Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases Ⅱ

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Neurology".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 27071

Special Issue Editors

1. Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Chiba, Japan
2. Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Chiba, Japan
3. Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
Interests: minimally invasive spinal treatment (MIST); percutaneous pedicle screws (PPS); lateral lumbar interbody fusion (LLIF); trans-sacral canal plasty (TSCP); navigation-guided spine surgery
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Guest Editor
Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Chiba 286-0124, Japan
Interests: minimally invasive spinal treatment (MIST); minimally invasive spine stabilization (MISt); spinal deformity; spinal infection; navigation-guided spine surgery; trans-sacral canal plasty (TSCP)
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Guest Editor
Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan
Interests: minimally invasive spinal treatment (MIST); antimicrobial implant; hip–spine syndrome; digital transformation; locomotive syndrome
Special Issues, Collections and Topics in MDPI journals
Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie 514-8507, Japan
Interests: adult spinal deformity; lateral lumbar interbody fusion (LLIF); minimally invasive spinal treatment (MIST); degenerative disc diseases; intervertebral disc therapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Due to an aging population and the needs of patients with spinal disorders, minimally invasive surgery (MIS) techniques are gaining popularity. MIS is a widely developing field that has the potential to decrease surgical risks and improve recovery, compared with traditional open spinal surgery. MIS techniques were initially applied to spinal decompression surgeries, with specific examples being microendoscopic discectomy (MED) and full-endoscopic surgery (FES). To date, these endoscopic surgeries have been widelypracticed and combined with various surgical procedures, including laminectomy, laminoplasty, and foraminotomy. During the last decade, MIS techniques have also been applied to spinal fusion or stabilization techniques, which are classified as minimally invasive spine stabilization (MISt) procedures and include percutaneous pedicle screw (PPS) fixation, lateral lumbar interbody fusion, balloon kyphoplasty, percutaneous vertebroplasty, interspinous process motion-sparing implant, cortical bone trajectory, and cervical total disc replacement. In particular, procedures that involve PPS are practiced widely, such as MIS-transforaminal lumbar interbody fusion (TLIF) and MIS long fixation. Although MIS procedures provide many advantages, they are associated with several problems and limitations, including technical difficulties, training opportunities, and radiation exposure, among others. These downsides of surgical treatments make conservative treatments a more feasible option. The field has witnessed advancements in pharmacological treatments, biologics, and rehabilitation therapy. During and after the coronavirus pandemic, spinal surgeons should consider not only various MIS surgical techniques, but also medical expenses and the use of conservative treatment. The concept of such a treatment strategy has been recently proposed as “minimally invasive spinal treatment (MIST)”.

Dr. Ken Ishii
Dr. Haruki Funao
Dr. Tadatsugu Morimoto
Dr. Koji Akeda
Guest Editors

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Keywords

  • minimally invasive spinal treatment (MIST)
  • minimally invasive spine stabilization (MISt)
  • percutaneous pedicle screws (PPS)
  • lateral lumbar interbody fusion (LLIF)
  • spinal endoscopic surgery
  • micro-endoscopic discectomy (MED)
  • full-endoscopic spine surgery (FESS)
  • MIS long fixation
  • trans-sacral canal plasty (TSCP)
  • navigation-guided spine surgery
  • physical therapy for spinal disorders
  • MIS-transforaminal lumbar interbody fusion (MIS-TLIF)
  • regenerative medicine for spinal disorders
  • osteoporosis
  • conservative treatment
  • radiation exposure

Published Papers (14 papers)

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12 pages, 595 KiB  
Article
Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion
by Gregory M. Mundis, Jr., Kenyu Ito, Nikita Lakomkin, Bahar Shahidi, Hani Malone, Tina Iannacone, Behrooz Akbarnia, Juan Uribe and Robert Eastlack
Medicina 2023, 59(6), 1149; https://doi.org/10.3390/medicina59061149 - 15 Jun 2023
Viewed by 956
Abstract
Background and Objectives: Mitigating post-operative complications is a key metric of success following interbody fusion. LLIF is associated with a unique complication profile when compared to other approaches, and while numerous studies have attempted to report the incidence of post-operative complications, there is [...] Read more.
