Pub Date : 2021-01-01DOI: 10.21608/ESJ.2021.55579.1161
Essam Youssef, A. Rizk, Mohamed Yahia
Background Data: Posterior lumbar decompression combined with instrumented posterior lumbar interbody fusion (PLIF) is the gold standard management of adult spondylolisthesis. Complete anatomic surgical reduction of slippage, although controversial, is associated with encouraging results. Purpose: This study aims to assess the clinical outcome of complete open surgical reduction and instrumented PLIF in adult single-level lumbar spondylolisthesis. Study design: Retrospective clinical case study. Patients and Methods: Retrospective review of standing data and radiographs of adult patients with single-level lumbar spondylolisthesis (regardless of the aetiology) from January 2018 to January 2020. All patients have undergone posterior lumbar decompression, pedicle screw instrumentation, complete reduction of the slippage, and PLIF. All patients were assessed at six and 12 months postoperatively by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and the Odom criteria. Results: A total of 118 patients met the inclusion criteria. There was no neurologic deterioration in any of the patients postoperatively. There was a significant change in VAS, ODI, and Odom’s criteria at six and 12 months postoperatively (p < 0.001). The mean value for VAS and ODI were 0.61 ± 1.03 and 4.52 ± 7.02, respectively, at the last follow-up. There was a significant change in Odom’s criteria as 61.9% of patients had excellent outcomes at the last follow-up. Conclusion: Complete surgical reduction of single-level lumbar spondylolisthesis combined with instrumented PLIF offers adequate neural element decompression and satisfactory clinical outcome. (2020ESJ227)
{"title":"Clinical Outcome Assessment following Open Reduction and Instrumented Posterior Interbody Fusion of Adult Single-Level Lumbar Spondylolisthesis","authors":"Essam Youssef, A. Rizk, Mohamed Yahia","doi":"10.21608/ESJ.2021.55579.1161","DOIUrl":"https://doi.org/10.21608/ESJ.2021.55579.1161","url":null,"abstract":"Background Data: Posterior lumbar decompression combined with instrumented posterior lumbar interbody fusion (PLIF) is the gold standard management of adult spondylolisthesis. Complete anatomic surgical reduction of slippage, although controversial, is associated with encouraging results. \u0000Purpose: This study aims to assess the clinical outcome of complete open surgical reduction and instrumented PLIF in adult single-level lumbar spondylolisthesis. \u0000Study design: Retrospective clinical case study. \u0000Patients and Methods: Retrospective review of standing data and radiographs of adult patients with single-level lumbar spondylolisthesis (regardless of the aetiology) from January 2018 to January 2020. All patients have undergone posterior lumbar decompression, pedicle screw instrumentation, complete reduction of the slippage, and PLIF. All patients were assessed at six and 12 months postoperatively by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and the Odom criteria. \u0000Results: A total of 118 patients met the inclusion criteria. There was no neurologic deterioration in any of the patients postoperatively. There was a significant change in VAS, ODI, and Odom’s criteria at six and 12 months postoperatively (p < 0.001). The mean value for VAS and ODI were 0.61 ± 1.03 and 4.52 ± 7.02, respectively, at the last follow-up. There was a significant change in Odom’s criteria as 61.9% of patients had excellent outcomes at the last follow-up. \u0000Conclusion: Complete surgical reduction of single-level lumbar spondylolisthesis combined with instrumented PLIF offers adequate neural element decompression and satisfactory clinical outcome. (2020ESJ227)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42237164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.21608/ESJ.2021.63103.1171
Hazem M. Alkosha, Basem I. Awad, H. Elsobky, A. Zidan, Amin Sabry
Background data: The sympathetic chain is a vulnerable structure in anterior reconstructive surgeries to upper lumbar fractures. Purpose: To explore the prevalence of sympathetic chain injuries following the anterior surgical approach to treat upper lumbar fractures and their impact on clinical outcomes. Study design: A nonrandomized prospective cohort study. Patients and Methods: Consecutive cases with upper lumbar fractures that undergone surgery by either anterior or posterior approaches were preoperatively and postoperatively evaluated for sympathetic chain injury and followed up six months after surgery to explore outcomes. Two simple, valid, and reliable bedside tests were used to assess sympathetic functions: the skin wrinkling test (SWT) and the skin temperature difference (STD). Outcomes were assessed using the Oswestry Disability Index (ODI) and the 12-Item Short Form Survey (SF-12) at six months in both positive and negative groups with sympathetic injury. Results: The 2 approach groups (32 cases each) showed comparable demographic and clinical criteria. The SWT showed high interrater reliability with agreement in 92% of cases. The positive group with confirmed sympathetic injury included 29 cases, all of which belonged to the anterior approach group. The negative group with equivocal or confirmed intact sympathetic function included 35 cases; 3 of them belonged to the anterior group. The ODI and SF-12 scores were found to be comparable between positive and negative groups 6 months after surgery. Conclusion: Sympathetic chain injury is a frequent complication (90.6% of cases) following the anterior approach to upper lumbar fractures. The cases are unilateral, relatively silent, and related to the side of approach with no clinical impact on quality of life on 6-month outcome assessment. (2020ESJ201)
