AIM: To evaluate two simple angle measurements for predicting lumbosacral transitional vertebra (LSTV) in magnetic resonance imaging (MRI) studies of the spine. METHODS: The lumbar spine MRI studies of 50 subjects wit...AIM: To evaluate two simple angle measurements for predicting lumbosacral transitional vertebra (LSTV) in magnetic resonance imaging (MRI) studies of the spine. METHODS: The lumbar spine MRI studies of 50 subjects with LSTV and 50 subjects with normal lumbosacral anatomy were retrospectively evaluated. In each study, the mid-sagittal T2-weighted image was used to measure the angle formed by a line parallel to the superior surface of the sacrum and a line perpendicular to the axis of the scan table (A-angle), as well as the angle formed by a line parallel to the superior endplate of the L3 vertebra and a line parallel to the superior surface of the sacrum (B-angle). RESULTS: The total study population consisted of 100 subjects (46 males, 54 females, 51 ± 16 years old). There were no differences in age and sex between the two groups. Both A-angle and B-angle were significantly increased in subjects with LSTV compared to controls (P < 0.05). The optimal cut-off values of A-angle and B-angle for the prediction of LSTV were 39.8° (sensitivity = 80%, specificity = 80%, accuracy = 83%; 95% confidence interval = 74%-89%, P = 0.0001) and 35.9° (sensitivity = 80%, specificity = 54%, accuracy = 69%; 95% confidence interval = 59%-78%, P = 0.0005), respectively. CONCLUSION: On sagittal MR images of the lumbar spine, an increased A-angle and/or B-angle should alert the radiologist to the presence of LSTV.展开更多
BACKGROUND The majority of published data report the results of biomechanical tests of various design pedicle screw performance.The clinical relevance and relative contribution of screw design to instrumentation stabi...BACKGROUND The majority of published data report the results of biomechanical tests of various design pedicle screw performance.The clinical relevance and relative contribution of screw design to instrumentation stability have been insufficiently studied.AIM To estimate the contribution of screw design to rate of pedicle screw loosening in patients with degenerative diseases of the lumbar spine.METHODS This study is a prospective evaluation of 175 patients with degenerative diseases and instability of the lumbar spine segments.Participants underwent spinal instrumentation employing pedicle screws with posterior only or transforaminal interbody fusion.Follow-up was for 18 mo.Patients with signs of pedicle screw loosening on computed tomography were registered;logistic regression analysis was used to identify the factors that influenced the rate of loosening.RESULTS Parameters included in the analysis were screw geometry,type of thread,external and internal screw diameter and helical pitch,bone density in Hounsfield units,number of levels fused,instrumentation without anterior support,laminectomy,and unilateral and bilateral total facet joint resection.The rate of screw loosening decreased with the increment in outer diameter,decrease in core diameter and helical pitch.The rate of screw loosening correlated positively with the number of fused levels and decreasing bone density.Bilateral facet joint removal significantly favored pedicle screw loosening.The influence of other factors was insignificant.CONCLUSION Screw parameters had a significant impact on the loosening rate along with bone quality characteristics,the number of levels fused and the extensiveness of decompression.The significance of the influence of screw parameters was comparable to those of patient-and surgery-related factors.Pedicle screw loosening was influenced by helical pitch,inner and outer diameter,but screw geometry and thread type were insignificant factors.展开更多