Background and Objectives: Mitigating post-operative complications is a key metric of success following interbody fusion. LLIF is associated with a unique complication profile when compared to other approaches, and while numerous studies have attempted to report the incidence of post-operative complications, there is currently no consensus regarding their definitions or reporting structure. The aim of this study was to standardize the classification of complications specific to lateral lumbar interbody fusion (LLIF). Materials and Methods: A search algorithm was employed to identify all the articles that described complications following LLIF. A modified Delphi technique was then used to perform three rounds of consensus among twenty-six anonymized experts across seven countries. Published complications were classified as major, minor, or non-complications using a 60% agreement threshold for consensus. Results: A total of 23 articles were extracted, describing 52 individual complications associated with LLIF. In Round 1, forty-one of the fifty-two events were identified as a complication, while seven were considered to be approach-related occurrences. In Round 2, 36 of the 41 events with complication consensus were classified as major or minor. In Round 3, forty-nine of the fifty-two events were ultimately classified into major or minor complications with consensus, while three events remained without agreement. Vascular injuries, long-term neurologic deficits, and return to the operating room for various etiologies were identified as important consensus complications following LLIF. Non-union did not reach significance and was not classified as a complication. Conclusions: These data provide the first, systematic classification scheme of complications following LLIF. These findings may improve the consistency in the future reporting and analysis of surgical outcomes following LLIF. Full article
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10 pages, 1707 KiB  
Article
Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees
by Masayuki Miyagi, Wataru Saito, Yusuke Mimura, Toshiyuki Nakazawa, Takayuki Imura, Eiki Shirasawa, Kentaro Uchida, Shinsuke Ikeda, Akiyoshi Kuroda, Sho Inoue, Yuji Yokozeki, Yoshihide Tanaka, Tsutomu Akazawa, Masashi Takaso and Gen Inoue
Medicina 2023, 59(6), 1090; https://doi.org/10.3390/medicina59061090 - 5 Jun 2023
Cited by 1 | Viewed by 1467
Abstract
Background and objectives: Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with anterior release and [...] Read more.
Background and objectives: Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with anterior release and pre- or intraoperative traction would be effective for severe spinal deformities but would be invasive. This study aimed to evaluate the outcomes of PSF-only surgery for patients with severe NMS with a Cobb angle > 100°. Materials and Methods: Thirty NMS patients (13 boys and 17 girls; mean age 13.8 years) who underwent PSF-only surgery for scoliosis with a Cobb angle > 100° were included. We reviewed the lower instrumented vertebra (LIV), duration of surgery, blood loss, perioperative complications, preoperative clinical findings, and radiographic findings, including Cobb angle and pelvic obliquity (PO) in the sitting position pre- and postoperatively. The correction rate and correction loss of the Cobb angle and PO were also calculated. Results: The mean duration of surgery was 338 min, intraoperative blood loss was 1440 mL, preoperative %VC was 34.1%, FEV1.0 (%) was 91.5%, and EF was 66.1%. There were eight cases of perioperative complications. The Cobb angle and PO correction rates were 48.5% and 42.0%, respectively. We divided the patients into two groups: the L5 group, in which the LIV was L5, and the pelvis group, in which the LIV was the pelvis. The duration of surgery and PO correction rate in the pelvis group were significantly higher than those in the L5 group. Conclusions: Patients with severe NMS demonstrated severe preoperative restrictive ventilatory impairments. PSF surgery without anterior release or any intra-/preoperative traction showed satisfactory outcomes, including acceptable scoliosis correction and improved clinical findings, even in patients with extremely severe NMS. Instrumentation and fusion to the pelvis for severe scoliosis in patients with NMS showed good PO correction and low correction loss of Cobb angle and PO, but a longer duration of surgery. Full article
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10 pages, 1978 KiB  
Article
Evaluation of Surgical Indications for Full Endoscopic Discectomy at Lumbosacral Disc Levels Using Three-Dimensional Magnetic Resonance/Computed Tomography Fusion Images Created with Artificial Intelligence
by Katsuhisa Yamada, Ken Nagahama, Yuichiro Abe, Yoshinori Hyugaji, Daisuke Ukeba, Tsutomu Endo, Takashi Ohnishi, Katsuro Ura, Hideki Sudo, Norimasa Iwasaki and Masahiko Takahata
Medicina 2023, 59(5), 860; https://doi.org/10.3390/medicina59050860 - 28 Apr 2023
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Abstract
Background and Objectives: Although full endoscopic lumbar discectomy with the transforaminal approach (FED-TF) is a minimally invasive spinal surgery for lumbar disc herniation, the lumbosacral levels present anatomical challenges when performing FED-TF surgery due to the presence of the iliac bone. Materials and [...] Read more.
