OBJECTIVE: To review the research progress of Modic changes and its influence on lumbar interbody fusion. METHODS: The domestic and foreign literature related to Modic changes and its influence on lumbar interbody fusion was extensively reviewed. The etiology of Modic changes was summarized, and the treatment measures of Modic changes on lumbar interbody fusion were discussed. RESULTS: The etiology of Modic changes is not clear, which may be related to mechanical factors, autoimmune factors, low toxic infection factors, and genetic factors. Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion. Preoperative evaluation of endplate sclerosis, reduction of iatrogenic endplate injury, fine operating of intervertebral space, management of osteoporosis, and selection of appropriate cage can prevent or reduce fusion failure or cage subsidence. CONCLUSION Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion, and active perioperative intervention of Modic changes is helpful to improve the clinical prognosis.
Humans ; Lumbosacral Region/surgery* ; Osteoporosis ; Spinal Fusion ; Treatment Failure

OBJECTIVEThe purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory (CBT) screw fixation technique, a new fixation technique for lumbar surgery.

DATA SOURCESThe data analyzed in this review are mainly from articles reported in PubMed published from 1994 to 2014.

STUDY SELECTIONOriginal articles and critical reviews relevant to CBT technique and lumbar pedicle fixation were selected.

RESULTSCBT technique was firstly introduced as a new fixation method for lumbar pedicle surgery in 2009. The concepts, morphometric study, biomechanical characteristics and clinical applications of CBT technique were reviewed. The insertional point of CBT screw is located at the lateral point of the pars interarticularis, and its trajectory follows a caudocephalad path sagittally and a laterally directed path in the transverse plane. CBT technique can be used for posterior fixation during lumbar fusion procedures. This technique is a minimally invasive surgery, which affords better biomechanical stability, fixation strength and surgical safety. Therefore, CBT technique has the greatest benefit in lumbar pedicle surgery for patients with osteoporosis and obesity.

CONCLUSIONCBT technique is a better alternative option of lumbar pedicle fixation, especially for patients with osteoporosis and obesity.

Cortical Bone ; surgery ; Humans ; Lumbar Vertebrae ; surgery ; Lumbosacral Region ; surgery ; Pedicle Screws

As a common disease in clinical, the treatment of lumbar disc herniation (LDH) focused on local intervertebral disc, such as surgery and other interventional therapy treatment, but postoperative complications and recurrence rate has been a difficult problem in the field of profession. With the development of spine biomechanics and anatomy, researches on lumbar herniation also increased. Researchers discovered that the incidence and prognosis of LDH were inseparable with local muscle and soft tissue. As the deep paraspinal muscles, multifidus muscle plays an important role to make lumbar stability. Its abnormal function could reduce the stable of lumbar spine, and the chronic lumbar disease could also lead to multifidus muscle atrophy.
Animals ; Humans ; Intervertebral Disc Displacement ; physiopathology ; surgery ; Lumbosacral Region ; physiopathology ; surgery ; Paraspinal Muscles ; physiopathology

Acupuncture Therapy ; Humans ; Low Back Pain ; surgery ; therapy ; Lumbosacral Region ; surgery ; Male ; Middle Aged ; Treatment Failure

OBJECTIVETo evaluate the clinical outcomes of primary anterior radical debridement, bone autograft, and sacral rod fixation for the treatment of tuberculosis of the lumbosacral segment.

METHODSFrom March 2004 to November 2008,11 patients with tuberculosis of the lumbosacral segments received antituberculosis medications for 2 to 3 weeks before anterior radical debridement, autologous iliac bone grafting, and internal sacral rod fixation. Among the patients, 5 patients were male and 6 patients were female, with an average age of (44.45 +/- 8.50) years (ranged from 29 to 56 years). The average time from stage of onset to operation was 11 months (ranged from 8 to 15 months). All the patients presented with various degrees of lower back pain; one patient experienced preoperative lower extremity radicular pain, while 2 patients experienced saddle area anaesthesia. However, only 6 patients exhibited mild to moderate tuberculous toxic reactions. All the patients were evaluated by plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). The diagnosis of tuberculosis was made with reference to clinical and radiological findings. Surgery was performed when the toxic symptoms of tuberculosis were controlled and erythrocyte sedimentation rates (ESR) decreased to (37.2 +/- 9.6) mm/h (25 to 54 mm/h). Lumbosacral angle, visual analogue scale (VAS) scores, ESR, and neurological performance were assessed before and after surgery.

