• Title, Summary, Keyword: Spine

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Impact of Multidisciplinary Spine Conferences on Surgical Planning and Perioperative Care in Elective Lumbar Spine Surgeries

  • Namiranian, Khodadad;Norris, Edward John;Jolissaint, James Gregory;Patel, Jigar Bharat;Lombardi, Celeste Marie
    • Asian Spine Journal
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    • v.12 no.5
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    • pp.854-861
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    • 2018
  • Study Design: Pre- and post-implementation analysis. Purpose: We examined the impact of implementing multidisciplinary spine conferences-"spine board" reviews-on the general utilization of elective lumbar spine surgeries in a tertiary medical institute. Overview of Literature: A multidisciplinary approach to spine care reportedly improves the appropriate utilization of surgical spine procedures. Methods: A multidisciplinary spine board was established to review candidates selected for elective lumbar spine surgery. The board comprised representatives from orthopedic spine surgery, neurosurgery, psychology, physical therapy, radiology, pharmacy, primary care, pain management, anesthesiology, and veteran advocacy. Two similar 6-month periods were selected to study the impact of this implementation: pre-implementing (June 1, 2015 to November 30, 2015) and post-implementation (June 1, 2016 to November 30, 2016) periods. Results: Between March 1, 2016 and December 30, 2016, the spine board discussed 11 patients. All patients underwent clinical examinations and radiological assessments findings that warranted elective lumbar surgery. The board recommended non-surgical interventions before proceeding with the planned surgeries in all cases. In the pre-implementation period, a total of 101 elective lumbar spine surgeries were performed. In the post-implementation period, a total of 51 elective lumbar spine surgeries were performed (p<0.05). The surgical plan for elective lumbar spine surgery in the post-implementation period was not directly influenced by the review of spine board because none of the cases were discussed in the conferences; however, the care occurred at a hospital where the spine board was implemented. There was no significant change in the number of cervical spine surgeries performed (66 preimplementation vs. 56 post-implementation). The average surgery duration was 52 minutes shorter in the post-implementation period compared with that in the pre-implementation period (p<0.05). Conclusions: Implementation of a multidisciplinary spine board was concurrent with an overall decrease in the utilization of lumbar spine surgeries for elective cases of low back pain in a tertiary medical center.

Endoscopic Spine Surgery

  • Choi, Gun;Pophale, Chetan S;Patel, Bhupesh;Uniyal, Priyank
    • Journal of Korean Neurosurgical Society
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    • v.60 no.5
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    • pp.485-497
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    • 2017
  • Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations. Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.

Application of Incidence Angle on Lumbar Spine Anteroposterior General Radiography Image according to Measured Intervertebral Disc Angle (방사선 일반 정면검사에서 허리뼈 추간판 계측 값에 따른 입사각 적용)

  • Moon, Seul-Ji-A;Kim, Gyeong-Rip;Cho, Hee-Jung;Sung, Soon-Ki;Kwak, Jong-Hyeok
    • The Journal of the Korea Contents Association
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    • v.19 no.6
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    • pp.471-480
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    • 2019
  • L-spine 3~4, L-spine 4~5, and L-spine 5~Sacrum 1 intervertebral disc(IVD) angle according to gender, age, body mass index(BMI), lumbar lordosis angle(LLA) were compared and analyzed. The anteriorposterior incidence angle of L-spine 3 ~ 4, L-spine 4 ~ 5 and L-spine 5~Sacrum 1 in body mass index were 5.66, 13.23 and 29.13 degrees in the head direction and L-spine 3 4, L-spine 4 ~ 5, L-spine 5~Sacrum 1 had 6.32 degrees, 16.09 degrees and 35.36 degrees in the head direction. The distortion area ratio comparison was performed with the phantom image using the proposed incidence angle. There was a significant difference in L-spine 4~5 and L-spine 5~Sacrum 1 IVD angle relative to body mass index and LLA(p<0.05), IVD angle and LLA were positively correlated(p<0.05).As a result of evaluating the usefulness of the image by applying the incidence angles of the disc angles according to the phantom angle of deviation to the head direction as 11 degrees for L4 and 26 degrees for L5, the distortion ratio area decreased from 14.90% to 12.11% in L4, And from 15.25% to 13.72% in L5. In anteriorposterior image of the Lumbar spine applying the incidence angle according to the measured disc angle, it is possible to reduce the distortion to purpose L4, L5. And improved the quality and diagnostic information of the target site.

