Disc height and sagittal alignment in operated and non-operated levels in the lumbar spine at long-term follow-up: a case-control study

Brief review

이 논문은 요추유합술을 시행한 환자 3명과 시행하지 않은 환자 25명을 수술시행 9년 후 추적관찰하여 임상적, 방사선학적 결과를 측정한 연구 입니다.

방사선학적 결과는 Distortion Compensated Roentgen Analysis (DCRA)라고 하는 지표를 이용해서 측정했고 임상적 결과는 ODI, VAS(back)으로 측정하였습니다.

결과적으로 디스크의 높이는 유합술을 시행한 환자의 모든 분절에서 감소하였으며,

유합술을 시행한 환자와 시행하지 않은 환자간의 디스크의 높이나 시상면 정렬에는 차이가 없었습니다.

요추 디스크의 퇴행은 유합술을 시행 9년 후, 해당 환자의 모든 분절에서 증가하였으며, 임상결과 또한 좋지 않다는 결론 입니다.

이 논문에서는 방사선학적 변수(disc height, sagittal alignment 등)을 측정 시 DCRA라고 하는 지표를 사용한 점이 특징 입니다. DCRA에 대한 자세한 측정 방법은 아래의 그림 참고하세요.

*Title: Disc height and sagittal alignment in operated and non-operated levels in the lumbar spine at long-term follow-up: a case-control study

요추 수술 분절과 비 수술 분절에서의 디스크의 높이와 시상면 정렬에 대한 장기 추적 결과: 사례통제 연구

*Authors: Froholdt A, Brox JI, Reikerås O, Leivseth G.

*Bibliography: Open OrthopJ. 2013 Jun 28;7:258-63.

PURPOSE

To compare lumbar disc degeneration at 9-year follow-up in patients with chronic low back pain who had instrumented lumbar fusion or no fusion.

MATERIAL AND METHODOLOGY

1. The main outcomes: 1)disc height, 2)sagittal alignment

-measured by Distortion Compensated Roentgen Analysis (DCRA)

2. Secondary outcome: Oswestry Disability Index and VAS back pain.

RESULTS

▶Subjects: 48 patients (23 fusion + 25 no fusion)

▶Follow-up period: pre and 9 year

▶including level: L2- S1

-Disc height was reduced at all levels independent of fusion.

-No difference in disc height and sagittal alignment was observed between patients fused and not fused.

-There were weak correlations, ranging from 0.04 to 0.36, between clinical and radiological parameters.

CONCLUSION

Lumbar disc degeneration increased at all measured levels independent of fusion and correlated poorly with clinical outcome.

Clinical analysis of percutaneous facet screw fixation after anterior lumbar interbody fusion

Brief review

이 논문은 전방경유요추체유합술 후의 경피적 나사못 고정술 시행의 임상적 결과를 연구한 내용 입니다.

percutaneous facet screw fixation 시행 그룹을 실험군으로, pedicle screw fixation 시행 그룹을 대조군으로 설정하여 수술 전, 후의 ODI(장애지수) 및 MacNab(만족도)를 조사하여 비교했습니다.

수술 시행 후 최소 2년의 기간 동안 추적조사 한 결과, 두 그룹 간에는 임상적으로 유의한 차이가 없었습니다.

percutaneous facet screw fixation은 요추체 유합술과 함께 시행할 때에 안전하고 최소침습적인 치료법이라는 결론 입니다.

*Title: Clinical analysis of percutaneous facet screw fixation after anterior lumbar interbody fusion.

전방경유 요추체 유합술 후 경피적 나사못 고정술 시행의 임상적인 분석

*Authors: JEE-SOO Jang, SANG-HO Lee.

*Bibliography: J Neurosurg Spine. 2005 Jul;3(1):40-6.

STUDY DESIGN

Retrospective study

OBJECT

To evaluate the results of percutaneous facet screw fixation (PFSF) after anterior lumbar interbody fusion (ALIF) in comparison with the post-ALIF pedicle screw fixation (PSF).

METHODS

▶Subject number: 84 patients (treated for degenerative spondylolisthesis or degenerative disc disease)

▶Grouping

-group1: 44 underwent percutaneous facet screw fixation

-group2: 40 underwent pedicle screw fixation (control group)

▶Evaluating method

-Functional outcome: using Oswestry Disability Index (ODI), Macnab criteria.