{"title":"Prevalence and Clinical Outcome of Sympathetic Chain Injury after Anterior Approach to Upper Lumbar Fractures","authors":"Hazem M. Alkosha, Basem I. Awad, H. Elsobky, A. Zidan, Amin Sabry","doi":"10.21608/ESJ.2021.63103.1171","DOIUrl":"https://doi.org/10.21608/ESJ.2021.63103.1171","url":null,"abstract":"Background data: The sympathetic chain is a vulnerable structure in anterior reconstructive surgeries to upper lumbar fractures. \u0000Purpose: To explore the prevalence of sympathetic chain injuries following the anterior surgical approach to treat upper lumbar fractures and their impact on clinical outcomes. \u0000Study design: A nonrandomized prospective cohort study. \u0000Patients and Methods: Consecutive cases with upper lumbar fractures that undergone surgery by either anterior or posterior approaches were preoperatively and postoperatively evaluated for sympathetic chain injury and followed up six months after surgery to explore outcomes. Two simple, valid, and reliable bedside tests were used to assess sympathetic functions: the skin wrinkling test (SWT) and the skin temperature difference (STD). Outcomes were assessed using the Oswestry Disability Index (ODI) and the 12-Item Short Form Survey (SF-12) at six months in both positive and negative groups with sympathetic injury. \u0000Results: The 2 approach groups (32 cases each) showed comparable demographic and clinical criteria. The SWT showed high interrater reliability with agreement in 92% of cases. The positive group with confirmed sympathetic injury included 29 cases, all of which belonged to the anterior approach group. The negative group with equivocal or confirmed intact sympathetic function included 35 cases; 3 of them belonged to the anterior group. The ODI and SF-12 scores were found to be comparable between positive and negative groups 6 months after surgery. \u0000Conclusion: Sympathetic chain injury is a frequent complication (90.6% of cases) following the anterior approach to upper lumbar fractures. The cases are unilateral, relatively silent, and related to the side of approach with no clinical impact on quality of life on 6-month outcome assessment. (2020ESJ201)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44854718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.21608/ESJ.2021.58068.1166
M. Adawy, M. Elhawary, R. Teama
Background Data: Cauda equina syndrome (CES) is a rare situation and is one of the few surgical emergencies in neurosurgery. While L4-L5 disc is the most common cause of CES, ependymoma and schwannoma are the most common tumors affecting cauda equina. Purpose: To present our experience and outcome of management of cauda equina tumors. Study Design: A retrospective clinical case study. Patients and Methods: We operated upon 22 cases with known cauda equina tumors at our institution in the period between October 2016 and April 2020. All patients were subjected to detailed general, neurological, and radiological evaluation both preoperatively and postoperatively according to our follow-up protocol. Moreover, the modified McCormick scale (MMS) has been used for pre- and postoperative functional evaluation. Patients underwent operation using the posterior midline approach, with neuromonitoring applied in 50% of patients. Results: The mean age was 44 ± 12.5 years. Nine (41%) patients were female and 13 (59%) were male. Ninety-one percent of patients presented with radiculopathy. Fifty percent of cases presented with schwannoma. Growth total tumor resection was achieved in 20 cases (91%). The last follow-up showed marked improvement in radiculopathy, motor power deficit, and MMS compared to preoperative values. Immediate postoperative motor power deterioration was reported in two cases. Recurrence was reported in one case of ependymoma at a two-year follow-up visit that underwent operation with no further recurrence after 1-year follow-up. Conclusion: The data of this study may suggest that most cauda equina tumors are benign and favorable outcome could be achieved in small-sized lesions with a short history and good preoperative clinical status. (2020ESJ220)
