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How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? A population-based comparison of workers' compensation systems.

BACKGROUND CONTEXT: In response to increasing use of lumbar fusion for improving back pain, despite unclear efficacy, particularly among inj … ersus 21%) and disc herniation (37% versus 21%), as opposed to spinal stenosis (6% versus 15%), and spondylolisthesis (25% versus 41%). A higher percentage of patients in California received circumferential procedures (26% versus 5%), fusion of three or more levels (10% versus 5%), and bone morphogenetic protein (50% versus 31%). California had higher adjusted risk …

The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial.

STUDY DESIGN: Spine Patient Outcomes Research Trial subgroup analysis. OBJECTIVE: To evaluate the effect of high obesity on management of lumbar spinal stenosis, degenerative spondylolisthesis (DS), and intervertebral disc herniation (IDH). SUMMARY OF BACKGROUND DATA: Prior Spine Patient Outcomes Research Trial analyses compared nonobese and obese patients. This study compares nonobese patients (body mass index<30 kg/m) with those with class I obesity (body mass index=30-35 kg/m) and class II/III high obesity (body mass index≥35 kg/m). METHODS: For spinal stenosis, 250 of 634 nonobese patie…

Nerve injury after lateral lumbar interbody fusion: a review of 919 treated levels with identification of risk factors.

BACKGROUND CONTEXT: Lateral lumbar interbody fusion (LLIF) has become an increasingly common minimally invasive procedure for selective degenerative deformity correction, reduction of low-grade spondylolisthesis, and indirect foraminal decompression. Concerns remain about the safety of the transpsoas approach to the spine due to proximity of the lumbosacral plexus. PURPOSE: To address risk factors for iatrogenic nerve injury in a large cohort of patients undergoing LLIF. STUDY DESIGN: Retrospective analysis of 919 LLIF procedures to identify risk factors for lumbosacral plexus injuries. MET…

[Diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery].

OBJECTIVE: To conduct a retrospective analysis of diagnosis and treatment of lumbar disc herniation by discography and percutaneous transfor … rotruded discs while 30 had prolapsed and sequestered discs. There were no obvious lumbar stenosis, spondylolisthesis, fracture, infection or tumor cases. The preoperative and postoperative visual analogue scale (VAS) were used to evaluate the sciatica and/or back pain. The outcomes were evaluated by Oswestry disability index (ODI) and the Macnab score. Precise ori …

Degenerative lumbar scoliosis in elderly patients: dynamic stabilization without fusion versus posterior instrumented fusion.

BACKGROUND CONTEXT: Posterolateral fusion with pedicle screw instrumentation is currently the most widely accepted technique for degenerativ … ovo lumbar scoliosis, associated with vertebral canal stenosis in 51 cases (89.4%) and degenerative spondylolisthesis in 24 patients (42.1%). OUTCOME MEASURES: Clinical (Oswestry Disability Index, visual analog scale, Roland-Morris Disability Questionnaire) and radiological (scoliosis and lordosis corrections) outcomes as well as incidence of complications. METHO …

Biomechanical analysis of a novel posterior construct in a transforaminal lumbar interbody fusion model an in vitro study.

BACKGROUND CONTEXT: Spinal fusion is a commonly performed surgical procedure. It is used to treat a variety of spinal pathologies, including degenerative disease, trauma, spondylolisthesis, and deformities. A mechanically stable spine provides an ideal environment for the formation of a fusion mass. Instrumented spinal fusion allows early ambulation with minimal need for a postoperative external immobilizer. Several biomechanical and clinical studies have evaluated the stability offered by different posterior instrumentation techniques and the effects of reduced instrumentation. PURPOSE: The …

Outcome of single level instrumented posterior lumbar interbody fusion using corticocancellous laminectomy bone chips.

BACKGROUND: Interbody fusion surgery has been considered by many to be a treatment of choice for instability in lumbar degenerative disc dis … ions, with back pain of instability type, normal disc height on radiology. Ten patients had grade 1 spondylolisthesis, with significant back pain and translational instability on radiography. Three patients were redo spine surgeries, and three patients had healed spondylodiscitis with significant back pain and instability. All patients were regularly followed up an …

An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion.

OBJECT: Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent to open procedures with regard to clinical … evel MIS and open posterior interbody fusion for lumbar spondylotic disease, disc degeneration, and spondylolisthesis treated at a single academic medical center. Patients presenting with bilateral neurological symptoms were treated with open surgery, and those with unilateral symptoms were treated with MIS. Overall hospital charges and surgical episode-related cha …

Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline.

STUDY DESIGN: Systematic review. OBJECTIVE: To systematically assess benefits and harms of surgery for nonradicular back pain with common d … in and function through 2 to 3 months. For symptomatic spinal stenosis with or without degenerative spondylolisthesis, we found good evidence that decompressive surgery is moderately superior to nonsurgical therapy through 1 to 2 years. For both conditions, patients on average experience improvement either with or without surgery, and benefits associated with surge …

The influence of subdiagnosis on radiographic and clinical outcomes after lumbar fusion for degenerative disc disorders: an analysis of the literature from two decades.

STUDY DESIGN: A critical review of published literature from 2 decades. OBJECTIVE: To critically analyze the literature from 1979 to 2000 i … s performed. Disorders were organized according to the following subdiagnostic groups: degenerative spondylolisthesis (DDDsp), herniated disc (DH), degenerative scoliosis (DDDsc), stable DDD (DDDs), dynamically unstable DDD (DDDu), and DDD that was not specified as either DDDu or DDDs (DDDn). For each group, the type of instrumentation, fusion location, fusion rate …

Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine.

