Pub Date : 2018-10-01DOI: 10.21608/ESJ.2019.4911.1062
A. Elayouty, W. Ghany
Background Data: In 1988, Modic et al first described magnetic resonance (MR) degenerative changes in the lumbar vertebral bodies. changes in the intervertebral endplates, Modic Changes (MC) can also be incriminated in the production of such pain due to the mechanical failure and structural changes that can be detected the most in the region of the highly pain sensitive intervertebral endplates. There is still a controversy regarding the surgical treatment of the predominantly axial pain secondary to degenerative lumbar disc disease. Study Design: This is a retrospective cohort study. Purpose: To evaluate the effect of adding fusion to simple discectomy in treatment of patients of lumbar disc herniation that show evidence of MC on preoperative MR images regarding the control of postoperative back pain and functional outcome. Patients and Methods: This study included 44 patients who underwent surgical management of low back pain and/or sciatica due to lumbar intervertebral disc herniation with concomitant presence of Modic changes in the preoperative MR images. Patients were divided into two groups: Group A (Discectomy group), and Group B (Fusion group). Patients included had single level lumbar disc herniation with modic changes. Patients with radiographic evidence of instability and patients whose 1-year post-operative data were incomplete were excluded. Twenty five patients were males and 19 were females with a mean age of 43.48 years. Nineteen patients (43.2%) were allocated in Group A and 25 patients (56.8 %) in Group B. Clinical results and functional outcome were assessed based on changes in preoperative and postoperative Visual Analogue Scale (VAS) of low back pain and Oswestry Disability Index (ODI) scores of the functional disability. Results: Postoperative back pain improvement was statistically significant in both groups when comparing preoperative values of VAS using paired student-t test with P<0.001 for both groups. Comparison of post-operative back pain VAS for both groups using independent student-t test revealed a statistically Address correspondence and reprint requests: Ahmad Elsayed Desoukey Elayouty, MD. Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt E-mail: dr.ahmad_elsayed@med.asu.edu.eg Submitted: May 22, 2018 Accepted: September 24, 2018 Published: October, 2018 The article does not contain information about medical device(s)/drug(s). No funds were received in support of this work. The authors report no conflict of interest.
{"title":"The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control","authors":"A. Elayouty, W. Ghany","doi":"10.21608/ESJ.2019.4911.1062","DOIUrl":"https://doi.org/10.21608/ESJ.2019.4911.1062","url":null,"abstract":"Background Data: In 1988, Modic et al first described magnetic resonance (MR) degenerative changes in the lumbar vertebral bodies. changes in the intervertebral endplates, Modic Changes (MC) can also be incriminated in the production of such pain due to the mechanical failure and structural changes that can be detected the most in the region of the highly pain sensitive intervertebral endplates. There is still a controversy regarding the surgical treatment of the predominantly axial pain secondary to degenerative lumbar disc disease. Study Design: This is a retrospective cohort study. Purpose: To evaluate the effect of adding fusion to simple discectomy in treatment of patients of lumbar disc herniation that show evidence of MC on preoperative MR images regarding the control of postoperative back pain and functional outcome. Patients and Methods: This study included 44 patients who underwent surgical management of low back pain and/or sciatica due to lumbar intervertebral disc herniation with concomitant presence of Modic changes in the preoperative MR images. Patients were divided into two groups: Group A (Discectomy group), and Group B (Fusion group). Patients included had single level lumbar disc herniation with modic changes. Patients with radiographic evidence of instability and patients whose 1-year post-operative data were incomplete were excluded. Twenty five patients were males and 19 were females with a mean age of 43.48 years. Nineteen patients (43.2%) were allocated in Group A and 25 patients (56.8 %) in Group B. Clinical results and functional outcome were assessed based on changes in preoperative and postoperative Visual Analogue Scale (VAS) of low back pain and Oswestry Disability Index (ODI) scores of the functional disability. Results: Postoperative back pain improvement was statistically significant in both groups when comparing preoperative values of VAS using paired student-t test with P<0.001 for both groups. Comparison of post-operative back pain VAS for both groups using independent student-t test revealed a statistically Address correspondence and reprint requests: Ahmad Elsayed Desoukey Elayouty, MD. Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt E-mail: dr.ahmad_elsayed@med.asu.edu.eg Submitted: May 22, 2018 Accepted: September 24, 2018 Published: October, 2018 The article does not contain information about medical device(s)/drug(s). No funds were received in support of this work. The authors report no conflict of interest.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43872275","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 : 2018-10-01DOI: 10.21608/ESJ.2019.5408.1068
Osama Dawood, A. Toubar, H. Anwer, M. Aziz
