The correlation between the sagittal lumbopelvic alignments in standing position and the risk factors influencing low back pain

Low back pain (LBP) is the most common health problem. Many factors have been demonstrated to be fundamental risk factors of LBP such as body mass index (BMI), age and sex. However, so far there have been few studies demonstrating the association between lumbo-pelvic alignment (LPA) and these factors. This present study was aimed to clarify the correlation between the LPA and the risk factors contributing to LBP. Standing lateral X-rays were taken from 100 healthy volunteers (70 males and 30 females) with no history of low back pain before their participation. Average age of subjects was 33.3±6.8 years (rang 21–50). Mean body weight was 59.1±7.9kg (range 40–82), mean body height was 163.6±7.2 cm (range 145–178) and mean BMI was 22.1±2.4 kg/m2 (range 18.0–29.3). The LPA was classified into 3 types according to the recently proposed pelvic orientation guidelines. No direct correlation was found between the pelvic orientation and age or BMI. Each LPA type was associated with sex but not BMI and age (P=0.00, 0.71, and 0.36, respectively). The results from this study demonstrated the differences in LPA between male and female, and also confirmed that the sagittal orientation of the pelvis remained constant in adults. The high prevalence of LPA type 1 in males may reduce the occurrence of LBP in obese male individuals

Anatomic Considerations of Intervertebral Disc Perspective in Lumbar Posterolateral Approach via Kambin's Triangle: Cadaveric Study

Study DesignAnatomical study.PurposeTo evaluate the anatomy of intervertebral disc (IVD) area in the triangular working zone of the lumbar spine based on cadaveric measurements.Overview of LiteratureThe posterolateral percutaneous approach to the lumbar spine has been widely used as a minimally invasive spinal surgery. However, to our knowledge, the actual perspective of disc boundaries and areas through posterolateral endoscopic approach are not well defined.MethodsNinety-six measurements for areas and dimensions of IVD in Kambin's triangle on bilateral sides of L1–S1 in 5 fresh human cadavers were studied.ResultsThe trapezoidal IVD area (mean±standard deviation) for true working space was 63.65±14.70 mm2 at L1–2, 70.79±21.88 mm2 at L2–3, 99.03±15.83 mm2 at L3–4, 116.22±20.93 mm2 at L4–5, and 92.18±23.63 mm2 at L5–S1. The average dimension of calculated largest ellipsoidal cannula that could be placed in IVD area was 5.83×11.02 mm at L1–2, 6.97×10.78 mm at L2–3, 9.30×10.67 mm at L3–4, 8.84×13.15 mm at L4–5, and 6.61×14.07 mm at L5–S1.ConclusionsThe trapezoidal perspective of working zone of IVD in Kambin's triangle is important and limited. This should be taken into consideration when developing the tools and instruments for posterolateral endoscopic lumbar spine surgery

Prevalence of High-Riding Vertebral Artery and Morphometry of C2 Pedicles Using a Novel Computed Tomography Reconstruction Technique

Study DesignCross-sectional, matched-pair comparative study.PurposeTo determine whether a thin-sliced pedicular-oriented computed tomography (TPCT) scan reconstructed from an existing conventional computed tomography (CCT) scan is more accurate for identifying vertebral artery groove (VAG) anomalies than CCT.Overview of LiteraturePosterior atlantoaxial transarticular screw fixation and C2 pedicle screws can cause vertebral artery (VA) injury. Two anatomic variations of VAG anomalies are associated with VA injury: a high-riding VA (HRVA) and a narrow pedicle of the C2 vertebra. CCT scan is a reliable method used to evaluate VAG anomalies; however, its accuracy level remains debatable. Literature comparing the prevalence of C2 VAG anomalies between CCT and TPCT is limited.MethodsA total of 200 computed tomography scans of the upper cervical spine obtained between January 2008 and December 2011 were evaluated for C2 VAG anomalies (HRVA and narrow pedicular width) using CCT and TPCT. The prevalence of C2 VAG anomalies was compared using these two different measurement methods via a McNemar's test.ResultsOf the 200 patients studied, 23 HRVA (6.01%; 95% confidence interval [CI], 3.61%–8.39%) were detected with CCT, whereas 66 HRVA (16.54%; 95% CI, 12.85%–20.23%) were detected with TPCT (p<0.001). Sixty-two narrow pedicles (15.58%; 95% CI, 11.99%–19.15%) were detected with CCT, whereas 90 narrow pedicles (22.83%; 95% CI, 18.58%–26.87%) were detected with TPCT (p<0.001).ConclusionsVAG anomalies are commonly observed. A preoperative evaluation using TPCT reconstructed from an existing CCT revealed a significantly higher prevalence of C2 VAG anomalies than did CCT and showed comparable prevalence to previously published studies using more sophisticated and higher risk techniques. Therefore, we propose TPCT as an alternative preoperative evaluation for C2 screw placement and trajectory planning