Background and Objectives: Although full endoscopic lumbar discectomy with the transforaminal approach (FED-TF) is a minimally invasive spinal surgery for lumbar disc herniation, the lumbosacral levels present anatomical challenges when performing FED-TF surgery due to the presence of the iliac bone. Materials and Methods: In this study, we simulated whether FED-TF surgery could be safely performed on a total of 52 consecutive cases with L5–S1 or L5–L6 disc herniation using fused three-dimensional (3D) images of the lumbar nerve root on magnetic resonance imaging (MRI) created with artificial intelligence and of the lumbosacral spine and iliac on computed tomography (CT) images. Results: Thirteen of the fifty-two cases were deemed operable according to simulated FED-TF surgery without foraminoplasty using the 3D MRI/CT fusion images. All 13 cases underwent FED-TF surgery without neurological complications, and their clinical symptoms significantly improved. Conclusions: Three-dimensional simulation may allow for the assessment from multiple angles of the endoscope entry and path, as well as the insertion angle. FED-TF surgery simulation using 3D MRI/CT fusion images could be useful in determining the indications for full endoscopic surgery for lumbosacral disc herniation. Full article
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9 pages, 1415 KiB  
Article
Elimination of Lumbar Plexus Injury by Changing the Entry Point and Traction Direction of the Psoas Major Muscle in Transpsoas Lateral Lumbar Spine Surgery
by Hidetoshi Nojiri, Takatoshi Okuda, Hiromitsu Takano, Motoshi Gomi, Ryosuke Takahashi, Arihisa Shimura, Shota Tamagawa, Takeshi Hara, Yukoh Ohara and Muneaki Ishijima
Medicina 2023, 59(4), 730; https://doi.org/10.3390/medicina59040730 - 8 Apr 2023
Cited by 1 | Viewed by 1436
Abstract
Background and Objectives: The lateral approach is commonly used for anterior column reconstruction, indirect decompression, and fusion in patients with lumbar degenerative diseases and spinal deformities. However, intraoperative lumbar plexus injury may occur. This is a retrospective comparative study to investigate and compare [...] Read more.
Background and Objectives: The lateral approach is commonly used for anterior column reconstruction, indirect decompression, and fusion in patients with lumbar degenerative diseases and spinal deformities. However, intraoperative lumbar plexus injury may occur. This is a retrospective comparative study to investigate and compare neurological complications between the conventional lateral approach and a modified lateral approach at L4/5. Materials and Methods: Patients with a lumbar degenerative disease requiring single-level intervertebral fusion at L4/5 were included and categorized into group X and group A. Patients in group X underwent conventional extreme lateral interbody fusion, while those in group A underwent a modified surgical procedure that included splitting of the anterior third of the psoas muscle, which was dilated by the retractor on the anterior third of the intervertebral disc. The incidence of lumbar plexus injury, defined as a decrease of ≥1 grade on manual muscle testing of hip flexors and knee extensors and sensory impairment of the thigh for ≥3 weeks, on the approach side, was investigated. Results: Each group comprised 50 patients. No significant between-group differences in age, sex, body mass index, and approach side were observed. There was a significant between-group difference in intraoperative neuromonitoring stimulation value (13.1 ± 5.4 mA in group X vs. 18.5 ± 2.3 mA in group A, p < 0.001). The incidence of neurological complications was significantly higher in group X than in group A (10.0% vs. 0.0%, respectively, p < 0.05). Conclusions: In our modified procedure, the anterior third of the psoas muscle was entered and split, and the intervertebral disc could be reached without damaging the lumbar plexus. When performing lumbar surgery using the lateral approach, lumbar plexus injury can be avoided by following surgical indication criteria based on the location of the lumbar plexus with respect to the psoas muscle and changing the transpsoas approach to the intervertebral disc. Full article
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15 pages, 2781 KiB  
Article
Retrospective Analysis of Factors Associated with the Treatment Outcomes of Intradiscal Platelet-Rich Plasma-Releasate Injection Therapy for Patients with Discogenic Low Back Pain
by Koji Akeda, Tatsuhiko Fujiwara, Norihiko Takegami, Junichi Yamada and Akihiro Sudo
Medicina 2023, 59(4), 640; https://doi.org/10.3390/medicina59040640 - 23 Mar 2023
Cited by 3 | Viewed by 1637
Abstract
Background and Objectives: Recently, the clinical application of platelet-rich plasma (PRP) has gained popularity for the treatment of degenerative disc diseases. However, the regenerative effects and factors associated with treatment outcomes after intradiscal injection of PRP remain unknown. This study aimed to [...] Read more.
