The spine journal : official journal of the North American Spine Society
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The favorable outcome of surgical treatment for degenerative lumbar spondylolisthesis (DS) is widely recognized, but some patients require reoperation because of complications, such as pseudoarthrosis, persistent pain, infection, and progressive degenerative changes. Among these changes, adjacent segmental disease (ASD) and same segmental disease (SSD) are common reasons for reoperation. However, the relative risks of the various factors and their interactions are unclear. ⋯ The incidence of reoperation in patients surgically treated for DS was 23.2% at a mean time of 5.9 years. A significantly higher incidence of reoperation was observed in patients treated with decompression alone compared with those treated with decompression and fusion. Body mass index and disc height were identified as independent risk factors for SSD, whereas male gender and facet degeneration were identified as independent risk factors for ASD. The results of this comprehensive review will guide spine surgeons in their preoperative planning and in the surgical management of patients with DS, thereby reducing the reoperation rate.
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Although direct repair (DR) with screw fixation at the pars defect is a common surgical treatment for lumbar spondylolysis, it is unknown whether DR leads to better outcomes for young patients with spondylolysis than traditional nonsurgical treatment. ⋯ Conservative treatment for young patients with spondylolysis may produce similar clinical outcomes and fewer complications over 12-month follow-up than surgical treatment with DR.
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Comparative Study Controlled Clinical Trial
Restoration of the spinopelvic sagittal balance in isthmic spondylolisthesis: posterior lumbar interbody fusion may be better than posterolateral fusion.
More and more orthopedic surgeons recognize the importance of the sagittal balance of the spine. ⋯ Either PLF or PLIF would lead a great change in spinopelvic parameters and deformity parameters. The decrease of PT may be an important role for the short-term surgical outcome. The PLIF could increase the LL and form a more reasonable sagittal alignment. From the point of the sagittal spinopelvic balance, the PLIF may be better than the PLF for patients with isthmic spondylolisthesis.
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There is growing concern that patient-reported outcomes (PROs) commonly used in clinical research evaluating treatments such as epidural steroid injections (ESIs) for lumbar spinal stenosis may not adequately capture outcomes of greatest importance to older adults. ⋯ Older adults with spinal stenosis rated problems related to pain and physical function as the most important outcomes to them. However, difficulty exercising and difficulty participating in hobbies and leisure activities were also among the most highly rated and were two areas not typically assessed in treatment studies. Commonly used PROs in spinal stenosis treatment studies may be insufficient to comprehensively assess outcomes from the patient perspective.
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Low back pain and disability are major public health problems and may be related to paraspinal muscle abnormalities, such as a reduction in muscle size and muscle fat content. ⋯ Paraspinal fat infiltration, but not muscle CSA, was associated with high-intensity pain/disability and structural abnormalities in the lumbar spine. Although cause and effect cannot be determined from this cross-sectional study, longitudinal data will help to determine whether disabling low back pain and structural abnormalities of the spine are a cause or result of fat replacement of paraspinal muscles.