No adverse events related to the material were reported. Conclusion: The present pilot study shows the effectiveness and the safety profile of an Mg-doped HA bone graft substitute used to achieve postero-lateral fusion in the treatment of degenerative spine diseases, laying down the basis for further larger clinical investigations.

P116. Five-year minimum outcomes of MI-TLIF in obesity: a matched cohort analysis

BACKGROUND CONTEXT Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is an established technique for the treatment of degenerative spine disease. However, obese patients increase the complexity of the MI-TLIF approach due to obstacles associated with increased body habitus, and there is conflicting evidence regarding postoperative outcomes after MI-TLIF in this population. PURPOSE To compare 5-year minimum postoperative outcomes in obese patients versus nonobese patients undergoing MI-TLIF through a matched-cohort analysis. STUDY DESIGN/SETTING Matched retrospective comparative study. PATIENT SAMPLE A total of 148 matched patients (74 obese, 74 nonobese). OUTCOME MEASURES 1) Patient demographics; 2) Perioperative data; 3) Revision rate; 4) Complications; 5) Radiographic outcomes: pelvic incidence-lumbar lordosis (PI-LL) mismatch, graft subsidence, fusion rate; 6) Patient reported outcome scores: Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). METHODS A retrospective review of a single institution was performed to identify patients who underwent MI-TLIF with a minimum follow up of 5 years. Patients were divided into two cohorts: obese (BMI > 30 kg/m2) and non-obese (BMI < 30 kg/m2). Each cohort was matched for age, sex and levels operated. Revision rates and complications were compared. Radiographic outcomes and fusion rate were measured at final followup. Patient-reported outcomes and radiographic outcomes were recorded and compared. Standard binomial and categorical comparative analyses were performed. RESULTS There were 148 patients included and matched (74 obese, 74 nonobese). Mean follow-up time was similar between obese and nonobese groups at 90.9 and 94.2 months, respectively. Significance was found for average blood loss (127.8 mL obese and 37.8 mL nonobese, p <.001) between groups; 17.6% of obese patients required revision surgery compared to 16.2% of nonobese patients (p= 0.826). Both cohorts achieved a similar proportion of PI-LL mismatch correction (79.2% obese and 83.3% nonobese, p= 0.780). Graft subsidence rates at final follow-up were 8.1% and 5.4% in the obese and nonobese cohorts, respectively (p= 0.512). Mean change in functional outcome scores were similar between cohorts. CONCLUSIONS This long-term matched comparative study demonstrates similar clinical and radiological outcomes between obese and nonobese patients undergoing MI-TLIF. Obese patients were found to have significantly greater blood loss and operative time than nonobese patients, however, the true clinical impact of these differences was minor. Our findings suggest that MI-TLIF is an appropriate lumbar fusion technique for the obese patient with degenerative pathology of the lumbar spine. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is an established technique for the treatment of degenerative spine disease. However, obese patients increase the complexity of the MI-TLIF approach due to obstacles associated with increased body habitus, and there is conflicting evidence regarding postoperative outcomes after MI-TLIF in this population. To compare 5-year minimum postoperative outcomes in obese patients versus nonobese patients undergoing MI-TLIF through a matched-cohort analysis. Matched retrospective comparative study. A total of 148 matched patients (74 obese, 74 nonobese). 1) Patient demographics; 2) Perioperative data; 3) Revision rate; 4) Complications; 5) Radiographic outcomes: pelvic incidence-lumbar lordosis (PI-LL) mismatch, graft subsidence, fusion rate; 6) Patient reported outcome scores: Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). A retrospective review of a single institution was performed to identify patients who underwent MI-TLIF with a minimum follow up of 5 years. Patients were divided into two cohorts: obese (BMI > 30 kg/m2) and non-obese (BMI < 30 kg/m2). Each cohort was matched for age, sex and levels operated. Revision rates and complications were compared. Radiographic outcomes and fusion rate were measured at final followup. Patient-reported outcomes and radiographic outcomes were recorded and compared. Standard binomial and categorical comparative analyses were performed. There were 148 patients included and matched (74 obese, 74 nonobese). Mean follow-up time was similar between obese and nonobese groups at 90.9 and 94.2 months, respectively. Significance was found for average blood loss (127.8 mL obese and 37.8 mL nonobese, p <.001) between groups; 17.6% of obese patients required revision surgery compared to 16.2% of nonobese patients (p= 0.826). Both cohorts achieved a similar proportion of PI-LL mismatch correction (79.2% obese and 83.3% nonobese, p= 0.780). Graft subsidence rates at final follow-up were 8.1% and 5.4% in the obese and nonobese cohorts, respectively (p= 0.512). Mean change in functional outcome scores were similar between cohorts. This long-term matched comparative study demonstrates similar clinical and radiological outcomes between obese and nonobese patients undergoing MI-TLIF. Obese patients were found to have significantly greater blood loss and operative time than nonobese patients, however, the true clinical impact of these differences was minor. Our findings suggest that MI-TLIF is an appropriate lumbar fusion technique for the obese patient with degenerative pathology of the lumbar spine.

