Obesity is associated with reduced disc height in the lumbar spine but not at the lumbosacral junction: 비만도는 요천추부 접합부가 아닌 요추의 디스크 높이 감소와 연관성이 있다

Brief review

이 연구는 비만도가 요천추부 접합부가 아닌 요추의 디스크 높이 감소와 연관성이 있다는 주제의 cross-sectional study 입니다.

비만도와 디스크 높이, 요천추부의 요통간의 연관성을 보기 위하여 연구 대상자 72명의 MRI를 흉추12번(T12)~천추까지 촬영하여, 이 자료를 가지고 L1-L2~L5-S1의 디스크 높이를 측정하였습니다. 또, 비만도(BMI)를 측정하였고, 이전 2주간의 요통도 평가하였습니다.

결과적으로 전체 요추 디스크의 높이가 비만인 그룹이 비만이 아닌 그룹에 비해 감소되는 양상을 보였습니다. 특히 비만도는 L1-2와 L3-L4에서 디스크 높이의 감소와 연관성을 보였고, 요천추부 접합부에서는 유의한 관련성이 없었습니다.

그리고 요추 디스크의 높이는 최근의 요통과는 유의한 연관성이 없었습니다.

비만도는 요추에서 디스크 높이의 감소와 연관성이 있지만, 요천추부 접합부에서는 관련이 없다는 결론 입니다. 초록이 너무 길다면 아래 키포인트만 보세요!

비만일수록 디스크 높이가 낮아지는 양상을 보인다면, 다양한 질환으로 이어질수도 있겠네요.. 비만은 만병의 근원!

*Title: Obesity is associated with reduced disc height in the lumbar spine but not at the lumbosacral junction

비만도는 요천추부 접합부가 아닌 요추의 디스크 높이 감소와 연관성이 있다.

*Authors: Urquhart DM, Kurniadi I, Triangto K, Wang Y, Wluka AE, OʼSullivan R, Jones G, Cicuttini FM

*Bibliography: Spine(Phila Pa 1976). 2014 Jul 15;39(16):E962-6

STUDY DESIGN

Cross-sectional, community-based study

OBJECTIVE

To investigate the relationships between obesity, disc height, and low back pain in the lumbosacral spine.

SUMMARY OF BACKGROUND DATA

Although obesity is a recognized risk factor for low back pain, our understanding of the mechanisms for this is limited.

The evidence for an association between obesity and spinal structural changes is also conflicting.

METHODS

-Seventy-two participants underwent magnetic resonance imaging from the T12 vertebral body to the sacrum. 

-Disc height was measured from L1-L2 to L5-S1.

-Body mass index(BMI) as measured and low back pain in the previous 2 weeks was assessed.

RESULTS

-연구 대상자들의 demographic data

-요천추부에서 비만도와 디스크 높이의 연관성

-요추와 요천추부 디스크 높이와 최근 요통과의 연관성

-The mean and total lumbar disc heights were reduced in obese individuals compared with nonobese individuals.

-Although obesity was associated with reduced disc heights at the L1-L2 and L3-L4 levels, there were no significant relationship at the lumbosacral junction.

-Both mean and total lumbar disc heights were negatively associated with recent pain after adjusting for age, sex, and height.

-There were no significant relationships between disc height and recent pain at the lumbosacral junction.

CONCLUSION

-Obesity was associated with reduced disc height in the lumbar spine, but not at the lumbosacral junction, suggesting these joints may have different risk factors. 

-There was also evidence for an inter-relationship between obesity, lumbar disc height, and recent pain, suggesting that structural changes have a role in back pain and may in part explain the association between obesity and back pain.

Dynamic stability of the trunk during unstable sitting in people with low back pain

Brief review

spine저널에서 이번 달에 출판된 논문 입니다.

*Title: Dynamic stability of the trunk during unstable sitting in people with low back pain

*Authors: Freddolini Marco, Strike Siobhan, Lee Raymond

*Bibliography: Spine (Phila Pa 1976). 2014 May1;39(10):785-90.

STUDY DESIGN

Cross-sectional study

OBJECTIVE

To evaluate the dynamic stability and kinematics of the trunk during unstable sitting.

To determine the differences in these biomechanical parameters between healthy participants and participants with low back pain (LBP).

SUMMARY OF BACKGROUND DATA

Patients with LBP exhibited alterations in trunk kinematics while performing different dynamic tasks and in static posture as a result of pain. It is not clear if changing in trunk motion may reduce postural control and the ability to perform a balancing task.

METHODS

Group1: 23 participants with LBP

Group2: 31 healthy participants

*Protocol:

1) participants were sitted on a custom-made swinging chair

2) To regain the balance after tilting the chair backward for 10° and 20°

-Lumbar spine, pelvis, and chair motions were recorded using FASTRAK sensors.

-The thoracolumbar curvature of all participants was also evaluated in the standing position.

-The angular displacement of the chair was fitted in an equation describing the underdamped second-order response to a step input.

RESULTS

Kinematic analysis showed that the hip range of motion increased whereas spine range of motion angle decreased in participants with LBP for both tilt angles (P < 0.05). There were no significant differences between the 2 subject groups in the time required to regain balance, and the natural frequency and damping ratio of the kinematic equation. Lumbar lordosis significantly decreased in LBP group.

CONCLUSION

Participants with LBP showed trunk postural and movement adaptations that seems to be compensatory strategies to decrease the risk of further injuries and aggravation of the symptoms, but their ability to regain the balance was not affected by LBP. Clinicians should encourage patients with LBP to remain active while they are experiencing pain.

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.

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) 

Clinical and Radiologic Outcomes of TLIF Applications With or Without Pedicle Screw: A Double Center Prospective Pilot Comparative Study

Brief review

*Title: Clinical and Radiologic Outcomes of TLIF Applications With or Without Pedicle Screw: A Double Center Prospective Pilot Comparative Study

척추경나사 사용 유무에 따른 추간공경유 요추 유합술의 임상적, 방사선학적 결과

: 두 기관의 예비 전향적 비교 연구

*Author: Kadir Kotil, Mustafa Ali Akc¸etin, Yildiray Savas

*Bibliography: J Spinal Disord Tech. 2013Oct;26(7):359-66.

STUDY DESIGN

Prospective cohort data by merging data from comparative studies.

OBJECTIVE

To compare clinical and radiologic outcomes of the transforaminal lumbar interbody fusion (TLIF) procedure with or without pedicle screw support in stable patients with a degenerative disease.

SUMMARY OF BACKGROUND DATA

-TLIF is routinely performed with the support of pedicle screws.

-Problem: TLIF procedure without pedicle screw support has not yet been reported.

METHODS

▶Period: 2006.02 ~ 2009.05

▶Subject: patients underwent decompression and fusion (using TLIF)

-Group A: TLIF with pedicle screw (n=30)

-Group B: TLIF without pedicle screw (n=30)

▶Mean follow-up period: 31mon

▶Mean age: 45.5 yrs

RESULTS

	group A	group B
Sex ratio (female: male)	19:11	18:12
Pseudoarthrosis (patients)	2	3
Mean operating time (min)	110	73
Mean blood loss (mL)	410	220
Cage loosening (patients)	0	1
sciatic pain	4	1

-VAS, ODI (after 1months):  A > B (P<0.005)

                 (after 3 months): Not significantly differ (P<0.89).

-Cost: A(3-fold higher) > B

CONCLUSIONS

-TLIF procedure without pedicle screw would be sufficient in the management of stable patients with lumbar degenerative disease after single-level decompression.

-And this technique is less costs and complications compared with pedicle screwing.