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Sudden bilateral foot drop: An unusual presentation of lumbar disc prolapse  [cached]
Mahapatra A,Gupta P,Pawar S,Sharma R
Neurology India , 2003,
Abstract: Bilateral acute foot drop is reported in a 30-year-old healthy male. He presented with a 7-day history of sudden severe backache, radiating to both the lower limbs and 1-day history of sudden bilateral ankle weakness that progressed to bilateral foot drop within 6 hours. He also developed retention of urine. Investigations revealed a large central disc prolapse at L3-4 with significant canal stenosis at that level. Following surgery the patient had progressive improvement.
Usefulness of the Core Outcome Measures Index in Daily Clinical Practice for Assessing Patients with Degenerative Lumbar Disease  [PDF]
Carlos Lozano-álvarez,Daniel Pérez-Prieto,Guillem Saló,Antoni Molina,Andreu Lladó,Manuel Ramírez
Advances in Orthopedics , 2012, DOI: 10.1155/2012/474685
Abstract: Introduction. Outcome evaluation is an important aspect of the treatment of patients with degenerative lumbar disease. We evaluated the usefulness of the Core Outcome Measures Index (COMI) in assessing people affected by degenerative lumbar disease in daily clinical practice. Methods. We evaluated 221 patients who had completed preoperatively and 2 years after surgery VAS pain, Short Form-36 (SF-36), Oswestry Disability Index (ODI) and COMI. We calculated the change of scores and its sensitivity to change. The internal consistency of the COMI items and the correlation between the COMI scores and the scores of the other measurements were assessed. Results. Statistically significant differences were observed between the mean scores of the preoperative and 2 years questionnaires for nearly all measurements. COMI showed a good internal consistency, except for the preoperative pain subscale. The sensitivity to change was high for the total COMI and its pain and well-being subscales and moderate for the rest. The COMI demonstrated strong correlation with the other measurements. Conclusions. The COMI is a useful tool for assessing the patient-based outcome in the studied population. Given its simplicity, good correlation with the SF-36 and ODI and its good sensitivity to change, it could replace more cumbersome instruments in daily clinical practice. 1. Introduction Degenerative lumbar disease (DLD) and chronic low back pain (CLBP) are orthopaedic problems of the highest incidence in the Spanish population [1]. In the United States, the lifetime prevalence of low back pain has been reported to be as high as 84% and the prevalence of CLBP to be about 23%, with 11-12% of the population being disabled by low back pain [2]. Often, DLD and CLBP require surgical intervention so that DLD has become the leading cause of arthrodesis in the spine [1]. In the USA, the annual number of lumbar fusions for degenerative lumbar disease has increased from 174,223 in 1998 to 413,171 in 2008 [3]. Patient-based outcomes may be the most important tool clinicians, patients, and policymakers can use to identify the effectiveness of different low back pain treatments. In 1998, a multinational group of back pain investigators designed the Core Outcome Measures Index (COMI) to evaluate pain, function, generic health status or well-being, disability, and satisfaction [4]. The COMI ultimate goal was to provide a standardized outcome assessment without an excessive burden of instruments or questions that make it difficult for patients to complete the instruments of evaluation. The COMI
Usefulness of the Core Outcome Measures Index in Daily Clinical Practice for Assessing Patients with Degenerative Lumbar Disease  [PDF]
Carlos Lozano-álvarez,Daniel Pérez-Prieto,Guillem Saló,Antoni Molina,Andreu Lladó,Manuel Ramírez
Advances in Orthopedics , 2012, DOI: 10.1155/2012/474685
Abstract: Introduction. Outcome evaluation is an important aspect of the treatment of patients with degenerative lumbar disease. We evaluated the usefulness of the Core Outcome Measures Index (COMI) in assessing people affected by degenerative lumbar disease in daily clinical practice. Methods. We evaluated 221 patients who had completed preoperatively and 2 years after surgery VAS pain, Short Form-36 (SF-36), Oswestry Disability Index (ODI) and COMI. We calculated the change of scores and its sensitivity to change. The internal consistency of the COMI items and the correlation between the COMI scores and the scores of the other measurements were assessed. Results. Statistically significant differences were observed between the mean scores of the preoperative and 2 years questionnaires for nearly all measurements. COMI showed a good internal consistency, except for the preoperative pain subscale. The sensitivity to change was high for the total COMI and its pain and well-being subscales and moderate for the rest. The COMI demonstrated strong correlation with the other measurements. Conclusions. The COMI is a useful tool for assessing the patient-based outcome in the studied population. Given its simplicity, good correlation with the SF-36 and ODI and its good sensitivity to change, it could replace more cumbersome instruments in daily clinical practice.