Obesity Does Not Adversely Affect Long-term Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Matched Cohort Analysis.

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is an established technique for the treatment of degenerative spine disease. The larger body habitus of obese patients increases the intraoperative complexity of MI-TLIF. Therefore, it is unclear whether this procedure is appropriate for this population. The goal of this study was to compare postoperative outcomes for obese patients vs nonobese patients undergoing MI-TLIF through a matched cohort analysis. A retrospective review was performed to identify patients who underwent MI-TLIF at a single institution with a minimum follow-up of 5 years. Patients were divided into 2 cohorts: nonobese (body mass index <30 kg/m2) and obese (body mass index ≥30 kg/m2). Each cohort was matched for age, sex, and levels operated. Perioperative data and patient-reported outcomes were compared. Radiographic outcomes were measured at final follow-up. Standard binomial and categorical comparative analyses were performed. A total of 148 patients were included. Of obese patients, 17.6% required revision surgery compared with 16.2% of nonobese patients (P=.826). Both cohorts had a similar proportion of pelvic incidence-lumbar lordosis mismatch correction (P=.780). Mean change in functional outcome scores for each cohort did not differ significantly. Obese patients had clinically minor but statistically significantly greater blood loss and longer operative times than nonobese patients (P<.001). Obese and non-obese patients undergoing MI-TLIF showed no long-term differences in revision rate, radiologic outcome, or functional outcome after long-term follow-up. Obese patients had slightly greater blood loss and longer operative times. Our findings suggest that MI-TLIF is an appropriate alternative to traditional open lumbar fusion for obese patients. [Orthopedics. 2022;45(4):203-208.].

A decade of experience with microsurgical discectomy

Ten years experience in microdiskectomy for the treatment of degenerative spine diseases (about 900 patients) is presented. Seven hundred and seventeen patients have been operated on by traditional W.Caspar technique and 21.4%) out of them required not only diskectomy but radiculolysis, resection of the arch margins and posterior longitudinal ligament. In some patients side by side with microdiskectomy, spondylodesis via interarch approach using CAC system combined with transpedicular system USS (AO) was performed. The same technique was used in patients with lumbar vertebra spondylolisthesis. Positive results were achieved in 88.2% of cases.

Postoperative Stroke after Anterior Cervical Discectomy and Fusion: A Clinical Case Report

Anterior cervical discectomy and fusion (ACDF) spine surgery has been performed extensively for the treatment of degenerative spine diseases with relatively low rates of complications. The reported incidence of postoperative cerebrovascular events associated with ACDF is only 0.13%, representing 1.51% of all complications. However, this complication is often highly disastrous and can lead to paralysis, and even death. In this study, a 42year-old male underwent anterior cervical discectomy and fusion (ACDF) at C34 and C45 levels through a right-sided approach. Three hours after the surgery, the patient suddenly developed left hemiplegia and facial palsy.. The patient was treated with aspirin and cerebromysin and fully recovered from motor and sensory deficits after 1 month.&#x0D; Keywords: Anterior cervical discectomy and fusion, postoperative stroke.&#x0D; References&#x0D; [1] P. S. Romano, D. R. Campa, J. A. Rainwater, Elective Cervical Discectomy in California: Postoperative in Hospital Complications And Their Risk Factors, Spine, Vol. 22, No. 1, 1997, pp. 2677-2692, https://doi.org/10.1097/00007632-199711150-00018.[2] B. S. Chozick, P. Watson, S. H. Greenblatt, Internal Carotid Artery Thrombosis After Cervical Corpectomy, Spine, Vol. 19, 1994, pp. 2230-2232, https://doi.org/10.1097/00007632-199410000-00020.[3] Y. C. Yeh, W. Z. Sun, C. P. Lin et al., Prolonged Retraction on The Normal Common Carotid Artery Induced Lethal Stroke After Cervical Spine Surgery, Spine, Vol. 29, No. 3, 2004, pp. 431-434, https://doi.org/10.1097/01.brs.0000141177.95850.b1.[4] J. E. Loret, P. Francois, C. Papagiannaki, Internal Sarotid Artery Dissection After Anterior Cervical Disc Replacement: First Case Report And Literature Review of Vascular Complications of The Approach, Eur J Orthop Surg Traumatol, Vol. 23, No. 1, 2013, pp. 107-110, https://doi.org/10.1007/s00590-013-1228-8.[5] M. Radhakrishnan, S. Bansal, G. S. Srihari, Perioperative Stroke Following Anterior Cervical Discectomy, Br J Neurosurg, Vol. 24, No. 1, 2010, pp. 592-594, https://doi.org/10.3109/02688691003711575.[6] Q. D. Yue, Carotid Artery Related Perioperative Stroke Following Anterior Cervical Spine Surgery: A Series of 3 Cases and Literature Review, Journal of Stroke And Cerebrovascular Diseases, Vol. 28, No. 2, 2019, pp. 458-463, https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.10.024.[7] E. Matthew, Changes in Carotid Artery Blood Flow During Anterior Cervical Spine Surgery, Spine, Vol. 27, No. 2, 2002, pp. 152-155, https://doi.org/10.1177/2192568216688192.[8] D. C. Brooks, J. L. Schindler, Perioperative Stroke: Risk Assessment, Prevention and Treatment, Curr Treat Options Cardiovasc, Meds, Vol. 16, No. 1, 2014, pp. 282, https://doi.org/10.1007/s11936-013-0282-1.[9] E. C. Jauch, J. L. Saver, J. Adams, Guidelines for The Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from The American Heart Association, American Stroke Association, Vol. 44, No. 1, 2013, pp. 870-947, https://doi.org/10.1161/STR.0b013e318284056a.[10] J. M. Cuellar, A. Petrizzo, R. Vaswani, Does Aspirin Administration Increase Perioperative Morbidity in Patients With Cardiac Stents Undergoing Spinal Surgery, Spine, Vol. 44, No. 1, 2015, pp. 629-635, https://doi.org/10.1097/BRS.0000000000000695.&#x0D; &#x0D;