Background Data: Anterior cervical discectomy and fusion (ACDF) has been standard procedure in treatment of degenerative cervical disc disease. In order to reduce risks associated with traditional methods of anterior cervical discectomy with fusion a new zero profile cage with screws has been introduced and widely used.Purpose: To compare the clinical and radiological outcomes of two levels ACDF using stand-alone peek cage and zero profile anchored cage with screws.Study Design: Two groups of patients were enrolled in this study; Group A involving 30 consecutive patients that underwent two levels ACDF using standalone peek cages, and Group B including 30 patients that underwent two levels ACDF with zero-profile anchored cage with screws.Patients and Methods: Both surgical groups were assessed clinically involving neck and arm pain Visual Analogue Score (VAS), neck disability index and Nurick score. Radiological evaluation involved the changes in vertebral heights (VH), both segmental (Cobb-s) and global (Cobb-c) Cobb angle and fusion rates via plain X-ray cervical spine that was done pre-operative, immediate post-operative and at 24 months post-operative.Results: The neck disability index and the Nurick score together with both VAS for neck and arm pain were significantly improved after surgery with no statistical difference between both groups. All patients in both groups showed satisfactory fusion rates except two patients in Group A. Both groups showed early marked increase in the VH followed later by cage subsidence that was significantly higher in Group A patients. In both groups; Cobb-c, and Cobb-s angles were significantly increased in the immediate postoperative compared to the preoperative measures. Terminal measures for both Cobb-c and Cobb-s, at 24 months follow up images, in both groups worsened but to a statistically significant lesser extent in Group B compared to Group A.Conclusion: The zero-profile anchored cage with screws compared to stand-alone peek cage was effective treatment for cervical disc disorders in two levels cervical discectomy and fusion and their results showed better result regarding the incidence of cage subsidence and maintaining cervical lordosis. (2018ESJ169)
{"title":"Anchored Spacers Versus Standalone Cages in Two Levels Anterior Cervical Discectomy for Treatment of Degenerative Cervical Disc Disease; A Comparative Study","authors":"Osama Dawood, A. Toubar, H. Anwer, M. Aziz","doi":"10.21608/ESJ.2019.5408.1068","DOIUrl":"https://doi.org/10.21608/ESJ.2019.5408.1068","url":null,"abstract":"Background Data: Anterior cervical discectomy and fusion (ACDF) has been standard procedure in treatment of degenerative cervical disc disease. In order to reduce risks associated with traditional methods of anterior cervical discectomy with fusion a new zero profile cage with screws has been introduced and widely used.Purpose: To compare the clinical and radiological outcomes of two levels ACDF using stand-alone peek cage and zero profile anchored cage with screws.Study Design: Two groups of patients were enrolled in this study; Group A involving 30 consecutive patients that underwent two levels ACDF using standalone peek cages, and Group B including 30 patients that underwent two levels ACDF with zero-profile anchored cage with screws.Patients and Methods: Both surgical groups were assessed clinically involving neck and arm pain Visual Analogue Score (VAS), neck disability index and Nurick score. Radiological evaluation involved the changes in vertebral heights (VH), both segmental (Cobb-s) and global (Cobb-c) Cobb angle and fusion rates via plain X-ray cervical spine that was done pre-operative, immediate post-operative and at 24 months post-operative.Results: The neck disability index and the Nurick score together with both VAS for neck and arm pain were significantly improved after surgery with no statistical difference between both groups. All patients in both groups showed satisfactory fusion rates except two patients in Group A. Both groups showed early marked increase in the VH followed later by cage subsidence that was significantly higher in Group A patients. In both groups; Cobb-c, and Cobb-s angles were significantly increased in the immediate postoperative compared to the preoperative measures. Terminal measures for both Cobb-c and Cobb-s, at 24 months follow up images, in both groups worsened but to a statistically significant lesser extent in Group B compared to Group A.Conclusion: The zero-profile anchored cage with screws compared to stand-alone peek cage was effective treatment for cervical disc disorders in two levels cervical discectomy and fusion and their results showed better result regarding the incidence of cage subsidence and maintaining cervical lordosis. (2018ESJ169)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47316816","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 : 2018-10-01DOI: 10.21608/ESJ.2019.5021.1064
A. Naggar, S. Elgawhary, Tarek A. Elhewala
ground Data: Thoracolumbar fractures nowadays are considered the commonest spinal fractures and its treatment remains one of the major controversies. Post-traumatic kyphosis (PTK) is considered the commonest serious complication of poorly managed thoracolumbar fractures which can affect the patient health quality of life. Different corrective osteotomy techniques are described to correct this deformity but with limited correction in sever angular kyphotic deformity. Our hypothesis was, among several osteotomies described to correct kyphosis, vertebral column resection (VCR) provides the highest angle of correction required to manage patients with severe PTK.Purpose: To evaluate the safety and efficacy of posterior VCR in the treatment of patients with severe degrees of post-traumatic thoracolumbar kyphosis and determine the degree of correction in sagittal imbalance and its relationship with functional outcome of the patients.Study Design: This prospective clinical case study.Patients and Methods: Twelve patients suffering from PTK and managed with posterior VCR were recruited for this study. The mean local kyphosis angle (LKA) was 64.1±6.3ᴼ. Outcome measures were Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) and radiological using local kyphosis angle (LKA), global kyphosis (GK), lumbar lordosis (LL) and sagittal vertical axis (SVA). The mean follow up time was 13.5±2 months.Results: The mean LKA and SVA score improved from 64.1± 6.3o and 52.6±8.3mm preoperatively to 8.8±3.4o and 13.1±4.8mm postoperatively, respectively. All were statistically significant. Functionally, the VAS score of back pain significantly reduced from 6.8±0.9 to 1.7±0.8 and the Oswestry Disability Index significantly improved from 59.8±7.5 to 11.6±3.4. No major complications were reported apart from intraoperative dural tear in 2 patients, superficial infection in one patient, deep infection in one patient and temporary paraparesis in one patient.Conclusion: Posterior VCR can provide satisfactory correction in severe PTK and improvement in functional outcome with appropriate application and fine surgical technique. (2018ESJ165)
