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Abstract Background To evaluate lumbar mobility in various positions using upright left and right bending radiographs in patients with degenerative lumbar spondylolisthesis (DLS), as well as to assess the impact of lateral instability on patient-reported outcomes. Methods This study retrospectively reviewed a consecutive series of patients with DLS between January 2019 and October 2020. The enrolled patients were divided into two groups: the lateral instability group (group L) and non-lateral instability group (group NL). Translational and angular motion in both sagittal and coronal planes and patient-reported outcomes were compared between the two groups. Results There were 104 (59.8%) patients in group L and 70 (40.2%) patients in group NL, with an average age of 60.6 ± 7.8 years. Patients with a right bending posture in group L had a higher slip percentage (14.2 ± 7.4% vs 9.2 ± 3.2%, p = 0.01) and slip angle (6.3 ± 1.5° vs 2.2 ± 0.8°, p = 0.021). Compared with group NL, group L demonstrated significantly larger angular motion in the coronal plane (2.4 ± 1.3° vs 1.0 ± 0.7°, p = 0.008). Patients with lateral instability had worse preoperative back pain (6.1 ± 1.6 vs 2.7 ± 1.9, p = 0.01) and Oswestry Disability Index (ODI) scores (37.7 ± 5.5 vs 25.6 ± 2.6, p = 0.002). In terms of pain characteristics, group L was characterized by pain when getting out of a car, when rising from a chair, and when climbing stairs (all p values

Background: To evaluate lumbar mobility in various positions using upright left and right bending radiographs in patients with degenerative lumbar spondylolisthesis (DLS), as well as to assess the impact of lateral instability on patient-reported outcomes.Methods: This study retrospectively reviewed a consecutive series of patients with DLS between January 2019 and October 2020. The enrolled patients were divided into two groups: the lateral instability group (group L) and non-lateral instability group (group NL). Translational and angular motion in both sagittal and coronal planes and patient-reported outcomes were compared between the two groups.Results: There were 104 (59.8%) patients in group L and 70 (40.2%) patients in group NL, with an average age of 60.6 ± 7.8 years. Patients with a right bending posture in group L had a higher slip percentage (14.2 ± 7.4% vs 9.2 ± 3.2%, p = 0.01) and slip angle (6.3 ± 1.5° vs 2.2 ± 0.8°, p = 0.021). Compared with group NL, group L demonstrated significantly larger angular motion in the coronal plane (2.4 ± 1.3° vs 1.0 ± 0.7°, p = 0.008). Patients with lateral instability had worse preoperative back pain (6.1 ± 1.6 vs 2.7 ± 1.9, p = 0.01) and Oswestry Disability Index (ODI) scores (37.7 ± 5.5 vs 25.6 ± 2.6, p = 0.002). In terms of pain characteristics, group L was characterized by pain when getting out of a car, when rising from a chair, and when climbing stairs (all p values < 0.05).Conclusion: Lumbar lateral instability, that is, increased mobility in the coronal plane on lateral bending radiographs, translational and/or angular, correlates to more pronounced patient related symptoms in degenerative L4-5 spondylolisthesis. The existence of lumbar lateral instability leads to worse impacts on patient-reported outcomes when patients change their positions including getting out of a car, rising from a chair, and climbing stairs. [ABSTRACT FROM AUTHOR]

Abstract Background The presence of bridging syndesmophytes (BS) in spinal osteotomy region serves traditionally as one critical determinant for selection of osteotomy techniques. While nowadays the proportion of kyphotic ankylosing spondylitis (AS) patients receiving pedicle subtraction osteotomy (PSO) with yet mobile neighboring disc has seen a substantial increase. Literatures investigating the clinical relevance of the presence of BS on kyphosis correction and maintenance following PSO are scarce. Methods A total of 71 thoracolumbar kyphotic AS patients treated with single-level PSO at our hospital between September 2010 and August 2014 were retrospectively reviewed, 32 of whom were stratified into the BS group (BG). The operative corrections of multiple spino-pelvic sagittal parameters were assessed. Comparison of the contribution of adjacent disc wedging to total correction per PSO segment was made between the BS and non-BS groups (NBG). The correction loss were also evaluated and compared with a minimum 2-year follow-up. Results A significantly younger age (30.97 ± 8.28 vs. 40.31 ± 8.44 yrs., p

Objective Segmental flexibility in adolescent idiopathic scoliosis is crucial for the development of nonfusion and osteotomy technology. However, only global curve flexibility has been assessed in previous studies. Knowledge about segmental characteristics is absent. Methods Twenty patients with severe adolescent idiopathic scoliosis were enrolled in the present study. The vertebral and disc wedge angles were measured, and the segmental flexibility index was assessed by the correction rate of disc wedging on the traction film. Least significant difference analysis was used to compare the distribution of the variable. The patients were divided into 2 groups according to the stiffness of the global curves, and their relative wedging was compared. Results Vertebral wedging decreased from the apex toward the end. The apical and adjacent vertebrae accounted for 67.44% ± 8.05% of the total vertebral wedging deformities. Disc wedging significantly decreased upward and downward from the apex. Disc wedging demonstrated no significant differences between U1 (first above the apex) and U2 or L1 (first below the apex) and L2, and these 4 discs accounted for 75.47% ± 9.25% of the total disc wedging deformities. The levels close to the apical discs (U2 and L2) had the smallest extent of limited correctability. Segment disc flexibility showed a W -shaped distribution. The disc angle in the non-stiff group was significantly larger than the vertebral angle (40.13° ± 4.67° vs. 26.62° ± 6.99°; P < 0.001); however, similar results were not noted in the stiff group. Conclusions Significant apical tethering in both vertebral body and disc wedging occurred, and the relative wedging changed significantly according to the rigidity of the main thoracic curves. Highlights • Apical tethering in both vertebral body and disc wedging. • The apical and adjacent vertebrae accounted for a large proportion of the total vertebral wedging deformities. • The relative wedging changed significantly according to the rigidity of the main thoracic curve. [ABSTRACT FROM AUTHOR]