P40. Indirect effect on adjacent segment after minimally invasive transforaminal lumbar interbody fusion

<h3>BACKGROUND CONTEXT</h3> MIS-TLIF is an alternative treatment for degenerative spine disease, which aims to decompress and stabilize the most stenotic level correlating with clinical symptoms, while sparing the less severe adjacent segments. According to previous studies, interbody fusion was reported to not only affect the fused level, but also the adjacent segments. These effects might cause changes in canal dimensions at the adjacent segments, leading to unsatisfactory postoperative symptoms. <h3>PURPOSE</h3> The goal of this study was to compare the dural sac area and other canal dimension parameters on MRI at the adjacent segments before and after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), including the change in segmental and regional parameters measured on plain radiograph. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study King Chulalongkorn Memorial Hospital. <h3>PATIENT SAMPLE</h3> Patients who underwent MIS-TLIF at L4/5 level in King Chulalongkorn Memorial Hospital The indications for surgery were spinal canal stenosis, herniated nucleus pulposus, and spondylolisthesis grade 1-2. <h3>OUTCOME MEASURES</h3> MR image parameters: dural sac area (DSA), sagittal spinal AP diameter (SAPD), ligamentum flavum area (LFA), ligamentum flavum thickness (LFT), foraminal area (FA), foraminal height (FH), at the adjacent segments of fused level. Standing lateral plain radiograph: disc height (DH), segmental angle (SA) of adjacent segments and fused level lumbar lordosis (LL) <h3>METHODS</h3> Forty-four patients who underwent MIS-TLIF at L4/5 level were examined. The indications for surgery were spinal canal stenosis, herniated nucleus pulposus, and spondylolisthesis grade 1-2. We reviewed their standing plain radiograph and MR image parameters, including dural sac area (DSA), sagittal spinal AP diameter (SAPD), ligamentum flavum area (LFA), ligamentum flavum thickness (LFT), foraminal area (FA), foraminal height (FH), disc height (DH), segmental angle (SA), and lumbar lordosis (LL) at the adjacent segments of fused level. Disc height and segmental angle at fused level was also reviewed. All parameters were compared before, and 3 months postoperatively. <h3>RESULTS</h3> The mean (SD) pre- and postoperative DSA at upper adjacent segment was 125.12 (35.72) and 133.17 (35.07) mm2, while pre- and postoperative DSA at lower adjacent segment was 103.58 (44.32) and 117.66 (46.34) mm2 respectively. The postoperative DSA significantly increased in the upper (mean change 8.05 (95%CI 4.44-11.66) mm2, P <0.001) and lower (14.08 (95%CI 9.47 – 18.69) mm2; P <0.001) adjacent segments. Eleven (25%) and 22 (25%) patients had preoperative upper adjacent segment areas <100 mm2 and ≥100 mm2respectively. The mean change in DSA was greater in patients with preoperative DSA <100 mm2 versus ≥100 mm2, but the difference was more pronounced in the upper versus the lower adjacent segment (4.3 (95%CI -4 to 12.7) mm2; P = 0.30 versus 1.1 (95%CI -8.3 to 10.4); P = 0.82, respectively). Significant increases in SAPD were also seen in both upper (0.85 (95%CI 0.45 to 1.25 mm; P <0.001) and lower (0.66 (95%CI 0.34 to 0.97) mm; P<0.001) adjacent segments. LFT significantly decreased in the lower adjacent segment (-0.37 (95%CI -0.62 to -0.11) mm; P=0.006); a small but non-significant decrease was also observed in the upper adjacent segment (-0.1 (95%CI -0.37 to 0.17) mm; P=0.47). No other significant changes in other canal dimensions were noted. <h3>CONCLUSIONS</h3> Adjacent segment DSA increased significantly after MIS-TLIF. In addition, other parameters representing canal dimension (SAPD, LFT) also significantly changed after the operation. Further studies are needed to assess the relationship between these changes and postoperative clinical outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Transumbilical Retroperitoneal Lumbar Interbody Fusion: A Technical Note and Preliminary Case Series.