The Effects of Pelvis, Lumbar Spine and Cervical Spine Manipulation on Joint Position Sense in Healthy Adults

  • Gong, Wontae
    • Journal of International Academy of Physical Therapy Research
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    • v.9 no.1
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    • pp.1381-1386
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    • 2018
  • The purpose of this study is to investigate the effect of pelvic, Lumbar spine and Cervical spine manipulation on the joint position sense in normal adults. Thirty normal adults were divided into an experimental group of 15 subjects and a control group of 15 subjects. The experimental group was treated with pelvic, Lumbar spine and Cervical spine manipulation with massage, whereas the control group received only massage. Both groups were evaluated in terms of joint position errors (JPEs) using a digital dual clinometer before and after the experiment. The comparison of the JPEs of the experimental group and the control group before and after the experiment showed that the experimental group's cervical spine results were significantly different in the flexion, left lateral flexion, and right rotation (p < .05) and lumbar spine results were significantly different in the flexion and extension (p < .05), but the control group's results were not statistically significant in all items (p > .05). The pelvic, lumbar spine and cervical spine manipulation makes an effect on the joint position sense in normal adults. The findings of this study suggest that the pelvis, lumbar spine and cervical spine manipulation improve the motor ability in people with low joint position sense.

Serotonergic Antidepressants Are Associated with Increased Blood Loss and Risk for Transfusion in Single-Level Lumbar Fusion Surgery

  • Schadler, Paul;Shue, Jennifer;Moawad, Mohamed;Girardi, Federico P.;Cammisa, Frank P.;Sama, Andrew A.;Huang, Russel C.;Lebl, Darren R.;Craig, Chad M.;Hughes, Alexander P.
    • Asian Spine Journal
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    • v.11 no.4
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    • pp.601-609
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    • 2017
  • Study Design: Retrospective case-control study. Purpose: The purpose of this study was to examine the effect of antidepressants on blood loss and transfusion requirements in spinal surgery patients. Overview of Literature: Several studies have shown an increase in perioperative bleeding in orthopedic surgery patients on antidepressant drug therapy, yet no study has examined the impact of these agents on spinal surgery patients. Methods: Charts of patients who underwent single-level spinal fusion (posterior lumbar interbody fusion with posterior instrumentation) performed by five fellowship-trained surgeons at a tertiary spine center between 2008 and 2013, were retrospectively reviewed. Exclusion criteria included select medical comorbidities, select drug therapy, and Amercian Society of Anesthesiologists Physical Status Classification score of greater than 2. Serotonergic antidepressants were examined in multivariate analysis to assess their predictive value on estimated blood loss and risk of transfusion. Results: A total of 235 patients, of which 52% were female, were included. Allogeneic blood was transfused in 7% of patients. The average estimated blood loss was $682{\pm}463mL$. Selective serotonin reuptake inhibitors were taken by 10% of all patients. Multivariable regression analysis showed that intake of selective serotonin reuptake inhibitors was a significant predictor for blood loss (average increase of 34%, p=0.015) and for the need of allogeneic blood transfusion (odds ratio, 4.550; p=0.029). Conclusions: There was a statistically significant association between selective serotonin reuptake inhibitors and both increased blood loss and risk of allogeneic red blood cell transfusion. Surgeons and perioperative providers should take these findings into account when assessing patients' preoperative risk for blood loss and transfusion.

Influence of the Duration of Smartphone Usage on Flexion Angles of the Cervical and Lumbar Spine and on Reposition Error in the Cervical Spine (스마트폰 사용시간이 목뼈 및 허리뼈의 굽힘각도와 목뼈의 재현오차에 미치는 영향)

  • Kim, Yang-Gon;Kang, Min-Hyeok;Kim, Ji-Won;Jang, Jun-Hyeok;Oh, Jae-Seop
    • Physical Therapy Korea
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    • v.20 no.1
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    • pp.10-17
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    • 2013
  • The purpose of this study was to assess the influence of the duration of smartphone usage on cervical and lumbar spine flexion angles and reposition error in the cervical spine. The study included 18 healthy smartphone users (7 males and 11 females). We measured the kinematics of the upper and lower cervical and lumbar spine flexion angles and the reposition error of the upper and lower cervical spine after 3 s and 300 s smartphone use in sitting. A paired t-test was used to compare the effects of the duration of smartphone usage on the kinematics of cervical and lumbar spine flexion angles and reposition error. The flexion angles of the lower cervical and lumbar spine and the reposition error in the upper and lower cervical spine were significantly increased after 300 s smartphone of use (p<.05). However, the flexion angle of the upper cervical spine was not significantly different between the 3 s and 300 s smartphone of use (p>.05). These findings suggest that prolonged use of smartphones can induce changes in cervical and lumbar spine posture and proprioception in the cervical spine.