As the elderly population continues to grow, the number of patients with low back pain is gradually increasing. Among them, Lumbar Degenerative Diseases (LDD) is one of the major contributors to low back pain. Biomech...As the elderly population continues to grow, the number of patients with low back pain is gradually increasing. Among them, Lumbar Degenerative Diseases (LDD) is one of the major contributors to low back pain. Biomechanical in vivo studies of the lumbar spine are mainly performed by implants or imaging data to record the real-time changes of form and stress on the intervertebral disc during motion. However, the current developments are slow due to the technological and ethical limitations. In vitro experiments include animal experiments and cadaver experiments, which are difficult to operate or differ greatly from normal human structures, and the results still need to be verified repeatedly to test their accuracy. As for finite element method, it is relatively low cost and can repeat the experimental results. Therefore, we believe that finite element analysis plays an extremely important role in biomechanical research, especially in analyzing the relationship between different surgical models and the degeneration caused by different mechanics.展开更多
Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western wor...Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology andsurgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine.展开更多
Purpose: Implant subsidence is a possible complication of spinal interbody fusion. We aim to evaluate porous titanium cages subsidence, fusion and functional outcomes in patients subjected to oblique lumbar interbody ...Purpose: Implant subsidence is a possible complication of spinal interbody fusion. We aim to evaluate porous titanium cages subsidence, fusion and functional outcomes in patients subjected to oblique lumbar interbody fusion (OLIF) with these novel devices. Methods: Our institutional review board approved a single-center experience which included 60 patients who underwent OLIF from June 2018 to June 2020 utilizing the porous titanium implants. Data was collected in accordance with the Declaration of Helsinki, and written informed consent was obtained. Imaging studies including radiographs 1, 3, 6 and 12 months and computed tomography (CT) scan at 6 months obtained during routine postoperative follow-up visits, were studied for signs of implant subsidence, fusion and clinical parameters to determine the effectiveness of surgery such as Oswestry disability index (ODI). Results: Radiographic subsidence occurred in 1 out of 89 porous titanium interbody cages (1.1%). No subsidence was observed in the posterior screws and rods fixation group (N = 57). However, one case of subsidence occurred in the lateral plate fixation group (N = 3). The subsidence occurred in an osteoporotic elderly patient operated for adjacent segment disease, and she was later revised with posterior instrumentation using cemented screws and rods. She had an uneventful recovery. Fusion rates were evaluated under CT scan at 6 months with a rate of 88%. In terms of clinical outcomes, ODI decreased significantly from 20.3 preop to 10.7 postop with a P-value Conclusions: In our study, the subsidence rate was lower than previously reported in the literature. Also, we had good fusion rates at 6 months likely due to the porous titanium cages use. We had no subsidence in the posterior instrumented group and one case in the lateral fixation group with improved clinical outcomes.展开更多
