AIM: To investigate whether congenital lumbar spinal stenosis(CLSS) is associated with a specific degenerative changes of the lumbar spine. METHODS: The lumbar spine magnetic resonance imaging studies of 52 subjects w...AIM: To investigate whether congenital lumbar spinal stenosis(CLSS) is associated with a specific degenerative changes of the lumbar spine. METHODS: The lumbar spine magnetic resonance imaging studies of 52 subjects with CLSS and 48 control subjects were retrospectively evaluated. In each examination, the five lumbar levels were assessed for the presence or absence of circumferential or shallow annular bulges, annular tears, anterior or posterior disc herniations, epidural lipomatosis, Schmorl's nodes,spondylolisthesis, pars defects, and stress reactions of the posterior vertebral elements. RESULTS: Compared to control individuals, subjects with CLSS exhibited increased incidence of circumferential and shallow annular bulges, annular tears, discherniations and spondylolisthesis(P < 0.05). CONCLUSION: CLSS is associated with increased incidence of degenerative changes in specific osseous and soft-tissue elements of the lumbar spine.展开更多
BACKGROUND Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis.On the other hand,the reported rate of revision surgery after indirect decompression highl...BACKGROUND Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis.On the other hand,the reported rate of revision surgery after indirect decompression highlights the necessity of working out prediction models for the radiographic results of indirect decompression with assessing their clinical relevance.AIM To assess factors that influence radiographic and clinical results of the indirect decompression in patients with stenosis of the lumbar spine.METHODS This study is a single-center cross-sectional evaluation of 80 consecutive patients(17 males and 63 females)with lumbar spinal stenosis combined with the instability of the lumbar spinal segment.Patients underwent single level or bisegmental spinal instrumentation employing oblique lumbar interbody fusion(OLIF)with percutaneous pedicle screw fixation.Radiographic results of the indirect decompression were assessed using computerized tomography,while MacNab scale was used to assess clinical results.RESULTS After indirect decompression employing anterior reconstruction using OLIF,the statistically significant increase in the disc space height,vertebral canal square,right and left lateral canal depth were detected(Р<0.0001).The median(M)relative vertebral canal square increase came toМ=24.5%with 25%-75%quartile border(16.3%;33.3%)if indirect decompression was achieved by restoration of the segment height.In patients with the reduction of the upper vertebrae slip,the median of the relative increase in vertebral canal square accounted for 49.5%with 25%-75%quartile border(2.35;99.75).Six out of 80 patients(7.5%)presented with unsatisfactory results because of residual nerve root compression.The critical values for lateral recess depth and vertebral canal square that were associated with indirect decompression failure were 3 mm and 80 mm2 respectively.CONCLUSION Indirect decompression employing anterior reconstruction is achieved by the increase in disc height along the posterior boarder and reduction of the slipped vertebrae in patients with degenerative spondylolisthesis.Vertebral canal square below 80 mm2 and lateral recess depth less than 3 mm are associated with indirect decompression failures that require direct microsurgical decompression.展开更多
BACKGROUND Radiologic adjacent segment degeneration(ASDeg)can occur after spinal surgery.Adjacent segment disease(ASDis)is defined as the development of new clinical symptoms corresponding to radiographic changes adja...BACKGROUND Radiologic adjacent segment degeneration(ASDeg)can occur after spinal surgery.Adjacent segment disease(ASDis)is defined as the development of new clinical symptoms corresponding to radiographic changes adjacent to the level of previous spinal surgery.Greater pre-existing ASDeg is generally considered to result in more severe ASDis;nonetheless,whether the ASDeg status before index surgery influences the postoperative risk of revision surgery due to ASDis warrants investigation.AIM To identify possible risk factors for ASDis and verify the concept that greater preexisting ASDeg leads to more severe ASDis.METHODS Data from 212 patients who underwent posterior decompression with Dynesys stabilization from January 2006 to June 2016 were retrospectively analyzed.Patients who underwent surgery for ASDis were categorized as group A(n=13),whereas those who did not were classified as group B(n=199).Survival analysis and Cox proportional hazards models were used to compare the modified Pfirrmann grade,University of California-Los Angeles grade,body mass index,number of Dynesys-instrumented levels,and age.RESULTS The mean time of reoperation was 7.22(1.65–11.84)years in group A,and the mean follow-up period was 6.09(0.10–12.76)years in group B.No significant difference in reoperation risk was observed:Modified Pfirrmann grade 3 vs 4(P=0.53)or 4 vs 5(P=0.46)for the upper adjacent disc,University of California-Los Angeles grade 2 vs 3 for the upper adjacent segment(P=0.66),age of<60 vs>60 years(P=0.9),body mass index<25 vs>25 kg/m2(P=0.3),and sex(P=0.8).CONCLUSION Greater preexisting upper ASDeg was not associated with a higher rate of reoperation for ASDis after Dynesys surgery.Being overweight tended to increase reoperation risk after Dynesys surgery for ASDis.展开更多
文摘AIM: To investigate whether congenital lumbar spinal stenosis(CLSS) is associated with a specific degenerative changes of the lumbar spine. METHODS: The lumbar spine magnetic resonance imaging studies of 52 subjects with CLSS and 48 control subjects were retrospectively evaluated. In each examination, the five lumbar levels were assessed for the presence or absence of circumferential or shallow annular bulges, annular tears, anterior or posterior disc herniations, epidural lipomatosis, Schmorl's nodes,spondylolisthesis, pars defects, and stress reactions of the posterior vertebral elements. RESULTS: Compared to control individuals, subjects with CLSS exhibited increased incidence of circumferential and shallow annular bulges, annular tears, discherniations and spondylolisthesis(P < 0.05). CONCLUSION: CLSS is associated with increased incidence of degenerative changes in specific osseous and soft-tissue elements of the lumbar spine.