Meta-Analysis of Clinical Outcomes of Lumbar Fusion Surgical Interventions for Degenerative Spondylolisthesis  [PDF]
Khaled Aneiba, Sabri Garoushi, Mohammed Elmajee, Mohamed Elsllabi, Osama A. Tashani
International Journal of Clinical Medicine (IJCM) , 2018, DOI: 10.4236/ijcm.2018.97050
Abstract: Introduction: Surgical interventions for degenerative spondylolisthesis are varied with comparable claims of success. Fusion based technique is one of the most commonly used surgical interventions in treating this condition. The aim of this meta-analysis is to compare the effectiveness of the Lumbar Interbody Fusion techniques (specifically Posterolateral Interbody approach—PLIF) versus Posterolateral Instrumented Fusion (PLF). The clinical outcomes investigated were: back pain, leg pain, function, Oswestery Disability Index (ODI), Disability Rating Index (DRI), fusion and revision rates if reported. Methods: Combinations of keywords and MeSH terms, where appropriate, were used to search for studies in Medline via Ovid, Embase, Cochrane Library, and Google scholar. The initial search was conducted on 10 August 2016 and updated on 13 June 2017. Eligibility criteria for the studies to be selected for this meta-analysis were: Randomised Controlled Trials (RCTs), cohort and consecutive cases studies that compared at PLIF versus PLF surgical interventions at the lumbar region. Heterogeneity indicators and Forest plot were computed using RevMan 5. Results: Out of the initial hits of 3021, 5 articles were selected as relevant and assessed for risk of bias and then data was extracted and tabulated. These 5 studies reported data from (900 patients’ records, follow up ranges from 6 months to 5 years) undergone one of 2 interventions (PLIF or PLF). The overall effect for ODI and leg pain showed no advantage of any intervention over the other while there was a greater odd ratio of fusion if the operation applied PLIF techniques (Overall Z = 2.86, p = 0.004). Conclusions: There is a need for more high quality clinical trials to compare these two interventions. However, available data indicate that there are comparable results in the main clinical outcomes between PLIF and PLF. PLIF has superior fusion rate which does not seem to affect post-operative pain ratings.
Pedicle-Screw-Based Dynamic Systems and Degenerative Lumbar Diseases: Biomechanical and Clinical Experiences of Dynamic Fusion with Isobar TTL  [PDF]
Cédric Barrey,Gilles Perrin,Sabina Champain
ISRN Orthopedics , 2013, DOI: 10.1155/2013/183702
Abstract: Dynamic systems in the lumbar spine are believed to reduce main fusion drawbacks such as pseudarthrosis, bone rarefaction, and mechanical failure. Compared to fusion achieved with rigid constructs, biomechanical studies underlined some advantages of dynamic instrumentation including increased load sharing between the instrumentation and interbody bone graft and stresses reduction at bone-to-screw interface. These advantages may result in increased fusion rates, limitation of bone rarefaction, and reduction of mechanical complications with the ultimate objective to reduce reoperations rates. However published clinical evidence for dynamic systems remains limited. In addition to providing biomechanical evaluation of a pedicle-screw-based dynamic system, the present study offers a long-term (average 10.2 years) insight view of the clinical outcomes of 18 patients treated by fusion with dynamic systems for degenerative lumbar spine diseases. The findings outline significant and stable symptoms relief, absence of implant-related complications, no revision surgery, and few adjacent segment degenerative changes. In spite of sample limitations, this is the first long-term report of outcomes of dynamic fusion that opens an interesting perspective for clinical outcomes of dynamic systems that need to be explored at larger scale. 1. Introduction Dynamic instrumentation for fusion has been introduced since the 1990s to address the adverse effects of traditional spinal fusion observed with rigid instrumentation: pseudarthrosis, bone rarefaction, and mechanical failure [1, 2]. Some authors suggested that eliminating mechanical loads on an interbody bone graft may result in negative bone remodeling, pseudarthrosis, and osteoporosis [3–6]. This “stress shielding” phenomenon at the disk space level may result from the excessive stiffness of traditional rigid instrumentation. Reducing the stiffness of the instrumentation, pedicle-screw-based posterior dynamic systems (PDSs) allow for load sharing between the instrumentation and the functional spine unit (FSU) at the instrumented level(s). Using a finite element model of the lumbar spine, several authors demonstrated that posterior dynamic instrumentation, compared to rigid instrumentation, increases the amount of load transmission through the anterior column and the interbody bone graft thus avoiding stress shielding phenomenon. This may favor osteogenesis and enhance interbody fusion in accordance with Wolff’s Law according to which the bone will adapt to the loads it is placed under; that is, the structure and shape of
