European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Review Meta Analysis
Clinical outcomes of lumbar spinal surgery in patients 80 years or older with lumbar stenosis or spondylolisthesis: a systematic review and meta-analysis.
This systematic review and meta-analysis of all available evidence was performed to assess the safety and efficacy of surgery for lumbar stenosis and spondylolisthesis in patients 80 years or older versus those younger than 80 years. ⋯ Our results revealed that the clinical improvement in pain and disability did not significantly differ according to age, although the patients aged 80 years or older had increased incidences of mortality and complication than younger patients. Age alone is not a contraindication for lumbar surgery in very old patients. A careful preoperative evaluation, proper patient selection and appropriate surgical approach are important to achieve successful surgical outcomes. These slides can be retrieved under Electronic Supplementary Material.
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In this prospective study, we aim to determine surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery. ⋯ This study reports the clinical course of pain, disability, and walking distance after LSS surgery with the 10-year follow-up. Based on our study results, patients with LSS could expect to have positive effects of their back surgery up to 10 years. However, minor worsening in pain and disability may occur and one-fourth of the patients may need a reoperation during the 10-year follow-up period.
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Coronal malalignment (CM) causes pain, impairment of function and cosmetic problems for adult spinal deformity (ASD) patients in addition to sagittal malalignment. Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons. ⋯ Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. Surgeons should consider both the sagittal and coronal planes, and this system may allow better surgical decision making for CM.
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To investigate GAP scores in an asymptomatic cohort of adults, including older adults with age-expected changes in spinal alignment. ⋯ Most patients in this asymptomatic, nonoperative cohort were normally proportioned. However, a large percentage of asymptomatic volunteers were moderately or severely disproportioned. Older patients had higher scores, indicating some disproportion. There was also a small number of severely sagittally misaligned and poorly proportioned, yet asymptomatic, volunteers. Further refinement of individualized targets is needed to determine the effect on mechanical complications and quality of life given the divergent recommendations of age-adjusted targets and GAP targets.
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To raise the diagnostic criteria, classification and treatment strategy of dynamic sagittal imbalance (DSI). ⋯ Our study proposed a quantitative diagnostic criteria and novel classification of DSI. Nonoperative treatment is effective for most DSI patients with ΔSVA < 100 mm, while the majority of DSI patients with ΔSVA ≥ 100 mm need operative intervention.