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Introduction: Lumbar and lumbosacral spinal fusion is an established procedure for the treatment of degenerative spondylolisthesis. However, the impact of reduction in the affected segment and of improvement in the radiological sagittal parameters on the clinical outcome remains unclear. Purpose of the study is to analyze the correlation between the radiological sagittal parameters and clinical outcome after lumbar spinal fusion in low-grade degenerative spondylolisthesis., Materials and Methods: In a monocentric prospective, clinical study, patients with low-grade degenerative spondylolisthesis of a single lumbar segment have been included. All patients received a lumbar spinal fusion according to the pathology of the treated segment. Patients attended clinical and radiological follow-up examination 1 and 2 years postoperatively. Clinical outcome was assessed using the Core Outcome Measurement Index (COMI), the Oswestry Disability Index (ODI) and the EuroQol 5D. The sagittal spinopelvic radiological parameters, sagittal rotation and anterior displacement of the affected segment and lumbar lordosis were assessed. The correlation between the sagittal radiological parameters and clinical outcome was analyzed using Spearman-Rho bi-serial test., Results: Sixty-two patients (35 female and 27 male) with an average age of 59.3 years were included in the study. All patients completed the follow-up examinations. Significant improvement in COMI, ODI and EuroQol 5D scores was shown in all follow-up examinations. Significant reduction in the anterior displacement was measured postoperatively, which was preserved during the follow-up. However, no correlation could be demonstrated between reduction in anterior displacement and improvement in clinical outcome. Nonetheless, correlation between correction of sagittal rotation and clinical outcome was shown., Conclusions: Reduction in anterior displacement of the affected segment in the surgical treatment of low-grade degenerative spondylolisthesis does not have an impact on the clinical outcome.

Background: Screw loosening is a major complication following spondylodesis. While several modifications increase screw stability, some, such as screw augmentation, are associated with potential complications; new techniques are needed to minimize the risk of screw loosening without increasing complication rates., Methods: 13 fresh-frozen human lumbar vertebral bodies (L1 to L5) were dissected. In group 1 (n = 7), pedicle screws were implanted conventionally, while in group 2 (n = 6), the screws were positioned divergent in the sagittal pathway. Screw stability was tested under cyclic axial load; one testing-cycle included 1000 repetitions. The first cycle started with a load of 100 N while the load was increased by +20 N in each following cycle until failure. Failure was defined by either a >5 mm movement of the screw heads or triggering of the switch-off threshold., Findings: Average number of cycles until failure was increased in group 2 compared with group 1 (12,046 vs 9761 cycles), as was the average load to failure (Fmax 313 N vs 260 N). Overall, in group 2, the number of cycles until screw loosening or failure increased by 23% (p = 0.28), while the required force increased by 20% (p = 0.3). Statistically significant correlation between BMD and increased number of cycles completed as well as with increased load (p < 0.01) could be observed., Interpretation: The results demonstrate, that divergent screw-drift of pairs of screws in the sagittal plane tends to increase stability, especially in vertebral bodies with lower bone density. Moreover, we could demonstrate a correlation between BMD and stability of screw-fixation., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Study Design: This single-center retrospective study analyzed patients with chronic low back pain (CLBP) who underwent endoscopic facet joint denervation (EFJD) between April 2018 and May 2019. Purpose: This study was designed to investigate the effectiveness of EFJD in treating CLBP. Overview of Literature: CLBP is a challenging burden to healthcare systems worldwide. As up to 45% of cases originate from the lumbar facet joints, sufficient therapy strategies must be developed. EFJD offers a precise depiction of the dorsal medial ramus and the facet joint capsule. Methods: In this study, 64 patients who underwent EFJD were included. The main outcome of interest was patients' Visual Analog Scale (VAS) pain score, which was recorded at 3-time points (i.e., before operation and 6 weeks and 12 months after surgery). Results: EFJD effectively reduced the VAS pain scores by 58% in the short term (6 weeks) and 38% in the long term (12 months). Patients with isolated facet joint osteoarthritis benefited more (p <0.001). Conclusions: EFJD is a good treatment alternative for CLBP originating from the facet joints, particularly in patients with isolated facet joint osteoarthritis. Moreover, this method can address not only the dorsal medial ramus but also the surrounding tissue (e.g., facet joint capsule, facet joint effusion, and osteophytes) as the origin of CLBP. [ABSTRACT FROM AUTHOR]

Background: Thoracolumbar spine fractures in multiple-injured patients are a common injury pattern. The appropriate timing for the surgical stabilization of vertebral fractures is still controversial. The purpose of this study was to analyse the impact of the timing of spinal surgery in multiple-injured patients both in general and in respect to spinal injury severity. Methods: A retrospective analysis of multiple-injured patients with an associated spinal trauma within the thoracic or lumbar spine (injury severity score (ISS) >16, age >16 years) was performed from January 2012 to December 2016 in two Level I trauma centres. Demographic data, circumstances of the accident, and ISS, as well as time to spinal surgery were documented. The evaluated outcome parameters were length of stay in the intensive care unit (ICU) (iLOS) and length of stay (LOS) in the hospital, duration of mechanical ventilation, onset of sepsis, and multiple organ dysfunction syndrome (MODS), as well as mortality. Statistical analysis was performed using SPSS. Results: A total of 113 multiple-injured patients with spinal stabilization and a complete dataset were included in the study. Of these, 71 multiple-injured patients (63%) presented with an AOSpine A-type spinal injury, whereas 42 (37%) had an AOSpine B-/C-type spinal injury. Forty-nine multiple-injured patients (43.4%) were surgically treated for their spinal injury within 24 h after trauma, and showed a significantly reduced length of stay in the ICU (7.31 vs. 14.56 days; p < 0.001) and hospital stay (23.85 vs. 33.95 days; p = 0.048), as well as a significantly reduced prevalence of sepsis compared to those surgically treated later than 24 h (3 vs. 7; p = 0.023). These adverse effects were even more pronounced in the case where cutoffs were increased to either 72 h or 96 h. Independent risk factors for a delay in spinal surgery were a higher ISS (p = 0.036), a thoracic spine injury (p = 0.001), an AOSpine A-type spinal injury (p = 0.048), and an intact neurological status (p < 0.001). In multiple-injured patients with AOSpine A-type spinal injuries, an increased time to spinal surgery was only an independent risk factor for an increased LOS; however, in multiple-injured patients with B-/C-type spinal injuries, an increased time to spinal surgery was an independent risk factor for increased iLOS, LOS, and the development of sepsis. Conclusion: Our data support the concept of early spinal stabilization in multiple-injured patients with AOSpine B-/C-type injuries, especially of the thoracic spine. However, in multiple-injured patients with AOSpine A-type injuries, the beneficial impact of early spinal stabilization has been overemphasized in former studies, and the benefit should be weighed out against the risk of patients' deterioration during early spinal stabilization. [ABSTRACT FROM AUTHOR]