Three-dimensional Analysis of the Spine using Formetric 4D according to Upper Limb Movement and Resistance Application (상지의 움직임과 저항 적용에 따른 Formetric 4D를 이용한 척추의 3차원적 분석)

  • Kim, Hyun-Jin;Shin, Won-Seob
    • Journal of the Korean Society of Physical Medicine
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    • v.15 no.3
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    • pp.69-77
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    • 2020
  • PURPOSE: The aim of this study was to measure changes in spine inclination and thoracolumbar structure and morphology according to upper-extremity movements with and without resistance in order to evaluate the spine stability in workers. METHODS: Forty-eight middle-aged male workers (mean age, 40.48 ± 6.27 years) participated in this study. Using the spine analysis system, changes in the inclination of the spine and structure as well as shape of the thoracolumbar spine were measured. For posture measurement, the postures of standing, lifting the right and left arms (shoulder joint 90° flexion), and lifting with both arms were measured in random order. In addition, variables were measured using a resistance of 3 kg for each posture. The statistical significance level was set at α = .05 for all variables. RESULTS: There were statistically significant differences between the front and back inclinations of the spine, kyphotic curve of the thoracic spine, lordotic curve of the lumbar spine, rotation changes in the thoracolumbar spine, and rotation changes in the T4 vertebra (p < .05). However, there was no significant difference in the left and right tilts of the spine. In the post-hoc analysis, rotation changes in the T4 vertebra showed a significant difference in posture when resistance was applied to the left and right sides CONCLUSION: Causes of musculoskeletal diseases include excessive thoracic spine rotation, torsion, and hyperlordosis of the lumbar spine. Therefore, it is necessary to improve the working environment in order to ensure a healthy posture and prevent musculoskeletal diseases that can reduce the ability to carry various and/or excessive loads.

Long Term Efficacy of Posterior Lumbar Interbody Fusion with Standard Cages alone in Lumbar Disc Diseases Combined with Modic Changes

  • Kwon, Young-Min;Chin, Dong-Kyu;Jin, Byung-Ho;Kim, Keun-Su;Cho, Yong-Eun;Kuh, Sung-Uk
    • Journal of Korean Neurosurgical Society
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    • v.46 no.4
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    • pp.322-327
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    • 2009
  • Objective : Posterior lumbar interbody fusion (PLIF) is considered to have the best theoretical potential in promoting bony fusion of unstable vertebral segments by way of a load sharing effect of the anterior column. This study was undertaken to investigate the efficacy of PLIF with cages in chronic degenerative disc disease with Modic degeneration (changes of vertebral end plate). Methods : A total of 597 patients underwent a PLIF with threaded fusion cages (TFC) from 1993 to 2000. Three-hundred-fifty-one patients, who could be followed for more than 3 years, were enrolled in this study. Patients were grouped into 4 categories according to Modic classification (no degeneration : 259, type 1 : 26, type 2 : 55, type 3 : 11). Clinical and radiographic data were evaluated retrospectively. Results : The clinical success rate according to the Prolo's functional and economic outcome scale was 86% in patients without degeneration and 83% in patients with Modic degeneration. The clinical outcomes in each group were 88% in type 1, 84% in type 2, and 73% in type 3. The bony fusion rate was 97% in patients without degeneration and 83% in patients with Modic degeneration. The bony fusion rate in each group was 81% in type 1, 84% in type 2, and 55% in type 3. The clinical success and fusion rates were significantly lower in patients with type 3 degeneration. Conclusion : The PLIF with TFC has been found to be an effective procedure for lumbar spine fusion. But, the clinical outcome and bony fusion rates were significantly low in the patients with Modic type 3. The authors suggest that PLIF combined with pedicle screw fixation would be the better for them.