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Xu Z, Zhuolin Z, Jing X, Hu Q. Biportal endoscopic transforaminal lumbar interbody fusion with large cage: a technique without additional spacer portal. J Orthop Surg Res 2024; 19:532. [PMID: 39218990 PMCID: PMC11367753 DOI: 10.1186/s13018-024-05018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Large spacers offer numerous advantages such as higher fusion rates and lower subsidence rates. However, due to the anatomical constraints of the approach, the use of large spacers in biportal endoscopic transforaminal lumbar interbody fusion(BE-TLIF) necessitates an additional incision and special instruments for spacer implantation leading to less frequent use. METHODS This study has refined several techniques within BE-TLIF. We insert the cage and impact the cage transverse with a special design instrument in the same working portal. This allows for the use of large spacers during BE-TLIF procedures without the need for an auxiliary cage-inserting incision. CONCLUSION The technique is a straightforward, safe, and minimally invasive method for inserting large cages in the treatment of lumbar instability.
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Affiliation(s)
- Zhengyu Xu
- Department of Orthopedics, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine，Zhejiang University, N1, Shangcheng.st, Yiwu City, China
| | - Zhong Zhuolin
- Department of Orthopedics, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine，Zhejiang University, N1, Shangcheng.st, Yiwu City, China
| | - Xiaowei Jing
- Department of Orthopedics, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine，Zhejiang University, N1, Shangcheng.st, Yiwu City, China
| | - Qingfeng Hu
- Department of Orthopedics, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine，Zhejiang University, N1, Shangcheng.st, Yiwu City, China.
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Chang SY, Kang DH, Cho SK. Innovative Developments in Lumbar Interbody Cage Materials and Design: A Comprehensive Narrative Review. Asian Spine J 2024; 18:444-457. [PMID: 38146053 PMCID: PMC11222887 DOI: 10.31616/asj.2023.0407] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023] Open
Abstract
This review comprehensively examines the evolution and current state of interbody cage technology for lumbar interbody fusion (LIF). This review highlights the biomechanical and clinical implications of the transition from traditional static cage designs to advanced expandable variants for spinal surgery. The review begins by exploring the early developments in cage materials, highlighting the roles of titanium and polyetheretherketone in the advancement of LIF techniques. This review also discusses the strengths and limitations of these materials, leading to innovations in surface modifications and the introduction of novel materials, such as tantalum, as alternative materials. Advancements in three-dimensional printing and surface modification technologies form a significant part of this review, emphasizing the role of these technologies in enhancing the biomechanical compatibility and osseointegration of interbody cages. In addition, this review explores the increase in biodegradable and composite materials such as polylactic acid and polycaprolactone, addressing their potential to mitigate long-term implant-related complications. A critical evaluation of static and expandable cages is presented, including their respective clinical and radiological outcomes. While static cages have been a mainstay of LIF, expandable cages are noted for their adaptability to the patient's anatomy, reducing complications such as cage subsidence. However, this review highlights the ongoing debate and the lack of conclusive evidence regarding the superiority of either cage type in terms of clinical outcomes. Finally, this review proposes future directions for cage technology, focusing on the integration of bioactive substances and multifunctional coatings and the development of patient-specific implants. These advancements aim to further enhance the efficacy, safety, and personalized approach of spinal fusion surgeries. Moreover, this review offers a nuanced understanding of the evolving landscape of cage technology in LIF and provides insights into current practices and future possibilities in spinal surgery.
