This prospective multicentre study was undertaken to determine segmental movement, disc height and sagittal alignment after total disc replacement (TDR) in the lumbosacral spine and to assess the correlation of biomechanical properties to clinical outcomes. A total of 173 patients with degenerative disc disease and low back pain for more than one year were randomised to receive either TDR or multidisciplinary rehabilitation (MDR). Segmental movement in the sagittal plane and disc height were measured using distortion compensated roentgen analysis (DCRA) comparing radiographs in active flexion and extension. Correlation analysis between the range of movement or disc height and patient-reported outcomes was performed in both groups. After two years, no significant change in movement in the sagittal plane was found in segments with TDR or between the two treatment groups. It remained the same or increased slightly in untreated segments in the TDR group and in this group there was a significant increase in disc height in the operated segments. There was no correlation between segmental movement or disc height and patient-reported outcomes in either group. In this study, insertion of an intervertebral disc prosthesis TDR did not increase movement in the sagittal plane and segmental movement did not correlate with patient-reported outcomes. This suggests that in the lumbar spine the movement preserving properties of TDR are not major determinants of clinical outcomes. Cite this article: Bone Joint J 2013;95-B:81–9

Aims. Chronic low back pain due to degenerative disc disease is sometimes treated with fusion. We compared the outcome of three different fusion techniques in the Swedish Spine Register: noninstrumented posterolateral fusion (PLF), instrumented posterolateral fusion (IPLF), and interbody fusion (IBF). Patients and Methods. A total of 2874 patients who were operated on at one or two lumbar levels were followed for a mean of 9.2 years (3.6 to 19.1) for any additional lumbar spine surgery. Patient-reported outcome data were available preoperatively (n = 2874) and at one year (n = 2274), two years (n = 1958), and a mean of 6.9 years (n = 1518) postoperatively and consisted of global assessment and visual analogue scales of leg and back pain, Oswestry Disability Index, EuroQol five-dimensional index, 36-Item Short-Form Health Survey, and satisfaction with treatment. Statistical analyses were performed with competing-risks proportional hazards regression or analysis of covariance, adjusted for baseline variables. Results. The number of patients with additional surgery were 32/183 (17%) in the PLF group, 229/1256 (18%) in the IPLF group, and 439/1435 (31%) in the IBF group. With the PLF group as a reference, the hazard ratio for additional lumbar surgery was 1.16 (95% confidence interval (CI) 0.78 to 1.72) for the IPLF group and 2.13 (95% CI 1.45 to 3.12) for the IBF group. All patient-reported outcomes improved after surgery (p < 0.001) but were without statistically significant differences between the groups at the one-, two- and 6.9-year follow-ups (all p ≥ 0.12). Conclusion. The addition of interbody fusion to posterolateral fusion was associated with a higher risk for additional surgery and showed no advantages in patient-reported outcome. Cite this article: Bone Joint J 2019;101-B:1526–1533

We have measured the dynamic movement of the lumbar spine in 57 patients with degenerative lumbar disc disease. Each completed a questionnaire which recorded pain and subjective signs and symptoms. From plain lateral radiographs, the subjects were graded using the criteria of Kellgren and Lawrence and those of Lane et al, which are both based on the severity of degenerative changes. Measurements of the height of the disc space and the vertebral height were obtained and expressed as a ratio. We found no relationship between the characteristics of spinal movement and the overall grading of degenerative disc disease with either system. Both were influenced (p < 0.01) by age, walking distance, severity of symptoms, drug intake and frequency of pain. The present systems for grading degenerative disc disease from plain lateral radiographs have limited application

Our study aims to evaluate the efficacy of Wallis implant in management of discogenic back pain. We have prospectively studied thirty patients between 2006 and 2007. Average age of patients was 40.8 years. Average follow-up period 20.6 months (9-28). Main inclusion criteria includes failure of conservative management of low back pain due to degenerative disc disease, preservation of 50% of the disc height and positive discographic features. In majority of the patients the implant was put in at the level of L4-L5. Pre-op and post op SF36 and Oswestry Disability Index (ODI) scores were assessed during clinic follow-up and by telephonic interview. Mean SF36 score improved from thirty-seven (8.3 – 54.3) to 51.4. Mean ODI improved from forty-three (20-60) to 26.5(2-60) (p = 0.026). Complications including superficial infection occurred in one patient, deep infection in one patient, erosion of spinous process in one and displacement of the implant in one case. Three (10%) patients had revision surgery due to various reasons. Wallis interspinous dynamic stabilization system could be used as a soft stabilisation device avoiding fusion and short-term results are promising. In selected group of discogenic low back pain patients it is a useful interim procedure. Long-term follow-up of our series is ongoing

