Outcomes of multisegmental transforaminal enlarged decompression plus posterior pedicle screw fixation for multilevel lumbar spinal canal stenosis associated with lumbar instability

Sun, Chao; Tian, Wei; Liu, Hui‐Xin; Guan, Ping Guo

doi:10.1016/j.ijsu.2017.12.031

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…Sun et al [19] also reported the satisfactory clinical and radiological outcomes with the use of multisegmental transforaminal enlarged decompression plus lumbar fusion for the treatment of multilevel lumbar spinal canal stenosis and found that this technique can reduce surgically induced instability.…”

Section: Discussionmentioning

confidence: 97%

Evaluating the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function

et al. 2020

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Background: Management of lumbar canal stenosis should be started with conservative treatment and preferably with a multimodal approach, but in cases of severe pain with extensive neurogenic claudication symptoms, surgical intervention is indicated. This retrospective study targets to evaluate the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function. Methods: Data of 184 patients of the study groups were divided into group A (data from patients who underwent laminectomy and foraminotomy only) and group B (data from patients who underwent laminectomy and foraminotomy with spinal fixation). Preoperative, operative, postoperative (PO), and follow-up data were extracted and analyzed from files of patients fulfilling the inclusion criteria. Results: Primary outcome was at least 50% improvement of pain severity regarding numeric rating scale (NRS) and Oswestry disability index (ODI) score at 6-months PO compared to preoperative scores. Operative time was significantly longer in group B than group A. Immediate PO data regarding PO analgesic requirement, amount of wound drainage, and PO hospital stay showed non-significant difference between both groups. There was a statically significant improvement of EHL muscle strength regarding Odom's scoring in group B in which the success rate for pain improvement was 81.8% and for disability was 66.8%. There were insignificant differences in patient's satisfaction to surgery with variable ages, a significant outcome in females and in patients with fewer levels of affection of both groups. Conclusion: The present study reported the efficacy and safety of the laminectomy, foraminotomy, discectomy, and medial facetectomy with spinal fixation using trans-pedicular screws for management of patients with spinal canal stenosis.

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Section: Discussionmentioning

confidence: 97%

Evaluating the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function

et al. 2020

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“…According to the actual clinical surgery method, facetectomy was performed by removing the ventral side of the superior FJ up to the dorsal side. Thus, three commonly used clinical needle IPs were selected: (1) The apex of the superior FJ (as the rst IP), (2) The midpoint of the ventral side of the superior FJ (as the second IP), (3) The lowest point of the ventral side of the superior FJ (as the third IP). In this experiment, a trephine with a diameter of 7.5 mm commonly used in clinical surgery was used to simulate the UPF.…”

Section: Insertion Point (Ip) Determinationmentioning

confidence: 99%

“…Lumbar instability often occurs after traditional open spinal surgery, leading to chronic pain in patients [1,2]. Thanks to the development of minimally invasive technology, percutaneous endoscopic transforaminal discectomy (PETD) is widely used in clinical practice due to its advantages, such as less damage and fast recovery [3,4].…”

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis and in Vitro Biomechanical Experiment on the Effect of Unilateral Partial Facetectomy Performed by Percutaneous Endoscopy on the Stability of Lumbar Spine

Xin-ru¹,

Zitong²,

Nong³

2021

Preprint

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Purpose: To investigate the lumbar biomechanical effects of unilateral partial facetectomy (UPF) of different facet joint (FJ) portions under percutaneous endoscopy. Methods: A 3D finite element (FE) model of the lumbar spine and 40 fresh calf spine models were used to simulate UPF under a physiological load performed through 3 commonly used needle insertion points (IPs) : (1) The apex of the superior FJ (as the first IP), (2) The midpoint of the ventral side of the superior FJ (as the second IP), (3) The lowest point of the ventral side of the superior FJ (as the third IP). The range of motion (ROM) and the L4/5 intradiscal maximum pressure (IMP) were measured and analyzed under a physiological load in all models during flexion, extension, left-right lateral flexion, and left-right axial rotation. Results: When UPF was performed through the first and the third IPs, the ROM of the lumbar spine and the L4/5 IMP in the FE model were significantly increased compared with those in the intact FE model. When UPF was performed through the second IP, the ROM of the lumbar spine and the L4/5 IMP were not significantly different compared with those in the intact FE model. When UPF was performed through the second IP, the ROM of the lumbar spine and the L4/5 IMP in the calf spine models were not statistically different from the intact calf spine model. Conclusion: UPF through the second IP resulted in a minimal impact on the biomechanics of the lumbar spine. Thus, it might be considered as the most appropriate IP for UPF.

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“…However, there is a risk for delayed union or even non-healing due to incomplete cleaning of the fracture site and/or early infection of the internal fixation device[ 3 ]. To reduce the risk of delayed union, stepwise delayed surgery has been used for the treatment of tibial pilon fractures, with satisfactory results reported[ 4 ]. These fractures, however, are generally associated with severe soft tissue injury.…”

Section: Introductionmentioning

confidence: 99%

Identification of risk factors for surgical site infection after type II and type III tibial pilon fracture surgery

Hu¹,

Zhang²,

Xie³

et al. 2022

WJCC

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BACKGROUND High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation. Infection can negatively impact patient outcomes. AIM To compare risk factors for postoperative infection after open reduction and internal fixation for a pilon fracture. METHODS Among the 137 patients included, 67 developed a surgical site infection. Demographic, clinical, and surgical factors were compared between the two groups. A binary logistic regression analysis was used to determine the odds ratio (OR) and corresponding 95%CI for significant risk factors for postoperative infection. RESULTS The distribution of pathogenic bacteria among the 67 patients who developed a surgical site infection was as follows: Gram-positive, 58.2% ( n = 39); Gram-negative, 38.8% ( n = 26); and fungal, 2.9% ( n = 2). The following factors were associated with postoperative infection ( P < 0.05): a Ruedi–Allgower pilon fracture type III (OR = 2.034; 95%CI: 1.109–3.738); a type III surgical incision (OR = 1.840; 95%CI: 1.177–2.877); wound contamination (OR = 2.280; 95%CI: 1.378–3.772); and diabetes as a comorbidity (OR = 3.196; 95%CI: 1.209–8.450). CONCLUSION Infection prevention for patients with a Ruedi–Allgower fracture type III, surgical incision type III, wound contamination, and diabetes lowers the postoperative infection risk after surgical management of tibial pilon fractures.

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Outcomes of multisegmental transforaminal enlarged decompression plus posterior pedicle screw fixation for multilevel lumbar spinal canal stenosis associated with lumbar instability

Cited by 5 publications

References 23 publications

Evaluating the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function

Evaluating the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function

Finite Element Analysis and in Vitro Biomechanical Experiment on the Effect of Unilateral Partial Facetectomy Performed by Percutaneous Endoscopy on the Stability of Lumbar Spine

Identification of risk factors for surgical site infection after type II and type III tibial pilon fracture surgery

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