Background and Objectives: Recently, the clinical application of platelet-rich plasma (PRP) has gained popularity for the treatment of degenerative disc diseases. However, the regenerative effects and factors associated with treatment outcomes after intradiscal injection of PRP remain unknown. This study aimed to evaluate time-dependent changes in imaging findings related to intervertebral disc (IVD) degeneration and to identify factors associated with the outcomes of PRP injection therapy. Materials and Methods: A retrospective analysis of a previous randomized clinical trial of intradiscal injection of the releasate isolated from PRP (PRPr) in patients with discogenic low back pain (LBP) was performed. Radiographic parameters (segmental angulation and lumbar lordosis) and MRI phenotypes, including Modic changes, disc bulge, and high-intensity zones (HIZs), were evaluated at baseline and 6 and 12 months post-injection. Treatment outcomes were evaluated based on the degree of LBP and LBP-related disability at 12 months post-injection. Results: A total of 15 patients (mean age: 33.9 ± 9.5 years) were included in this study. Radiographic parameters showed no significant changes after the PRPr injection. There were no remarkable changes in the prevalence or type of MRI phenotype. Treatment outcomes were significantly improved after treatment; however, the number of targeted discs and the presence of posterior HIZs at baseline were significantly but negatively associated with treatment outcomes. Conclusions: Intradiscal injection of PRPr significantly improved LBP and LBP-related disability 12 months post-injection; however, patients with multiple target lesions or posterior HIZs at baseline were significantly associated with poor treatment outcomes. Full article
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12 pages, 1584 KiB  
Article
Subsequent Domino Osteoporotic Vertebral Fractures Adversely Affect Short-Term Health-Related Quality of Life: A Prospective Multicenter Study
by Tomoyuki Kusukawa, Keishi Maruo, Masakazu Toi, Tetsuto Yamaura, Masaru Hatano, Kazuma Nagao, Hayato Oishi, Yutaka Horinouchi, Fumihiro Arizumi, Kazuya Kishima, Norichika Yoshie and Toshiya Tachibana
Medicina 2023, 59(3), 590; https://doi.org/10.3390/medicina59030590 - 16 Mar 2023
Cited by 1 | Viewed by 1551
Abstract
Background and Objectives: Conservative treatment is the gold standard for acute osteoporotic vertebral fractures (AOVFs). However, the treatment strategy for multiple AOVFs remains unknown. We conducted a prospective study using magnetic resonance imaging (MRI) to investigate how rapidly subsequent osteoporotic vertebral fractures [...] Read more.
Background and Objectives: Conservative treatment is the gold standard for acute osteoporotic vertebral fractures (AOVFs). However, the treatment strategy for multiple AOVFs remains unknown. We conducted a prospective study using magnetic resonance imaging (MRI) to investigate how rapidly subsequent osteoporotic vertebral fractures (OVFs) occur as domino OVFs within 3 months. This study aimed to assess the incidence and impact of domino OVFs on quality of life (QOL) following conservative treatment for initial AOVFs. Materials and Methods: A prospective multicenter cohort study was conducted at eight hospitals. The included patients were those with AOVFs occurring within 3 weeks, aged >60 years, and diagnosed using MRI. All patients were treated conservatively and underwent MRI after 3 months. Subsequent domino OVFs were defined as newly occurring OVFs within 3 months. Patient characteristics, types of conservative treatment, and patient-reported outcomes, including a visual analogue scale (VAS), the Oswestry disability index (ODI), and the Japanese Orthopaedic Association back pain evaluation questionnaire (JOABPEQ), were evaluated and compared between the domino OVF and non-domino OVF groups. Results: A total of 227 patients were analyzed. The mean age was 80.1 ± 7.3 years and 78% were female. Subsequent domino OVFs were observed in 31 (13.6%) patients within 3 months. An increasing number of prevalent OVFs were significantly associated with domino OVFs (p = 0.01). No significant differences in bone mineral density, type of brace, and anti-osteoporosis medications were found between the two groups. The JOABPEQ (excluding social function), ODI, and VAS were significantly improved after 3 months. Patients with domino OVFs at 3 months had poorer JOABPEQ social life function, ODI, and VAS than those with non-domino OVFs. Conclusions: In this study, the incidence of domino OVFs was 13.6% within 3 months. Domino OVFs had a negative impact on QOL at 3 months and were associated with prevalent OVFs. Full article
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8 pages, 281 KiB  
Article
Protective Attitudes toward Occupational Radiation Exposure among Spine Surgeons in Japan: An Epidemiological Description from the Survey by the Society for Minimally Invasive Spinal Treatment
by Yasukazu Hijikata, Yoshihisa Kotani, Akinobu Suzuki, Koichi Morota, Haruki Funao, Masayuki Miyagi, Tadatsugu Morimoto, Haruo Kanno and Ken Ishii
Medicina 2023, 59(3), 545; https://doi.org/10.3390/medicina59030545 - 10 Mar 2023
Cited by 5 | Viewed by 1464
Abstract
Background and Objectives: The global trend toward increased protection of medical personnel from occupational radiation exposure requires efforts to promote protection from radiation on a societal scale. To develop effective educational programs to promote radiation protection, we clarify the actual status and [...] Read more.