文摘BACKGROUND Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis.On the other hand,the reported rate of revision surgery after indirect decompression highlights the necessity of working out prediction models for the radiographic results of indirect decompression with assessing their clinical relevance.AIM To assess factors that influence radiographic and clinical results of the indirect decompression in patients with stenosis of the lumbar spine.METHODS This study is a single-center cross-sectional evaluation of 80 consecutive patients(17 males and 63 females)with lumbar spinal stenosis combined with the instability of the lumbar spinal segment.Patients underwent single level or bisegmental spinal instrumentation employing oblique lumbar interbody fusion(OLIF)with percutaneous pedicle screw fixation.Radiographic results of the indirect decompression were assessed using computerized tomography,while MacNab scale was used to assess clinical results.RESULTS After indirect decompression employing anterior reconstruction using OLIF,the statistically significant increase in the disc space height,vertebral canal square,right and left lateral canal depth were detected(Р<0.0001).The median(M)relative vertebral canal square increase came toМ=24.5%with 25%-75%quartile border(16.3%;33.3%)if indirect decompression was achieved by restoration of the segment height.In patients with the reduction of the upper vertebrae slip,the median of the relative increase in vertebral canal square accounted for 49.5%with 25%-75%quartile border(2.35;99.75).Six out of 80 patients(7.5%)presented with unsatisfactory results because of residual nerve root compression.The critical values for lateral recess depth and vertebral canal square that were associated with indirect decompression failure were 3 mm and 80 mm2 respectively.CONCLUSION Indirect decompression employing anterior reconstruction is achieved by the increase in disc height along the posterior boarder and reduction of the slipped vertebrae in patients with degenerative spondylolisthesis.Vertebral canal square below 80 mm2 and lateral recess depth less than 3 mm are associated with indirect decompression failures that require direct microsurgical decompression.
基金The study was approved by our institutional review board,Research Ethics Committee China Medical University and Hospital,Taichung,Taiwan(Protocol No.:CMUH108-REC2-133).
文摘BACKGROUND Radiologic adjacent segment degeneration(ASDeg)can occur after spinal surgery.Adjacent segment disease(ASDis)is defined as the development of new clinical symptoms corresponding to radiographic changes adjacent to the level of previous spinal surgery.Greater pre-existing ASDeg is generally considered to result in more severe ASDis;nonetheless,whether the ASDeg status before index surgery influences the postoperative risk of revision surgery due to ASDis warrants investigation.AIM To identify possible risk factors for ASDis and verify the concept that greater preexisting ASDeg leads to more severe ASDis.METHODS Data from 212 patients who underwent posterior decompression with Dynesys stabilization from January 2006 to June 2016 were retrospectively analyzed.Patients who underwent surgery for ASDis were categorized as group A(n=13),whereas those who did not were classified as group B(n=199).Survival analysis and Cox proportional hazards models were used to compare the modified Pfirrmann grade,University of California-Los Angeles grade,body mass index,number of Dynesys-instrumented levels,and age.RESULTS The mean time of reoperation was 7.22(1.65–11.84)years in group A,and the mean follow-up period was 6.09(0.10–12.76)years in group B.No significant difference in reoperation risk was observed:Modified Pfirrmann grade 3 vs 4(P=0.53)or 4 vs 5(P=0.46)for the upper adjacent disc,University of California-Los Angeles grade 2 vs 3 for the upper adjacent segment(P=0.66),age of<60 vs>60 years(P=0.9),body mass index<25 vs>25 kg/m2(P=0.3),and sex(P=0.8).CONCLUSION Greater preexisting upper ASDeg was not associated with a higher rate of reoperation for ASDis after Dynesys surgery.Being overweight tended to increase reoperation risk after Dynesys surgery for ASDis.