{"title":"Posterior Vertebral Column Resection in Management of Severe Post-traumatic Thoracolumbar Kyphosis","authors":"A. Naggar, S. Elgawhary, Tarek A. Elhewala","doi":"10.21608/ESJ.2019.5021.1064","DOIUrl":"https://doi.org/10.21608/ESJ.2019.5021.1064","url":null,"abstract":"ground Data: Thoracolumbar fractures nowadays are considered the commonest spinal fractures and its treatment remains one of the major controversies. Post-traumatic kyphosis (PTK) is considered the commonest serious complication of poorly managed thoracolumbar fractures which can affect the patient health quality of life. Different corrective osteotomy techniques are described to correct this deformity but with limited correction in sever angular kyphotic deformity. Our hypothesis was, among several osteotomies described to correct kyphosis, vertebral column resection (VCR) provides the highest angle of correction required to manage patients with severe PTK.Purpose: To evaluate the safety and efficacy of posterior VCR in the treatment of patients with severe degrees of post-traumatic thoracolumbar kyphosis and determine the degree of correction in sagittal imbalance and its relationship with functional outcome of the patients.Study Design: This prospective clinical case study.Patients and Methods: Twelve patients suffering from PTK and managed with posterior VCR were recruited for this study. The mean local kyphosis angle (LKA) was 64.1±6.3ᴼ. Outcome measures were Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) and radiological using local kyphosis angle (LKA), global kyphosis (GK), lumbar lordosis (LL) and sagittal vertical axis (SVA). The mean follow up time was 13.5±2 months.Results: The mean LKA and SVA score improved from 64.1± 6.3o and 52.6±8.3mm preoperatively to 8.8±3.4o and 13.1±4.8mm postoperatively, respectively. All were statistically significant. Functionally, the VAS score of back pain significantly reduced from 6.8±0.9 to 1.7±0.8 and the Oswestry Disability Index significantly improved from 59.8±7.5 to 11.6±3.4. No major complications were reported apart from intraoperative dural tear in 2 patients, superficial infection in one patient, deep infection in one patient and temporary paraparesis in one patient.Conclusion: Posterior VCR can provide satisfactory correction in severe PTK and improvement in functional outcome with appropriate application and fine surgical technique. (2018ESJ165)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49313553","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 : 2018-10-01DOI: 10.21608/ESJ.2019.4725.1057
A. Toubar, Osama Dawood
Background Data: The facet arthropathy is the source of persistent low back pain that could refer to both lower limbs. The referred lower limb pain of facet origin may refer to the proximal lower extremities, buttocks, and/or back. The medial branches of the dorsal rami are the main innervations of the facet joints. Blocking pain transmission through these medial branches can be performed by conventional nerve block, intra-articular injection, and radiofrequency ablation.Purpose: The aim of this study was to compare the therapeutic benefits of the conventional facet joint block and the non pulsed radiofrequency denervation to the medial branches of dorsal rami in the treatment of facet arthropathy in non-surgical patients.Study Design: This study was a randomized clinical study included 58 patients suffering from chronic back pain due to facet joint arthropathy.Patients and Methods: Fifty-eight patients were included in this study. The outcome measure was: the visual analogue score (VAS) for low back pain. Patients were randomized into two groups: Group A: included 29 patients who were subjected to conventional facet join injection with steroids. Group B: included 29 patients who were subjected to radiofrequency denervation of the facet joints. All patients were regularly assessed through the follow up period of six months post intervention.Results: The study included 58 patients, 26 males; the mean age was 42.2±9.57 years. In group A, who had facet steroids injection, the mean preoperative VAS was 4.86±0.97, the mean post injection at one-week VAS was reduced to 4.29±0.94, at three months the mean VAS was 4.11±0.84, and at the sixth months; it dropped to 2.64±0.91. Preoperative and after six months VAS changes were not significant (P=0.1654). In group B, who had facet radiofrequency ablation, the mean preoperative VAS was 4.73±0.2, the mean post injection at one-week VAS was reduced to 3.40±0.12, at three months the mean VAS was 2.63±0.18, and at the sixth months it dropped to 1.8±0.14. Preoperative and after six months VAS changes were significant (P=0.0012).Conclusion: Both facet joint steroids injection and radiofrequency ablation have a significant result in non-surgical management of low back pain due to facet arthropathies. None-pulsed radiofrequency ablation has better results in pain relief at the third and sixth month post intervention when compared to facet steroids injection. (2018ESJ164)
{"title":"Facet Joint Injection versus Radiofrequency Facet Neurotomy for Treatment of Lumbar Facet Joint Arthropathy","authors":"A. Toubar, Osama Dawood","doi":"10.21608/ESJ.2019.4725.1057","DOIUrl":"https://doi.org/10.21608/ESJ.2019.4725.1057","url":null,"abstract":"Background Data: The facet arthropathy is the source of persistent low back pain that could refer to both lower limbs. The referred lower limb pain of facet origin may refer to the proximal lower extremities, buttocks, and/or back. The medial branches of the dorsal rami are the main innervations of the facet joints. Blocking pain transmission through these medial branches can be performed by conventional nerve block, intra-articular injection, and radiofrequency ablation.Purpose: The aim of this study was to compare the therapeutic benefits of the conventional facet joint block and the non pulsed radiofrequency denervation to the medial branches of dorsal rami in the treatment of facet arthropathy in non-surgical patients.Study