Posterior Transpedicular Dynamic Stabilization versus Total Disc Replacement in the Treatment of Lumbar Painful Degenerative Disc Disease: A Comparison of Clinical Results  [PDF]
Tunc Oktenoglu,Ali Fahir Ozer,Mehdi Sasani,Yaprak Ataker,Cengiz Gomleksiz,Irfan Celebi
Advances in Orthopedics , 2013, DOI: 10.1155/2013/874090
Abstract: Study Design. Prospective clinical study. Objective. This study compares the clinical results of anterior lumbar total disc replacement and posterior transpedicular dynamic stabilization in the treatment of degenerative disc disease. Summary and Background Data. Over the last two decades, both techniques have emerged as alternative treatment options to fusion surgery. Methods. This study was conducted between 2004 and 2010 with a total of 50 patients (25 in each group). The mean age of the patients in total disc prosthesis group was 37,32 years. The mean age of the patients in posterior dynamic transpedicular stabilization was 43,08. Clinical (VAS and Oswestry) and radiological evaluations (lumbar lordosis and segmental lordosis angles) of the patients were carried out prior to the operation and 3, 12, and 24 months after the operation. We compared the average duration of surgery, blood loss during the surgery and the length of hospital stay of both groups. Results. Both techniques offered significant improvements in clinical parameters. There was no significant change in radiologic evaluations after the surgery for both techniques. Conclusion. Both dynamic systems provided spine stability. However, the posterior dynamic system had a slight advantage over anterior disc prosthesis because of its convenient application and fewer possible complications. 1. Introduction Currently, one of the most important causes of chronic low back pain is thought to be a painful disc [1–3]. Some biomechanical and biochemical changes play a role in intervertebral disc degeneration; on the other hand intrinsic, extrinsic, and genetic factors are also important. Compression of the spine, torsional injuries, overload, and congenital anomalies have been shown to contribute to disc degeneration with applying excessive pressure onto intervertebral discs [4–10]. Despite numerous research studies, the etiology and physiopathology of disc degeneration remain unknown [2]. Annular tears resulting from degeneration of the annulus fibrosis, that contains pain receptors and internal disc ruptures, are the most common cause of pain [11–13]. Today, it is believed that degenerative disc disease (DDD) might cause instability in spine segments, and it is widely accepted that progressive back pain results due to this instability [14–16]. In fact, segmental instability begins when disc height deterioration is initiated by the progression of intervertebral disc degeneration. Instability as a consequence of disc degeneration has been described by Frymoyer [14, 15] as primary segmental
The mechanism and clinical effectiveness of the six-step Chinese Daoyin technique on hemiplegic patients with drop-foot  [PDF]
Wen-Ru Zhao, Hai-Hong Zhao, Xue-Min Zhang, Xiao Cao, Xin Li
Journal of Biomedical Science and Engineering (JBiSE) , 2012, DOI: 10.4236/jbise.2012.511081
Abstract: Objective: The aim of this study was to improve the Chinese Daoyin technique (physical and breathing exercises), which is an ancient rehabilitation method, to elevate its effect and to standardize its operational procedure. Methods: Based on the ancient Chinese Daoyin technique, a six-step method was developed including: 1) motion imagination and imitation; 2) mental and breathing regulation; 3) target point determination; 4) motion percussion; 5) motion persistence; 6) relaxation. Sixty drop-foot patients who suffered from hemiparesis after a stroke were randomly divided into the experimental group and the control group. Functional evaluation including Fugl-Meyer assessment score, Lovett manual muscle test (MMT), active range of motion of the ankle joint and electromyography were performed before and after the training course. The data were analyzed using the statistical software SPSS 12.0. Results: The differences between the two groups were significant. The effectiveness of the six-step group was significantly better than the effectiveness of the control group. Conclusion: The six-step method of the Chinese Daoyin technique is an effective rehabilitation training method for drop-foot in stroke patients with hemiparesis.