Introduction: Posterior selective thoracolumbar or lumbar (TL/L) fusion with pedicle screw constructs for adolescent idiopathic scoliosis (AIS) has been studied in a few researches. However, few studies have discussed the indication for selective TL/L fusion and the behaviors of its adjacent disc angle. The present study aims to discuss the indication for posterior selective TL/L fusion and the behavior of the adjacent disc angle.Methods: 45 consecutive cases of AIS undergoing posterior selective TL/L fusion were retrospectively evaluated, with an average follow-up of 36 months. Radiographs were reviewed to determine the coronal curve magnitude and the sagittal alignment preoperatively, postoperatively and at final follow-up. Thoracic curves in groups A had a correction loss of more than 5°, while thoracic curves in group B had a correction loss of not more than 5°.Results: The coronal curve magnitude of the TL/L curve averaged 44° preoperatively and it was corrected to 6° immediately with a correction rate of 84.8 %. At final follow-up it was 9° with a correction loss of 3°. The minor thoracic curve was 26° preoperatively, and the convex side bending curve magnitude averaged 8° with a flexibility of 72.7 %. It was corrected to 13° immediately with a spontaneous correction of 48.5 %. At final follow-up it was 14° with a correction loss of 1°. UIVA decreased from 4° to 2° after surgery, and it was 2° at final follow-up. LIVA decreased from 7° to 4° after surgery, and it was 5° at final follow-up. Maximal correction of TL/L curves in group A is significantly less than that in group B. 1 patient received revision surgery to fuse the progressive thoracic curve.Conclusion: Posterior selective TL/L fusion with pedicle screw constructs allows for spontaneous thoracic correction and maintains coronal and sagittal balance during the follow-up. Maximal correction instead of undercorrection was recommended for moderate Lenke 5C curves. Disc wedging could be improved after surgery and well maintained during the follow-up. [ABSTRACT FROM AUTHOR]

Study Design. Prospective consecutive series. Objective. The objective of this 10-year follow-up study was to assess the efficacy of concave PLIF for lumbosacral hemicurve in treating patients with adult scoliosis. Summary of Background Data. Long-term results and clinical significance of PLIF for allowing L3 vertebra to become horizontal in adult scoliosis have not yet been reported. Methods. Fourteen patients (53-72 yr) were operatively treated and prospectively studied. The surgical procedure was, after decompression of the affected nerve root, to correct the wedged disc below the caudal end vertebra, L3 or L4, which allowed for the end vertebra to become horizontal by way of concave PLIF. The followup period was 10 years. Results. Mean visual analogue scale (100 mm) score was 78 before surgery, 20 at 2 years after surgery, and 17 at the final follow-up in leg pain, 67, 25, and 28, respectively, in low back pain, and 13, 7, and 7, respectively, in the disability score (Rolland-Morris). The mean Cobb angles were 24 °, 16 °, and 17 °, respectively, in scoliosis, 17 °, 9 °, and 10 °, respectively, in L3 vertebral tilt, and 21 °, 28 °, and 26 °, respectively, in lumbar lordosis. In 7 patients with postoperative L3 vertebral tilt of less than 5 °, the Cobb angle of the unfused main curve improved over time. Conclusion. The results of this study suggest that horizontal fixation of the L3 vertebra can prevent the long-term development of unfused adult scoliosis. [ABSTRACT FROM AUTHOR]

A single-center retrospective comparative study was designed to identify the risk factors for restenosis of lumbar foraminal stenosis (LFS) after microscopic foraminal decompression (MFD). 21 consecutive patients who underwent single-level MFD with an average of 19-month follow-up were divided into two study groups based on clinical outcomes; group 1 (7 patients with poor outcomes requiring revision surgery), group 2 (14 patients with good outcomes with no revision surgery required). Changes of lumbar spinal alignment on plain standing radiographs were compared and analyzed between two study groups to investigate the pathology and risk factors associated with restenosis after MFD. Preoperative disc wedging (DW) angle was significantly larger in group 1 than in group 2 (3.5 ± 1.0° vs 1.1 ± 0.2°, P < 0.01). Postoperatively, disc height (DH) and foraminal height (FH) decreased (P < 0.05), and DW deteriorated (P < 0.01) significantly in group 1, while there were no significant changes in group 2. Lumbar lordosis (LL) remarkably improved postoperatively in group 2 (24.7 ± 8.0 to 32.0 ± 7.0, P < 0.001), contrary to limited improvement in group 1 (25.1 ± 9.2 to 27.0 ± 12.0, P = 0.45). Postoperative LL is a predictive factor for restenosis after MFD. Decrease in DH or progression of DW was contributing to restenosis. LFS presenting with large DW and lumbar degenerative kyphosis should be excluded from surgical indications for MFD without instrumented fusion, considering the high recurrence rate.