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Akamaru, Tomoyuki; Kawahara, Norio; Yoon, S. Tim; Minamide, Akihito; Kh, Kim; Tomita, Katsuro; Hutton, William

doi:10.1097/00007632-200307150-00016

Cited by 31 publications

(30 citation statements)

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“…Because loss of segmental motion at the L4-5 level is shown to be redistributed among multiple cranial segments, in most cases at the first cranial adjacent level2), individuals used to sitting on the floor are more prone to adjacent segment hypermobility after low lumbar fusion. Akamaru et al1) demonstrated that hypolordotic fusion at the L4-5 level caused the greatest amount of flexion-extension motion at the L3-4 level. Bae et al3) reported that postoperative hypolordotic SL is a risk factor for adjacent segment degeneration.…”

Section: Discussionmentioning

confidence: 99%

A Comparison Study on the Change in Lumbar Lordosis When Standing, Sitting on a Chair, and Sitting on the Floor in Normal Individuals

Bae

Jang

Lee

et al. 2012

J Korean Neurosurg Soc

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ObjectiveTo compare radiographic analysis on the sagittal lumbar curve when standing, sitting on a chair, and sitting on the floor.MethodsThirty asymptomatic volunteers without a history of spinal pathology were recruited. The study population comprised 11 women and 19 men with a mean age of 29.8 years. An independent observer assessed whole lumbar lordosis (WL) and segmental lordosis (SL) between L1 and S1 using the Cobb's angle on lateral radiographs of the lumbar spine obtained from normal individuals when standing, sitting on a chair, and sitting on the floor. WL and SL at each segment were compared for each position.ResultsWL when sitting on the floor was reduced by 72.9% than the average of that in the standing position. Of the total decrease in WL, 78% occurred between L4 to S1. There were significant decreases in SL at all lumbar spinal levels, except L1-2, when sitting on the floor as compared to when standing and sitting on a chair. Changes in WL between the positions when sitting on a chair and when sitting on the floor were mostly contributed by the loss of SL at the L4-5 and L5-S1 levels.ConclusionWhen sitting on the floor, WL is relatively low; this is mostly because of decreasing lordosis at the L4-5 and L5-S1 levels. In the case of lower lumbar fusion, hyperflexion is expected at the adjacent segment when sitting on the floor. To avoid this, sitting with a lordotic lumbar curve is important. Surgeons should remember to create sufficient lordosis when performing lower lumbar fusion surgery in patients with an oriental life style.

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Section: Discussionmentioning

confidence: 99%

A Comparison Study on the Change in Lumbar Lordosis When Standing, Sitting on a Chair, and Sitting on the Floor in Normal Individuals

Bae

Jang

Lee

et al. 2012

J Korean Neurosurg Soc

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“…The possible benefits of reduction of lumbar degenerative spondylolisthesis have not been adequately studied. Segmental imbalance may be a factor influencing the later development of adjacent segment disease [6]. The sagittal balance could significantly affect low back pain in patients undergoing posterior decompression and instrumented fusion for degenerative lumbar spine disease [7].…”

Section: Introductionmentioning

confidence: 99%

Lever reduction using polyaxial screw and rod fixation system for the treatment of degenerative lumbar spondylolisthesis with spinal stenosis: technique and clinical outcome