{"title":"Intradural Cauda Equina Tumors: Early Surgical Experience of a Small Neurosurgical Team","authors":"M. Adawy, M. Elhawary, R. Teama","doi":"10.21608/ESJ.2021.58068.1166","DOIUrl":"https://doi.org/10.21608/ESJ.2021.58068.1166","url":null,"abstract":"Background Data: Cauda equina syndrome (CES) is a rare situation and is one of the few surgical emergencies in neurosurgery. While L4-L5 disc is the most common cause of CES, ependymoma and schwannoma are the most common tumors affecting cauda equina. \u0000Purpose: To present our experience and outcome of management of cauda equina tumors. \u0000Study Design: A retrospective clinical case study. \u0000Patients and Methods: We operated upon 22 cases with known cauda equina tumors at our institution in the period between October 2016 and April 2020. All patients were subjected to detailed general, neurological, and radiological evaluation both preoperatively and postoperatively according to our follow-up protocol. Moreover, the modified McCormick scale (MMS) has been used for pre- and postoperative functional evaluation. Patients underwent operation using the posterior midline approach, with neuromonitoring applied in 50% of patients. \u0000Results: The mean age was 44 ± 12.5 years. Nine (41%) patients were female and 13 (59%) were male. Ninety-one percent of patients presented with radiculopathy. Fifty percent of cases presented with schwannoma. Growth total tumor resection was achieved in 20 cases (91%). The last follow-up showed marked improvement in radiculopathy, motor power deficit, and MMS compared to preoperative values. Immediate postoperative motor power deterioration was reported in two cases. Recurrence was reported in one case of ependymoma at a two-year follow-up visit that underwent operation with no further recurrence after 1-year follow-up. \u0000Conclusion: The data of this study may suggest that most cauda equina tumors are benign and favorable outcome could be achieved in small-sized lesions with a short history and good preoperative clinical status. (2020ESJ220)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46673964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.21608/ESJ.2021.56527.1162
Emad H. Abouelmaaty, Ahmed Darwish, Z. Fayed, S. Hamada
Background Data: Posterior lumbar interbody fusion (PLIF) provides better stability and fusion as a surgical treatment for degenerative disc disease (DDD) and spondylolisthesis. Different cage designs are available for interbody fusion. Tantalum cages are recent and appealing options in these techniques. Purpose: To assess the clinical and radiological outcome of tantalum interbody cage in PLIF without autologous bone graft inside the cage. Study Design: A retrospective case series study. Patients and Methods: A total of 25 patients with single-level DDD (n = 16) or spondylolisthesis (n = 9) who underwent single-level PLIF surgeries with 1-year follow-up were recruited for this study. Clinical and functional assessment was done using the visual analogue scale (VAS) for low back pain and Oswestry Disability Index (ODI). Tantalum cage stability and fusion were assessed radiologically on static and dynamic lateral X-ray. Results: VAS and ODI showed significant postoperative improvement at 6-week and 3-, 6-, and 12-month follow-up intervals. No significant migration or subsidence of tantalum cage was reported on static X-ray, no significant mobility was reported on dynamic X-ray, and the total sound bone fusion rate was 96% at 1-year follow-up. Conclusion: Our data suggest that PLIF with tantalum interbody cage in lumbar DDD and low-grade spondylolisthesis showed good clinical and functional results in 1-year follow-up with high spinal stability and bone fusion rate (2020ESJ225).
{"title":"Outcome of Tantalum Cage in Posterior Lumbar Interbody Fusion in Lumbar Degenerative Disc Disease and Low-grade Spondylolisthesis","authors":"Emad H. Abouelmaaty, Ahmed Darwish, Z. Fayed, S. Hamada","doi":"10.21608/ESJ.2021.56527.1162","DOIUrl":"https://doi.org/10.21608/ESJ.2021.56527.1162","url":null,"abstract":"Background Data: Posterior lumbar interbody fusion (PLIF) provides better stability and fusion as a surgical treatment for degenerative disc disease (DDD) and spondylolisthesis. Different cage designs are available for interbody fusion. Tantalum cages are recent and appealing options in these techniques. \u0000Purpose: To assess the clinical and radiological outcome of tantalum interbody cage in PLIF without autologous bone graft inside the cage. \u0000Study Design: A retrospective case series study. \u0000Patients and Methods: A total of 25 patients with single-level DDD (n = 16) or spondylolisthesis (n = 9) who underwent single-level PLIF surgeries with 1-year follow-up were recruited for this study. Clinical and functional assessment was done using the visual analogue scale (VAS) for low back pain and Oswestry Disability Index (ODI). Tantalum cage stability and fusion were assessed radiologically on static and dynamic lateral X-ray. \u0000Results: VAS and ODI showed significant postoperative improvement at 6-week and 3-, 6-, and 12-month follow-up intervals. No significant migration or subsidence of tantalum cage was reported on static X-ray, no significant mobility was reported on dynamic X-ray, and the total sound bone fusion rate was 96% at 1-year follow-up. \u0000Conclusion: Our data suggest that PLIF with tantalum interbody cage in lumbar DDD and low-grade spondylolisthesis showed good clinical and functional results in 1-year follow-up with high spinal stability and bone fusion rate (2020ESJ225).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45072907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.21608/ESJ.2021.64567.1173