Design: This study was a randomized clinical study included 58 patients suffering from chronic back pain due to facet joint arthropathy.Patients and Methods: Fifty-eight patients were included in this study. The outcome measure was: the visual analogue score (VAS) for low back pain. Patients were randomized into two groups: Group A: included 29 patients who were subjected to conventional facet join injection with steroids. Group B: included 29 patients who were subjected to radiofrequency denervation of the facet joints. All patients were regularly assessed through the follow up period of six months post intervention.Results: The study included 58 patients, 26 males; the mean age was 42.2±9.57 years. In group A, who had facet steroids injection, the mean preoperative VAS was 4.86±0.97, the mean post injection at one-week VAS was reduced to 4.29±0.94, at three months the mean VAS was 4.11±0.84, and at the sixth months; it dropped to 2.64±0.91. Preoperative and after six months VAS changes were not significant (P=0.1654). In group B, who had facet radiofrequency ablation, the mean preoperative VAS was 4.73±0.2, the mean post injection at one-week VAS was reduced to 3.40±0.12, at three months the mean VAS was 2.63±0.18, and at the sixth months it dropped to 1.8±0.14. Preoperative and after six months VAS changes were significant (P=0.0012).Conclusion: Both facet joint steroids injection and radiofrequency ablation have a significant result in non-surgical management of low back pain due to facet arthropathies. None-pulsed radiofrequency ablation has better results in pain relief at the third and sixth month post intervention when compared to facet steroids injection. (2018ESJ164)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42545999","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}
Background Data: The treatment of lumbar stenosis has originally included extensive resections of posterior neural arch components. Moreover, wide muscular dissection and retraction is generally used to accomplish sufficient visualization. With the advancing noninvasive neuro-imaging modalities; the major component of neurological pressure typically occurs at the level of the interlaminar window. Microendoscopic decompressive laminotomies (MEDL) have now increased popularity among spine specialists for the treatment of lumbar canal stenosis. It has been developed from the unilateral hemilaminotomy technique.Purpose: To evaluate the efficacy of lumbar endoscopic decompression in patients of segmental lumbar canal stenosis from a unilateral skin incision.Study Design: A prospective clinical case study.Patients and Methods: A total of 30 patients 10 males and 20 females were operated in Alexandria Main University Hospital, during the period from January 2013 to June 2015. The degree of pain and disability were assessed pre-operatively using the Visual Analogue Scale (VAS), both for radicular pain and back pain (if present), and the Oswestry Disability Index (ODI). The length of the incision, the duration of surgery, the operative blood loss, and duration of hospital stay were calculated. Mean follow up period for patients was 38.5±18.2 months (Range, 36-48).Results: The mean age was 62.7±6.9 years. All patients had claudicating sciatica; 57% had bilateral sciatica, while 43 % had unilateral sciatica. 60% had low back pain. Only 3 patients (10%) had motor weakness preoperatively. 24 patients (80%) had single level affection, while 6 patients (20%) had double level affection. We operated totally on 36 segmental levels. There was a statistically significant reduction for the mean values of VAS both for radicular pain and back pain in the follow up period (P<0.001). Also, there was a statistically significant reduction for the ODI mean value in the follow up period (P<0.001). Operative blood loss was 109.5±63.2 ML. Mean operative time was 103.8±32.7 minutes. Mean duration of hospital stay was 1.5±0.6 days (Range, 1-3 days). We had two patients of intraoperative dural tears (7%) with no postoperative CSF leak occurred, two patients (7%) had superficial wound infection, no patients had deep wound infection or discitis, and no patients encountered of postoperative instability in the follow up period. Conclusion: Endoscopic surgery for bilateral decompression through a unilateral approach is a useful and effective procedure for treating patients with lumbar canal stenosis with encouraging results. (2018ESJ161)
{"title":"Efficacy of Endoscopic Surgery in Management of Patients with Lumbar Canal Stenosis","authors":"A. Elwany, I. Zidan, A. Sultan","doi":"10.21608/ESJ.2018.18292","DOIUrl":"https://doi.org/10.21608/ESJ.2018.18292","url":null,"abstract":"Background Data: The treatment of lumbar stenosis has originally included extensive resections of posterior neural arch components. Moreover, wide muscular dissection and retraction is generally used to accomplish sufficient visualization. With the advancing noninvasive neuro-imaging modalities; the major component of neurological pressure typically occurs at the level of the interlaminar window. Microendoscopic decompressive laminotomies (MEDL) have now increased popularity among spine specialists for the treatment of lumbar canal stenosis. It has been developed from the unilateral hemilaminotomy technique.Purpose: To evaluate the efficacy of lumbar endoscopic decompression in patients of segmental lumbar canal stenosis from a unilateral skin incision.Study Design: A prospective clinical case study.Patients and Methods: A total of 30 patients 10 males and 20 females were operated in Alexandria Main University Hospital, during the period from January 2013 to June 2015. The degree of pain and disability were assessed pre-operatively using the Visual Analogue Scale (VAS), both for radicular pain and back pain (if present), and the Oswestry Disability Index (ODI). The length of the incision, the duration of surgery, the operative blood loss, and duration of hospital stay were calculated. Mean follow up period for patients was 38.5±18.2 months (Range, 36-48).Results: The mean age was 62.7±6.9 years. All patients had claudicating sciatica; 57% had bilateral sciatica, while 43 % had unilateral sciatica. 