目的探讨单侧双通道脊柱内镜(UBE)治疗退行性腰椎疾病(DLD)术后疗效与影响因素关系。方法对2021年2月至2023年3月收治本科室的61例DLD患者进行回顾性分析,评价其术后疗效。随访时间12~38个月。男35个,女26个,年龄19~81岁,平均年龄54.4...目的探讨单侧双通道脊柱内镜(UBE)治疗退行性腰椎疾病(DLD)术后疗效与影响因素关系。方法对2021年2月至2023年3月收治本科室的61例DLD患者进行回顾性分析,评价其术后疗效。随访时间12~38个月。男35个,女26个,年龄19~81岁,平均年龄54.4岁。手术节段均为单节段,共61节段。记录患者围手术期及手术并发症情况;随访以末次随访为终止时间。采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和改良MacNab标准评价临床疗效;手术前后行腰椎CT三维重建检查,观察并测量关节突关节切除内侧角(β角);椎间盘类型按照分类定位系统MSU(Michgan State University)基于MRI横断位分A、B、C区,依据区域定位法FSU(Functional Spine Unit)基于MRI或CT横断位、矢状位分级1~4级;统计采用配对t检验,及方差分析。结果61例患者均顺利完成手术。其中行腰椎间盘突出手术61例,其中合并中央管狭窄29例,合并侧隐窝狭窄54例。术中出现硬膜囊撕裂2例。术后出现短暂性下肢麻木3例,类脊髓综合征1例,感染1例。患者术后随访(12~38)个月。术后随访时,患者腿部VAS、ODI较术前明显下降(P值均<0.05)。术后末次随访时依据改良MacNab标准,优良率为65.6%(40/61)。腰椎三维CT影像学方面,测量β角均小于90°,平均值83.59°,范围(66.72°~89.32°)。基于MSU分区,A区37例,B区15例,C区9例;基于FSU位置分级,分别为1级1例,2级25例,3级2例,合并1和2级26例,2和3级4例,1和2、3级3例。方差分析显示术后满意度与椎间盘分区及分级、β角无关,与术后疼痛及功能障碍指数相关。结论单侧双通道脊柱内镜治疗退行性腰椎疾病术后疗效可能与术后β角及椎间盘分区、分级无关。分级、分区越复杂,手术难度越大,早期开展这项技术遇到的困难可能越多。展开更多
目的本研究通过分析膝骨关节炎(knee osteoarthritis,KOA)患者西安大略和麦克马斯特大学(the Western Ontario and McMaster universities,WOMAC)关节炎指数与冠状位下肢力线角度及腰椎生物力学因素的相关性,为临床诊治KOA提供新思路。...目的本研究通过分析膝骨关节炎(knee osteoarthritis,KOA)患者西安大略和麦克马斯特大学(the Western Ontario and McMaster universities,WOMAC)关节炎指数与冠状位下肢力线角度及腰椎生物力学因素的相关性,为临床诊治KOA提供新思路。方法选自2022年10月至2023年5月就诊于河北中医药大学第一附属医院骨伤三科门诊且符合入组标准的267例KOA患者,其中男49例,女218例;年龄50~83岁,平均(61.55±8.72)岁。拍摄腰椎联合双下肢全长正位负重位X线片,观察腰骶偏移方向,测量冠状位下肢力线角度:髋膝踝角(hip knee ankle,HKA)、机械轴偏移距离(mechanical axis deviation,MAD)、关节线相交角(joint line convergence angle,JLCA)以及腰椎生物力学因素:腰骶偏移距离(lumbosacral offset distance,LOD)、腰膝偏移距离(waist and knee offset distance,WKOD),并对受试者进行WOMAC评分及基线资料记录,分析其与冠状位力线角度及腰椎生物力学因素的相关性。结果腰骶偏移方向与KOA疼痛严重侧存在相关性(P<0.05,r=0.569),LOD、WKOD、HKA、MAD、JLCA、病程与WOMAC评分均存在相关性(P<0.05,r值分别为:0.585、0.579、-0.156、0.173、0.175、0.189)。结论KOA患者关节疼痛、功能受限与腰椎重心的偏移及下肢力线角度存在相关性,KOA患者关节僵硬程度与病程存在相关性,其腰椎冠状位重心偏移是诱发或加重KOA的危险因素之一。展开更多
文摘AIM: To evaluate two simple angle measurements for predicting lumbosacral transitional vertebra (LSTV) in magnetic resonance imaging (MRI) studies of the spine. METHODS: The lumbar spine MRI studies of 50 subjects with LSTV and 50 subjects with normal lumbosacral anatomy were retrospectively evaluated. In each study, the mid-sagittal T2-weighted image was used to measure the angle formed by a line parallel to the superior surface of the sacrum and a line perpendicular to the axis of the scan table (A-angle), as well as the angle formed by a line parallel to the superior endplate of the L3 vertebra and a line parallel to the superior surface of the sacrum (B-angle). RESULTS: The total study population consisted of 100 subjects (46 males, 54 females, 51 ± 16 years old). There were no differences in age and sex between the two groups. Both A-angle and B-angle were significantly increased in subjects with LSTV compared to controls (P < 0.05). The optimal cut-off values of A-angle and B-angle for the prediction of LSTV were 39.8° (sensitivity = 80%, specificity = 80%, accuracy = 83%; 95% confidence interval = 74%-89%, P = 0.0001) and 35.9° (sensitivity = 80%, specificity = 54%, accuracy = 69%; 95% confidence interval = 59%-78%, P = 0.0005), respectively. CONCLUSION: On sagittal MR images of the lumbar spine, an increased A-angle and/or B-angle should alert the radiologist to the presence of LSTV.