Background and Objectives: The global trend toward increased protection of medical personnel from occupational radiation exposure requires efforts to promote protection from radiation on a societal scale. To develop effective educational programs to promote radiation protection, we clarify the actual status and stage of behavioral changes of spine surgeons regarding radiation protection. Materials and Methods: We used a web-based questionnaire to collect information on the actual status of radiation protection and stages of behavioral change according to the transtheoretical model. The survey was administered to all members of the Society for Minimally Invasive Spinal Treatment from 5 October to 5 November 2020. Results: Of 324 members of the Society for Minimally Invasive Spinal Treatment, 229 (70.7%) responded. A total of 217 participants were analyzed, excluding 12 respondents who were not exposed to radiation in daily practice. A trunk lead protector was used by 215 (99%) participants, while 113 (53%) preferred an apron-type protector. Dosimeters, thyroid protector, lead glasses, and lead gloves were used by 108 (50%), 116 (53%), 82 (38%), and 64 (29%) participants, respectively. While 202 (93%) participants avoided continuous irradiation, only 120 (55%) were aware of the source of the radiation when determining their position in the room. Regarding the behavioral change stage of radiation protection, 134 (62%) participants were in the action stage, while 37 (17%) had not even reached the contemplation stage. Conclusions: We found that even among the members of the Society for Minimally Invasive Spinal Treatment, protection of all vulnerable body parts was not fully implemented. Thus, development of educational programs that cover the familiar risks of occupational radiation exposure, basic protection methods in the operating room, and the effects of such protection methods on reducing radiation exposure in actual clinical practice is warranted. Full article
11 pages, 1737 KiB  
Article
Association between the Phase Angle and the Severity of Horizontal Gaze Disorder in Patients with Idiopathic Dropped Head Syndrome: A Cross-Sectional Study
by Ryunosuke Urata, Tatsuya Igawa, Shomaru Ito, Akifumi Suzuki, Norihiro Isogai, Yutaka Sasao, Haruki Funao and Ken Ishii
Medicina 2023, 59(3), 526; https://doi.org/10.3390/medicina59030526 - 8 Mar 2023
Cited by 1 | Viewed by 1535
Abstract
Background and Objectives: The phase angle, calculated by bioelectrical impedance analysis, can help elucidate the pathology of patients with idiopathic dropped head syndrome (IDHS) and explain the motor dysfunction associated with the horizontal gaze disorder. The aim of this study was to [...] Read more.
Background and Objectives: The phase angle, calculated by bioelectrical impedance analysis, can help elucidate the pathology of patients with idiopathic dropped head syndrome (IDHS) and explain the motor dysfunction associated with the horizontal gaze disorder. The aim of this study was to clarify the characteristics of phase angle in IDHS patients and the relationship between the phase angle and the severity of horizontal gaze disorder. Materials and Methods: This cross-sectional study included 43 female patients with IDHS and 69 healthy female volunteers. A multi-frequency segmental body composition analyzer was used to calculate body composition parameters, including whole-body and lower extremity phase angles. Propensity score (PS) matching analysis was performed to compare the body composition parameters between the IDHS and healthy groups. Variables that determine the PS were identified by correlation analysis, using the whole-body phase angle as the dependent variable. In addition, correlation analysis was performed between the severity of horizontal gaze disorder as assessed by McGregor’s slope (McGS), phase angle, and other body composition parameters. Results: Unadjusted group comparisons showed no significant difference in whole-body and lower extremity phase angles between the IDHS and healthy groups. PS matching created a total of 38 matched pairs for age, height, and fat-free mass index. Although the comparison between groups of matched samples showed no significant difference in the whole-body phase angle, the lower extremity phase angle in the IDHS group was significantly lower than that in the healthy group (p = 0.033). Correlation analysis showed significant negative correlations only between McGS and whole-body (r = −0.31, p = 0.043) and lower extremity phase angle (r = −0.39, p = 0.009) in the IDHS group. Conclusions: Abnormal body composition of the lower extremities were observed in IDHS patients. Furthermore, it was suggested that horizontal gaze disorder in IDHS patients is associated with whole-body and lower extremity phase angles. Full article
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10 pages, 1201 KiB  
Article
Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis
by Eiki Shirasawa, Wataru Saito, Masayuki Miyagi, Takayuki Imura, Toshiyuki Nakazawa, Yusuke Mimura, Yuji Yokozeki, Akiyoshi Kuroda, Ayumu Kawakubo, Kentaro Uchida, Tsutomu Akazawa, Masashi Takaso and Gen Inoue
Medicina 2023, 59(2), 387; https://doi.org/10.3390/medicina59020387 - 16 Feb 2023
Cited by 3 | Viewed by 1745
Abstract
Background and Objectives: Several predictive factors have been reportedly associated with intraoperative total blood loss (TBL) during posterior spinal fusion (PSF) for idiopathic scoliosis (IS). To reduce TBL, preoperative factors and interoperative factors are considered important. However, there are few reports that [...] Read more.