60% had low back pain. Only 3 patients (10%) had motor weakness preoperatively. 24 patients (80%) had single level affection, while 6 patients (20%) had double level affection. We operated totally on 36 segmental levels. There was a statistically significant reduction for the mean values of VAS both for radicular pain and back pain in the follow up period (P<0.001). Also, there was a statistically significant reduction for the ODI mean value in the follow up period (P<0.001). Operative blood loss was 109.5±63.2 ML. Mean operative time was 103.8±32.7 minutes. Mean duration of hospital stay was 1.5±0.6 days (Range, 1-3 days). We had two patients of intraoperative dural tears (7%) with no postoperative CSF leak occurred, two patients (7%) had superficial wound infection, no patients had deep wound infection or discitis, and no patients encountered of postoperative instability in the follow up period. Conclusion: Endoscopic surgery for bilateral decompression through a unilateral approach is a useful and effective procedure for treating patients with lumbar canal stenosis with encouraging results. (2018ESJ161)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46174652","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}
M. Ibrahim, Mohamed El-Meshtawy, M. Shousha, H. Boehm
Background Data: Ankylosing spondylitis (AS) is a chronic inflammatory disease that can severely alter the normal spinal sagittal balance resulting in functional and social disability. Although the traditional open corrective techniques have provided a great radiographic improvement, they are associated with relatively high morbidity and mortality in an already vulnerable patient with several medical comorbidities. Therefore, a new less invasive technique has been developed in an attempt to achieve both radiographic and clinical improvement while minimizing the possible surgical risks of conventional open approaches.Purpose: To present an innovative less invasive technique for management of thoracic and/or lumbar sagittal imbalance in AS and to evaluate the morbidity, clinical results and radiographic correction following the use of this technique.Study design: Retrospective analysis of prospectively collected data.Methods: Between September 2008 and September 2013, 51 patients (43 males and 8 females) with thoracic and/or lumbar sagittal imbalance due to AS were operated upon. Those patients underwent minimally invasive dorso-ventral osteotomy and reconstruction plus posterior percutaneous instrumentation in the same prone position. Sagittal vertical axis (SVA), T1 pelvic angle (TPA), angle of fusion levels (AFL) and chin-brow vertical angle (CBVA) were used to evaluate radiographic outcomes and degree of correction. Clinical outcomes were assessed by Oswestry Disability Index (ODI) and visual analogue scale (VAS).Results: The mean age at operation was 49.02 years. The mean operative time was 419.31 min with a mean blood loss of 698.24 ml. One third of the patients underwent more than one single dorso-ventral osteotomy. All clinical and radiographic parameters (except for PI) showed a statistically significant improvement after surgery (P 30% improvement from the baseline ODI. Moreover, the changes in ODI were significantly related to the changes in SVA, TPA, AFL and CBVA. Dural tear and transient radiculopathy were the most common complications.onclusion: This technique has obvious advantages in reducing blood loss, optimizing correction and reconstruction, facilitating the postoperative course, and providing satisfactory clinical outcomes. We believe that this novel technique, although technically demanding, offers a safe and effective alternative for traditional open surgery in managing thoracic and/or lumbar sagittal imbalance due to AS. (2018ESJ159)
{"title":"A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis","authors":"M. Ibrahim, Mohamed El-Meshtawy, M. Shousha, H. Boehm","doi":"10.21608/ESJ.2018.18290","DOIUrl":"https://doi.org/10.21608/ESJ.2018.18290","url":null,"abstract":"Background Data: Ankylosing spondylitis (AS) is a chronic inflammatory disease that can severely alter the normal spinal sagittal balance resulting in functional and social disability. Although the traditional open corrective techniques have provided a great radiographic improvement, they are associated with relatively high morbidity and mortality in an already vulnerable patient with several medical comorbidities. Therefore, a new less invasive technique has been developed in an attempt to achieve both radiographic and clinical improvement while minimizing the possible surgical risks of conventional open approaches.Purpose: To present an innovative less invasive technique for management of thoracic and/or lumbar sagittal imbalance in AS and to evaluate the morbidity, clinical results and radiographic correction following the use of this technique.Study design: Retrospective analysis of prospectively collected data.Methods: Between September 2008 and September 2013, 51 patients (43 males and 8 females) with thoracic and/or lumbar sagittal imbalance due to AS were operated upon. Those patients underwent minimally invasive dorso-ventral osteotomy and reconstruction plus posterior percutaneous instrumentation in the same prone position. Sagittal vertical axis (SVA), T1 pelvic angle (TPA), angle of fusion levels (AFL) and chin-brow vertical angle (CBVA) were used to evaluate radiographic outcomes and degree of correction. Clinical outcomes were assessed by Oswestry Disability Index (ODI) and visual analogue scale (VAS).Results: The mean age at operation was 49.02 years. The mean operative time was 419.31 min with a mean blood loss of 698.24 ml. One third of the patients underwent more than one single dorso-ventral osteotomy. All clinical and radiographic parameters (except for PI) showed a statistically significant improvement after surgery (P 30% improvement from the baseline ODI. Moreover, the changes in ODI were significantly related to the changes in SVA, TPA, AFL and CBVA. Dural tear and transient radiculopathy were the most common complications.onclusion: This technique has obvious advantages in reducing blood loss, optimizing correction and reconstruction, facilitating the postoperative course, and providing satisfactory clinical outcomes. We believe that this novel technique, although technically demanding, offers a safe and effective alternative for traditional open surgery in managing thoracic and/or lumbar sagittal imbalance due to AS. (2018ESJ159)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43541939","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}