-Radiologic outcome: dynamic lateral (flexion-extension) radiography and CT scanning (to evaluate the osseous union status)

▶Follow up period: min 2 yrs

RESULTS

▶Functional outcome: ODI and Macnab outcome- no significant difference between 2 groups (p > 0.05).

-Excellent or good outcome: 40 (90.9%) of the 44 patients (Group 1) and 37 (92.5%) of the 40 patients (Group 2) (p > 0.05).

-No patient required a blood transfusion in either group.

▶Fusion rates: 95.8% (Group 1) and 97.5% (Group 2) -at 24 months after surgery

CONCLUSIONS

-There are no significant difference in clinical outcome between percutaneous facet screw fixation and pedicle screw fixation after ALIF.

-Percutaneous facet screw fixation represents a safe and minimally invasive modality with which to achieve solid fusion in the lumbar spine.

Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases

Brief review

이 논문은 퇴행성 척추질환으로 후방경유 요추 유합술을 시행한 817명의 환자 데이터를 리뷰하여 감염에 영향을 끼칠 수 있는 요소를 밝힌 논문 입니다.

감염과 연관된 요소를 밝히기 위해 ‘단계적 다변량 비례 위험도 회기 분석법’을 이용하였습니다.

결과적으로, 연령의 증가와 당뇨병, 비만, 이전의 척추수술 경험 및 재원일수의 증가 등이 후방 경유 요추 유합술 후의 감염의 위험성을 증가시킬 수 있는 요인으로 드러났습니다.

*Title: Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases

퇴행성 척추질환으로 후방 경유 요추 유합술을 시행한 817명 환자들의 감염 위험성

*Authors: Kaisorn L. Chaichana, M.D., Mohamad Bydon, M.D., David R. Santiago-Dieppa, M.D., Lee Hwang, M.D., Gregory McLoughlin, M.D., Daniel M. Sciubba, M.D., Jean-Paul Wolinsky, M.D., Ali Bydon, M.D., Ziya L. Gokaslan, M.D., and Timothy Witham, M.D.Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

*Bibliography: J Neurosurg Spine 20:45–52, 2014

Summary of Background

Posterior lumbar spinal fusion for degenerative spine disease is a common procedure, and its use is increasing annually. The rate of infection, as well as the factors associated with an increased risk of infection, remains unclear for this patient population. A better understanding of these features may help guide treatment strategies aimed at minimizing infection for this relatively common procedure.

Object

To ascertain the incidence of postoperative spinal infections and identify factors associated with postoperative spinal infections.

Methods

▶Subject: patients underwent instrumented posterior lumbar fusion for degenerative spine disease (1993~2010)

“Stepwise multivariate proportional hazards regression analysis” was used to identify factors associated with infection.

Variables with p < 0.05 were considered statistically significant.

Results

▶Total subjects: 817 patients underwent lumbar fusion

▶Infection patients: 37(4.5%)

-21 (57%) required operative intervention but only 3 (8%) required instrumentation removal as part of their infection management.

▶The factors independently associated with an increased risk of infection.

1) increasing age (RR 1.004 [95% CI 1.001–1.009], p = 0.049)

2) diabetes (RR 5.583 [95% CI 1.322–19.737], p = 0.02)

3) obesity (RR 6.216 [95% CI 1.832–9.338], p = 0.005)

4) previous spine surgery (RR 2.994 [95% CI 1.263–9.346], p = 0.009)

5) increasing duration of hospital stay (RR 1.155 [95% CI 1.076–1.230], p = 0.003)

Conclusions

-older age, diabetes, obesity, prior spine surgery, and length of hospital stay: independently associated with an increased risk of infection in lumbar fusion for degenerative spine disease

-The overwhelming majority of these patients were treated effectively without hardware removal.

The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

Brief review

*Title: The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry.

*Author: Zoher Ghogawala, Christopher I. Shaffrey, Anthony L. Asher, Robert F. Heary, Tanya Logvinenko, Neil R. Malhotra, Stephen J. Dante, R. John Hurlbert, Andrea F. Douglas, Subu N. Magge, Praveen V. Mumm aneni, Joseph S. Cheng, Justin S. Smith, Michael G. Kaiser, Khalid M. Abbed, Daniel M. Sciubba, Daniel K. Resnick

*Bibliography: J Neurosurg Spine. 2013 Nov;19(5):555-63.