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Affiliation(s)
- Sam Yeol Chang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul,
Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
| | - Dong-Ho Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
- Department of Orthopaedic Surgery, Spine Center, Samsung Medical Center, Seoul,
Korea
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
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Tao X, Matur AV, Khalid S, Onyewadume L, Garner R, McGrath K, Owen B, Gibson J, Cass D, Mejia Munne JC, Vorster P, Shukla G, Gupta S, Wu A, Childress K, Palmisciano P, Duah HO, Motley B, Cheng J, Adogwa O. TLIF is Associated With Lower Rates of Adjacent Segment Disease and Complications Compared to ALIF: A Matched-Cohort Analysis. Spine (Phila Pa 1976) 2023; 48:1335-1341. [PMID: 37146059 DOI: 10.1097/brs.0000000000004694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/10/2023] [Indexed: 05/07/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare the rate of adjacent segment disease (ASD) in patients undergoing anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) for the treatment of degenerative stenosis and spondylolisthesis. SUMMARY OF BACKGROUND DATA ALIF and TLIF are frequently used to treat Lumbar stenosis and spondylolisthesis. While both approaches have distinct advantages, it is unclear whether there are any differences in rates of ASD and postoperative complications. METHODS A retrospective cohort study of patients who underwent index 1-3 levels ALIF or TLIF between 2010 and 2022, using the PearlDiver Mariner Database, an all-claims insurance database (120 million patients). Patients with a history of prior lumbar surgery and those undergoing surgery for cancer, trauma, or infection were excluded. Exact 1:1 matching was performed using demographic factors, medical comorbidities, and surgical factors found to be significantly associated with ASD in a linear regression model. The primary outcome was a new diagnosis of ASD within 36 months of index surgery, and secondary outcomes were all-cause medical and surgical complications. RESULTS Exact 1:1 matching resulted in 2 equal groups of 106,451 patients undergoing TLIF and ALIF. The TLIF approach was associated with a lower risk of ASD (RR 0.58, 95% CI 0.56-0.59, P < 0.001) and all-cause medical complications (RR 0.94, 95% CI 0.91-0.98, P =0.002). All-cause surgical complications were not significantly different between both groups. CONCLUSION After 1:1 exact matching to control for confounding variables, this study suggests that for patients with symptomatic degenerative stenosis and spondylolisthesis, a TLIF procedure (compared to ALIF) is associated with a decreased risk of developing ASD within 36 months of index surgery. Future prospective studies are needed to corroborate these findings. LEVEL OF EVIDENCE Level-3.
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Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois College of Medicine, Chicago, IL
| | - Louisa Onyewadume
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Rebecca Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kyle McGrath
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Bryce Owen
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Juan C Mejia Munne
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry O Duah
- Institute for Nursing Research & Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Ke W, Zhang T, Wang B, Hua W, Wang K, Cheung JPY, Yang C. Biomechanical Comparison of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases after Primary Transforaminal Lumbar Interbody Fusion: A Finite Element Analysis. Orthop Surg 2023; 15:2701-2708. [PMID: 37620961 PMCID: PMC10549837 DOI: 10.1111/os.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Adjacent segment disease (ASD) is a well-known complication after interbody fusion. Revision surgery is necessary for symptomatic ASD to further decompress and fix the affected segment. However, no optimal construct is accepted as a standard in treating ASD. The purpose of this study was to compare the biomechanical effects of different surgical approaches for the treatment of ASD after primary transforaminal lumbar interbody fusion (TLIF). METHODS A finite element model of the L1-S1 was conducted based on computed tomography scan images. The primary surgery model was developed with a single-level TLIF at L4-L5 segment. The revision surgical models were developed with anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), or TLIF at L3-L4 segment. The range of motion (ROM), intradiscal pressure (IDP), and the stress in cages were compared to investigate the biomechanical influences of different surgical approaches. RESULTS The results indicated that all the three surgical approaches can stabilize the spinal segment by reducing the ROM at revision level. The ROM and IDP at adjacent segments of revision model of TLIF was greater than those of other revision models. While revision surgery with ALIF and LLIF had similar effects on the ROM and IDP of adjacent segments. Compared among all the surgical models, cage stress in revision model of TLIF was the maximum in extension and axial rotation. CONCLUSION The IDP at adjacent segments and stress in cages of revision model of TLIF was greater than those of ALIF and LLIF. This may be that direct extension of the surgical segment in the same direction results in stress concentration.