ObjectiveAnterior lumbar interbody fusion (ALIF) has advantages over posterior lumbar interbody fusion or transforaminal lumbar interbody fusion techniques in that it minimizes damage to the anatomical structure of the posterior spinal segment and enables indirect decompression of the foramen by insertion of a tall cage. However, the predominant abdominal scar tissue reduces patients’ satisfaction after ALIF. Herein, we describe the technique of transumbilical lumbar interbody fusion (TULIF) and its preliminary results in a case series. MethodsA retrospective review of 154 consecutive patients who underwent TULIF between the L2–3 and L4–5 levels was performed. After preoperatively selecting patients by evaluating the location of the umbilicus and vessel anatomy, a vertical skin incision was made on the umbilicus to minimize the abdominal scar tissue. ResultsThere were 120 single-level (110 L4–5 and 10 L3–4), 31 two-level, and 3 three-level surgeries. All patients were very satisfied with their postoperative abdominal scars, which were noticeably faint compared to those after conventional ALIF. ConclusionTULIF is a feasible, minimally invasive surgical option that can achieve both the treatment of degenerative spinal disease and satisfactory cosmesis. Although it is technically demanding, patients obtain sufficient benefits.

Fluoroscopic versus CT-guided cortical bone trajectory pedicle screw fixation: Comparing trajectory related complications

Cortical bone trajectory (CBT) pedicle screw fixation is an emerging technique for treatment of degenerative spine disease which requires either intraoperative fluoroscopy or intraoperative CT guidance (iCT). To date, there has been no direct comparison of these two navigation modalities; here we compare fluoroscopic versus iCT navigation for CBT pedicle screw fixation. We retrospectively reviewed all patients who underwent CBT screw fixation with either fluoroscopic or iCT guidance for lumbar degenerative disease by the senior author. Trajectory-related complications such as medial or lateral breach were compared on postoperative CT, in addition to the incidence of trajectory-related dural tear. We also compared general surgical complications such as postoperative infection and decompression related durotomies. Thirty-eight patients (19 fluoroscopic, 19 CT-guided) who underwent placement of 182 cortical screws (88 fluoroscopic, 94 CT-guided) were identified. In terms of trajectory-related complications, the iCT cohort had fewer medial breaches (1/94) compared to the fluoroscopic cohort (6/88) (p = 0.05). Each group had one lateral breach (p = 0.73). There was one case of CSF leak from screw placement in the fluoroscopic cohort, but none in the iCT cohort (p = 0.48). Overall, there were eight trajectory-related complications in the fluoroscopic cohort versus two in the iCT cohort (p = 0.04). Our data suggests statistically significant decreased trajectory-related complications with iCT-guided CBT screw fixation as compared to fluoroscopically guided. In terms of general surgical complications, while we observed increased postoperative infections in our fluoroscopic cohort, there was no statistically significant difference.

Bone cement pedicle screw fixation and fusion in the treatment of degenerative spinal disease with osteoporosis: one-year follow-up

Bone cement pedicle screw fixation and fusion in the treatment of degenerative spinal disease with osteoporosis: one-year follow-up

Minimally invasive surgery and modern view on the treatment of degenerative spine diseases

To summarize and analyze the results of minimally invasive spine surgery. A retrospective quantitative analysis of surgical interventions for the period 2011-2018 was carried out. All procedures were performed at the neurosurgical department of the Neurology Research Center. Structure and effectiveness of minimally invasive interventions were reported. There were over 800 endoscopic minimally invasive interventions on the lumbar spine and 127 procedures on the cervical spine. For the period from 2011 to 2018, we found an increase in the number of minimally invasive interventions (104 endoscopic discectomies in 2018), active use of percutaneous approaches (87 operations in 2018) along with microsurgical discectomy (81 operations in 2018). The total efficiency of the methods ranges from 91.42% to 95.69%. Own results and literature data confirm the validity and expediency of surgical treatment of patients with degenerative-dystrophic spine diseases. Highly effective and safe minimally invasive surgery should be preferred in these cases.