Giant sacral schwannoma: A report of six cases

Sacral and presacral schwannomas are often found incidentally, because they present with vague symptoms or symptomless. Schwannoma occurring in this area occasionally presents with enormous dimensions, known as a giant schwannoma. The tumor removal is a surgical challenge due to the difficult approach and abundant vascularity. The aim of this study is to review cases of giant sacral schwannomas focusing the surgical management and outcome. Six patients with sacral and presacral schwannoma were treated surgically. The patients included two males and four females, and the mean age was 47.8 years. All patients experienced pain at the time of presentation. The tumors were classified as intraosseous type in one case, dumb-bell type in four cases, and retroperitoneal type in one case. The tumors were removed with a piecemeal subtotal excision in three patients, a partial excision in two patients, and enucleation in one patient. The surgeries were performed by the combination of an anterior and posterior approach in three patients, a posterior approach in two patients, and an anterior approach in one patient. The mean surgical time was 7.8 hrs, and the mean blood loss was 2572 g. The tumor recurred in one patient after the partial excision and was removed completely in a second surgery. No patient, including the patient who underwent the second surgery, presented with pain and obvious neurological deficit at the final follow-up. The surgical treatment of the giant sacral schwannoma with a piecemeal subtotal excision can achieve a good outcome, avoiding unnecessary neurological deficit

Shaft-Condylar Angle for Surgical Correction in Neglected and Displaced Lateral Humeral Condyle Fracture in Children

Purpose            To assess the outcome after using Shaft-Condylar angle (SCA) as intraoperative reference for sagittal plane correction in displaced lateral humeral condyle fracture in children presented after 3-weeks of injury.Methods            Ten children, with delayed presentation of displaced lateral humeral condyle fracture and undergoing surgery during 1999-2011, were reviewed. The goal was to obtain smooth articular surface with an intraoperative 40-degree SCA and nearest-anatomical carrying angle. They were allocated into two groups according to postoperative SCA [Good-reduction group (SCA=30-50o), and Bad-reduction group (SCA&lt;30o, &gt;50o)] and the final outcomes were then compared.Results            All fractures were united without avascular necrosis. Good-reduction group(n=7) showed a significant improvement in final range-of-motion and functional outcome compared to Bad-reduction group(n=3)(p=0.02 both). However, there was no significant difference in pain, carrying angle and overall outcome between both groups.Conclusion            SCA is a possible intraoperative reference for sagittal alignment correction in delayed-presentation displaced lateral humeral condyle fracture.

Survey research of patient’s preference on choosing microscopic or endoscopic spine surgery for lumbar discectomy

Background There are several surgical methods of lumbar discectomy which provide the similar clinical outcomes. There is no clear evidence for how to select the procedures. To better understand the patient’s opinion and decision process in the selection of surgical methods between microscopic lumbar discectomy (MLD) and endoscopic lumbar discectomy (ELD). Methods A cross-sectional survey study. Summary information sheet was created by reviewing the comparative literatures, and tested for quality and bias. Participants read the summary information sheet then were asked to complete the anonymous questionnaire. Results Seventy-six patients (71%) of patients who had no experience in lumbar discectomy selected ELD while 31 patients (29%) selected MLD. There were significant differences of score between patients who selected MLD and ELD in this group for wound size, anesthetic method, operative time, blood loss and length of stay (PConclusions About two thirds of the participants preferred ELD after reading the summary evidence information. The most important factor in MLD group was outcomes of treatment while the most important factor in ELD group was wound size

“Platelet-Rich Plasma” epidural injection an emerging strategy in lumbar disc herniation: a Randomized Controlled Trial

Abstract Background Lumbar herniated disc (HNP) is mainly treated by conservative management. Epidural steroid injection (ESI) has been an option to treat failed cases prior to surgery. Triamcinolone has been widely used due to its efficacy in bringing about pain reduction for up to three months. However, several reports have shown some severe adverse events. Platelet-rich plasma (PRP) is made from blood through centrifugation. Several studies supported the potential short to long-term effects, and safety of PRP injection in treating HNP. The study objective was to evaluate the efficacy of PRP in treatment of single-level lumbar HNP in comparison to triamcinolone. Methods Thirty patients were treated by transforaminal epidural injections. PRP was obtained from 24 ml venous blood through standardized double-spin protocol. Participants included fifteen patients each being in triamcinolone and PRP groups. The same postoperative protocols and medications were applied. The visual analogue scale of leg (LegVAS), collected at baseline, 2, 6, 12, and 24 weeks, was the primary outcome. The BackVAS, Oswestry Disability Index (ODI), adverse event, and treatment failure were the secondary endpoints. Results Platelet ratio of PRP in fifteen patients was 2.86 ± 0.85. Patients treated by PRP injections showed statistically and clinically significant reduction in LegVAS at 6, 12, and 24 weeks, and in ODI at 24 weeks. It demonstrated comparable results on other aspects. No adverse event occurred in either group. Conclusion Noncommercial epidural double-spin PRP yielded superior results to triamcinolone. Due to its efficacy and safety, the procedure is recommended in treating single level lumbar HNP. Trial registration NCT, NCT05234840. Registered 1 January 2019, https://clinicaltrials.gov/ct2/show/record/NCT05234840