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Affiliation(s)
- Wencan Ke
- Department of OrthopaedicsUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Teng Zhang
- Department of Orthopaedics and TraumatologyThe University of Hong KongHong Kong SARChina
| | - Bingjin Wang
- Department of OrthopaedicsUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Wenbin Hua
- Department of OrthopaedicsUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Kun Wang
- Department of OrthopaedicsUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and TraumatologyThe University of Hong KongHong Kong SARChina
| | - Cao Yang
- Department of OrthopaedicsUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
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Liu J, Xie R, Chin CT, Rajagopalan P, Duan P, Li B, Burch S, Berven SH, Mummaneni PV, Chou D. Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2-Year Follow-Up. Orthop Surg 2023; 15:2334-2341. [PMID: 37526121 PMCID: PMC10475659 DOI: 10.1111/os.13812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE Generally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the realistic lumbosacral arthrodesis rates following ALIF and TLIF in patients with degenerative spondylolisthesis as measured by CT and radiology. METHODS Ninety-six patients who underwent single-level L5-S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan-Steffee-Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow-up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t-test or chi-square test. RESULTS The mean follow-up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow-up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow-up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p < 0.05). Overall complication rates were similar between the TLIF and ALIF groups (10.4% vs 8.33%; p > 0.999). CONCLUSIONS With a minimum 2-year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups.
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Affiliation(s)
- Jinping Liu
- Department of Neurosurgery, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Rong Xie
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
- Department of NeurosurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Cynthia T. Chin
- Department of RadiologyUniversity of California San FranciscoSan FranciscoCAUSA
| | - Priya Rajagopalan
- Department of RadiologyUniversity of California San FranciscoSan FranciscoCAUSA
| | - Ping‐Guo Duan
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Bo Li
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Shane Burch
- Department of Orthopaedic SurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Sigurd H. Berven
- Department of Orthopaedic SurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Praveen V. Mummaneni
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Dean Chou
- Department of NeurosurgeryColumbia UniversityNew YorkUSA
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Sebaaly A, Kreichati G, Tarchichi J, Kharrat K, Daher M. Transforaminal lumbar interbody fusion using banana-shaped and straight cages: meta-analysis of clinical and radiological outcomes. 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 2023; 32:3158-3166. [PMID: 37326836 DOI: 10.1007/s00586-023-07797-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Transforaminal lumbar interbody fusion (TLIF) surgery rate increased over the last decade. There is no consensus about the better shape of cage to use in TLIF. This meta-analysis was conducted to compare the shape focusing on bony union, lordosis restoration as well as perioperative complications. METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched till September 2022. The clinical outcomes consisted of the bony union, segmental and lumbar lordosis restoration, quality of life, and operation-related outcomes. RESULTS Only 5 studies were included in this meta-analysis. Straight-shaped cages tended to have a lower subsidence rate compared to banana-shaped cages (p = 0.10), had a better restoration of segmental lordosis (p < 0.0001), better disc height restoration (p = 0.01), as well as a higher Oswestry Disability Index decrease (p = 0.0002). CONCLUSION Straight-shaped cages had a better restoration of lumbar lordosis, disc height, and a lower subsidence rate when compared to banana-shaped cages. This may be explained by the absence of the optimal placement of the curved cages, which is at the most anterior part of the disc space. Better conducted randomized controlled trial could strengthen these findings.