RESULTSAll surgical procedures were performed successfully without intra or postoperative complications. There were no instances of spinal tuberculosis recurrence. Patients were followed up for a mean of (19.64 +/- 5.43) months. The mean lumbosacral angle significantly increased from the preoperative mean (12.9 +/- 5.0) degrees to postoperative (21.5 +/- 6.1) degrees and at final follow-up (20.1 +/- 5.2) degrees (P < 0.001). The mean VAS scores and ESR significantly decreased from preoperative (7.3 +/- 1.2) score and (37.2 +/- 9.6) mm/h respectively to final follow-up (0.6 +/- 0.5) score and (10.5 +/- 2.3) mm/h respectively (P < 0.001). Bone fusion occurred in all patients at a mean of (9.0 +/- 1.9) months (ranged 6 to 12 months) after surgery. Three patients who had impaired neurological performance before surgery had normal neurological performance after surgery.

CONCLUSIONOur findings suggest that anterior radical debridement, interbody fusion, and sacral rod fixation can be an effective treatment option for lumbosacral segment tuberculosis.

Adult ; Debridement ; Female ; Humans ; Lumbosacral Region ; Male ; Middle Aged ; Sacrum ; surgery ; Spinal Fusion ; Tuberculosis, Spinal ; surgery

BACKGROUNDBilateral transpedicular screw fixation in conjunction with interbody fusion is widely used to treat lumbar degenerative diseases; however, there are some disadvantages of using this fixation system. This study comparatively analyzes the results of unilateral and bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion (TLIF) for one-level lumbar degenerative diseases.

METHODSSixty-six cases with one-level lumbar degenerative diseases were studied. The patients were divided according to surgical approach into a unilateral group (Group A) and a bilateral group (Group B). The patients were evaluated for pain by visual analog scale (VAS) and Oswestry Disability Index (ODI). Operating time, blood loss, duration of hospitalization, and complication rate were also evaluated. Patients were examined at 1, 3, 6, and 12 months postoperatively and every year thereafter.

RESULTSGroup A patients' average preoperative VAS and ODI scores were 7.03 ± 0.98 and (64.22 ± 6.38)%, respectively, significantly decreased to 2.91 ± 0.88 and (14.42±2.08)%, respectively, at the last follow-up (P = 0.000). In Group B, the average preoperative VAS and ODI scores were 6.79 ± 0.86 and (63.22 ± 4.70)%, respectively, significantly decreased to 3.12 ± 0.96 and (14.62 ± 2.08)%, respectively, at the last follow-up (P = 0.000). No significant difference in the duration of hospitalization was found between groups. Operating time and blood loss of (125.9 ± 13.0) minutes and (211.4 ± 28.3) ml, respectively, in Group A were significantly less than (165.2 ± 15.3) minutes and (258.6 ± 18.3) ml, respectively, in Group B (P = 0.000). All patients achieved good bone union and had no pseudarthrosis at the last follow-up.

CONCLUSIONSThere are no clinical differences between unilateral and bilateral pedicle screw fixation combined with TLIF for one-level lumbar degenerative diseases. Unilateral fixation reduces operating time, bleeding, and cost of hospitalization.

Female ; Humans ; Intervertebral Disc Degeneration ; surgery ; Lumbosacral Region ; surgery ; Male ; Middle Aged ; Pedicle Screws

OBJECTIVE: To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L_{4, 5} degenerative lumbar spondylolisthesis (DLS). METHODS: The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. RESULTS: Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). CONCLUSION OSE-assisted posterolateral approach lumbar interbody fusion for L_{4, 5} DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.
Humans ; Spondylolisthesis/surgery* ; Low Back Pain/surgery* ; Retrospective Studies ; Lumbosacral Region ; Blood Loss, Surgical ; Endoscopes

OBJECTIVETo provide anatomic data for reducing lumbar plexus nerve injury.

METHODSThe applied anatomy of lumbar plexus was studied by 15 formaldehyde-preserved cadavers, two groups of sectional images of lumbar segment and three series of virtual chinese human dataset.