Background and Objectives: Several predictive factors have been reportedly associated with intraoperative total blood loss (TBL) during posterior spinal fusion (PSF) for idiopathic scoliosis (IS). To reduce TBL, preoperative factors and interoperative factors are considered important. However, there are few reports that have evaluated bleeding patterns according to surgical stages. This study aimed to elucidate bleeding patterns at different surgical stages and determine the predictive factors for TBL during PSF surgery in patients with IS. Materials and Methods: Preoperative data, radiographic parameters, and intraoperative data of patients undergoing PSF for IS were retrospectively collected. We divided the patients into six stages: stage 1, exposure; stage 2, implant placement; stage 3, release; stage 4, correction; stage 5, bone grafting; and stage 6, closure; then we reviewed the blood loss and bleeding speed. Multiple-regression analysis was performed to generate a predictive formula for blood loss using preoperative and intraoperative factors, including blood loss at stage 1, as explanatory variables. Results: Forty-five patients (mean age: 17.6 years) were included. The mean operative time and TBL were 287.9 min and 756.5 mL, respectively. Blood loss was the highest at stage 3, followed by stage 4. Bleeding speed was the highest at stage 4, followed by stage 3. Bleeding speeds at stages 3 and 4 were significantly higher than those at stages 1 and 2. Preoperative Cobb angle, activated partial thromboplastin time (aPTT), number of fused vertebrae, and blood loss at stage 1 were significant contributing factors. Conclusions: Blood loss and bleeding speed during the release and correction stages were high. Specifically, bleeding speed significantly increased during and after the release procedure. The preoperative Cobb angle, aPTT, number of fixed vertebrae, and blood-loss volume during PSF were significantly associated with TBL. Our findings would be helpful for reducing TBL in patients undergoing PSF for IS. Full article
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12 pages, 7154 KiB  
Article
Vertebral Endplate Concavity in Lateral Lumbar Interbody Fusion: Tapered 3D-Printed Porous Titanium Cage versus Squared PEEK Cage
by Naoki Segi, Hiroaki Nakashima, Ryuichi Shinjo, Yujiro Kagami, Masaaki Machino, Sadayuki Ito, Jun Ouchida, Kazuaki Morishita, Ryotaro Oishi, Ippei Yamauchi and Shiro Imagama
Medicina 2023, 59(2), 372; https://doi.org/10.3390/medicina59020372 - 15 Feb 2023
Cited by 2 | Viewed by 1880
Abstract
Background and Objectives: To prevent postoperative problems in extreme lateral interbody fusion (XLIF), it is critical that the vertebral endplate not be injured. Unintentional endplate injuries may depend on the cage. A novel porous titanium cage for XLIF has improved geometry with [...] Read more.
Background and Objectives: To prevent postoperative problems in extreme lateral interbody fusion (XLIF), it is critical that the vertebral endplate not be injured. Unintentional endplate injuries may depend on the cage. A novel porous titanium cage for XLIF has improved geometry with a tapered tip and smooth surface. We hypothesized that this new cage should lead to fewer endplate injuries. Materials and Methods: This retrospective study included 32 patients (mean 74.1 ± 6.7 years, 22 females) who underwent anterior and posterior combined surgery with XLIF for lumbar degenerative disease or adult spinal deformity from January 2018 to June 2022. A tapered 3D porous titanium cage (3DTi; 11 patients) and a squared PEEK cage (sPEEK; 21 patients) were used. Spinal alignment values were measured on X-ray images. Vertebral endplate concavity (VEC) was defined as concavity ≥ 1 mm of the endplate on computed tomography (CT) images, which were evaluated preoperatively and at 1 week and 3 months postoperatively. Results: There were no significant differences in the patient demographic data and preoperative and 3-month postoperative spinal alignments between the groups. A 3DTi was used for 25 levels and an sPEEK was used for 38 levels. Preoperative local lordotic angles were 4.3° for 3DTi vs. 4.7° for sPEEK (p = 0.90), which were corrected to 12.3° and 9.1° (p = 0.029), respectively. At 3 months postoperatively, the angles were 11.6° for 3DTi and 8.2° for sPEEK (p = 0.013). VEC was present in 2 levels (8.0%) for 3DTi vs. 17 levels (45%) for sPEEK (p = 0.002). After 3 months postoperatively, none of the 3DTi had VEC progression; however, eight (21%) levels in sPEEK showed VEC progression (p = 0.019). Conclusions: The novel 3DTi cage reduced endplate injuries by reducing the endplate load during cage insertion. Full article
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10 pages, 7660 KiB  
Article
A Comparative Clinical Study of Lateral Lumbar Interbody Fusion between Patients with Multiply Operated Back and Patients with First-Time Surgery
by Masato Nakano, Hayato Futakawa, Shigeharu Nogami, Miho Kondo, Tatsuro Imai and Yoshiharu Kawaguchi
Medicina 2023, 59(2), 342; https://doi.org/10.3390/medicina59020342 - 10 Feb 2023
Viewed by 1893
Abstract
Background and Objectives: Patients with multiply operated back (MOB) may suffer from persistent lower-back pain associated with back muscle damage and epidural fibrosis following repeated back surgery (Failed Back Spinal Syndrome). Lateral lumbar interbody fusion (LLIF) is considered to be favorable for MOB [...] Read more.