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Affiliation(s)
- Amer Sebaaly
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Gaby Kreichati
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jean Tarchichi
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Mohammad Daher
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Platz U, Halm H, Thomsen B, Pecsi F, Köszegvary M, Bürger N, Berlin C, Quante M. Anterior Lumbar Interbody Fusion (ALIF) or Transforaminal Lumbar Interbody Fusion (TLIF) for Fusion Surgery in L5/S1 - What Is the Best Way to Restore a physiological Alignment? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:646-656. [PMID: 34496423 DOI: 10.1055/a-1560-3106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN A retrospective single center cohort study with prospective collected data from an institutional spine registry. OBJECTIVES To determine whether restoration of lordosis L5/S1 is possible with both anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF) and to find out which technique is superior to recreate lordosis in L5/S1. METHODS Seventy-seven patients with ALIF and seventy-nine with TLIF L5/S1 were included. Operation time, estimated blood loss), and complications were evaluated. Segmental lordosis L5/S1 and L4/5, overall lordosis, and proximal lordosis (L1 to L4) were measured in X-rays before and after surgery. Oswesery disability index and EQ-5D were assessed before surgery, and 3 and 12 months after surgery. RESULTS Mean operation time was 176.9 minutes for ALIF and 195.7 minutes for TLIF (p = 0.048). Estimated blood loss was 249.2 cc for ALIF and 362.9 cc for TLIF (p = 0.005). In terms of complications, only a difference in dural tears were found (TLIF 6, ALIF none; p = 0.014). Lordosis L5/S1 increased in the ALIF group (15.8 to 24.6°; p < 0.001), whereas no difference was noted in the TLIF group (18.4 to 19.4°; p = 0.360). Clinical results showed significant improvement in the Oswesery disability index (ALIF: 43 to 21.9, TLIF: 45.2 to 23.0) and EQ-5D (ALIF: 0.494 to 0.732, TLIF: 0.393 to 0.764) after 12 months in both groups, without differences between the groups. CONCLUSION ALIF and TLIF are comparable methods for performing fusion at L5/S1, with good clinical outcomes and comparable rates of complications. However, there is only a limited potential for recreating lordosis at L5/S1 with a TLIF.
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Affiliation(s)
- Uwe Platz
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Henry Halm
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Björn Thomsen
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Ferenc Pecsi
- Klinik für Wirbelsäulenchirurgie, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Mark Köszegvary
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Nina Bürger
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Clara Berlin
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Markus Quante
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
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Eum JH, Park JH, Song KS, Lee SM, Suh DW, Jo DJ. Endoscopic Extreme Transforaminal Lumbar Interbody Fusion With Large Spacers: A Technical Note and Preliminary Report. Orthopedics 2022; 45:163-168. [PMID: 35112965 DOI: 10.3928/01477447-20220128-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This report describes a novel endoscopic fusion technique performed with unilateral biportal endoscopy (UBE) that is known as extreme transforaminal lumbar interbody fusion (eXTLIF) and is performed with a large spacer. We also present the short-term results of this procedure. Previous studies reported that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) could achieve acceptable rates of fusion; therefore, it is often used for treating various degenerative lumbar diseases. Moreover, MIS-TLIF can be performed with a unilateral approach; hence, it is commonly performed with the UBE technique. The biportal endoscopic TLIF procedure is usually performed with a single spacer in the interbody space. It is important to insert the maximum amount of graft material into the preparation site via an autologous bone marrow transplant or any other suitable substance with spacer insertion. Because MIS-TLIF with UBE is performed in water, it might provide an inadequate environment for excellent fusion. Therefore, a modified method was used to increase the surface contact area and insert the maximum amount of bone material with a larger spacer. However, the use of a large spacer necessitates a larger spacer orifice. For this purpose, eXTLIF was performed, which inserts the spacer more laterally compared with the current TLIF position. We report the surgical method and short-term results, which have been satisfactory thus far. [Orthopedics. 2022;45(3):163-168.].