RESULTSArrangement of the lumbar nerve was regular. From anterior view, lumbar plexus nerve arranged from lateral to medial from L2 to L5; from lateral view, lumbar nerve arrange from ventral to dorsal from L2 to L5. The angle degree between the lumbar nerve and lumbar increased from L1 to L5. The lumbar plexus nerve was revealed to be in close contact with transverse process. By sectional anatomy, all parts of the lumbar plexus nerve were located in the dorsal third of the psoas major. The safety zone of the psoas major to prevent nerve injuries was ventrally 2/3.

CONCLUSIONSPsoas major can be considered as surgery landmark when expose the lateral anterior of lumbar by incising the psoas muscle. Incising the psoas muscle ventral 2/3 can prevent lumbar plexus injury. Transverse process can be considered as landmark for the position of lumbar plexus in operation.

Female ; Humans ; Lumbar Vertebrae ; anatomy & histology ; surgery ; Lumbosacral Plexus ; anatomy & histology ; Lumbosacral Region ; anatomy & histology ; Male ; Minimally Invasive Surgical Procedures

OBJECTIVE: To explore the dynamic changes of lumbosacral sagittal parameters after real-time three-dimensional navigation assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional open TLIF for treatment of lumbar degenerative disease. METHODS: The clinical data of 61 patients with lumbar degenerative disease underwent single-segment surgery from September 2017 to September 2019 were retrospectively analyzed. Among them, 31 cases underwent MIS-TLIF with 3D navigation techniques (MIS-TLIF group) and another 30 cases underwent conventional open TLIF (traditional open TLIF group). The basic information, operative time and intraoperative blood loss were collected. The sagittal radiologic parameters were measured before surgery and 3 months after surgery, including lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), anterior disc height (ADH), posterior disc height(PDH).And the average disc height(DH) and pelvic incidence to lumbar lordosis mismatch (PI-LL) were calculated. RESULTS: Operative time and intraoperative blood loss in MIS-TLIF group were significantly less than in traditional open TLIF group( CONCLUSION Real-time navigation-assisted MIS-TLIF and traditional open TLIF can recover DH in a short term for lumbar degenerative diseases, improve LL and PI-LL, and make the arrangement of the sagittal plane of the lumbosacral region more coordinated after surgery. But only the navigation assisted MIS -TLIF can significantly improve SL. Compared with traditional open TLIF, real-time navigation assisted MIS-TLIF in the treatment of degenerative lumbar diseases has the advantages of short operation time and less intraoperative bleeding.
Humans ; Lumbar Vertebrae/surgery* ; Lumbosacral Region ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome

OBJECTIVE: To compare the effect of erector spinae plane block and retrolaminar block for relieving acute pain after posterior lumbar surgery. METHODS: Eighty-nine patients undergoing selective posterior lumbar surgery under general anesthesia in our hospital between January and December, 2018, were recruited. Of these patients, 30 received total intravenous general anesthesia to serve as the control group, 28 received total intravenous general anesthesia (TIVA) combined with erector spinae plane block (ESPB), and 31 had TIVA combined with retrolaminar block (RLB). All the patients received patient-controlled intravenous analgesia (PCIA) for postoperative analgesia, and their heart rate, blood pressure, and pulse oximetry were routinely monitored during the anesthesia. VAS scores were evaluated before and at 2, 8, 12, 24, and 48 h after the surgery. Sufentanil consumption during the operation and PCIA were also recorded. The postoperative complications such as nausea and vomiting, urinary retention, itching and respiratory depression within 48 h after the surgery were also recorded. RESULTS: At 2, 8 and 12 h postoperatively, VAS scores in the ESPB group and RLB group were significantly lower than those in the control group; the scores were significantly lower in RLB group than in ESPB group ( < 0.05). Compared with that in the control group, sufentanil consumption during the operation and PCIA were significantly decreased in both ESPB and RLB groups, particularly in the latter group ( < 0.05). Two patients experienced nausea and vomiting and 1 patient complained of pruritus in control group; 1 patient had over sedation and 1 had urinary retention in ESPB group; 1 patient had urinary retention in RLB group. CONCLUSIONS Ultrasound-guided RLB has better analgesic effect than ESPB for management of perioperative pain following posterior lumbar surgery.
Analgesia, Patient-Controlled ; Humans ; Lumbosacral Region ; surgery ; Nerve Block ; Pain, Postoperative ; Sufentanil