Purpose and Background:. Clinical interpretations of Degenerative Lumbar Disc Disease are not described in the literature. The purpose of this study was to establish a consensus of expert clinical opinion in order to fuel further research. Methods:. A reliable and valid electronic survey was designed to include theoretical constructs relating to training and education, general knowledge, assessment and management practices. Clinicians from the Society of Back Pain Research U.K. were invited to take part. Quantitative data was collated and coded using Bristol on-line survey software, and content analysis was used to systematically code and categorize qualitative data. Results:. Respondents represented a wide range of clinical specialties. The majority graduated in the U.K. (87%), were clinically active and had greater than 9 years postgraduate clinical experience (84%). MRI (36%) and physical assessment (21%) were cited as the most important clinical assessment tools. Reduction in disc height (92%) and disc dehydration (90%) were reported as the most important variables with respect to DLDD diagnosis. The most effective treatment approaches varied from education and reassurance, pain management, cognitive behavioural approaches to core stability training and group activity. Health professionals viewed the future of care advancement in terms of improvements in patient communication (35%) and education (38%). Treatment stratification (24%) and advancing evidence based management practices through research were also regarded as essential (27%). Conclusion:. Spinal clinical experts have clear views on DLDD assessment. In terms of management the results are varied suggesting inconsistency and uncertainty

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Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse.

Background. It has become increasingly important to conduct studies assessing clinical outcomes, reoperation rates, and revision rates to better define the indications and efficacy of lumbar spinal procedures and its association with symptomatic adjacent segment degeneration (sASD). Adjacent segment degeneration (ASD) is defined as the radiographic change in the intervertebral discs adjacent to the surgically treated spinal level. SASD represents adjacent segment degeneration which causes pain or numbness due to post-operative spinal instability or nerve compression at the same level. The most common reason for early reoperation and late operation is sASD, therefore is in our best interest to understand the causes of ASD and make steps to limit the occurrence. Method. A comprehensive literature search was performed selecting Randomized controlled trials (RCTs) and retrospective or prospective studies published up to December 2023. Meta-analysis was performed on 38 studies that met the inclusion criteria and included data of clinical outcomes of patients who had degenerative disc disease, disc herniation, radiculopathy, and spondylolisthesis and underwent lumbar fusion or motion-preservation device surgery; and reported on the prevalence of ASD, sASD, reoperation rate, visual analogue score (VAS), and Oswestry disability index (ODI) improvement. Results. When compared to fusion surgery, a significant reduction of ASD, sASD and reoperation was observed in the cohort of patients that underwent motion-preserving surgery. Conclusion. Dynamic fusion constructs are treatment options that may help to prevent sASD. Conflicts of interest. This research was funded by Paradigm Spine. Sources of funding. Paradigm Spine

Aim. Assess efficacy of caudal epidural injection with epidurogram with validated outcome measures. Introduction. The administration of local steroids and other drugs into caudal epidural space has been well established procedure in the management of low back pain with or without leg symptoms. Various studies have been done to assess the efficacy of the different routes of administration of epidural injections. However, only a few published prospective studies have been done on performing caudal epidural injections under fluoroscopic guidance with validated outcome measures. Methods. Between 2007 and 2009, a total of 129 patients underwent caudal epidural injections under image intensifier guidance with epidurogram. The study included 69 males and 60 females ranging from 20 to 80 years of age. They were prospectively followed up using validated outcome measures at 6 weeks, 3 months, 6 months and 12 months. Results. Out of 129 patients 120 patients were followed at one year. There was statistically significant improvement in mean Low Back Outcome Score (LBOS) and Oswestry Disability Index (ODI) Scores in these patients which was maintained at the end of one year. Based on LBOS and ODI scores, 76% of patients at 6 weeks, 68% at 3 months, 55% at 6 months and 49% at 1 year had excellent and good results. Patients with less than two levels of degenerative disc disease, with predominant unilateral leg symptoms and with symptomatic duration of less than 6 months had a better outcome of results when compared with patients with predominant back symptoms, multi-level degenerative disc disease, bilateral involvement and history of previous lumbo-sacral spine surgery. Discussion and Conclusion. Our study on caudal epidural injections done under fluoroscopic guidance indicate improved and predictable outcome in addition to the patient satisfaction