文摘BACKGROUND The majority of published data report the results of biomechanical tests of various design pedicle screw performance.The clinical relevance and relative contribution of screw design to instrumentation stability have been insufficiently studied.AIM To estimate the contribution of screw design to rate of pedicle screw loosening in patients with degenerative diseases of the lumbar spine.METHODS This study is a prospective evaluation of 175 patients with degenerative diseases and instability of the lumbar spine segments.Participants underwent spinal instrumentation employing pedicle screws with posterior only or transforaminal interbody fusion.Follow-up was for 18 mo.Patients with signs of pedicle screw loosening on computed tomography were registered;logistic regression analysis was used to identify the factors that influenced the rate of loosening.RESULTS Parameters included in the analysis were screw geometry,type of thread,external and internal screw diameter and helical pitch,bone density in Hounsfield units,number of levels fused,instrumentation without anterior support,laminectomy,and unilateral and bilateral total facet joint resection.The rate of screw loosening decreased with the increment in outer diameter,decrease in core diameter and helical pitch.The rate of screw loosening correlated positively with the number of fused levels and decreasing bone density.Bilateral facet joint removal significantly favored pedicle screw loosening.The influence of other factors was insignificant.CONCLUSION Screw parameters had a significant impact on the loosening rate along with bone quality characteristics,the number of levels fused and the extensiveness of decompression.The significance of the influence of screw parameters was comparable to those of patient-and surgery-related factors.Pedicle screw loosening was influenced by helical pitch,inner and outer diameter,but screw geometry and thread type were insignificant factors.
文摘As the elderly population continues to grow, the number of patients with low back pain is gradually increasing. Among them, Lumbar Degenerative Diseases (LDD) is one of the major contributors to low back pain. Biomechanical in vivo studies of the lumbar spine are mainly performed by implants or imaging data to record the real-time changes of form and stress on the intervertebral disc during motion. However, the current developments are slow due to the technological and ethical limitations. In vitro experiments include animal experiments and cadaver experiments, which are difficult to operate or differ greatly from normal human structures, and the results still need to be verified repeatedly to test their accuracy. As for finite element method, it is relatively low cost and can repeat the experimental results. Therefore, we believe that finite element analysis plays an extremely important role in biomechanical research, especially in analyzing the relationship between different surgical models and the degeneration caused by different mechanics.
文摘Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology andsurgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine.
文摘Purpose: Implant subsidence is a possible complication of spinal interbody fusion. We aim to evaluate porous titanium cages subsidence, fusion and functional outcomes in patients subjected to oblique lumbar interbody fusion (OLIF) with these novel devices. Methods: Our institutional review board approved a single-center experience which included 60 patients who underwent OLIF from June 2018 to June 2020 utilizing the porous titanium implants. Data was collected in accordance with the Declaration of Helsinki, and written informed consent was obtained. Imaging studies including radiographs 1, 3, 6 and 12 months and computed tomography (CT) scan at 6 months obtained during routine postoperative follow-up visits, were studied for signs of implant subsidence, fusion and clinical parameters to determine the effectiveness of surgery such as Oswestry disability index (ODI). Results: Radiographic subsidence occurred in 1 out of 89 porous titanium interbody cages (1.1%). No subsidence was observed in the posterior screws and rods fixation group (N = 57). However, one case of subsidence occurred in the lateral plate fixation group (N = 3). The subsidence occurred in an osteoporotic elderly patient operated for adjacent segment disease, and she was later revised with posterior instrumentation using cemented screws and rods. She had an uneventful recovery. Fusion rates were evaluated under CT scan at 6 months with a rate of 88%. In terms of clinical outcomes, ODI decreased significantly from 20.3 preop to 10.7 postop with a P-value Conclusions: In our study, the subsidence rate was lower than previously reported in the literature. Also, we had good fusion rates at 6 months likely due to the porous titanium cages use. We had no subsidence in the posterior instrumented group and one case in the lateral fixation group with improved clinical outcomes.
