The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial Comparative Study
Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial.
Percutaneous laser disc decompression (PLDD) is a minimally invasive treatment for lumbar disc herniation, with Food and Drug Administration approval since 1991. However, no randomized trial comparing PLDD to conventional treatment has been performed. ⋯ At 1 year, a strategy of PLDD, followed by surgery if needed, resulted in noninferior outcomes compared with surgery.
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Multicenter Study
Lumbar extraforaminal entrapment: performance characteristics of detecting the foraminal spinal angle using oblique coronal MRI. A multicenter study.
Previous conventional magnetic resonance imaging reports on extraforaminal entrapment (e-FE) on L5-S1 have been problematic because of their complexity or lack of sensitivity and specificity. In this study, we propose a simple diagnostic method for e-FE. ⋯ Determining differences in the FSN angle between the symptomatic and asymptomatic sides of greater than 10° via OC-T2WI represented a simple, readily available, and complementary diagnostic method for lumbar e-FE.
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The transforaminal lumbar interbody fusion (TLIF) technique supplements posterior instrumented lumbar spine fusion and has been tested with different types of screw fixation for stabilization. Transforaminal lumbar interbody fusion is usually placed through a unilateral foraminal approach after unilateral facetectomy, although extraforaminal entry allows the facet to be spared. ⋯ These results suggest that fixation at L4-L5 with TFPS is a promising alternative to PSR, with or without TLIF. A TLIF device was less stable than the native disc with both methods of instrumentation presumably because of a fulcrum effect from a relatively small footplate. Additional interbody support may be considered for improved biomechanics with TLIF.
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Revision surgery for pseudarthrosis after a lumbar spinal fusion has unpredictable functional results. ⋯ The clinical outcomes after revision surgery for pseudarthrosis are worse in patients with DDD compared with spondylolisthesis despite successful repair of nonunion. Risks and benefits should be well discussed with the patients before deciding on surgical treatment for the management of pseudarthrosis, especially in patients with previous short-segment fusions done for DDD.
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Recent reports have suggested that excessive motion of the lumbar spine might be associated with low back pain and accelerated disc degeneration and may negatively influence the outcome of posterior lumbar interbody fusion (PLIF) surgery. These findings suggest that generalized joint laxity (GJL) might be a negative factor affecting PLIF outcome, although this relationship has not been well studied. In addition, the impact of GJL on adjacent segment pathology (ASP) after PLIF has not been reported. ⋯ Generalized joint laxity at baseline does not impact fusion rate or clinical outcome with respect to pain intensity or functional status but could negatively impact ASP compared with that in patients without GJL. Consequently, GJL should be evaluated preoperatively, and patients with GJL undergoing PLIF should be informed of the potential risks of surgery.