Background Data: Percutaneous screws fixation became popular as it depends on minimal muscle destruction and no para-spinal muscle stripping. However, there is a lot of disadvantages of percutaneous fixation technique including the high radiation exposure. Complications reported in conventional midline approach including muscle stripping from lamina and spinous processes and long-term postoperative pain and muscle weakness led the spine surgeon to rediscover minimally invasive technique to manage spinal fractures through posterior approach. One of these techniques is Wiltse technique which access the pedicle through blunt dissection between the longissimus muscle and multifidus muscle. Purpose: This study aims to compare pedicle screw fixation via Wiltse approach, and the traditional posterior midline approach outcome. Study Design: Prospective comparative study. Patients and Methods: A total of 36 patients of single-level thoracolumbar fractures without neurologic injury underwent pedicle screw fixation using two different approaches. Twenty patients were treated using conventional technique (Group 1 ), and 16 patients were operated using Wiltse technique (Group 2 ). Screw placement accuracy rate, operative time, blood loss, postoperative hospitalization time, radiation exposure time, postoperative improvement of Cobb angle for regional kyphosis, functional disability index using Oswestry Disability Index, and Visual Analogue Scale (VAS) of the two groups were compared. Results: There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and Cobb angle improvement between the two groups. However, the Wiltse technique had obvious advantages over the conventional technique in operative time, blood loss, hospitalization time, ODI improvement and postoperative short-term improvement in VAS. Conclusion: Our data suggest that pedicle screw insertion using Wiltse technique for treatment of thoracolumbar fracture has the advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no significant increased radiation exposure. (2018ESJ160)
{"title":"Wiltse Approach versus Conventional Open Approach in Neurologically Intact Patients with Thoracolumbar Fractures: Clinical and Radiological Outcome Study","authors":"M. Shater, M. Hassanein","doi":"10.21608/esj.2018.18389","DOIUrl":"https://doi.org/10.21608/esj.2018.18389","url":null,"abstract":"Background Data: Percutaneous screws fixation became popular as it depends on minimal muscle destruction and no para-spinal muscle stripping. However, there is a lot of disadvantages of percutaneous fixation technique including the high radiation exposure. Complications reported in conventional midline approach including muscle stripping from lamina and spinous processes and long-term postoperative pain and muscle weakness led the spine surgeon to rediscover minimally invasive technique to manage spinal fractures through posterior approach. One of these techniques is Wiltse technique which access the pedicle through blunt dissection between the longissimus muscle and multifidus muscle. Purpose: This study aims to compare pedicle screw fixation via Wiltse approach, and the traditional posterior midline approach outcome. Study Design: Prospective comparative study. Patients and Methods: A total of 36 patients of single-level thoracolumbar fractures without neurologic injury underwent pedicle screw fixation using two different approaches. Twenty patients were treated using conventional technique (Group 1 ), and 16 patients were operated using Wiltse technique (Group 2 ). Screw placement accuracy rate, operative time, blood loss, postoperative hospitalization time, radiation exposure time, postoperative improvement of Cobb angle for regional kyphosis, functional disability index using Oswestry Disability Index, and Visual Analogue Scale (VAS) of the two groups were compared. Results: There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and Cobb angle improvement between the two groups. However, the Wiltse technique had obvious advantages over the conventional technique in operative time, blood loss, hospitalization time, ODI improvement and postoperative short-term improvement in VAS. Conclusion: Our data suggest that pedicle screw insertion using Wiltse technique for treatment of thoracolumbar fracture has the advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no significant increased radiation exposure. (2018ESJ160)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49237337","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}
M. Shater, A. Abou-Madawi, H. Al-Shatoury, Khaled Elsayed, M. Shousha
Background Data: Thoracic and thoracolumbar fractures are commonly provoked by axial compression which disrupts the anterior column. In this setting, posterior stabilization using pedicle screws alone may lead to delayed kyphosis and hardware failure due to inadequate anterior column support. Application of thoracoscopic anterior column reconstruction while patient in prone position for posterior percutaneous instrumentation is a minimally invasive combined technique.Purpose: To evaluate the outcome of percutaneous pedicle screw instrumentation in combination with thoracoscopically assisted vertebral reconstruction using expandable titanium cage.Study Design: Prospective clinical case study.Patients and Methods: Eighteen patients with acute thoracolumbar fractures with different preoperative neurological status were recruited for this study. Patients were treated using a short segment percutaneous screw fixation construct combined with thoracoscopic corpectomy and insertion of expandable cage. Patients were followed for at least 6 months. Visual analogue scale (VAS), Oswestry disability index (ODI) and local kyphotic angle were recorded prospectively and compared to preoperative parameters. Intraoperative