Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

Brief review

전방경유 요추 유합술과 추간공경유 요추 유합술을 비교하여 술 후의 추간공의 높이와 디스크의 각도, 요추전만각 및 시상면 정렬 등의 항목을 측정하여 연구한 논문 입니다.

전방경유 요추 유합술이 추간공경유 요추 유합술에 비해 위에서 언급한 추간공의 높이와 디스크의 각도, 요추전만각 및 시상면 정렬 등의 항목에서 우수한 결과를 보였습니다.

이 논문은 방사선학적 측정값이 주를 이루므로 설명보다는 표로 보는게 쉬워서 아래와 같이 첨부했습니다.

*Title: Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

*Authors: PATRICK C. HSIEH, TYLER R. KOSKI, BRIAN A. O’SHAUGHNESSY, PATRICK SUGRUE, SEAN SALEHI, STEPHEN ONDRA, JOHN C. LIU

*Bibliography: J Neurosurg Spine. 2007 Oct;7(4):379-86.

Backgroud of data

-A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance.

-There has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters.

OBJECT

The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis.

METHODS

▶Study design : retrospective study(medical records and radiographs review)

▶Subjects: 32 patients (ALIF)+ 25 patients (TLIF) (2000~2004)

▶Data measurement

-Clinical data: VAS score (pre&post:6,12,24mon)

-radiographic data: foraminal height, local disc angle, and lumbar lordosis (pre&post)

▶Statistical analyses: included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed.

RESULTS

-ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis.

▶increasing rate or degree in radiographic data

-foraminal height: 18.5%(ALIF) vs 0.4%(TLIF)

-local disc angle: 8.3 degrees(ALIF) vs 0.1 degree(TLIF)

-lumbar lordosis: 6.2 degrees(ALIF)  vs 2.1 degrees(TLIF)

CONCLUSIONS
-The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis.

-The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.

Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery

Brief review

전방, 후방 그리고 전/후방 척추 유합술 후의 합병증 및 사망률에 대해 연구한 논문 입니다.

National Inpatient Sample을 이용해 해당기간동안 전방, 후방 그리고 전/후방 척추 유합술을 시행한 입원환자의 표본을 구하여 사망률, 동반질환 발병률, 합병증 발병률 등을 조사하고 사망률에 대한 risk factor를 알아보았습니다.

결론적으로, 전방 및 전/후방 척추 유합술 환자들이 후방 경유 환자에 비해 더 젊고 동반질환의 발병률이 적었지만 사망률은 더 높았습니다.

*Title: Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery

*Authors: Stavros G. Memtsoudis , Vassilios I. Vougioukas, Yan Ma, Licia K. Gaber-Baylis, Federico P. Girardi

*Bilbiography: Spine (Phila Pa 1976). 2011 Oct 15;36(22):1867-77.

STUDY DESIGN

Analysis of population-based national hospital discharge data collected for the National Inpatient Sample(NIS).

OBJECTIVE

-To examine demographics of patients undergoing primary anterior spine fusion (ASF), posterior spine fusion (PSF), and anterior/posterior spine fusion (APSF) of the noncervical spine.

-To assess the incidence of perioperative morbidity and mortality, and determine independent risk factors for in-hospital death.

SUMMARY OF BACKGROUND DATA

The utilization of surgical fusion has been increasing dramatically. Despite this trend, a paucity of literature addressing perioperative outcomes exists.

METHODS

-Subjects: National Inpatient Sample (1998~2006)

-Discharges with a procedure code for primary noncervical spine fusion were included in the sample.

-The prevalence of patient as well as health care system-related demographics were evaluated by procedure type (ASF, PSF, and APSF).

-Frequencies of procedure-related complications and in-hospital mortality were analyzed.

-Independent predictors for in-hospital mortality were determined.

RESULTS

-We identified 261,256 entries representing an estimated 1,273,228 hospitalizations for primary spine fusion.

▶ASF and APSF patients were significantly younger and had lower average comorbidity indeces than PSF patients. 

(age: 44.8 ± 0.08 and 44.22 ± 0.11 yrs vs 52.12 ± 0.04 yrs  / comorbidity: 0.30 ± 0.002 and 0.31 ± 0.004 vs 0.41 ± 0.002)

▶The incidence of complications:

- ASF: 18.68%

- PSF: 15.72%

- APSF: 23.81% (P < 0.0001)

^ comorbidity(동반질환)의 종류 별 분포율

▶In-hospital mortality rates: APSF were twice of PSF (0.51 ± 0.038 vs. 0.26 ± 0.012) (P < 

0.0001)

▶Risk factors for in-hospital mortality included the following: male gender, increasing age, and increasing comorbidity burden. Several comorbidities and complications independently increased the risk for perioperative death, as did underlying spinal pathology (APSF and ASF compared to PSF)

 

CONCLUSION

-Despite being performed in generally younger and healthier patients, APSF and ASF are associated with increased morbidity and mortality.