S. Rudrappa, Ramachandran Govindasamy, V. S. Chander, Akash Hosthota
Background Data: Adult spinal deformity (ASD) needing surgical treatment is often seen in the aging population. Radiological goals for ASD surgery have been standardized to achieve a good functional outcome. Lesser complication rates and blood loss have made MIS surgeries more popular in the current day. Trans-psoas / Pre-psoas Lateral Lumbar Interbody Fusion (LIF) has been the cornerstone of MIS surgeries for ASD. The corrective potential of conventional MIS surgeries was limited, owing to which various modifications have been described. Despite the demonstration of good clinical outcomes by various studies employing different surgical techniques, cumulative analysis of the radiological outcome of the various modifications of LIF is poorly discussed in the literature. A recommendation of an ideal MIS technique based on the type and magnitude of ASD is also lacking. Purpose: We aim to perform a qualitative systematic review of the radiological outcomes of various modifications of LIF surgeries for ASD and to decipher a treatment algorithm based on the type and severity of ASD with existing literature. Study design: Systematic review. Patients and Methods: A systematic search of two electronic databases (PubMed & Google Scholar) from its inception till December 2020 was done independently by 3 different authors. Relevant keywords and MeSH terms were used to identify articles and further filtered by applying appropriate selection criteria. Results: A total of 171 articles were selected for abstract screening, followed by full-text screening. After applying the selection criteria, 28 articles were selected for the systematic review. The methodology and radiological parameters of each study were analyzed qualitatively, and the inferences in regards to the radiological outcomes were validated. Conclusion: Circumferential MIS (cMIS) seems to be adequate in milder forms of ASD, while hybrid surgeries may be needed in higher magnitude deformities. Addressing the L5-S1 junction using LIF and anterior column realignment (ACR) are useful tools to correct more severe deformities. (2020ESJ223)
{"title":"Radiological outcomes of Lateral Lumbar Interbody Fusion (LIF) in Adult Spinal Deformity – A Systematic Review","authors":"S. Rudrappa, Ramachandran Govindasamy, V. S. Chander, Akash Hosthota","doi":"10.21608/ESJ.2021.64567.1173","DOIUrl":"https://doi.org/10.21608/ESJ.2021.64567.1173","url":null,"abstract":"Background Data: Adult spinal deformity (ASD) needing surgical treatment is often seen in the aging population. Radiological goals for ASD surgery have been standardized to achieve a good functional outcome. Lesser complication rates and blood loss have made MIS surgeries more popular in the current day. Trans-psoas / Pre-psoas Lateral Lumbar Interbody Fusion (LIF) has been the cornerstone of MIS surgeries for ASD. The corrective potential of conventional MIS surgeries was limited, owing to which various modifications have been described. Despite the demonstration of good clinical outcomes by various studies employing different surgical techniques, cumulative analysis of the radiological outcome of the various modifications of LIF is poorly discussed in the literature. A recommendation of an ideal MIS technique based on the type and magnitude of ASD is also lacking. \u0000Purpose: We aim to perform a qualitative systematic review of the radiological outcomes of various modifications of LIF surgeries for ASD and to decipher a treatment algorithm based on the type and severity of ASD with existing literature. \u0000Study design: Systematic review. \u0000Patients and Methods: A systematic search of two electronic databases (PubMed & Google Scholar) from its inception till December 2020 was done independently by 3 different authors. Relevant keywords and MeSH terms were used to identify articles and further filtered by applying appropriate selection criteria. \u0000Results: A total of 171 articles were selected for abstract screening, followed by full-text screening. After applying the selection criteria, 28 articles were selected for the systematic review. The methodology and radiological parameters of each study were analyzed qualitatively, and the inferences in regards to the radiological outcomes were validated. \u0000Conclusion: Circumferential MIS (cMIS) seems to be adequate in milder forms of ASD, while hybrid surgeries may be needed in higher magnitude deformities. Addressing the L5-S1 junction using LIF and anterior column realignment (ACR) are useful tools to correct more severe deformities. (2020ESJ223)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47550971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.21608/ESJ.2021.67423.1176
Prashant Punia, A. Chugh, S. Gotecha
