Developmental and Acquired Disorders of The Spine
Milosh Perovitch in Radiological Evaluation of the Spinal Cord, 2019
The developmental or acquired disorders of the spine can affect the spinal cord in two ways, directly or through an indirect involvement. The congenital dysplasia of the odontoid, a local expression for generalized skeletal dysplasia, often leads to altanto-axial instability. In patients with achondroplasia in whom a myelography had to be performed, people used oxygen as a contrast medium because of considerable difficulties in forcing the opaque insoluble contrast to move cranially in the stenotic canal. Spondylolisthesis is marked by a forward displacement of the vertebral body affected by congenital or acquired disorders. Standard radiographs of the cervical spine and skull will demonstrate the characteristic features of the Klippel-Feil deformity. Fluorosis is a toxic disorder of the spine that may cause narrowing of the spinal canal with a subsequent compression of the spinal cord and its nerve roots. Disorders of bone metabolism affecting the spinal cord are of different origins, and some are well studied.
Evaluation of the Spine in a Child
Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child, 2021
This chapter focuses on pediatric spine examination starts with information on the relevant basic anatomy of the spine and then goes on to an elaborate discussion on relevant points in history-taking. It discusses the examination of the spine in the pediatric age group with a special focus on pathologies specific to the pediatric age group. A differential diagnosis of certain pathologies can be made depending on age. In children, the spectrum of disease is quite different from adults. Growth-related disturbances, such as deformities of the spine and spondylolisthesis, are common in children. Pain should be described in terms of site, onset, nature of pain, radiation, aggravating factors, and relieving factors. Insidious onset pain is usually a feature of developmental conditions like Scheuermann’s kyphosis and benign neoplasms. Fever in a child with acute onset back pain points to an infectious or neoplastic etiology. Birth history includes antenatal, natal, and neonatal history.
Lumbar Spine
Harry Griffiths in Musculoskeletal Radiology, 2008
Spondylolisthesis was first described by Herbiniaux in Belgium in 1782, but it was not until 1854 that Kilian discussed spondylolisthesis in any detail. Spondylolisthesis occurs in association with a number of other spinal anomalies, including spondylolysis, which occurs in at least one-third of cases of spondylolisthesis. Radiologically, spinal stenosis can occasionally be diagnosed on a lateral view of the lumbar spine if it is primarily bony in origin. The normal sagittal diameter of the lumbar spinal canal is greater than 20 mm although this is variable. Classically, the diagnosis of a pars defect depends on good oblique views of the lumbar spine. The importance of spondylolysis and its relationship to low back pain is still improperly understood. The etiology is unknown, but since it is not congenital, it must be “developmental” or associated with either acute or chronic trauma.
Comparison of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolithesis: A Meta-Analysis
Published in Journal of Investigative Surgery, 2019
Ying-Chun Chen, Lin Zhang, Er-Nan Li, Li-Xiang Ding, Gen-Ai Zhang, Yu Hou, Wei Yuan
Aim: Both posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) are the frequently-used techniques to treat lumbar spondylolithesis. The aim of this meta-analysis is to compare the safety and effectiveness between these two methods. Materials and Methods: The multiple databases were used to search for the relevant studies, and full-text articles involved in the comparison between PLIF and PLF were reviewed. Review Manager 5.0 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Results: Finally, 11 relevant studies were eventually satisfied the included criteria. The meta-analysis suggested that there was no significant difference of the clinical outcome, fusion rate, complication rate and blood loss (RR = 1.07, 95%CI [0.97, 1.17], P = 0.16; RR = 0.84, 95%CI [0.49, 1.45], P = 0.54; RR = 1.07, 95%CI [0.95, 1.21], P = 0.25; SMD = 0.24, 95%CI [−0.50, 0.98], P = 0.52; respectively). No publication bias was observed in this study (P > 0.05). Conclusions: Both these two procedures provide excellent outcomes for patients with spondylolisthesis. There was no significant difference of clinical outcome, complication rate, fusion rate and blood loss between PLIF and PLF techniques.
Hollow modular anchorage (HMA) screws for anterior transvertebral fixation in high-grade spondylolisthesis cases requiring 360 degrees in-situ fusion
Published in British Journal of Neurosurgery, 2018
Matthias A. König, Bronek M. Boszczyk
Objective: 360 degrees in-situ fusion for high-grade spondylolisthesis showed satisfying clinical long-term results. Combining anterior with posterior surgery increases fusion rates. Anteriorly inserted transvertebral HMA screws could be an alternative to strut graft constructs or cages, avoiding donor site complications. In addition, complete posterior muscle detachment is avoided and the injury risk of neural structures is minimized. This study investigates the use of HMA screws in this context. Material and methods: Five consecutive patients requiring L4-S1 in-situ fusion for isthmic spondylolisthesis (four Grade 3 and one Grade 4) were included. The L5/S1 level was fused with an HMA screw filled with local bone and bone morphogenic protein (BMP2), inserted via the L4/5 disc space level. An L4/5 stand-alone interbody fusion with additional minimal invasive posterior screw fixation was added. Results: Transvertebral insertion of the HMA device was accomplished via a retroperitoneal approach to L4/L5 in all cases without exposure of L5/S1. Blood loss ranged from 150 ml–350 ml. No intraoperative complication occurred. One patient developed posterior wound infection requiring debridement. Solid fusion was confirmed with a CT scan after 6 months in all patients. All patients improved to unrestricted activities of daily living with two being limited by occasional back pain. Conclusions: HMA screws allow for effective lumbosacral fusion via a limited anterior exposure. This is technically easier than posterior exposure of the lumbosacral junction in high-grade spondylolisthesis requiring 360 degrees fusion.
Does minimally invasive fusion technique influence surgical outcomes in isthmic spondylolisthesis?
Published in Minimally Invasive Therapy & Allied Technologies, 2019
Dal-Sung Ryu, Sang-Soak Ahn, Kyung-Hyun Kim, Jeong-Yoon Park, Sung-Uk Kuh, Dong-Kyu Chin, Keun-Su Kim, Yong-Eun Cho
Objective: To compare the clinical and radiographic results between open transforaminal interbody fusion (TLIF-O) and minimally invasive TLIF (TLIF-M) for single-level low grade isthmic spondylolisthesis (IS). Methods: This study enrolled 45 patients who underwent single-level TLIF with low grade IS. The patients were divided into two groups according to operative method: TLIF-M (20 patients) and TLIF-O (25 patients). TLIF-O group was matched with TLIF-M. Results: At one-year postoperatively, there were no significant differences in any radiologic parameters between the two groups. Perioperative results such as blood loss, operation time, and hospital stay were superior in TLIF-M than in TLIF-O. Fusion was achieved in 17 of 20 patients (85.0%) in TLIF-M and 23 of 25 (92.0%) patients in TLIF-O. Back Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores of TLIF-O were significantly lower than TLIF-M at one (back VAS, ODI) and six months (ODI) postoperatively. Conclusions: TLIF-M and TLIF-O produced similar clinical and radiological outcomes, including reduction of spondylolisthesis and disc space height restoration at one-year follow-up for single-level low grade IS. However, considering perioperative outcomes, back pain, and quality of life, TLIF-M might be a better option for single-level low grade IS compared to TLIF-O.
Related Knowledge Centers
- Lumbar Vertebrae
- Scoliosis
- Vertebra
- Spondylolysis
- Pars Interarticularis
- Neural Arch
- Herniated Disc