Liu

Qian

et al. 2015

J Orthop Surg Res

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BackgroundThe management for degenerative lumbar spondylolisthesis with spinal stenosis remains controversial. Reduction of lumbar spondylolisthesis has been performed via numerous techniques. Most of them need extra reduction assembly.MethodsIn this retrospective analysis, 27 patients of degenerative lumbar spondylolisthesis with spinal stenosis underwent reduction using polyaxial screw and rod constructs and posterolateral fusion. The average age at the time of surgery was 53 ± 3.23 years. The outcome measures consisted of a radiographic assessment of deformity and fusion rate and a clinical assessment of perioperative improvement in low back pain and function. Preoperative and postoperative radiographic evaluation included the percent slip, slip angle, and the lumbar lordosis between L1 and the sacrum measured using the Cobb method. Before surgery and at the final follow-up, the Oswestry Disability Index (ODI) and the visual pain analog scale (VPAS) between 0 (no pain) and 10 (maximal pain) were quantified.ResultsThe average follow-up period more than 5 years was available. The mean operative time was 90.19 ± 14.51 min, and the mean blood loss during surgery was 152.59 ± 45.71 ml. The mean length of incision was 4.83 ± 0.63 cm. The average percent slippage and the mean slip angle were, respectively, 19.8 ± 4.49% and 9.69 ± 3.79° before surgery, 5.09 ± 3.40% and 6.39 ± 3.16° after surgery, and 5.67 ± 3.92% and 7.21 ± 3.05° at the last follow-up. The average lumbar lordosis was 36.88 ± 2.64° before surgery, 41.96 ± 1.64° after surgery, and 40.27 ± 1.19° at the final follow-up. No neurologic deficit occurred. Solid fusion was achieved for all cases. Compared with the outcome preoperation, the data improved from 6.56 ± 1.40 to 2.48 ± 1.16 for VPAS pain scores and from 32.22 ± 3.57 to 10.93 ± 4.93 for the ODI at the final follow-up.ConclusionsLever slip reduction maneuver techniques using polyaxial screw and rod fixation system was simple and practicable. The treatment outcomes showed satisfactory radiographic characteristics and clinical results. The length of the incision was relatively small with a low intraoperative blood loss and short operation time.

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“…[6,7,17] Therefore, ASD always occurred in the facet joints above the reconstructed segment. Akamaru et al [18] demonstrated that the highest increase in motion is the cranial segment (L3/4) to L4/5 after its hypolordotic floating fusion. In addition, the change in joint orientation is a major risk factor in the degenerative process of that segment.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the change in joint orientation is a major risk factor in the degenerative process of that segment. [17,18] The Wallis implants can restrict the motion of the lumbar spine. The Wallis implant consists of an interspinous spacer that limits the extension and 2 bands that secure the implant in the interspinous space and limit flexion.…”

Section: Discussionmentioning

confidence: 99%

Adjacent segmental degeneration following Wallis interspinous stabilization implantation

Zhou

Xiong²,

et al. 2017

Medicine

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Adjacent segmental degeneration (ASD) is a major issue after pedicular fixation. This study examined the degeneration of the adjacent levels due to the insertion of the Wallis interspinous stabilization system compared with discectomy, using magnetic resonance imaging (MRI).Thirty-eight patients diagnosed with lumbar degeneration disorders at L4-L5 were reviewed: 19 patients underwent discectomy and Wallis system implantation (group A), and 19 patients underwent discectomy (group B). The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were assessed preoperatively and postoperatively. ASD was evaluated by MRI.There was no difference in the preoperative ODI scores between the 2 groups (non-normal distribution, median, 50 (40, 50) vs 50 (50, 50), P = .331), but the postoperative ODI scores were different (non-normal distribution, median, 0 (0, 32) vs 20 (20, 30), P < .005). Similar results were observed for VAS. In group A, ASD occurred in 4 patients (21.1%) in the disc and 8 (42.1%) in the facet joint at L3/4, and in 4 (21.1%) in the disc and 5 (26.3%) in the facet joint at L5/S1. In Group B, ASD occurred in 3 patients (15.8%) in the disc at L3/4, and in 4 (21.1%) in the disc at L5/S1. In general, there was no difference between the 2 groups (P > .05), except at L3/4 (P = .015).ASD of the facet joint in the cranial segment occurred after Wallis system implantation, suggesting that the Wallis system cannot prevent ASD of the facet joint, but could have some other benefits for the discs.

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Cited by 31 publications

References 0 publications

A Comparison Study on the Change in Lumbar Lordosis When Standing, Sitting on a Chair, and Sitting on the Floor in Normal Individuals

A Comparison Study on the Change in Lumbar Lordosis When Standing, Sitting on a Chair, and Sitting on the Floor in Normal Individuals

Lever reduction using polyaxial screw and rod fixation system for the treatment of degenerative lumbar spondylolisthesis with spinal stenosis: technique and clinical outcome

Adjacent segmental degeneration following Wallis interspinous stabilization implantation

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