scholarly journals Controversies about Interspinous Process Devices in the Treatment of Degenerative Lumbar Spine Diseases: Past, Present, and Future

2014 ◽  
Vol 2014 ◽  
pp. 1-15 ◽  
Author(s):  
Roberto Gazzeri ◽  
Marcelo Galarza ◽  
Alex Alfieri
Keyword(s):  
Lumbar Spine ◽  
Clinical Results ◽  
Comprehensive Overview ◽  
Minimally Invasive Surgical ◽  
Interspinous Implants ◽  
Wide Range ◽  
Spine Diseases ◽  
Lumbar Spinal ◽  
Foraminal Height ◽  
Rate Of Failure

A large number of interspinous process devices (IPD) have been recently introduced to the lumbar spine market as an alternative to conventional decompressive surgery in managing symptomatic lumbar spinal pathology, especially in the older population. Despite the fact that they are composed of a wide range of different materials including titanium, polyetheretherketone, and elastomeric compounds, the aim of these devices is to unload spine, restoring foraminal height, and stabilize the spine by distracting the spinous processes. Although the initial reports represented the IPD as a safe, effective, and minimally invasive surgical alternative for relief of neurological symptoms in patients with low back degenerative diseases, recent studies have demonstrated less impressive clinical results and higher rate of failure than initially reported. The purpose of this paper is to provide a comprehensive overview on interspinous implants, their mechanisms of action, safety, cost, and effectiveness in the treatment of lumbar stenosis and degenerative disc diseases.

Degenerative lumbar spinal stenosis: analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression

2007 ◽  
Vol 7 (6) ◽  
pp. 579-586 ◽  
Author(s):  
Francesco Costa ◽  
Marco Sassi ◽  
Andrea Cardia ◽  
Alessandro Ortolina ◽  
Antonio De Santis ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Surgical Technique ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Consecutive Series ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Neurological Improvement ◽  
Minimally Invasive Surgical ◽  
Lumbar Spinal

Object Surgical decompression is the recommended treatment in patients with moderate to severe degenerative lumbar spinal stenosis (DLSS) in whom symptoms do not respond to conservative therapy. Multilevel disease, poor patient health, and advanced age are generally considered predictors of a poor outcome after surgery, essentially because of a surgical technique that has always been considered invasive and prone to causing postoperative instability. The authors present a minimally invasive surgical technique performed using a unilateral approach for lumbar decompression. Methods A retrospective study was conducted of data obtained in a consecutive series of 473 patients treated with unilateral microdecompression for DLSS over a 5-year period (2000–2004). Clinical outcome was measured using the Prolo Economic and Functional Scale and the visual analog scale (VAS). Radiological follow-up included dynamic x-ray films of the lumbar spine and, in some cases, computed tomography scans. Results Follow-up was completed in 374 (79.1%) of 473 patients—183 men and 191 women. A total of 520 levels were decompressed: 285 patients (76.2%) presented with single-level stenosis, 86 (22.9%) with two-level stenosis, and three (0.9%) with three-level stenosis. Three hundred twenty-nine patients (87.9%) experienced a clinical benefit, which was defined as neurological improvement in VAS and Prolo Scale scores. Only three patients (0.8%) reported suffering segmental instability at a treated level, but none required surgical stabilization, and all were successfully treated conservatively. Conclusions Evaluation of the results indicates that unilateral microdecompression of the lumbar spine offers a significant improvement for patients with DLSS, with a lower rate of complications.

scholarly journals Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: Assessment of functional outcome following lumbar fusion

2014 ◽  
Vol 21 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Zoher Ghogawala ◽  
Daniel K. Resnick ◽  
William C. Watters ◽  
Praveen V. Mummaneni ◽  
Andrew T. Dailey ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Functional Outcome ◽  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Minimum Clinically Important Difference ◽  
Degenerative Disease ◽  
Psychological State ◽  
Lumbar Spinal Fusion ◽  
Patient Reported ◽  
Lumbar Spinal

Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.

scholarly journals What Do Meditators Do When They Meditate? Proposing a Novel Basis for Future Meditation Research

Mindfulness ◽  
2021 ◽  
Author(s):  
Karin Matko ◽  
Ulrich Ott ◽  
Peter Sedlmeier
Keyword(s):  
Qualitative Study ◽  
Quantitative Study ◽  
Literature Search ◽  
Comprehensive Overview ◽  
Contemplative Practices ◽  
Comprehensive List ◽  
Scientific Investigations ◽  
Wide Range ◽  
Vast Range ◽  
Selection Of