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.

[기사]만성 허리통증, 그냥 참는 것이 답일까?

기사출처
: http://www.moneyweek.co.kr/news/mwView.phptype=1&no=2014050911208036036&outlink=1

오랫동안 지속되는 허리통증은 그냥 참는것이 능사는 아니겠죠!
전문가의 정확한 진단에 따라 본인에게 알맞는 치료를 받아야 합니다.

Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery

Brief review

*Title: Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery.

*Authors: Wang H, Huang B, Li C, Zhang Z, Wang J, Zheng W, Zhou Y.

*Bibliography: Clin Neurol Neurosurg. 2013 Oct;115(10):1987-91.

PURPOSE

To evaluate the differences of learning curve for PELD depending on the surgeon's training level of minimally invasive spine surgery.

METHODS

We retrospectively reviewed the medical records of 120 patients (surgeon A with his first 60 patients, surgeon B with his first 60 patients) with sciatica and single-level L4/5 disk herniation who underwent PELD by the two surgeons with different training level of minimally invasive spine surgery (Group A: surgeon with little professional training of PELD; Group B: surgeon with 2 years of demonstration teaching of PELD).

RESULTS

Significant differences were observed in the operation time (p=0.000), postoperative hospital stay (p=0.026) and reoperation rate (p=0.050) between the two groups.

In the operation time, significant differences were observed between the 1-20 patients group and 41-60 patients group in Group B (p=0.041), but there were no significant differences among the 1-20 patients group, 21-40 patients group and 41-60 patients group in Group A. In the postoperative hospital stay, the significant differences were observed in the 1-20 patients group between Group A and Group B (p=0.011). Significant differences were observed between preoperative and postoperative VAS back score, VAS leg score and JOA score. Higher improvement in the VAS leg score was observed in Group B than Group A (p=0.031). In the rate of reoperation, the significant difference was observed between the 1-20 patients group and 41-60 patients group in Group A (p=0.028) but there were no significant differences among the 1-20 patients group, 21-40 patients group and 41-60 patients group in Group B.

CONCLUSIONS

The surgeons' training level of minimally invasive spine surgery was an important factor for the success of PELD, especially the demonstration teaching of PELD for the new minimally invasive spine surgeons.

The memory metal minimal access cage: a new concept in lumbar interbody fusion-a prospective, noncomparative study to evaluate the safety and performance

Brief review

*Title: The memory metal minimal access cage: a new concept in lumbar interbody fusion-a prospective, noncomparative study to evaluate the safety and performance

*Authors: D. Kok, R. D. Donk, F. H.Wapstra, and A. G. Veldhuizen

*Bibliography: Adv Orthop. 2012;2012:898606.

Study Design

A single-centre, prospective, non-comparative study

Objective

To evaluate the performance and safety of the Memory Metal Minimal Access Cage (MAC) in Lumbar Interbody Fusion.

Summary of Background Data

Interbody fusion cages in general are designed to withstand high axial loads and in the meantime to allow ingrowth of new bone for bony fusion.

In many cages the contact area with the endplate is rather large leaving a relatively small contact area for the bone graft with the adjacent host bone.

MAC is constructed from the memory metal Nitinol and builds on the concept of sufficient axial support in combination with a large contact area of the graft facilitating bony ingrowth and ease in minimal access implantation due to its high deformability.

Methods

▶Subjects: 25 patients with back and radicular leg pain from a single level degenerative lumbar disc underwent an interbody fusion using MAC and pedicle screws.

▶Clinical evaluation: Oswestry Disability Index (ODI), Short Form 36 questionnaire (SF-36) and pain visual analogue scale (VAS) scores

-The interbody fusion status was assessed using conventional radiographs and CT scan.

-Safety of the device was studied by registration of intra- and post-operative adverse effects.

Results

▶Clinical performance: improved significantly (P < .0018)

-CT scan confirmed solid fusion in all 25 patients at two year follow-up.

-In 2 patients migration of the cage occurred, which was resolved uneventfully by placing a larger size at the subsequent revision.

Conclusions

We conclude that the Memory Metal Minimal Access Cage (MAC) resulted in 100% solid fusions in 2 years and proved to be safe, although two patients required revision surgery in order to achieve solid fusion.