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Ashayeri K, Alex Thomas J, Braly B, O'Malley N, Leon C, Cheng I, Kwon B, Medley M, Eisen L, Protopsaltis TS, Buckland AJ. Lateral decubitus single position anterior-posterior (AP) fusion shows equivalent results to minimally invasive transforaminal lumbar interbody fusion at one-year follow-up. 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 2022; 31:2227-2238. [PMID: 35551483 DOI: 10.1007/s00586-022-07226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study compares perioperative and 1-year outcomes of lateral decubitus single position circumferential fusion (L-SPS) versus minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for degenerative pathologies. METHODS Multicenter retrospective chart review of patients undergoing AP fusion with L-SPS or MIS TLIF. Demographics and clinical and radiographic outcomes were compared using independent samples t tests and chi-squared analyses with significance set at p < 0.05. RESULTS A total of 445 patients were included: 353 L-SPS, 92 MIS TLIF. The L-SPS cohort was significantly older with fewer diabetics and more levels fused. The L-SPS cohort had significantly shorter operative time, blood loss, radiation dosage, and length of stay compared to MIS TLIF. 1-year follow-up showed that the L-SPS cohort had higher rates of fusion (97.87% vs. 81.11%; p = 0.006) and lower rates of subsidence (6.38% vs. 38.46%; p < 0.001) compared with MIS TLIF. There were significantly fewer returns to the OR within 1 year for early mechanical failures with L-SPS (0.0% vs. 5.4%; p < 0.001). 1-year radiographic outcomes revealed that the L-SPS cohort had a greater LL (56.6 ± 12.5 vs. 51.1 ± 15.9; p = 0.004), smaller PI-LL mismatch (0.2 ± 13.0 vs. 5.5 ± 10.5; p = 0.004). There were no significant differences in amount of change in VAS scores between cohorts. Similar results were seen after propensity-matched analysis and sub-analysis of cases including L5-S1. CONCLUSIONS L-SPS improves perioperative outcomes and does not compromise clinical or radiographic results at 1-year follow-up compared with MIS TLIF. There may be decreased rates of early mechanical failure with L-SPS.
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Affiliation(s)
- Kimberly Ashayeri
- Department of Neurosurgery, NYU Langone Medical Center, 462 1st Avenue, Suite 7S4, New York, NY, USA.
| | - J Alex Thomas
- Atlantic Neurosurgical and Spine Specialists, Wilmington, NC, USA
| | - Brett Braly
- Oklahoma Sports, Science and Orthopaedics, Oklahoma City, OK, USA
| | | | - Carlos Leon
- Oklahoma Sports, Science and Orthopaedics, Oklahoma City, OK, USA
| | | | - Brian Kwon
- Division of Spine Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Mark Medley
- Department of Neurosurgery, NYU Langone Medical Center, 462 1st Avenue, Suite 7S4, New York, NY, USA
| | - Leon Eisen
- Oklahoma Sports, Science and Orthopaedics, Oklahoma City, OK, USA
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Roh YH, Lee JC, Hwang J, Cho HK, Soh J, Choi SW, Shin BJ. Long-Term Clinical and Radiological Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion: 10-Year Follow-up Results. J Korean Med Sci 2022; 37:e105. [PMID: 35380029 PMCID: PMC8980361 DOI: 10.3346/jkms.2022.37.e105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Many studies have reported that minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) provides satisfactory treatment comparable to other fusion methods. However, in the case of MI-TLIF, there are concerns about the long-term outcome compared to conventional bilateral PLIF due to the small amount of disc removal and the lack of autogenous bone graft. Long-term follow-up studies are still lacking as most of the previous reports have follow-up periods of up to 5 years. METHODS Thirty patients who underwent MI-TLIF were followed up for > 10 years (mean, 11.1 years). Interbody fusion rates were determined using a modified Bridwell grading system. Adjacent segment disease (ASD) was defined as radiological adjacent segment degeneration (R-ASDeg) as seen on plain X-rays; reoperated adjacent segment disease referred to the subsequent need for revision surgery. Clinical outcomes after surgery were assessed based on back and leg pain as well as the Oswestry disability index (ODI). RESULTS The overall radiological fusion rate, at the 1-, 5-, and 10-year follow-up was 77.1%, 91.4%, and 94.3%, respectively. The incidence of R-ASDeg 1, 5, and 10 years after surgery was 6.7%, 16.7%, and 43.3% at the proximal adjacent segment and 4.8%, 14.3%, and 28.6% at the distal adjacent segment, respectively. R-ASDeg at either the proximal or distal segment was determined in 50.0% of the patients 10 years postoperatively. All clinical parameters improved significantly during follow-up, although the ODI and the visual analog scale (VAS) for leg pain at the 10-year follow-up were significantly worse in the R-ASDeg group than in the other patients (P = 0.009, P = 0.040). CONCLUSION MI-TLIF improved both clinical and radiological outcomes, and the improvements were maintained for up to 10 years after surgery. However, R-ASDeg developed in up to 50% of the patients within 10 years, and both leg pain on the VAS and the ODI were worse in patients with R-ASDeg.