Background Data:Myxopapillary ependymoma (MPE) is a low-grade variant of ependymoma that typically occurs in conus medullaris and filum terminale of the spinal cord. Only rarely do these tumors present at an extradural location in the sacrococcygeal region and even rarer is the development of these extradural tumors inside the spinal canal. The authors report a case of an intraspinal extradural MPE of the sacrum with relevant literature review on salient features and management. Study Design: Case Report. Purpose: To report a rare entity at an uncommon location. Case Report: A 12-year-old male child presented with chief complaints of low backache and radiation of pain in both lower limbs for six months. The patient also had a history of straining during micturition for one month. On examination, he was found to have mild weakness of bilateral ankle plantar flexion and knee flexion (grade 3). Ankle jerks were absent and there was evidence of sacral hypoaesthesia. Intraoperatively sacral lamina was found to be thinned out. Laminectomy was performed at L5 and sacrum, an extradural, fleshy lesion extending from L5 to S5 was identified, and gross total resection was achieved. There was no intradural expansion of the tumor. Results: Patient had an uneventful course and was discharged home on day 4. Conclusion: Intraspinal extradural MPE is a rare entity and should be kept in mind while diagnosing a midline lower back lesion. Treatment consists of gross total excision wherever possible coupled with radiotherapy. These tumors tend to recur locally and systemically and, thus, patients should be followed up periodically. (2020ESJ226)
{"title":"Intraspinal Extradural Myxopapillary Ependymoma of the Sacrum: A Case Report","authors":"Prashant Punia, A. Chugh, S. Gotecha","doi":"10.21608/ESJ.2021.67423.1176","DOIUrl":"https://doi.org/10.21608/ESJ.2021.67423.1176","url":null,"abstract":"Background Data:Myxopapillary ependymoma (MPE) is a low-grade variant of ependymoma that typically occurs in conus medullaris and filum terminale of the spinal cord. Only rarely do these tumors present at an extradural location in the sacrococcygeal region and even rarer is the development of these extradural tumors inside the spinal canal. The authors report a case of an intraspinal extradural MPE of the sacrum with relevant literature review on salient features and management. \u0000Study Design: Case Report. \u0000Purpose: To report a rare entity at an uncommon location. \u0000Case Report: A 12-year-old male child presented with chief complaints of low backache and radiation of pain in both lower limbs for six months. The patient also had a history of straining during micturition for one month. On examination, he was found to have mild weakness of bilateral ankle plantar flexion and knee flexion (grade 3). Ankle jerks were absent and there was evidence of sacral hypoaesthesia. Intraoperatively sacral lamina was found to be thinned out. Laminectomy was performed at L5 and sacrum, an extradural, fleshy lesion extending from L5 to S5 was identified, and gross total resection was achieved. There was no intradural expansion of the tumor. \u0000Results: Patient had an uneventful course and was discharged home on day 4. \u0000Conclusion: Intraspinal extradural MPE is a rare entity and should be kept in mind while diagnosing a midline lower back lesion. Treatment consists of gross total excision wherever possible coupled with radiotherapy. These tumors tend to recur locally and systemically and, thus, patients should be followed up periodically. (2020ESJ226)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46918595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.21608/ESJ.2021.50482.1156
H. Sabry, Salah A. Hemida, K. Saoud, Emad H. Abouelmaaty
Background Data: Degenerative lumbar spine disorders are common pathologies that usually affect females in their sixth decade or older. Patients usually present with various symptoms, including back pain, radiculopathy, or neurogenic claudication, among other less common presentations. Different fusion procedures are available to manage these problems. Purpose: This study was designed to evaluate the clinical and radiological outcome of transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) in managing degenerative lumbar disorders. Study Design: A prospective study. Patients and Methods: This study was conducted on patients with degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis who underwent lumbar spine fixation with either TLIF or PLF. Patients were randomized into two groups according to the operative procedure: Group A (20 patients) underwent TLIF and Group B (20 patients) underwent PLF. Patients were followed up and assessed for back and leg pain, functional disability, and spinal fusion. Results: We found that both TLIF and PLF improve disability and pain in patients with degenerative lumbar disorders. TLIF was found to be superior to PLF as regards achieving radiographic outcomes. We did not find strong evidence to support the use of interbody fusion along with transpedicular fixation compared to traditional posterolateral fusion in the treatment of degenerative lumbar disorders, taking into consideration the higher material costs added with interbody fusion. Conclusion: The reported data in the present study suggest that both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. They also suggest that TLIF is superior to PLF when comparing the achievement of radiographic fusion. However, there is no significant clinical outcome difference to recommend using TLIF over traditional PLF in treating degenerative lumbar disorders, especially with the higher treatment costs related to the use of interbody fusion. (2020ESJ217)