Background and Objectives: Patients with multiply operated back (MOB) may suffer from persistent lower-back pain associated with back muscle damage and epidural fibrosis following repeated back surgery (Failed Back Spinal Syndrome). Lateral lumbar interbody fusion (LLIF) is considered to be favorable for MOB patients. However, little scientific research has been carried out for this issue due to variety of the pathogenesis. The purpose of this study was to compare the clinical results of MOB patients and first-time surgery patients who underwent LLIF for lumbar spinal stenosis with degenerative scoliosis and/or degenerative spondylolisthesis (spinal instability). Materials and Methods: LLIF was performed for lumbar spinal stenosis with spinal instability in 55 consecutive cases of single hospital (30 males, 25 females, average age: 69). Clinical outcomes were compared between the MOB patient group (MOB group) and the first surgical patient group (F group). We evaluated the Japanese Orthopaedic Association (JOA) scores and JOA Back Pain Evaluation Questionnaire (JOABPEQ) before and 2 years after surgery. MOB patients were defined as those who have had one or more lumbar surgery on the same intervertebral or adjacent vertebrae in the past. Results: There were 20 cases (12 males, 8 females, average age: 71) in MOB group, and 35 cases (19 males, 16 females, average age: 68) in the F group. There was no significant difference between the two groups in terms of age, sex, number of intervertebral fixations, modic change in fused intervertebral end plate, score of brief scale for evaluation of psychiatric problem, lumbar lordosis, and sagittal vertical axis before and after surgery. The preoperative JOA scores averaged 12.5 points in the MOB group and averaged 11.6 points in the F group. The postoperative JOA scores averaged 23.9 points in the MOB group and averaged 24.7 points in the F group. The preoperative JOABPEQ averaged 36.3 points in the MOB group and averaged 35.4 points in the F group. The postoperative average JOA score was 75.4 in the MOB group and 70.2 in the F group. Conclusions: Based on the results, there was no significant difference in clinical outcomes of the two groups, and there was no new residual lower-back pain. Thus, we considered that LLIF one option for patients with MOB. Full article
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Review

Jump to: Research, Other

13 pages, 664 KiB  
Review
Cardiopulmonary Cement Embolism Following Cement-Augmented Pedicle Screw Fixation: A Narrative Review
by Tadatsugu Morimoto, Takaomi Kobayashi, Hirohito Hirata, Masatsugu Tsukamoto, Tomohito Yoshihara, Yu Toda and Masaaki Mawatari
Medicina 2023, 59(2), 407; https://doi.org/10.3390/medicina59020407 - 19 Feb 2023
Cited by 4 | Viewed by 1787
Abstract
Fixation using cement-augmented pedicle screws (CAPS) is being increasingly performed. However, CAPS-associated cement leakage is a critical problem that can lead to cardiopulmonary cement embolism (CPCE). This narrative review aimed to explore the incidence of and risk factors and treatment strategies for CPCE [...] Read more.
Fixation using cement-augmented pedicle screws (CAPS) is being increasingly performed. However, CAPS-associated cement leakage is a critical problem that can lead to cardiopulmonary cement embolism (CPCE). This narrative review aimed to explore the incidence of and risk factors and treatment strategies for CPCE and cement leakage-related complications after CAPS fixation. Data were extracted from each article, including characteristics of CPCE after CAPS fixation (incidence, location, diagnostic method and criteria, treatment, and outcome and prognosis). Overall, 28 case series and 14 case reports that met the inclusion criteria were included. Of the 1974 cases included in the review, CPCE was noted in 123, symptomatic CPCE in 35, and death in six, respectively. The frequencies of PCE and symptomatic PCE after CAPS fixation were 6% (range: 0–28.6%) and 1.3% (range: 0–26%), respectively. The range of frequencies of PCE and symptomatic PCE after CAPS fixation may have been wide because the definition of CPCE and data collection methods differed among the reports analyzed. Since PCE due to large cement emboli may be primarily related to the surgical technique, improved technique, such as minimizing the number of CAPSs by injecting low-volume high-viscosity cement at low velocity and pressure, and careful observation of cement leakage during CAPS insertion may reduce PCE associated with cement leakage. Spinal surgeons should pay more attention to the occurrence of CPCE during and after CAPS insertion, which can cause serious complications in some patients. Full article
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Other

Jump to: Research, Review

11 pages, 1662 KiB  
Technical Note
Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note
by Ken Ishii, Norihiro Isogai, Ryunosuke Urata, Haruki Funao, Tatsuya Igawa, Hisanori Mihara and Tetsuya Yamazaki
Medicina 2023, 59(7), 1303; https://doi.org/10.3390/medicina59071303 - 14 Jul 2023
Viewed by 3290
Abstract
Background and Objectives: Thoracic ossification of the ligamentum flavum (OLF) often causes myelopathy and/or radiculopathy. The disease is frequently observed in East Asian populations. Although thoracic OLF in young athletes who have underwent decompression surgery has been reported, the removal of posterior [...] Read more.