DEGENERATIVE LUMBAR SPINAL STENOSIS
M.A. Javaid
The Professional Medical Journal , 1995,
Abstract: 50 patients with degenerative lumbar spinal stenosis underwent decompressive laminectomy, 18 with onelevel, 9 with two level and 23 more than 2 levels. The average age was 57 years (45-65). Male to femaleratio was 3:2. 5 patients were lost in follow up. Out of 45 patients 23 had excellent improvement, 14 hadfair recovery, 6 remained unchanged, 2 deteriorated as compared to pre-operative status. No patient hadrevision surgery. There were two dural leaks which healed spontaneously. Decompressive laminectomy issafe and effective procedure for degenerative spinal stenosis.
Degenerative lumbar scoliosis: features and surgical treatment
C. Faldini,S. Pagkrati,G. Grandi,V. Digennaro,O. Faldini,S. Giannini
Journal of Orthopaedics and Traumatology , 2006, DOI: 10.1007/s10195-006-0123-z
Abstract: Degenerative lumbar scoliosis is a de novo deformity of the spine occurring after the fourth or fifth decade of life in patients with no history of scoliosis in the growing age. We evaluated complications and functional and radiographic outcomes of twelve patients with degenerative lumbar scoliosis, treated by spinal decompression associated with posterolateral and/or interbody fusion. Mean lumbar scoliosis angle was 18° (SD=4°) and mean age at surgery was 57 years (SD=6 years). Average follow–up was 3.5 years. Surgical treatment consisted in decompression of one or more roots, associated with stabilization with pedicle screws and posterolateral fusion. To correct the deformity, the collapse of the disc was corrected by implanting a cage in the anterior interbody cage. Clinical symptoms and functional tolerance for daily activities improved after surgery. Radiographic evaluation showed a reduction in the deformity on the frontal and sagittal planes. There were no infections, evidence of pseudoarthrosis, instrumentrelated failures or re–operations in this series. In patients with persisting pain caused by degenerative scoliosis associated with spinal stenosis, in whom conservative treatment has failed, spinal decompression and segmented fusion with instrumentation represents a valid treatment option.
Degenerative lumbar stenosis: update
Joaquim, Andrei F.;Sansur, Charles A.;Hamilton, David K.;Shaffrey, Christopher I.;
Arquivos de Neuro-Psiquiatria , 2009, DOI: 10.1590/S0004-282X2009000300039
Abstract: we present a literature review of the diagnosis and treatment of acquired lumbar spinal stenosis (ls), with a brief description of new surgical techniques. ls is the most common cause of spinal surgery in individuals older than 65 years of age. neurogenic claudication and radiculopathy result from compression of the cauda equina and lumbosacral nerve roots by degenerated spinal elements. surgical decompression is a well established treatment for patients with refractory, or moderate to severe clinical symptoms. however, the variety of surgical options is vast. new techniques have been developed with the goal of increasing long term functional outcomes. in this article we review lumbar decompression and fusion as treatment options for ls but also present other recent developments. prospective long term studies are necessary to know which procedures would result in optimal patient outcome.
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