{"title":"Outcome of Transforaminal Lumbar Interbody Fusion versus Posterolateral Lumbar Fusion with Instrumentation in Treatment of Degenerative Lumbar Disorders","authors":"H. Sabry, Salah A. Hemida, K. Saoud, Emad H. Abouelmaaty","doi":"10.21608/ESJ.2021.50482.1156","DOIUrl":"https://doi.org/10.21608/ESJ.2021.50482.1156","url":null,"abstract":"Background Data: Degenerative lumbar spine disorders are common pathologies that usually affect females in their sixth decade or older. Patients usually present with various symptoms, including back pain, radiculopathy, or neurogenic claudication, among other less common presentations. Different fusion procedures are available to manage these problems. \u0000Purpose: This study was designed to evaluate the clinical and radiological outcome of transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) in managing degenerative lumbar disorders. \u0000Study Design: A prospective study. \u0000Patients and Methods: This study was conducted on patients with degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis who underwent lumbar spine fixation with either TLIF or PLF. Patients were randomized into two groups according to the operative procedure: Group A (20 patients) underwent TLIF and Group B (20 patients) underwent PLF. Patients were followed up and assessed for back and leg pain, functional disability, and spinal fusion. \u0000Results: We found that both TLIF and PLF improve disability and pain in patients with degenerative lumbar disorders. TLIF was found to be superior to PLF as regards achieving radiographic outcomes. We did not find strong evidence to support the use of interbody fusion along with transpedicular fixation compared to traditional posterolateral fusion in the treatment of degenerative lumbar disorders, taking into consideration the higher material costs added with interbody fusion. \u0000Conclusion: The reported data in the present study suggest that both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. They also suggest that TLIF is superior to PLF when comparing the achievement of radiographic fusion. However, there is no significant clinical outcome difference to recommend using TLIF over traditional PLF in treating degenerative lumbar disorders, especially with the higher treatment costs related to the use of interbody fusion. (2020ESJ217)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43872958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.21608/esj.2021.61632.1168
E. Said, M. Abdel-Wanis, Mohamed Ameen, H. Tammam
Background Data: Lumbar spondylolisthesis is a major cause of back pain. It occurs most commonly at only one spinal level. Multiple-level lumbar spondylolisthesis is uncommon, with few reports available in the literature. It can be treated by instrumented posterolateral fusion (PLF) using iliac crest bone graft (ICBG) with possible reported donor site complications. A reasonable alternative is local bone graft obtained from the laminae and spinous processes harvested during neural decompression. Purpose: To evaluate the outcome of multiple-level spondylolisthesis treated by PLF using a local bone graft. Study Design: Prospective clinical case series. Patients and Methods: Eleven patients (6 males and 5 females) with mean age 48.18 ± 9.7 years with multiple-level lumbar spondylolisthesis who underwent PLF using local bone graft in our University Hospital between 2015 and 2017 were evaluated. The mean duration of low back pain (LBP) was 11.36 ± 1.8 (range, 9–14) months. Operation time and blood loss were recorded. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), while fusion was evaluated using the Lenke classification for posterolateral fusion. Results: The mean operative time was 87.7 ± 19.1 minutes, while blood loss was 541.8 ± 135.5 ml, and the mean follow-up period was 34.55 ± 3.2 months. VAS and ODI improved significantly from preoperatively to postoperatively and at last follow-up (p < 0.05) with no significant difference in terms of gender or age. Radiologically, solid bone fusion was achieved in 23 out of 27 operated levels (85%). One screw was broken, and two patients had superficial wound infections. Conclusion: Our data suggest that instrumented PLF using local bone graft can effectively be used to manage multiple-level lumbar spondylolisthesis with satisfactory outcome and avoid ICBG donor site morbidity. (2020ESJ222)