The study was designed to observe the patients emotional and physical response to total disc replacement surgery in the cervical spine. A prospective cohort study of patients undergoing Cervical total disc replacement (TDR) surgery at our institution. Surgery was carried for radicular and or axial neck pain. The Activ-C TDR (Aesculap) was used. Pre and post operative data was collected using validated questionnaires. 13 Consecutive patients from Nov 2007 to Aug 2008 were studied. All patients were planned for surgical intervention for symptomatic degenerative cervical disc disease at single or multiple levels. 7 male, 6 female. The Centre for Epidemiological Studies Depression Scale (CES-D) was used to assess the psychological impact. The Neck Disability Index (NDI) and a visual analogue scale (VAS) were used to assess the physical impact of the surgery. NDI shows a significant improvement at 6 and 12 months (p= 0.002 and p=0.02 respectively). The VAS also shows significant improvement at 6 and 12 months (p=0.004 and 0.008 respectively) The CES-D improved but failed to show any significant improvement at either interval. In our patient population surgical intervention with TDR for degenerative disc disease offers significant physical benefit over the short term. This does not correlate with an improvement in their emotional state

Surgical management of symptomatic lumbar degenerative disc disease (DDD) currently consists of fusion or implantation of a first generation total disc replacement (TDR). This study is the first to evaluate an elastomeric one-piece TDR in a 50-patient European study. Fifty patients with single-level, symptomatic lumbar DDD at L4-S1 who were unresponsive to at least 6-months of non-operative therapy were enrolled in a clinical trial of a viscoelastic TDR (VTDR) at three European sites. Patients were assessed clinically and radiographically at 6 weeks, 3 and 6 months, and 1 and 2 years. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) were used to assess clinical outcomes. Twenty-eight males and twenty-two females were enrolled in the study. The average age of patients was 39.7 (23 to 61). The operative level was L4/L5 in 13 patients and L5/S1 in 37 patients. There were no intra-operative complications. Quantitative radiographic assessment indicates that the VTDR restores and maintains a physiologically appropriate disc height and angle, while providing range of motion and translation similar to those provided by the natural disc. Mean ODI scores decreased from 48% pre-operatively to 25% at two years follow up. Mean VAS low back pain scores decreased from 7.1 cm pre-op to 3 cm at two years. Median scores indicate that half of the patient population has ODI scores below 13% and VAS back pain scores below 0.5 cm. Clinically and radiologically, this elastomeric disc is performing satisfactorily, and the causes of clinical failures can be more readily identified

Study Design. Single surgeon prospective cohort with radiological follow-up. Background. Anjarwalla et al. have shown that the addition of posterior pedicle supplementation without posterolateral fusion during an ALIF procedure significantly increases the rate of interbody fusion when using a carbon fibre / PEEK cage packed with autogenous iliac crest graft. Stand alone ALIF cages which utilise screws passing through the interbody cage and into the vertebral bodies were designed to obviate the need for a posterior procedure by increasing the anterior construct stability and fusion rate. Objective. To assess the effect of posterior pedicle screw supplementation without posterolateral fusion on the fusion rate of ALIF when using anterior cage and screw constructs. Method. Between 2003 and 2008 91 patients underwent ALIF procedure under a single surgeon for low back pain associated with degenerative disc disease or lytic spondylolisthesis. Routine CT was performed at around 1 to 2 years follow up to ensure union prior to discharge. It was noted that there was a significant number of locked pseudathroses, especially in 2 level cases, and in 2006 the surgeon started to perform simultaneous supplementary posterior pedicle screw stabilisation without posterolateral fusion in the majority of cases. Results. Of the 91 patients, 77 (85%) had CT follow up at mean 21 months. 45 patients had anterior surgery alone (26 single level and 19 two level) and 32 had front back surgery (15 single level and 17 two level). Pseudarthrosis was seen in 16 patients (36%) of the anterior alone group and 2 (6%) of the front back group. In the anterior alone group, pseudarthosis occurred in 6 / 26 (23%) patients with single level surgery and 10 /19 (53%) of those with two level surgery. In this last group, the pseudarthosis occurred in the upper fusion level in five patients and at both fusion levels in other five. Conclusion. Posterior pedicle screw supplementation without posterolateral fusion improves the fusion rate of ALIF when using anterior cage and screw constructs. We would recommend supplementary posterior fixation especially in cases where more than one level is being operated

