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Purpose of Study:  Standard treatment protocols for lumbar degenerative lesions in the setting of rheumatoid arthritis (RA) are lacking. The purpose of this study was to evaluate the clinical and radiologic outcomes of minimally invasive oblique lumbar interbody fusion (MI-OLIF) in RA patients having degenerative lumbar spine lesions., Methods:  This was a retrospective hospital-based case series (evidence level 4). Eight patients with degenerative lumbar disease with significant back pain and neurologic claudication underwent MI-OLIFwith polyetheretherketone cage insertion and posterior pedicle screw instrumentation. The clinical outcomes were measured by the numerical rating scale (NRS) for back and leg pain and the Oswestry Disability Index (ODI), and radiologic outcomes were studied on radiographs, computed tomography, and magnetic resonance imaging. Minimum follow-up duration was 1 year., Results:  Mean NRS results for back and leg pain preoperatively were 6.3 and 7.1 that improved to 2.6 and 2 for back and leg pain, respectively, at last follow-up. The mean ODI scores preoperatively were 58.02 that improved to 39.06 at last follow-up. All patients had good functional outcomes, good fusion rates, and were able to continue their activities of daily living without much disability at last follow-up., Conclusion:  MI-OLIF in patients with symptomatic lumbar spine degenerative lesions with RA seems to provide good short-term clinical and radiologic outcomes., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To compare the radiologic and clinical outcomes between oblique lumbar interbody fusion (OLIF) without laminectomy and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)., Methods: This was a retrospective study. Between April 2012 and January 2017, 25 patients in each of the MI-TLIF and OLIF groups were recruited as matched pairs. Clinical outcomes included visual analogue scale, Oswestry Disability Index, and satisfaction rates. Radiographic outcomes comprised disc height (DH) and fusion status. Intraoperative data and complications were collected. All patients completed the clinical and radiologic outcomes. Outcomes were compared preoperatively and postoperatively., Results: Matched pairs were compared between 2 groups in terms of demographic data and preoperative measurements; less blood loss and shorter operative time were found in OLIF versus MI-TLIF (P < 0.001). The total complication rate was 36% in OLIF and 32% in MI-TLIF (P = 0.77). The outcomes of visual analogue scale and Oswestry Disability Index were significantly improved in both groups, and there was no significant difference between 2 groups. Satisfaction rates of the both groups were more than 90%. OLIF was superior to MI-TLIF with respect its capability to restore DH (P < 0.001). Earlier time of fusion was observed in OLIF (80%) compared with MI-TLIF (52%) at 6 months (P = 0.04)., Conclusions: OLIF may achieve equivalent clinical and radiologic outcomes compared with MI-TLIF when the stenosis is minimal because the decompression performed is indirect. Furthermore, the OLIF shows less blood loss and shorter operative time, better restoration of DH, and earlier time to fusion than the MI-TLIF., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To measure the morphological dimensions of the spinous process (SP) and interspinous space, and provide a basis for the development of interspinous devices for the Korean or East Asian populations.Methods: We retrospectively analyzed the anatomical parameters of 120 patients. The parameters included height, length, and width of SP, interspinous distance (supine, standing, and dynamic), cortical thickness of SP, and spino-laminar (S-L) angle. Correlations between measurements, age, and gender were investigated.Results: The largest height, length, and cortical thickness and S-L angle were noted at L3. The largest width was observed at S1. The interspinous distance decreased significantly from L2-3 to L5-S1 and was significantly larger in the supine than in standing posture for L5-S1. Cortical thickness was gradually tapered from the anterior to the posterior position. The S-L angle at L2 and L3 was similar and significantly decreased from L3 to S1. An increased trend in width with aging and a decreased trend in distance (supine) were noted. A significant increase in height, length, and distance in males compared with females was also observed.Conclusions: The interspinous space is wider at the anterior, and the cortex is thicker anteriorly. Accordingly, it appears that the optimized implant position lies in the interspinous space anteriorly. The varying interspinous space with different postures and gradually narrowing with age suggest the need for caution when sizing the device. Gender differences also need to be considered when designing implantable devices. [ABSTRACT FROM AUTHOR]