[기사] 손발 차고 저리면 척추 목뼈 이상일 수도

코메디 닷컴-입력 F 2014.02.28 16:21 수정 2014.02.28 16:56

출처: http://www.kormedi.com/news/article/1209834_2892.html

사진출처: http://ask.nate.com/qna/view.html?n=8897446

손발이 저리고 차다는 사람들을 볼 수 있다. 이런 경우 날씨 탓에 혈액순환이 잘 이뤄지지 않기 때문이라고 생각하고 무심코 넘기게 된다. 하지만 손과 발의 저림이 지속되고 목이나 허리 통증까지 느껴진다면 척추와 관절 질환을 의심해 봐야 한다. 

허리디스크(추간판 탈출증)의 가장 두드러진 증상은 허리와 다리가 아프고 저린 증상이다. 다리 통증은 허리나 엉덩이에서 시작해 허벅지와 장딴지의 뒤쪽, 바깥쪽을 따라서 발등이나 발바닥까지 내려가는 양상으로 나타난다. 

대부분 한쪽 다리나 엉덩이에서 통증을 느끼지만 심한 경우 양쪽 다리 모두 증상이 나타나기도 한다. 디스크(추간판)는 대개 향하고 있는 방향과 반대되는 방향으로 돌출되는데 이 경우 바로 곁에 있는 척추신경을 누르게 돼 전기가 통하는 것처럼 엉덩이나 다리, 심지어 발바닥까지 아프게 된다. 

이 같은 증상을 예방하려면 흡연 및 과도한 음주를 삼가고 저염식과 섬유질의 균형 잡힌 식사로 근육 손상을 막아주고 꾸준한 운동을 생활화하는 것이 좋다. 잘못된 자세는 허리에 더 치명적으로 작용하기 때문에 서 있는 자세에서는 머리, 가슴, 엉덩이가 일직선을 이뤄 몸의 중심이 기울지 않도록 하고 앉은 상태에서는 엉덩이를 의자 끝까지 밀어 넣은 후 의자를 바싹 당겨 배가 책상에 붙도록 해야 한다. 

허리통증이 있을 때는 잠잘 때 베개나 쿠션을 무릎에 끼고 조금 구부린 자세로 옆으로 누우면 허리에 가는 부담을 덜 수 있다. 연세바른병원 조보영 원장은 “다리에 마비증상이 느껴질 때 발 끝 혹은 뒤꿈치로만 걷거나 한발로 뛰기가 어렵다면 반드시 병원에서 진단을 받아야 한다”고 말했다. 

손 저림 증상이 심하다면 목 디스크를 의심해봐야 한다. 흔히 목 디스크는 5~6번 경추(목뼈)와 6~7번 경추 사이에서 주로 발생한다. 증상은 목이나 어깨에서 시작해 팔, 손가락까지 뻗치는 것 같은 통증으로 나타난다. 

여기에 어깨, 팔, 손가락의 근육을 지배하는 신경이 눌리면 해당 부위 근육의 힘이 빠지고 글씨를 제대로 쓰지 못하거나 물건을 들다가 놓치는 등 팔이 뜻대로 움직이지 않는 증상이 나타난다. 목 디스크는 손목터널증후군가 비슷한 증상을 보여 혼동하기 쉽기 때문에 전문의의 정확한 진단이 필요하다. 

40대 후반부터 60대 중장년층에서 발 시림과 저림 증상이 지속되고 걸을 때 다리까지 아프다면 척추관협착증을 의심해 볼 수 있다. 척추관협착증은 나이가 들어감에 따라 척추가 노화되고 뼈와 뼈 사이에 있는 인대가 두꺼워지면서 척추관이 좁아지는 현상이다. 

이를 예방하기 위해서는 지나치게 오래 앉아 있거나 서 있는 일을 삼가고 스트레칭을 통해 허리근육과 척추 관절의 긴장을 풀어 주는 것이 좋다. 특히 무거운 짐을 드는 것을 피하고 무거운 것을 들 때는 몸을 최대한 물건 쪽으로 밀착하거나 여러 사람과 함께 들도록 해야 한다. 

--------------------------------------------------------------------------------------------------------------

[review]

①"추간판탈출증"과"목 디스크"의 증상으로 손발이 차고 저릴 수도 있다는 기사 내용이다. 우리는 일반적으로 손발이 차고 저리면 혈관계 이상(혈액순환장애)이 있다는 생각을 하게된다. 

     

이러한 시점에서 볼 때 기사가 전체적으로 가정하에 쓰여져 있으므로 구체적으로 근거가 필요 하다.  (ex)손발이 차고 저림을 느껴 내원한 환자들 중 척추 목뼈에 이상이 있는 환자의 수

 

② 그렇다면 우리가 오해할 수 있는"수족냉증"&"손목터널증후군"과 구별할 수 있는 방법도 기재하였으면 하는 아쉬움이 든다.