Abstract Objectives Meditation is an umbrella term for a vast range of contemplative practices. Former proposals have struggled to do justice to this variety. To our knowledge, there is to date no comprehensive overview of meditation techniques spanning all major traditions. The present studies aimed at providing such a comprehensive list of meditation techniques. Methods In a qualitative study, we compiled a collection of 309 meditation techniques through a literature search and interviews with 20 expert meditators. Then, we reduced this collection to 50 basic meditation techniques. In a second, quantitative study, 635 experienced meditators from a wide range of meditative backgrounds indicated how much experience they had with each of these 50 meditation techniques. Results Meditators’ responses indicated that our choice of techniques had been adequate and only two techniques had to be added. Our additional statistical and cluster analyses illustrated preferences for specific techniques across and within diverse traditions as well as sets of techniques commonly practiced together. Body-centered techniques stood out in being of exceptional importance to all meditators. Conclusions In conclusion, we found an amazing variety of meditation techniques, which considerably surpasses previous collections. Our selection of basic meditation techniques might be of value for future scientific investigations and we encourage researchers to use this set.

scholarly journals UV Nanoimprint Lithography: Geometrical Impact on Filling Properties of Nanoscale Patterns

Nanomaterials ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 822
Author(s):  
Christine Thanner ◽  
Martin Eibelhuber
Keyword(s):  
Layer Thickness ◽  
Process Parameters ◽  
Nanoimprint Lithography ◽  
Failure Modes ◽  
Production Method ◽  
Efficient Production ◽  
Comprehensive Overview ◽  
Replication Method ◽  
Wide Range ◽  
Pattern Size

Ultraviolet (UV) Nanoimprint Lithography (NIL) is a replication method that is well known for its capability to address a wide range of pattern sizes and shapes. It has proven to be an efficient production method for patterning resist layers with features ranging from a few hundred micrometers and down to the nanometer range. Best results can be achieved if the fundamental behavior of the imprint resist and the pattern filling are considered by the equipment and process parameters. In particular, the material properties and pattern size and shape play a crucial role. For capillary force-driven filling behavior it is important to understand the influencing parameters and respective failure modes in order to optimize the processes for reliable full wafer manufacturing. In this work, the nanoimprint results obtained for different pattern geometries are compared with respect to pattern quality and residual layer thickness: The comprehensive overview of the relevant process parameters is helpful for setting up NIL processes for different nanostructures with minimum layer thickness.

scholarly journals Electrospun Fiber Scaffolds for Engineering Glial Cell Behavior to Promote Neural Regeneration

2020 ◽  
Vol 8 (1) ◽  
pp. 4
Author(s):  
Devan L. Puhl ◽  
Jessica L. Funnell ◽  
Derek W. Nelson ◽  
Manoj K. Gottipati ◽  
Ryan J. Gilbert
Keyword(s):  
Nervous System ◽  
Glial Cell ◽  
Cell Response ◽  
Electrospun Fiber ◽  
Neural Regeneration ◽  
Cell Phenotype ◽  
Comprehensive Overview ◽  
Fiber Alignment ◽  
Wide Range ◽  
Fiber Scaffolds

Electrospinning is a fabrication technique used to produce nano- or micro- diameter fibers to generate biocompatible, biodegradable scaffolds for tissue engineering applications. Electrospun fiber scaffolds are advantageous for neural regeneration because they mimic the structure of the nervous system extracellular matrix and provide contact guidance for regenerating axons. Glia are non-neuronal regulatory cells that maintain homeostasis in the healthy nervous system and regulate regeneration in the injured nervous system. Electrospun fiber scaffolds offer a wide range of characteristics, such as fiber alignment, diameter, surface nanotopography, and surface chemistry that can be engineered to achieve a desired glial cell response to injury. Further, electrospun fibers can be loaded with drugs, nucleic acids, or proteins to provide the local, sustained release of such therapeutics to alter glial cell phenotype to better support regeneration. This review provides the first comprehensive overview of how electrospun fiber alignment, diameter, surface nanotopography, surface functionalization, and therapeutic delivery affect Schwann cells in the peripheral nervous system and astrocytes, oligodendrocytes, and microglia in the central nervous system both in vitro and in vivo. The information presented can be used to design and optimize electrospun fiber scaffolds to target glial cell response to mitigate nervous system injury and improve regeneration.

Spinal anesthesia in contemporary and complex lumbar spine surgery: experience with 343 cases

2021 ◽  
pp. 1-8
Author(s):  
Jeffrey M. Breton ◽  
Calvin G. Ludwig ◽  
Michael J. Yang ◽  
T. Jayde Nail ◽  
Ron I. Riesenburger ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spinal Anesthesia ◽  
Spine Surgery ◽  
Outcome Data ◽  
Lumbar Spine Surgery ◽  
Class Iii ◽  
Instrumented Fusion ◽  
Fusion Procedure ◽  
Physical Status Classification ◽  
Wide Range

