scholarly journals PEEK versus Silicon Interspinous Spacer for Reduction of Supradjacent Segment Degeneration following Decompression and Short-Segment Instrumentation for Degenerative Lumbar Spinal Stenosis

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Panagiotis Korovessis ◽  
Vasileios Syrimpeis ◽  
Vasileios Tsekouras ◽  
Konstantinos Vardakastanis ◽  
Peter Fennema
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Interspinous Spacer ◽  
Additional Surgery ◽  
Spinopelvic Balance ◽  
Lumbar Spinal

Purpose. A retrospective study that aims to report Adjacent Segment Degeneration (ASD) incidence and spinopelvic balance in short lumbosacral instrumentation for degenerative lumbar spinal stenosis. Although ASD is a common complication following lumbar fusion, the effect of an interspinous spacer (IS) in the supradjacent segment in short lumbosacral instrumented fusion and its interaction with spinopelvic balance has not been studied adequately. Methods. From 55 consecutive age-, diagnosis-, and gender-matched patients aged 60±11 years, 17 (Group R) received PEEK IS; 18 (Group S) received Silicon IS compared with 20 controls (Group C) without receiving any IS. The functional outcome was evaluated with VAS and ODI. Spinopelvic balance was evaluated using SVA, T12-S1 LL, SS, PT, PI, and supradjacent segment disc heights. All spines were preoperatively balanced (SVA<40 mm). Results. The follow-up averaged out to 56±11 months. VAS and ODI scores improved postoperatively in all 3 groups. SS and anterior disc height in the supradjacent free segment increased postoperatively compensatory to spinal alterations. Although 6, 4, and 5 patients from Groups R, S, and C, respectively, showed radiological progression of the preoperative degeneration grade in the supradjacent disc, only 2, 1, and 2 patients in Groups R, S, and C, respectively, developed symptomatic ASD in the 1st supradjacent segment solely. No additional surgery was required in any patient. Conclusion. ASD incidence in the supradjacent segment following short lumbar fusion did not statistically significantly differ between PEEK and Silicon IS. There was a trend towards lower ASD incidence in Silicon IS. IS reduced ASD in both 1st and 2nd supradjacent segments. The authors speculate that soft stabilization provided by IS may be more advantageous for preventing ASD. This trial is registered with ClinicalTrials.govNCT03477955.

scholarly journals Clinical efficacy and radiographic K-Rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis

2020 ◽  
Author(s):  
Chaohua Fu ◽  
Tianju Chen ◽  
Yuhao Yang ◽  
Hua Yang ◽  
Maohui Diao ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Lordosis ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Rigid System ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal ◽  
Rigid Group

Abstract Background: This study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS).Methods: A total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n=25) and rigid systems (n=15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system. Results: JOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system. Conclusions: Compared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.

scholarly journals Clinical efficacy and radiographic K-Rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis

2020 ◽  
Author(s):  
Chaohua Fu ◽  
Tianju Chen ◽  
Yuhao Yang ◽  
Hua Yang ◽  
Maohui Diao ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Lordosis ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Rigid System ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal ◽  
Rigid Group

Abstract Background: This study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS). Methods: A total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n=25) and rigid systems (n=15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system. Results: JOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system. Conclusions: Compared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.

scholarly journals Outcomes of Revision Surgery Following Instrumented Posterolateral Fusion in Degenerative Lumbar Spinal Stenosis: A Comparative Analysis between Pseudarthrosis and Adjacent Segment Disease

2017 ◽  
Vol 11 (3) ◽  
pp. 463-471 ◽  
Author(s):  
Seung-Pyo Suh ◽  
Young-Hoon Jo ◽  
Hae Won Jeong ◽  
Won Rak Choi ◽  
Chang-Nam Kang
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Revision Surgery ◽  
Adjacent Segment Disease ◽  
Posterolateral Fusion ◽  
Adjacent Segment ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Group A ◽  
Lumbar Spinal