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Patients with cauda equina syndrome (CES) require emergency imaging and surgical decompression. The severity and type of symptoms may influence the timing of imaging and surgery, and help predict the patient’s prognosis. Categories of CES attempt to group patients for management and prognostication purposes. We aimed in this study to assess the inter-rater reliability of dividing patients with CES into categories to assess whether they can be reliably applied in clinical practice and in research.

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The aim of this study was to assess the accuracy of pedicle screw placement, as well as intraoperative factors, radiation exposure, and complication rates in adult patients with degenerative disorders of the thoracic and lumbar spines who have undergone robotic-navigated spinal surgery using a contemporary system.

Background. Wallis implant was developed in 1986 to stiffen unstable operated degenerate lumbar segments while preserving some intervertebral mobility. The long-term results of first-generation Wallis implant from developers were promising. However, documentation pertaining to safety and efficacy of second generation Wallis implant is sparse in literature. Purpose. The objective of this study was to assess the clinical outcome of the second generation Wallis interspinous device for degenerative lumbar disc disease. Study design. Prospective consecutive single surgeon series. Methods. Patients were selected according to recommendations by developers of Wallis implant. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) were used to assess patient outcomes. Implant failure was determined by disc recurrence, implant removal and revision. Results. 25 patients (13 male, 12 female) with mean age of 51 years (range 47-76) had Wallis implantation (22 one level and 3 two level). Clinical outcome data at average of 60 months (47-76) available for 24 patients (96% FU). Mean ODI scores decreased from 59.1% pre-operatively to 24.7 and 40.5% at 2 years and 5 years follow up, respectively. 34.4 points change from baseline at 2 years and 18.6 points at final follow-up. Mean VAS scores decreased from 7.2 to 3.0 and 4.8 cm for back pain at 2 and 5 years; from 6.8 to 3.8 and 4.2 cm for leg pain at 2 and 5 years follow-up, respectively. Taking a 24 point change in ODI as representing good outcome 96 % (24 patients) of study subjects achieved this at 2 years. Taking a 16 point change in ODI as representing minimum change needed for clinical success 40% (10 patients) failed to achieve this at 5 years. 2 revisions have occurred so far (8% failure rate). Conclusion. The results of our series indicate that the study device is safe and efficacious in the treatment of symptomatic lumbar degenerative discs. However, good clinical outcome obtained at early years is not maintained in medium-term. Interest Statement. There was no commercial support or funding of any sort

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During revision procedures for aseptic reasons, there remains a suspicion that failure may have been the result of an undetected subclinical infection. However, there is little evidence available in the literature about unexpected positive results in presumed aseptic revision spine surgery. The aims of our study were to estimate the prevalence of unexpected positive culture using sonication and to evaluate clinical characteristics of these patients.

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We compared the clinical and radiological outcomes of using a polyetheretherketone cage with (TiPEEK) and without a titanium coating (PEEK) for instrumented transforaminal lumbar interbody fusion (TLIF).

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The aim of this study was to determine the diagnostic utility of histological analysis in spinal biopsies for spondylodiscitis (SD).

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Although we often encounter patients with an aortic aneurysm who also have diffuse idiopathic skeletal hyperostosis (DISH), there are no reports to date of an association between these two conditions and the pathogenesis of DISH remains unknown. This study therefore evaluated the prevalence of DISH in patients with a thoracic aortic aneurysm (AA).

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The aim of this study was to investigate the clinical and radiographic outcomes of microendoscopic laminotomy in patients with lumbar stenosis and concurrent degenerative spondylolisthesis (DS), and to determine the effect of this procedure on spinal stability.

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Minimally invasive transforaminal lumbar interbody fusion (MITLIF) has been well validated in overweight and obese patients who are consequently subject to a higher radiation exposure. This prospective multicentre study aimed to investigate the efficacy of a novel lumbar localisation system for MITLIF in overweight patients.