Background and Objectives: Thoracic ossification of the ligamentum flavum (OLF) often causes myelopathy and/or radiculopathy. The disease is frequently observed in East Asian populations. Although thoracic OLF in young athletes who have underwent decompression surgery has been reported, the removal of posterior spinal bony elements and ligamentous complex may often cause postoperative thoracolumbar instability. We established a novel surgical technique that preserves the posterior spinal elements, including the spinous processes, facet joints, and supraspinous and interspinous ligaments for thoracic OLF. This is the first case report to describe a navigation-assisted micro-window excision of thoracic OLF. Case: A 32-year-old male right-handed professional baseball pitcher with significant weakness and numbness in the left leg was referred to our hospital. The patient was diagnosed with thoracic OLF at T10-11 based on radiographic and magnetic resonance images in August 2022. After exposure of the left T10-11 laminae via a small unilateral incision, the location of T10-11 OLF was detected over the lamina by O-arm navigation. Then, the micro-window was made directly above the OLF using a navigated air drill, and the OLF was removed on the ipsilateral side. The contralateral side of OLF was also resected through the same micro-window, achieving complete spinal cord decompression. Results: The next day of the surgery, his leg weakness and numbness were significantly improved. Six weeks after the surgery, he started pitching. Three months after surgery, his symptoms had gone completely, and he pitched from the mound. Approximately 6 months after surgery, he successfully pitched in a professional baseball game. Conclusions: A navigation-assisted micro-window excision of thoracic OLF effectively preserved the spinal posterior bony elements and ligamentous complex. However, long-term clinical outcomes should be evaluated in future studies. Full article
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9 pages, 3426 KiB  
Technical Note
Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical Note
by Masato Tanaka, Naveen Sake, Dae-Geun Kim, Shinya Arataki, Dhvanit Desai, Yoshihiro Fujiwara and Taro Yamauchi
Medicina 2023, 59(1), 11; https://doi.org/10.3390/medicina59010011 - 20 Dec 2022
Viewed by 3821
Abstract
Study design: Technical note. Objectives: To present a novel C-arm-free technique guided by navigation to insert and place a C1 lateral mass screw. Background and Objectives: Atlantoaxial subluxation (AAS) is a relatively common sequelae in patients with rheumatoid arthritis (RA) [...] Read more.
Study design: Technical note. Objectives: To present a novel C-arm-free technique guided by navigation to insert and place a C1 lateral mass screw. Background and Objectives: Atlantoaxial subluxation (AAS) is a relatively common sequelae in patients with rheumatoid arthritis (RA) and upper cervical trauma. If they present with severe symptoms, surgical intervention such as posterior fusion is indicated. The established treatment for AAS is fixation with a C1 lateral mass screw and C2 pedicle screw (modified Goel technique) to achieve bony fusion. However, this technique requires fluoroscopy for C1 screw insertion. To avoid exposing the operating team to radiation, we present here a novel C-arm-free C1 lateral mass screw insertion technique for AAS. Materials and Methods: A 67-year-old man was referred to our hospital with neck pain, quadriparesis, and clumsiness and numbness of both upper and lower limbs. He had undergone C3–6 posterior fusion previously in another hospital. In physical examination, he had severe muscle weakness of bilateral upper limbs and hypoesthesia of all four limbs. He had hyper-reflexia of bilateral lower limbs and pollakiuria. His Japanese orthopedic score was 8 points out of 17. Preoperative radiograms showed AAS with an atlantodental interval (ADI) of 7 mm. MRI indicated retro-odontoid pseudotumor and severe spinal cord compression at the C1–2 level. The patient underwent posterior atlantoaxial fixation under navigation guidance. To prevent epidural bleeding during the insertion and placement of a C1 lateral mass screw, we have here defined a novel screw insertion technique. Results: The surgical time was clocked as 127 min and blood loss was 100 mL. There were no complications per-operatively or in the postoperative period. The patient showed almost full recovery (JOA 16/17) at two months follow-up and a solid bony fusion was noticed in the radiograms at one year follow-up. Conclusions: This novel surgical procedure and C1 lateral mas screw placement technique is a practical and safe method in recent advances of AAS treatment. Procedurally, the technique helps prevent epidural bleeding from the screw entry point and also allows for proper C1 screw insertion under navigation guidance without exposing surgeons and staff to the risk of fluoroscopic radiation. Full article
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