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Affiliation(s)
- Young-Ho Roh
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
| | - Jinyeong Hwang
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyung-Ki Cho
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jaewan Soh
- Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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El-Ghandour N, Sawan M, Goel A, Abdelkhalek AA, Abdelmotleb AM, Ali T, Abdel Aziz MS, Soliman MAR. A Prospective Randomized Study of the Safety and Efficacy of Transforaminal Lumbar Interbody Fusion Versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis: A Cost utility from a Lower-middle-income Country Perspective and Review of Literature. Open Access Maced J Med Sci 2021; 9:636-645. [DOI: 10.3889/oamjms.2021.6569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The safety and efficacy of transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis have not been validated in many prospective randomized trials.
AIM: We aimed to validate the safety and efficacy of TLIF and PLIF surgery in lumbar spondylolisthesis using the clinical, radiographic, and cost-utility outcomes.
METHODS: The data of surgically treated single-level spondylolisthesis patients were randomized prospectively into two groups. The groups were compared regarding demographics, perioperative complications, hospital stay, total expenditure, fusion rate, and clinical outcomes (visual analog scale, Oswestry disability index, Zurich claudication scale, and Odom’s criteria). A review of literature was done to compare the outcomes with the ones from higher-income nations.
RESULTS: Thirty-three patients underwent prospective randomization. The improvement in the clinical outcomes at 12-month follow-up showed improvement in the TLIF group more than the PLIF group but with no significant difference. The mean operative time was significantly longer in the PLIF (p < 0.05), also, the blood loss was significantly less in the TLIF (p < 0.001). The complications frequency did not show any statistical significance between both groups and no significant difference in the patient’s post-operative patient satisfaction (p = 0.6). The mean hospital stay was non-significantly longer in the PLIF (p = 0.7). At 12-month follow-up, 93.3% of the TLIF patients were fused versus 86.7% of the PLIF (p = 0.5). The total cost of the TLIF was significantly less (p < 0.001).
CONCLUSION: Both PLIF and TLIF could achieve similar fusion rates and clinical satisfaction in the management of lumbar spondylolisthesis. The TLIF group was significantly better in terms of financial burden, operative time, and blood loss.
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12
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Moses ZB, Razvi S, Oh SY, Platt A, Keegan KC, Hamati F, Witiw C, David BT, Fontes RBV, Deutsch H, O'Toole JE, Fessler RG. A retrospective comparison of radiographic and clinical outcomes in single-level degenerative lumbar disease undergoing anterior versus transforaminal lumbar interbody fusion. JOURNAL OF SPINE SURGERY 2021; 7:170-180. [PMID: 34296029 DOI: 10.21037/jss-20-673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/29/2021] [Indexed: 11/06/2022]
Abstract
Background Single-level lumbar degenerative disc disease (DDD) remains a significant cause of morbidity in adulthood. Anterior lumbar interbody fusion (ALIF) and Transforaminal lumbar interbody fusion (TLIF) are surgical techniques developed to treat this condition. With limited studies on intermediate term outcomes in a single cohort, we compare radiographic and clinical outcomes in patients undergoing ALIF and TLIF. Methods A retrospective chart review was performed on 164 patients (111 TLIF; 53 ALIF) over a 60-month period. X-ray radiographs obtained pre-operatively, prior to discharge, and at one year were utilized for radiographic assessment. Segmental lordosis, lumbar lordosis and HRQOL scores were measured preoperatively and at one-year timepoints. Results Changes in lumbar lordosis and segmental lordosis were significantly greater after ALIF (4.6° vs. -0.6°, P=0.05; 4.7° vs. -0.7°, P<0.05) at one year (mean time, 366±20 days). At one year or greater, there was a greater reduction in mean VAS-leg score in TLIF patients (3.4 vs. 0.6, P<0.05) and ODI score (16.2 vs. 5.4, P<0.05). Similar outcomes were seen for VAS-back, SF-12 Physical Health, and SRS-30 Function/Activity. SF-12 Mental Health scores were found to be lower in patients undergoing TLIF (-3.5 vs. 2.7, P<0.05). Conclusions ALIF demonstrated a superior method of increasing lumbar and segmental lordosis. TLIF was utilized more in patients with higher pre-operative VAS-leg pain scores and therefore, showed a greater magnitude of VAS-leg pain improvement. TLIF also demonstrated a greater improvement in ODI scores despite similar baseline scores, suggesting a possible enhanced functional outcome.
