The spine journal : official journal of the North American Spine Society
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Transforaminal epidural steroid injections (TFESIs) are a commonly used, effective treatment for radicular pain. Accurate delivery of the injected medication helps to ensure maximum therapeutic efficacy and to decrease possible adverse events, and fluoroscopy is the preferred and most common image-guidance modality used to ensure accurate needle placement during lumbar TFESIs. However, fluoroscopic-guided lumbar TFESIs put patients at risk because of radiation exposure. The purpose of this study was to determine the relationship between body mass index (BMI) and fluoroscopy time and radiation dose during lumbar TFESIs. ⋯ The findings of this study demonstrate that fluoroscopy radiation dose and fluoroscopy time during lumbar TFESIs are increased in patients with an elevated BMI, and in patients of greater age, but the presence of a trainee had no effect on fluoroscopy time.
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Defects in the annulus fibrosus (AF) remain a challenge in the surgical treatment of lumbar disc herniations with persistent defects, allowing potential re herniation of nucleus pulposus (NP) tissue. A cervical porcine model was chosen to simulate human lumbar intervertebral disc (IVD). ⋯ This study demonstrates that it is technically feasible to perform AF defect closure in a porcine model. This novel device achieved AF defect closure that was maintained through 4 weeks in vivo.
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Comparative Study Observational Study
Differences in bone mineral density of fixation points between lumbar cortical and traditional pedicle screws.
The use of a novel lumbar pedicle cortical bone trajectory (CBT) screw has recently gained popularity, allowing for a minimally invasive approach and potentially improved screw purchase. However, to date, no studies have identified the ideal patient population to utilize this technology. ⋯ Bone mineral density as measured by HU values for the fixation point of the CBT screw is significantly greater than that of the traditional pedicle screw. This difference is even more pronounced when comparing osteoporotic and elderly patients to the general population. The data in this study suggest that the potential advantages from the CBT screw such as screw purchase may increase linearly with age and in osteoporotic patients.
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Adjacent segment degeneration (ASD) is one of the major complications after lumbar fusion. Several studies have evaluated the risk factors of ASD. Although the paraspinal muscles play an important role in spine stability, no study has assessed the relationship between paraspinal muscle atrophy and the incidence of ASD after lumbar fusion. ⋯ The occurrence of radiological ASD is most likely multifactorial, and is associated with a higher BMI, preexisting facet and disc degeneration on preoperative examination, and a smaller preoperative relative CSA of the paraspinal muscle on MRI.
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Comparative Study
A comparison of two methods to evaluate a narrow spinal canal: routine magnetic resonance imaging versus three-dimensional reconstruction.
In routine clinical practice, the presence of lumbar spinal stenosis (LSS) is assessed on axial magnetic resonance images (MRI) typically acquired using a preselected spine sagittal angle. Given the natural lordosis of the lumbar spine, not all axial slices will be parallel to the disc and perpendicular to the spinal canal and, thus, are not optimal for the assessment of dural sac cross-sectional area (DCSA). ⋯ When canal size is of interest, particularly when LSS affecting the lower lumbar levels is of concern, 3D reconstruction of clinical images should be considered.