{"title":"Multiple-Level Low-Grade Lumbar Spondylolisthesis: Instrumented Posterolateral Fusion Using a Local Bone Graft","authors":"E. Said, M. Abdel-Wanis, Mohamed Ameen, H. Tammam","doi":"10.21608/esj.2021.61632.1168","DOIUrl":"https://doi.org/10.21608/esj.2021.61632.1168","url":null,"abstract":"Background Data: Lumbar spondylolisthesis is a major cause of back pain. It occurs most commonly at only one spinal level. Multiple-level lumbar spondylolisthesis is uncommon, with few reports available in the literature. It can be treated by instrumented posterolateral fusion (PLF) using iliac crest bone graft (ICBG) with possible reported donor site complications. A reasonable alternative is local bone graft obtained from the laminae and spinous processes harvested during neural decompression. Purpose: To evaluate the outcome of multiple-level spondylolisthesis treated by PLF using a local bone graft. Study Design: Prospective clinical case series. Patients and Methods: Eleven patients (6 males and 5 females) with mean age 48.18 ± 9.7 years with multiple-level lumbar spondylolisthesis who underwent PLF using local bone graft in our University Hospital between 2015 and 2017 were evaluated. The mean duration of low back pain (LBP) was 11.36 ± 1.8 (range, 9–14) months. Operation time and blood loss were recorded. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), while fusion was evaluated using the Lenke classification for posterolateral fusion. Results: The mean operative time was 87.7 ± 19.1 minutes, while blood loss was 541.8 ± 135.5 ml, and the mean follow-up period was 34.55 ± 3.2 months. VAS and ODI improved significantly from preoperatively to postoperatively and at last follow-up (p < 0.05) with no significant difference in terms of gender or age. Radiologically, solid bone fusion was achieved in 23 out of 27 operated levels (85%). One screw was broken, and two patients had superficial wound infections. Conclusion: Our data suggest that instrumented PLF using local bone graft can effectively be used to manage multiple-level lumbar spondylolisthesis with satisfactory outcome and avoid ICBG donor site morbidity. (2020ESJ222)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44074864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.21608/ESJ.2021.57160.1169
T. A. Ahmed
Background Data: Coccydynia is defined as pain in the coccyx or tailbone area, usually caused by sitting acutely on a hard object. Because it often runs a chronic course, the management of this medical problem remains controversial. Different therapeutic options are available for the treatment of this condition. Purpose: To evaluate the effectiveness of a local betamethasone-17α,21-dipropionate and 21-disodium phosphate injections versus NSAIDs and physiotherapy in its management. Study Design: Prospective clinical cases study. Materials and Methods: Forty-eight patients who presented with pain in the tailbone area for more than four weeks were recruited for the study. They were subdivided randomly into two groups:Group I patients were treated with a local injection with betamethasone-17α,21-dipropionate and 21-disodium phosphate (n = 24), whereas Group II were treated with oral NSAIDs and physiotherapy (n = 24). Oral diclofenac sodium (150 mg/day) with physiotherapy program was given to patients in Group II for six weeks. Clinical evaluation was based on the severity of the coccyx pain by Visual Analog Scales (VAS) at 1-, 3-, 6-, and 12-month follow-up and comparison to the baseline pain at presentation. Results: The incidence was more in the third decade (52%, n = 25), with female overbalance (85%, n = 40). In Group I, the mean of VAS was 8.1 before treatment and after one month of treatment, the score reached 3.9 and improved to 0.2 at the end of one year. However, in Group II, the mean of VAS was 7.5 before treatment; then after one month, it changed to 6.6 and improved to 2.5 at the end of one year. Conclusion: The reported outcome in this study suggests that local betamethasone-17α,21-dipropionate and betamethasone 21-disodium phosphate injections are more effective than NSAIDs and physiotherapy for the treatment of coccydynia. (2020ESJ224)
{"title":"Evaluation of Treatment of Coccydynia using Local Injection of Betamethasone-17α,21-dipropionate and 21-Disodium Phosphate versus Oral NSAIDs and Physiotherapy","authors":"T. A. Ahmed","doi":"10.21608/ESJ.2021.57160.1169","DOIUrl":"https://doi.org/10.21608/ESJ.2021.57160.1169","url":null,"abstract":"Background Data: Coccydynia is defined as pain in the coccyx or tailbone area, usually caused by sitting acutely on a hard object. Because it often runs a chronic course, the management of this medical problem remains controversial. Different therapeutic options are available for the treatment of this condition. \u0000Purpose: To evaluate the effectiveness of a local betamethasone-17α,21-dipropionate and 21-disodium phosphate injections versus NSAIDs and physiotherapy in its management. \u0000Study Design: Prospective clinical cases study. \u0000Materials and Methods: Forty-eight patients who presented with pain in the tailbone area for more than four weeks were recruited for the study. They were subdivided randomly into two groups:Group I patients were treated with a local injection with betamethasone-17α,21-dipropionate and 21-disodium phosphate (n = 24), whereas Group II were treated with oral NSAIDs and physiotherapy (n = 24). Oral diclofenac sodium (150 mg/day) with physiotherapy program was given to patients in Group II for six weeks. Clinical evaluation was based on the severity of the coccyx pain by Visual Analog Scales (VAS) at 1-, 3-, 6-, and 12-month follow-up and comparison to the baseline pain at presentation. \u0000Results: The incidence was more in the third decade (52%, n = 25), with female overbalance (85%, n = 40). In Group I, the mean of VAS was 8.1 before treatment and after one month of treatment, the score reached 3.9 and improved to 0.2 at the end of one year. However, in Group II, the mean of VAS was 7.5 before treatment; then after one month, it changed to 6.6 and improved to 2.5 at the end of one year. \u0000Conclusion: The reported outcome in this study suggests that local betamethasone-17α,21-dipropionate and betamethasone 21-disodium phosphate injections are more effective than NSAIDs and physiotherapy for the treatment of coccydynia. (2020ESJ224)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46404006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.21608/esj.2021.55152.1160