<sec><title>Study Design</title><p>Retrospective study.</p></sec><sec><title>Purpose</title><p>We examined the clinical and radiological outcomes of patients who received revision surgery for pseudarthrosis or adjacent segment disease (ASD) following decompression and instrumented posterolateral fusion (PLF).</p></sec><sec><title>Overview of Literature</title><p>At present, information regarding the outcomes of revision surgery for complications such as pseudarthrosis and ASD following instrumented PLF is limited.</p></sec><sec><title>Methods</title><p>This study examined 60 patients who received PLF for degenerative lumbar spinal stenosis and subsequently developed pseudarthrosis or ASD leading to revision surgery. Subjects were divided into a group of 21 patients who received revision surgery for pseudarthrosis (Group P) and a group of 39 patients who received revision surgery for ASD (Group A). Clinical outcomes were evaluated using the visual analogue scales for back pain (VAS-BP) and leg pain (VAS-LP), the Korean Oswestry disability index (K-ODI), and each patient's subjective satisfaction. Radiological outcomes were evaluated from the extent of bone union, and complications in the two groups were compared.</p></sec><sec><title>Results</title><p>VAS-LP at final follow-up was not statistically different between the two groups (<italic>p</italic> =0.353), although VAS-BP and K-ODI at final follow-up were significantly worse in Group P than in Group A (all <italic>p</italic> &lt;0.05), and only 52% of the patients in Group P felt that their overall well-being had improved following revision surgery. Fusion rates after the first revision surgery were 71% (15/21) in Group P and 95% (37/39) in Group A (<italic>p</italic> =0.018). The rate of reoperation was significantly higher in Group P (29%) than in Group A (5%) (<italic>p</italic> =0.021) due to complications.</p></sec><sec><title>Conclusions</title><p>Clinical and radiological outcomes were worse in patients who had received revision surgery for pseudarthrosis than in those who had revision surgery for ASD. Elderly patients should be carefully advised of the risks and benefits before planning revision surgery for pseudarthrosis.</p></sec>

scholarly journals The identification of novel gene mutations for degenerative lumbar spinal stenosis using whole-exome sequencing in a Chinese cohort

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Xin Jiang ◽  
Dong Chen
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Gene Mutations ◽  
Specific Gene ◽  
Single Nucleotide ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Whole Exome ◽  
Lumbar Spinal

Abstract Background Degenerative lumbar spinal stenosis (DLSS) is a common lumbar disease that requires surgery. Previous studies have indicated that genetic mutations are implicated in DLSS. However, studies on specific gene mutations are scarce. Whole-exome sequencing (WES) is a valuable research tool that identifies disease-causing genes and could become an effective strategy to investigate DLSS pathogenesis. Methods From January 2016 to December 2017, we recruited 50 unrelated patients with symptoms consistent with DLSS and 25 unrelated healthy controls. We conducted WES and exome data analysis to identify susceptible genes. Allele mutations firstly identified potential DLSS variants in controls to the patients’ group. We conducted a site-based association analysis to identify pathogenic variants using PolyPhen2, SIFT, Mutation Taster, Combined Annotation Dependent Depletion, and Phenolyzer algorithms. Potential variants were further confirmed using manual curation and validated using Sanger sequencing. Results In this cohort, the major classification variant was missense_mutation, the major variant type was single nucleotide polymorphism (SNP), and the major single nucleotide variation was C > T. Multiple SNPs in 34 genes were identified when filtered allele mutations in controls to retain only patient mutations. Pathway enrichment analyses revealed that mutated genes were mainly enriched for immune response-related signaling pathways. Using the Novegene database, site-based associations revealed several novel variants, including HLA-DRB1, PARK2, ACTR8, AOAH, BCORL1, MKRN2, NRG4, NUP205 genes, etc., were DLSS related. Conclusions Our study revealed that deleterious mutations in several genes might contribute to DLSS etiology. By screening and confirming susceptibility genes using WES, we provided more information on disease pathogenesis. Further WES studies incorporating larger DLSS patient cohorts are required to comprehend the genetic landscape of DLSS pathophysiology fully.

scholarly journals Severity of degenerative lumbar spinal stenosis affects pelvic rigidity during walking

2020 ◽  
Vol 20 (1) ◽  
pp. 112-120 ◽  
Author(s):  
Helen Bumann ◽  
Corina Nüesch ◽  
Stefan Loske ◽  
S. Kimberly Byrnes ◽  
Balázs Kovacs ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal
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