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2014년 5월 28일 수요일

Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

Brief review

전방경유 요추 유합술과 추간공경유 요추 유합술을 비교하여 술 후의 추간공의 높이와 디스크의 각도, 요추전만각 및 시상면 정렬 등의 항목을 측정하여 연구한 논문 입니다.

전방경유 요추 유합술이 추간공경유 요추 유합술에 비해 위에서 언급한 추간공의 높이와 디스크의 각도, 요추전만각 및 시상면 정렬 등의 항목에서 우수한 결과를 보였습니다.

이 논문은 방사선학적 측정값이 주를 이루므로 설명보다는 표로 보는게 쉬워서 아래와 같이 첨부했습니다.



*Title: Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

*Authors: PATRICK C. HSIEH, TYLER R. KOSKI, BRIAN A. O’SHAUGHNESSY, PATRICK SUGRUE, SEAN SALEHI, STEPHEN ONDRA, JOHN C. LIU




Backgroud of data
-A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance.

-There has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters.


OBJECT
The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis.


METHODS
Study design : retrospective study(medical records and radiographs review)
Subjects: 32 patients (ALIF)+ 25 patients (TLIF) (2000~2004)
Data measurement
-Clinical data: VAS score (pre&post:6,12,24mon)
-radiographic data: foraminal height, local disc angle, and lumbar lordosis (pre&post)

Statistical analyses: included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed.


RESULTS
-ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis.
increasing rate or degree in radiographic data
-foraminal height: 18.5%(ALIF) vs 0.4%(TLIF)
-local disc angle: 8.3 degrees(ALIF) vs 0.1 degree(TLIF)
-lumbar lordosis: 6.2 degrees(ALIF)  vs 2.1 degrees(TLIF)












































































CONCLUSIONS
-The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis.

-The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.




2014년 5월 26일 월요일

Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery

Brief review

전방, 후방 그리고 전/후방 척추 유합술 후의 합병증 및 사망률에 대해 연구한 논문 입니다.
National Inpatient Sample을 이용해 해당기간동안 전방, 후방 그리고 전/후방 척추 유합술을 시행한 입원환자의 표본을 구하여 사망률, 동반질환 발병률, 합병증 발병률 등을 조사하고 사망률에 대한 risk factor를 알아보았습니다.
결론적으로, 전방 및 전/후방 척추 유합술 환자들이 후방 경유 환자에 비해 더 젊고 동반질환의 발병률이 적었지만 사망률은 더 높았습니다.



*Title: Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery

*Authors: Stavros G. Memtsoudis , Vassilios I. Vougioukas, Yan Ma, Licia K. Gaber-Baylis, Federico P. Girardi
*Bilbiography: Spine (Phila Pa 1976). 2011 Oct 15;36(22):1867-77.



STUDY DESIGN
Analysis of population-based national hospital discharge data collected for the National Inpatient Sample(NIS).


OBJECTIVE
-To examine demographics of patients undergoing primary anterior spine fusion (ASF), posterior spine fusion (PSF), and anterior/posterior spine fusion (APSF) of the noncervical spine.

-To assess the incidence of perioperative morbidity and mortality, and determine independent risk factors for in-hospital death.


SUMMARY OF BACKGROUND DATA
The utilization of surgical fusion has been increasing dramatically. Despite this trend, a paucity of literature addressing perioperative outcomes exists.


METHODS
-Subjects: National Inpatient Sample (1998~2006)
-Discharges with a procedure code for primary noncervical spine fusion were included in the sample.
-The prevalence of patient as well as health care system-related demographics were evaluated by procedure type (ASF, PSF, and APSF).
-Frequencies of procedure-related complications and in-hospital mortality were analyzed.
-Independent predictors for in-hospital mortality were determined.


RESULTS
-We identified 261,256 entries representing an estimated 1,273,228 hospitalizations for primary spine fusion.
ASF and APSF patients were significantly younger and had lower average comorbidity indeces than PSF patients. 
(age: 44.8 ± 0.08 and 44.22 ± 0.11 yrs vs 52.12 ± 0.04 yrs  / comorbidity: 0.30 ± 0.002 and 0.31 ± 0.004 vs 0.41 ± 0.002)

The incidence of complications:
- ASF: 18.68%
- PSF: 15.72%
- APSF: 23.81% (P < 0.0001)








^ comorbidity(동반질환)의 종류 별 분포율

In-hospital mortality rates: APSF were twice of PSF (0.51 ± 0.038 vs. 0.26 ± 0.012) (P < 
0.0001)

Risk factors for in-hospital mortality included the following: male gender, increasing age, and increasing comorbidity burden. Several comorbidities and complications independently increased the risk for perioperative death, as did underlying spinal pathology (APSF and ASF compared to PSF)

 

CONCLUSION

-Despite being performed in generally younger and healthier patients, APSF and ASF are associated with increased morbidity and mortality.

2014년 5월 10일 토요일

Dynamic stability of the trunk during unstable sitting in people with low back pain

Brief review


spine저널에서 이번 달에 출판된 논문 입니다.


*Title: Dynamic stability of the trunk during unstable sitting in people with low back pain

*Authors: Freddolini Marco, Strike Siobhan, Lee Raymond


STUDY DESIGN
Cross-sectional study


OBJECTIVE
To evaluate the dynamic stability and kinematics of the trunk during unstable sitting.
To determine the differences in these biomechanical parameters between healthy participants and participants with low back pain (LBP).


SUMMARY OF BACKGROUND DATA
Patients with LBP exhibited alterations in trunk kinematics while performing different dynamic tasks and in static posture as a result of pain. It is not clear if changing in trunk motion may reduce postural control and the ability to perform a balancing task.


METHODS
Group1: 23 participants with LBP
Group2: 31 healthy participants

*Protocol:
1) participants were sitted on a custom-made swinging chair
2) To regain the balance after tilting the chair backward for 10° and 20°
-Lumbar spine, pelvis, and chair motions were recorded using FASTRAK sensors.
-The thoracolumbar curvature of all participants was also evaluated in the standing position.
-The angular displacement of the chair was fitted in an equation describing the underdamped second-order response to a step input.
































RESULTS
Kinematic analysis showed that the hip range of motion increased whereas spine range of motion angle decreased in participants with LBP for both tilt angles (P < 0.05). There were no significant differences between the 2 subject groups in the time required to regain balance, and the natural frequency and damping ratio of the kinematic equation. Lumbar lordosis significantly decreased in LBP group.




CONCLUSION
Participants with LBP showed trunk postural and movement adaptations that seems to be compensatory strategies to decrease the risk of further injuries and aggravation of the symptoms, but their ability to regain the balance was not affected by LBP. Clinicians should encourage patients with LBP to remain active while they are experiencing pain.


2014년 5월 9일 금요일