M. Nagy, Mohamed elgaidi
Background Data: Gunshot injuries of the spinal cord represent a complex, multidisciplinary management challenge for spine surgeons. Many unique factors can affect the decision-making and management of this controversial type of injuries. Study Design: A retrospective cohort study. Purpose: To assess the clinical outcome and complications after treating patients with gunshot injuries of the spinal cord and the thecal sac. Patients and Methods: This study included 21 patients with spinal gunshot injuries. The mean age was 30.9 ± 4.1 (range, 24–40) years; all patients were males except for one female. The American Spinal Injury Association (ASIA) scale was used to assess the initial neurological status and during the follow-up period. Twelve patients had complete spinal cord injury (CSCI), whereas nine patients had incomplete spinal cord injury (ISCI). The most common involved spinal region was the thoracic spine (52.4%), followed by the lumbar spine (28.6%), then the cervical spine (19%). Results: Fourteen patients were managed conservatively: eight (57.1%) improved, including two patients with CSCI. Seven patients were managed surgically: four (57.1%) improved, including one patient with CSCI. There was no significant difference in the final clinical outcome between the two management protocols. The mean improvement of the 12 patients who showed improvement was 1.17 ASIA grade: only two patients improved two grades (none of them had CSCI), and the other ten patients improved only one grade. The worst prognosis was the thoracic injury with the occurrence of the two follow-up deaths and the least recovery rate of 3/11 (27.3%), while the lumbar spine had the best prognosis with all six patients improving with a mean 1.3 ASIA grade improvement without any follow-up deaths. Conclusion: The clinical outcome of gunshot injuries of the spine was dependent on the initial ASIA grade and the spinal injury level, while the cauda equina injuries had a better prognosis irrespective of the management modality. (2020ESJ218)
{"title":"Gunshot Injuries of the Spine: The Outcome Assessment of Series of Twenty-One Patients","authors":"M. Nagy, Mohamed elgaidi","doi":"10.21608/esj.2021.55152.1160","DOIUrl":"https://doi.org/10.21608/esj.2021.55152.1160","url":null,"abstract":"Background Data: Gunshot injuries of the spinal cord represent a complex, multidisciplinary management challenge for spine surgeons. Many unique factors can affect the decision-making and management of this controversial type of injuries. Study Design: A retrospective cohort study. Purpose: To assess the clinical outcome and complications after treating patients with gunshot injuries of the spinal cord and the thecal sac. Patients and Methods: This study included 21 patients with spinal gunshot injuries. The mean age was 30.9 ± 4.1 (range, 24–40) years; all patients were males except for one female. The American Spinal Injury Association (ASIA) scale was used to assess the initial neurological status and during the follow-up period. Twelve patients had complete spinal cord injury (CSCI), whereas nine patients had incomplete spinal cord injury (ISCI). The most common involved spinal region was the thoracic spine (52.4%), followed by the lumbar spine (28.6%), then the cervical spine (19%). Results: Fourteen patients were managed conservatively: eight (57.1%) improved, including two patients with CSCI. Seven patients were managed surgically: four (57.1%) improved, including one patient with CSCI. There was no significant difference in the final clinical outcome between the two management protocols. The mean improvement of the 12 patients who showed improvement was 1.17 ASIA grade: only two patients improved two grades (none of them had CSCI), and the other ten patients improved only one grade. The worst prognosis was the thoracic injury with the occurrence of the two follow-up deaths and the least recovery rate of 3/11 (27.3%), while the lumbar spine had the best prognosis with all six patients improving with a mean 1.3 ASIA grade improvement without any follow-up deaths. Conclusion: The clinical outcome of gunshot injuries of the spine was dependent on the initial ASIA grade and the spinal injury level, while the cauda equina injuries had a better prognosis irrespective of the management modality. (2020ESJ218)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43094204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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