data including operative time, blood loss and perioperative complication was documented.Results: Patients were operated within 7 days after trauma using combined anterior and posterior stabilization technique. Mean operative time was 213±42 min (Range, 170-300). The mean blood loss was 225±79 ml (Range, 100-350). The mean VAS score improved significantly after surgery. The mean of ODI preoperatively was 74±6.9 preoperatively and improved after 6 months to become 17.5±14.6. The mean regional kyphotic angle was 22.6±6.82ᴼ preoperatively, improved to 6.9±4.1ᴼ postoperatively and at final follow-up it became 8.67±4.8ᴼ. No patient had neurological deterioration or hardware failure during ≥6 months of follow up.Conclusion: our data suggest that thoracoscopic anterior reconstruction and decompression augmented with posterior percutaneous in prone position yield good clinical and radiological results with minimal complications in thoracolumbar trauma. (2018ESJ158)
{"title":"Thoracoscopically Assisted Vertebral Reconstruction Simultaneously with Percutaneous Pedicle Screws Fixation for Management of Thoracic and Thoracolumbar Spinal Fractures.","authors":"M. Shater, A. Abou-Madawi, H. Al-Shatoury, Khaled Elsayed, M. Shousha","doi":"10.21608/ESJ.2018.18289","DOIUrl":"https://doi.org/10.21608/ESJ.2018.18289","url":null,"abstract":"Background Data: Thoracic and thoracolumbar fractures are commonly provoked by axial compression which disrupts the anterior column. In this setting, posterior stabilization using pedicle screws alone may lead to delayed kyphosis and hardware failure due to inadequate anterior column support. Application of thoracoscopic anterior column reconstruction while patient in prone position for posterior percutaneous instrumentation is a minimally invasive combined technique.Purpose: To evaluate the outcome of percutaneous pedicle screw instrumentation in combination with thoracoscopically assisted vertebral reconstruction using expandable titanium cage.Study Design: Prospective clinical case study.Patients and Methods: Eighteen patients with acute thoracolumbar fractures with different preoperative neurological status were recruited for this study. Patients were treated using a short segment percutaneous screw fixation construct combined with thoracoscopic corpectomy and insertion of expandable cage. Patients were followed for at least 6 months. Visual analogue scale (VAS), Oswestry disability index (ODI) and local kyphotic angle were recorded prospectively and compared to preoperative parameters. Intraoperative data including operative time, blood loss and perioperative complication was documented.Results: Patients were operated within 7 days after trauma using combined anterior and posterior stabilization technique. Mean operative time was 213±42 min (Range, 170-300). The mean blood loss was 225±79 ml (Range, 100-350). The mean VAS score improved significantly after surgery. The mean of ODI preoperatively was 74±6.9 preoperatively and improved after 6 months to become 17.5±14.6. The mean regional kyphotic angle was 22.6±6.82ᴼ preoperatively, improved to 6.9±4.1ᴼ postoperatively and at final follow-up it became 8.67±4.8ᴼ. No patient had neurological deterioration or hardware failure during ≥6 months of follow up.Conclusion: our data suggest that thoracoscopic anterior reconstruction and decompression augmented with posterior percutaneous in prone position yield good clinical and radiological results with minimal complications in thoracolumbar trauma. (2018ESJ158)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41912173","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}
Background Data: Surgical treatment of isthmic spondylolisthesis includes decompression, fixation and bone fusion. There are different suitable techniques for fusion as (PLF) posterolateral fusion (TLIF) transforaminal lumbar interbody fusion, (PLIF) posterior lumbar interbody fusion, (ALIF) anterior lumbar interbody fusion but still controversy remains about the best technique.Purpose: To evaluate and compare the surgical results of PLF versus TLIF with pedicle screw fixation in treatment of low-grade isthmic spondylolisthesis.Study design: A prospective randomized clinical case series.Patients and methods: This study included 40 patients with low grade isthmic spondylolisthesis. All patients were surgically treated by posterior decompression, transpedicular screw fixation and bone fusion. Patients were divided into two equal groups according to the type of bone fusion. Group A included 20 patients treated with PLF, and Group B included another 20 patients and were treated with TLIF. We used Visual Analogue Scale (VAS) for assess pain and the Oswestry Disability Index (ODI) to evaluate the functional outcome among our patients. Patients have been followed up for at least six months after surgery.Results: The improvement of VAS of back pain was significantly greater in group B (TLIF) (change 5.25±1.55) than in group A (PLF) (change, 4.4±1.14) (P<0.05). There was no significant difference in improvement of ODI in both groups. Patients with BMI³30 showed that group B experienced more clinical improvement than in group A in the VAS (P=0.021). The operative time in group B (185±24.5 min) was significantly longer than in group A (123.3±19.6 min) (P=0.034). Intraoperative blood loss in group B (584±192.1 ml) was significantly greater than in group A (417±182.4 ml) (P=0.008). The complication rate in group A (30%) was significantly less than in group B (55%) (P= 0.032) but broken screws (hardware failure) were more common in group A (20%) than in group B (0.0%) (P=0.01). The fusion rate in group B (95%) was higher than in group A (75%).Conclusion: Our data suggest that although TLIF is better than PLF in achievement of successful bone fusion and improvement of patient’s symptoms (back pain and sciatica), PLF still considered simple technique with minimal operative blood loss, less operative time and little complications. (2018ESJ162)