文摘目的探讨单侧双通道脊柱内镜(UBE)治疗退行性腰椎疾病(DLD)术后疗效与影响因素关系。方法对2021年2月至2023年3月收治本科室的61例DLD患者进行回顾性分析,评价其术后疗效。随访时间12~38个月。男35个,女26个,年龄19~81岁,平均年龄54.4岁。手术节段均为单节段,共61节段。记录患者围手术期及手术并发症情况;随访以末次随访为终止时间。采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和改良MacNab标准评价临床疗效;手术前后行腰椎CT三维重建检查,观察并测量关节突关节切除内侧角(β角);椎间盘类型按照分类定位系统MSU(Michgan State University)基于MRI横断位分A、B、C区,依据区域定位法FSU(Functional Spine Unit)基于MRI或CT横断位、矢状位分级1~4级;统计采用配对t检验,及方差分析。结果61例患者均顺利完成手术。其中行腰椎间盘突出手术61例,其中合并中央管狭窄29例,合并侧隐窝狭窄54例。术中出现硬膜囊撕裂2例。术后出现短暂性下肢麻木3例,类脊髓综合征1例,感染1例。患者术后随访(12~38)个月。术后随访时,患者腿部VAS、ODI较术前明显下降(P值均<0.05)。术后末次随访时依据改良MacNab标准,优良率为65.6%(40/61)。腰椎三维CT影像学方面,测量β角均小于90°,平均值83.59°,范围(66.72°~89.32°)。基于MSU分区,A区37例,B区15例,C区9例;基于FSU位置分级,分别为1级1例,2级25例,3级2例,合并1和2级26例,2和3级4例,1和2、3级3例。方差分析显示术后满意度与椎间盘分区及分级、β角无关,与术后疼痛及功能障碍指数相关。结论单侧双通道脊柱内镜治疗退行性腰椎疾病术后疗效可能与术后β角及椎间盘分区、分级无关。分级、分区越复杂,手术难度越大,早期开展这项技术遇到的困难可能越多。
文摘目的本研究通过分析膝骨关节炎(knee osteoarthritis,KOA)患者西安大略和麦克马斯特大学(the Western Ontario and McMaster universities,WOMAC)关节炎指数与冠状位下肢力线角度及腰椎生物力学因素的相关性,为临床诊治KOA提供新思路。方法选自2022年10月至2023年5月就诊于河北中医药大学第一附属医院骨伤三科门诊且符合入组标准的267例KOA患者,其中男49例,女218例;年龄50~83岁,平均(61.55±8.72)岁。拍摄腰椎联合双下肢全长正位负重位X线片,观察腰骶偏移方向,测量冠状位下肢力线角度:髋膝踝角(hip knee ankle,HKA)、机械轴偏移距离(mechanical axis deviation,MAD)、关节线相交角(joint line convergence angle,JLCA)以及腰椎生物力学因素:腰骶偏移距离(lumbosacral offset distance,LOD)、腰膝偏移距离(waist and knee offset distance,WKOD),并对受试者进行WOMAC评分及基线资料记录,分析其与冠状位力线角度及腰椎生物力学因素的相关性。结果腰骶偏移方向与KOA疼痛严重侧存在相关性(P<0.05,r=0.569),LOD、WKOD、HKA、MAD、JLCA、病程与WOMAC评分均存在相关性(P<0.05,r值分别为:0.585、0.579、-0.156、0.173、0.175、0.189)。结论KOA患者关节疼痛、功能受限与腰椎重心的偏移及下肢力线角度存在相关性,KOA患者关节僵硬程度与病程存在相关性,其腰椎冠状位重心偏移是诱发或加重KOA的危险因素之一。