Object

Purpose:

-To establish a multicenter cooperative research group.

-To demonstrate the feasibility of developing a registry to assess the efficacy of common lumbar spinal procedures.

Methods

▶Study type: Observational prospective cohort study (13 US academic, community sites)

▶Subject: Total 160 patients (lumbar disc herniation 125 + spondylolisthesis 35)

-Unselected patients undergoing lumbar discectomy or single-level fusion for spondylolisthesis.

▶Follow-up time: 1, 3, 6, 12 months after surgery

▶Evaluation method: SF-36, Oswestry Disability Index (ODI), and visual analog scale (VAS)

-pre&post

Results

-There were 198 enrolled over 1 year.

▶Median age: 45 yrs (49% female) for lumbar discectomy (n = 148)/

58 yrs (58% female) for lumbar spondylolisthesis (n = 50)

▶Complications: 12 patients (6.1%)  -At 30 days

(10 patients (6.8%) with disc herniation and 1 (2%) with spondylolisthesis)

▶Follow-up rate: 88.3% (over 1 yr)

▶Clinical outcomes(VAS, ODI, SF-36 scores): Both lumbar discectomy and single-level fusion procedures were significant improvements(p ≤ 0.0002).

▶Return to work: 80% of patients (for 1 yr).

-Flow diagram of the NeuroPoint-SD study showing enrollment and follow-up compliance rates.

Conclusions

-It is feasible to build a national spine registry for the collection of high-quality prospective data to demonstrate the effectiveness of spinal procedures in actual practice.

Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases.

Brief review

이 논문은 퇴행성 척추질환 때문에 후방경유 요추 유합술을 받은 817명의 환자에게 나타난 감염률과 감염에 영향을 끼치는 요소들을 연구한 논문 입니다.

후향적으로 환자의 데이터를 검토하여 감염률을 조사했고, 단계적 다변량 비례 위험 회귀분석법을 통하여 요추감염과 연관성이 있는 요소들을 알아냈습니다.

연구대상인 817명의 환자에 대해서는 감염률이 4.5%로 나타났고,  나이, 당뇨지수, 비만도, 이전에 척추수술을 시행했는지의 여부, 재원기간 등의 요소들이 감염에 영향을 끼치는 것으로 나타났습니다.

*Title: Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases.

퇴행성 척추질환으로 후방경유 요추 유합술을 시행한 817명의 사례에 대한 감염의 위험성

*Author: Kaisorn L. Chaichana, Mohamad Bydon, David R. Santiago-Dieppa, Lee Hwang, Gregory McLoughlin, Daniel M. Sciubb a, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan, Timothy Witham

*Bibliography: J Neurosurg Spine. 2013 Nov 8. [Epub aheadof print]

Object

The rate and factors of infection risk remains unclear for Posterior lumbar spinal fusion (for degenerative spine disease)

Purpose: To ascertain the incidence and factors of postoperative spinal infections.

Methods

▶Period: 1993 ~ 2010

▶Subject: 817 patients who underwent posterior lumbar fusion for degenerative disease.

-Retrospectively data reviewed.

-To identify the infection factors, using Stepwise multivariate proportional hazards regression analysis.

Results

1. Infection rate: 4.5%

(37 patients out of 817 patients developed postoperative spine infection at a median of 0.6 months (IQR 0.3-0.9) ).

2. Infection factors

1. age (RR 1.004 [95% CI 1.001-1.009], p = 0.049)

2. diabetes (RR 5.583 [95% CI 1.322-19.737], p = 0.02)

3. obesity (RR 6.216 [95% CI 1.832-9.338], p = 0.005)

4. previous spine surgery (RR 2.994 [95% CI 1.263-9.346], p = 0.009)

5. duration of hospital stay (RR 1.155 [95% CI 1.076-1.230], p = 0.003).

Conclusions

-Several factors were associated with an risk of infection among patients underwent lumbar fusion for degenerative disease. (factors: older age, diabetes, obesity, prior spine surgery, and length of hospital stay)