{"title":"Posterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis","authors":"A. Farid, A. Elkholy","doi":"10.21608/ESJ.2018.18390","DOIUrl":"https://doi.org/10.21608/ESJ.2018.18390","url":null,"abstract":"Background Data: Surgical treatment of isthmic spondylolisthesis includes decompression, fixation and bone fusion. There are different suitable techniques for fusion as (PLF) posterolateral fusion (TLIF) transforaminal lumbar interbody fusion, (PLIF) posterior lumbar interbody fusion, (ALIF) anterior lumbar interbody fusion but still controversy remains about the best technique.Purpose: To evaluate and compare the surgical results of PLF versus TLIF with pedicle screw fixation in treatment of low-grade isthmic spondylolisthesis.Study design: A prospective randomized clinical case series.Patients and methods: This study included 40 patients with low grade isthmic spondylolisthesis. All patients were surgically treated by posterior decompression, transpedicular screw fixation and bone fusion. Patients were divided into two equal groups according to the type of bone fusion. Group A included 20 patients treated with PLF, and Group B included another 20 patients and were treated with TLIF. We used Visual Analogue Scale (VAS) for assess pain and the Oswestry Disability Index (ODI) to evaluate the functional outcome among our patients. Patients have been followed up for at least six months after surgery.Results: The improvement of VAS of back pain was significantly greater in group B (TLIF) (change 5.25±1.55) than in group A (PLF) (change, 4.4±1.14) (P<0.05). There was no significant difference in improvement of ODI in both groups. Patients with BMI³30 showed that group B experienced more clinical improvement than in group A in the VAS (P=0.021). The operative time in group B (185±24.5 min) was significantly longer than in group A (123.3±19.6 min) (P=0.034). Intraoperative blood loss in group B (584±192.1 ml) was significantly greater than in group A (417±182.4 ml) (P=0.008). The complication rate in group A (30%) was significantly less than in group B (55%) (P= 0.032) but broken screws (hardware failure) were more common in group A (20%) than in group B (0.0%) (P=0.01). The fusion rate in group B (95%) was higher than in group A (75%).Conclusion: Our data suggest that although TLIF is better than PLF in achievement of successful bone fusion and improvement of patient’s symptoms (back pain and sciatica), PLF still considered simple technique with minimal operative blood loss, less operative time and little complications. (2018ESJ162)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47056871","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}
Background data: Radiofrequency Ablation (RFA) procedure for Lumbar facet arthritis and pain is a promising option for management of chronic low back pain due to facet arthropathy.Purpose: The aim of this study is to evaluate the clinical outcomes in patients treated with Radiofrequency Ablation for lumbar facet syndrome.Study Design: A retrospective clinical study.Patients and Methods: Eighteen consecutive patients diagnosed with Lumbar Facet Syndrome were included in this study. The Radiofrequency Ablation procedure for Lumbar facets was performed for all of them in the period between 2016 and 2017. The clinical outcome was assessed by the Visual Analogue Scale (VAS) before procedure and at follow-up. Overall patients’ satisfaction from the procedure outcome was graded according to Odom’s criteria.Results: Among the eighteen patients included in the study, eight patients were females and ten were males. The mean age was 46.5±6 (33-60)years. Duration of pain at presentation varied between 1-4 years with mean duration of 30.2 months. Fourteen (77.7%) patients received bilateral facet denervation while only four had unilateral facet ablation. After the intervention, the mean Visual Analog Score for back pain was significantly improved from 7.1±1.4 to 3.0±1.2 (P=0.01).At the end of the follow up, patient satisfaction according to Odom’s criteria of outcome grading showed 34.8% of patients had good recovery and 30.2% had fair recovery.Conclusion: Radiofrequency Ablation is an emerging treatment for lumbar facet syndrome; it improves the clinical outcome on short-term follow-up. Further studies are encouraged to assess its long term efficacy. (2018ESJ126)
{"title":"Radiofrequency Ablation for Management of Lumbar Facet Syndrome: A Case Series","authors":"Ahmed M. Elsayed","doi":"10.21608/ESJ.2018.18391","DOIUrl":"https://doi.org/10.21608/ESJ.2018.18391","url":null,"abstract":"Background data: Radiofrequency Ablation (RFA) procedure for Lumbar facet arthritis and pain is a promising option for management of chronic low back pain due to facet arthropathy.Purpose: The aim of this study is to evaluate the clinical outcomes in patients treated with Radiofrequency Ablation for lumbar facet syndrome.Study Design: A retrospective clinical study.Patients and Methods: Eighteen consecutive patients diagnosed with Lumbar Facet Syndrome were included in this study. The Radiofrequency Ablation procedure for Lumbar facets was performed for all of them in the period between 2016 and 2017. The clinical outcome was assessed by the Visual Analogue Scale (VAS) before procedure and at follow-up. Overall patients’ satisfaction from the procedure outcome was graded according to Odom’s criteria.Results: Among the eighteen patients included in the study, eight patients were females and ten were males. The mean age was 46.5±6 (33-60)years. Duration of pain at presentation varied between 1-4 years with mean duration of 30.2 months. Fourteen (77.7%) patients received bilateral facet denervation while only four had unilateral facet ablation. After the intervention, the mean Visual Analog Score for back pain was significantly improved from 7.1±1.4 to 3.0±1.2 (P=0.01).At the end of the follow up, patient satisfaction according to Odom’s criteria of outcome grading showed 34.8% of patients had good recovery and 30.2% had fair recovery.Conclusion: Radiofrequency Ablation is an emerging treatment for lumbar facet syndrome; it improves the clinical outcome on short-term follow-up. Further studies are encouraged to assess its long term efficacy. (2018ESJ126)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48613429","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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