PowerPoint Presentation

Lordosis

MARK ANTHONY O.BERNABE

The Human Spine

Spine made up of 33 vertebrae

Five regions:

Cervical Vertebrae

Thoracic Vertebrae

Lumbar Vertebrae

Sacrum

Coccyx

Intervertebral Disc

Spongy, cartilaginous

Natural curve in the

spine helps distribute

stress

-Cervical (7), Thoracic (12), Lumbar (5/6), Sacrum (5 fused), Coccyx (3)

http://www.spineuniverse.com/anatomy/vertebral-column

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Pathophysiology of Lordosis

Background

Inward curvature of the lumbar and cervical vertebrae (swayback appearance)

Anterior pelvic tilt, when the pelvis tips forward when resting on top of the femurs

Can cause herniated disc

Symptoms

Severe lower back pain

Exaggerated Posture

Diagnosis

Physical Examination

MRI/CT Scan

Who is at risk?

Discitis

Spondylolisthesis

Kyphosis

Osteoporosis

Obesity

Significant lordotic curves are most often discovered by a physical exam. X-ray or spinal MRI imaging will usually be performed to determine the exact extent of the curvature. MRI or CT scan will also show any neurological effects that the curve is producing.

Discitis inflammation of disc space

Spondylolisthesis vertebrae slips forward

Kyphosis abnormally rounded upper back

Osteoporosis bones become fragile and

may fracture

Obesity excess belly fat can cause

imbalance in muscle strength

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Treatment Methods

Drugs

Nonsteroidal antiinflammatory drugs

Prevent discomfort and swelling

Physical Therapy

Strengthening of muscles

Improving posture

Reducing body weight

Brace

Lordactiv lumbar belt

Surgery

Depuy Bengal Stackable Cage System

-Treatment method rarely required usually condition just needs to be monitored. Severe conditions will cause compression on nerves and cause pain.

-Drugs: over-the-counter, if more severe then doctors prescribe more stuff

-Physical Therapy: Exercises may be used to strengthen muscles and increase range of motion. You may also be taught how to maintain a correct posture.

-Brace: Used with younger children to prevent worsening of condition. Study show that it helps improve balance

-Surgery: Spine straightened, sometimes involves using bone graft to promote new growth and stability

http://www.cure-back-pain.org/lordosis-treatment.html

http://www.thirdage.com/hc/c/lordosis-treatment

http://www.sciencedirect.com/science/article/pii/S1877056810000630

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Product

Used to treat vertebrae T1-L5

Materials

Carbon Fiber Reinforced Polymer (CFRP)

Titanium Rods

Tantalum Beads

Versatile

Adjustable height and angles options

Stackable Cage System

Replace excised vertebral tissue

Used singularly or stacked

Similar in dimension to normal vertebrae

Thoracic and Lumbar vertebral bones

CFRP: densities and electrical conductivity/resistivity properties close to bone with strengths much higher than metals on a per-weight basis, increased osteoconductivity in study on rats

Tantalum is a metal, corrosion resistant, elasticity prevents stress shielding (Stress shieldingrefers to the reduction inbone density(osteopenia) as a result of removal of normal stress from the bone by an implant)

http://www.hindawi.com/journals/ijps/2011/168924/

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Advantages over other Methods

Structure supports loads with modulus of elasticity close to that of cortical bone

Ridges and teeth resist rotation and migration

Cavities accept bone graft

Radiolucent so healing can be assessed by normal radiographic methods

Costs

Cost is dependent on size

~$1800 for 18mm

$6190 for 66mm

Disectomy costs can vary from $15,000 to $75,000

Corpectomy can range between $25,000 and $40,000

Hospitals sometimes have contract rates

Insurance coverage is dependent

on individual insurance companies

Surgical Protocol

Disectomy

Removes the herniated or affected disc

Incision down the center of the back, muscles and nerves moved aside and problematic disc is removed and device is implanted

Suture or metal staples are used to close up

Corpectomy

Removes multiple vertebrae, more invasive

Device implanted in the removed area

Suture or metal staples are used to close up

Caliper to determine defect height

Fluorscopy to determine lordotic

angle

"Discectomy" means "remove the disc". A discectomy relieves the pressure on a nerve root by removing the herniated disc causing the pressure.

The discectomy procedure is performed through an incision down the center of the back over the area of the herniated disc. The muscles are moved to the side so that the surgeon can see the back of the vertebrae. X-rays may be required during surgery to make sure the correct vertebra is located. The surgeon cuts a small opening through the lamina (lam-in-ah) bone on the back of the spinal column. This procedure, called "laminotomy," is used to give the doctor room to see and work inside the spinal canal.

The nerve roots are moved out of the way. Upon locating the problem disc, the surgeon removes it, easing pressure and irritation on the nerves of the spine. Small instruments that fit inside the disc are used to remove as much of the nucleus as possible. This prevents the remaining disc material from herniating in the future.

After the discectomy, the muscles of the back are returned to their normal position around the spine. The skin incision is repaired with sutures or metal staples. In some cases, a discectomy may be combined with a spinal fusion, where the two vertebrae above and below the removed disc are joined together or fused.

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Recovery After Surgery

Most patients go home 1-2 days

(disectomy) or 4-5 days (corpectomy)

later

1-4 weeks recovery time.

8-12 weeks recovery needed for more labor intensive jobs

Surgical tape to affix suture, keep wound dry and clean

Narcotic medication may be taken for pain for 2-4 weeks (not more because addictive)

Physical therapy recommended

Do not sit for long periods of time or drive for the first 2-4 weeks

http://www.mayfieldclinic.com/PE-LumDiscectomy.htm

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Possible Complications

Potential Complications of Surgery

Haematoma

Skin necrosis outside operation region

Deep infection around implantation

Thrombosis

Osteoporosis patients may encounter problems with device fixation

Obesity (too much stress)

1. Use of these systems is contraindicated when there is active systemic infection, infection localized to the site of the proposed implantation, or when the patient has demonstrated allergy or foreign body sensitivity to any of the implant materials.2. Severe osteoporosis may prevent adequate fixation and thus preclude the use of this or any other orthopaedic implant.3. Conditions that may place excessive stresses on bone and implants, such as severe obesity or degenerative diseases, are relative contraindications. The decision whether to use these devices in such conditions must be made by the physician taking into account the risks versus the benefits to the patient.

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Improvements after Procedure

80-90% of patients show good results

Better sitting posture

Improved sagittal balance

Reduced pain

Optimized fusion environment