OBJECTIVE Spinal anesthesia (SA) is an alternative to general anesthesia (GA) for lumbar spine surgery, including complex instrumented fusion, although there are relatively few outcome data available. The authors discuss their experience using SA in a modern complex lumbar spine surgery practice to describe its utility and implementation. METHODS Data from patients receiving SA for lumbar spine surgery by one surgeon from March 2017 to December 2020 were collected via a retrospective chart review. Cases were divided into nonfusion and fusion procedure categories and analyzed for demographics and baseline medical status; pre-, intra-, and postoperative events; hospital course, including Acute Pain Service (APS) consults; and follow-up visit outcome data. RESULTS A total of 345 consecutive lumbar spine procedures were found, with 343 records complete for analysis, including 181 fusion and 162 nonfusion procedures and spinal levels from T11 through S1. The fusion group was significantly older (mean age 65.9 ± 12.4 vs 59.5 ± 15.4 years, p < 0.001) and had a significantly higher proportion of patients with American Society of Anesthesiologists (ASA) Physical Status Classification class III (p = 0.009) than the nonfusion group. There were no intraoperative conversions to GA, with infrequent need for a second dose of SA preoperatively (2.9%, 10/343) and rare preoperative conversion to GA (0.6%, 2/343) across fusion and nonfusion groups. Rates of complications during hospitalization were comparable to those seen in the literature. The APS was consulted for 2.9% (10/343) of procedures. An algorithm for the integration of SA into a lumbar spine surgery practice, from surgical and anesthetic perspectives, is also offered. CONCLUSIONS SA is a viable, safe, and effective option for lumbar spine surgery across a wide range of age and health statuses, particularly in older patients and those who want to avoid GA. The authors’ protocol, based in part on the largest set of data currently available describing complex instrumented fusion surgeries of the lumbar spine completed under SA, presents guidance and best practices to integrate SA into contemporary lumbar spine practices.

scholarly journals Incidence of Iatrogenic Lumbar Spinal Instability after Laminectomy, Discectomy or Facetectomy

2021 ◽  
Vol 9 (B) ◽  
pp. 588-592
Author(s):  
Ahmed A. Hafez ◽  
Ahmed Hamdy Ashry ◽  
Ahmed Elsayed ◽  
Amr El Tayeb ◽  
Mohamed Badran Abdel Salam ElShenawy
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Prospective Study ◽  
Lumbar Spine Surgery ◽  
Spinal Instability ◽  
Lumbar Stenosis ◽  
University Hospitals ◽  
Lumbar Spinal ◽  
A Prospective Study ◽  
Postoperative Instability

OBJECTIVE: This thesis aim to report the incidence of iatrogenic spinal instability that occurs after laminectomy, discectomy or facetectomy in Lumbar spine surgery. METHODS: This is a prospective study of 50 cases of degenerative lumbar spondylosis complaining of various symptoms of claudication, sciatica and back pain which were surgically managed by laminectomy according to the level of stenosis in the period between October 2018 and October 2020 in the neurosurgery department at Cairo university hospitals. Mesial facetectomy was added according to the degree of stenosis if needed. Some patients needed discectomy if sciatica was an eminent symptom. RESULTS: Out of 50 patients included: 9 patients (18%) developed postoperative instability. The number of levels operated on and the degree of mesial facetectomy were found to be variables that may affect postoperative stability. CONCLUSION: Iatrogenic instability may result from large laminectomy and extensive facetectomy for lumbar stenosis in patients who do not have obvious pre-existing instability. Key words: Iatrogenic spinal instability - Laminectomy - conventional open discectomy - Mesial facetectomy.

scholarly journals Insights into Clinical, Genetic, and Pathological Aspects of Hereditary Spastic Paraplegias: A Comprehensive Overview

2021 ◽  
Vol 8 ◽  
Author(s):  
Liena E. O. Elsayed ◽  
Isra Zuhair Eltazi ◽  
Ammar E. Ahmed ◽  
Giovanni Stevanin
Keyword(s):  
Clinical Symptoms ◽  
Disease Onset ◽  
Lower Limbs ◽  
Special Focus ◽  
Clinical Genetic ◽  
Comprehensive Overview ◽  
Functional Studies ◽  
Hereditary Spastic Paraplegias ◽  
Wide Range ◽  
Complex Forms

Hereditary spastic paraplegias (HSP) are a heterogeneous group of motor neurodegenerative disorders that have the core clinical presentation of pyramidal syndrome which starts typically in the lower limbs. They can present as pure or complex forms with all classical modes of monogenic inheritance reported. To date, there are more than 100 loci/88 spastic paraplegia genes (SPG) involved in the pathogenesis of HSP. New patterns of inheritance are being increasingly identified in this era of huge advances in genetic and functional studies. A wide range of clinical symptoms and signs are now reported to complicate HSP with increasing overall complexity of the clinical presentations considered as HSP. This is especially true with the emergence of multiple HSP phenotypes that are situated in the borderline zone with other neurogenetic disorders. The genetic diagnostic approaches and the utilized techniques leave a diagnostic gap of 25% in the best studies. In this review, we summarize the known types of HSP with special focus on those in which spasticity is the principal clinical phenotype (“SPGn” designation). We discuss their modes of inheritance, clinical phenotypes, underlying genetics, and molecular pathways, providing some observations about therapeutic opportunities gained from animal models and functional studies. This review may pave the way for more analytic approaches that take into consideration the overall picture of HSP. It will shed light on subtle associations that can explain the occurrence of the disease and allow a better understanding of its observed variations. This should help in the identification of future biomarkers, predictors of disease onset and progression, and treatments for both better functional outcomes and quality of life.

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