STUDY DESIGN: An analysis of consecutive adult patients treated surgically with anterior column structural allografts for sagittal plane abn … (average, 7 +/- 3 years; range, 5 +/- 4-10 +/- 3 years). Diagnoses included kyphoscoliosis (n = 8), spondylolisthesis (n = 3), degenerative disc disease (n = 3), and acute or chronic fracture (n = 6). The allografts spanned only disc spaces in 16 patients, and vertebral bodies and disc spaces in 4 patients. Forty disc spaces and four vertebral bodies were grafted, …

Laser disc decompression. The importance of proper patient selection.

STUDY DESIGN: The value of adherence to selection criteria for laser disc decompression (LDD) was evaluated. A total of 204 patients who und … o did not meet the selection criteria (had a normal physical examination, the presence of stenosis, spondylolisthesis, extruded disc fragment, leakage of discographic dye from the outer annulus, multiple prior lumbar surgeries); or 3) those who could not be assigned to either of the first two groups for reasons such as discography not being performed or inadequate …

Fixation, Stabilization, Dynamic Stabilization, Fusion, and Reconstruction in Spine Surgery- Decoding Terminologies!

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… Some of the early treatment options explored with un-instrumented fusion in high-grade spondylolisthesis include Capener, who described the treatment of patients with a bony dowel between L5 and S1 vertebrae. … High-grade spondylolisthesis treated using a modified Bohlman technique:Results among multiple surgeons. J Neurosurg Spine. 2014;20:523–30. doi: 10.3171/2014.1.SPINE12904. …

Retrospective review of outcomes in patients with Bertolotti's syndrome who underwent fluoroscopically-guided pseudojoint injections.

INTRODUCTION: A lumbosacral transitional vertebra (LSTV) is an articulation or fusion of the transverse process of the fifth lumbar vertebra … TS: The patients had a mean age of 44 years, and 62.5 % (35/56) of the patients were female. Lumbar spondylolisthesis was found in 20.0 % of patients (11/55). Using the Castellvi classification, the most common type of LSTV was Type 2a (42/56, 75.0 %). Of the patients, 55.4 % had an anxiety disorder (N = 31/56) and 42.9 % had depression (24/56). Numeric rating scal …

Midline-preserving vs. midline-removing surgery for lumbar spinal stenosis: national registry study based on the Finnish spine registry (FinSpine).

PURPOSE: Lumbar spinal stenosis (LSS) can be treated surgically by decompressing the affected nervous structures, either by removing or pres … the corresponding numbers were 1536 and 371, respectively. Patients with less than 3mm degenerative spondylolisthesis were included. We recorded the baseline information, and the primary outcomes were the between-group differences in improvement in functional outcome and back and leg pain at one, two and five years postoperatively. Oswestry disability index (ODI) a …

Unprecedented journey to 650 transpedicular screws using freehand technique and intraoperative C-arm imaging with technical nuances.

INTRODUCTION: Pedicle screw placement plays a crucial role in treating various cases such as fractures, scoliosis, degenerative spine issues … with 43.1% of patients having vertebral column instability due to trauma. The other etiologies were spondylolisthesis and lumbar canal stenosis (39.2%), Pott's spine (11.7%), tumors (2.9%), and osteoporotic fractures (2.9%). Majority of patients (44.1%) presented with lower backache with radiculopathy. All the transpedicular screws inserted were evaluated by C-arm …

Development and validation of a novel scoring tool for predicting facility discharge after elective posterior lumbar fusion.

BACKGROUND CONTEXT: Discharge to acute/intermediate care facilities is a common occurrence after posterior lumbar fusion and can be associat … disease (p=.001), cancer (p=.010), revision surgery (p<.001), number of levels fused (p<.001), and spondylolisthesis (p=.049) were identified as significant risk factors for facility discharge. The area under the receiver operating characteristic curve (AUC) indicated a strong predictive model (AUC=0.750), with similar predictive ability in the testing (AUC=0.757) …

Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion.

BACKGROUND: The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar … llowed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, rad …

Does minimally invasive transsacral fixation provide anterior column support in adult scoliosis?

BACKGROUND: Spinal fusion to the sacrum, especially in the setting of deformity and long constructs, is associated with high complication an … transsacral fixation were situations where the fusion needed to be extended to the sacrum, such as spondylolisthesis, prior laminectomy, stenosis, oblique take-off, and disc degeneration at L5-S1. Contraindications included anatomic variations in the sacrum, vascular anomalies, prior intrapelvic surgery, and rectal fistulas or abscesses. Fusion rates were assessed …

Extraforaminal compression of the L-5 nerve root at the lumbosacral junction: clinical analysis, decompression technique, and outcome.

OBJECT: Extraforaminal compression of the L-5 nerve encompasses multiple pathological entities and may result from disc herniations as well … oraminal stenosis was found in 38.5%, and adjacent-level stenosis was noted in 22 cases (42.3%) and spondylolisthesis in 4 (7.7%). Osteophytes were noted in 18 cases. A coronal wedging angle ≥ 3° was found in 46.2%, and the laterality of wedging corresponded to the symptomatic side in 91% of cases. Fifteen patients (28.8%) complained of postoperative dysesthesias, …