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Affiliation(s)
- Ziev B Moses
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Sharmeen Razvi
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Seok Yoon Oh
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew Platt
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C Keegan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Fadi Hamati
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher Witiw
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian T David
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Ricardo B V Fontes
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Harel Deutsch
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Walter C, Baumgärtner T, Trappe D, Frantz S, Exner L, Mederake M. Influence of Cage Design on Radiological and Clinical Outcomes in Dorsal Lumbar Spinal Fusions: A Comparison of Lordotic and Non-Lordotic Cages. Orthop Surg 2021; 13:863-875. [PMID: 33763988 PMCID: PMC8126915 DOI: 10.1111/os.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/14/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives To evaluate the comparison between lordotic and non‐lordotic transforaminal lumbar interbody fusion (TLIF) cages in degenerative lumbar spine surgery and analyze radiological as well as clinical outcome parameters in long‐term follow up. Methods In a retrospective study design, we compared 37 patients with non‐lordotic cage (NL‐group) and 40 with a 5° lordotic cage (L‐group) implanted mono‐ or bi‐segmental in TLIF‐technique from 2013 to 2016 and analyzed radiological parameters of pre‐ and postoperative (Lumbar lordosis (LL), segmental lordosis (SL), and pelvic tilt (PT), as well as clinical parameters in a follow‐up physical examination using the Oswestry disability index (ODI), Roland–Morris Score (RMS), and visual analog scale (VAS). Results Surgery was mainly performed in lower lumbar spine with a peak in L4/5 (mono‐segmental) and L4 to S1 (bi‐segmental), long‐term follow‐up was on average 4 years postoperative. According to the literature, we found significantly better results in radiological outcome in the L‐group compared to the NL‐group: LL increased 6° in L‐group (51° preoperative to 57° postoperative) and decreased 1° in NL‐group (50° to 49° (P < 0.001). Regarding SL, we found an increase of 5° in L‐group (13° to 18°) and no difference in NL‐group (15°)(P < 0.001). In PT, we found a clear benefit with a decrease of 2° in L‐group (21° to 19°) and no difference in NL‐group (P = 0.008). In direct group comparison, ODI in NL‐group was 23% vs 28% in L‐group (P = 0.25), RMS in NL‐group was 8 points vs 9 points in L‐group (P = 0.48), and VAS was in NL‐group 2.7 vs 3.2 in L‐group (P = 0.27) without significant differences. However, the clinical outcome in multivariate analysis indicated a significant multivariate influence across ODI and RMS of BMI (Wilks λ = 0.57, F [4, 44] = 3.61, P = 0.012) and preoperative SS (Wilks λ = 0.66, F [4, 44] = 2.54, P = 0.048). Age, gender, cage type and postoperative PT had no significant influence (P > 0.05). Intraoperatively, we saw three dura injuries that could be sutured without problems and had no consequences for the patient. In the follow‐up, we did not find any material‐related problems, such as broken screws or cage loosening, also no pseudarthrosis. Conclusion In conclusion, we think it's not cage design but other influenceable factors such as correct indication and adequate decompression that lead to surgical success and the minimal difference in the LL therefore seemed to be of subordinate importance.
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14
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He L, Xiang Q, Yang Y, Tsai TY, Yu Y, Cheng L. The anterior and traverse cage can provide optimal biomechanical performance for both traditional and percutaneous endoscopic transforaminal lumbar interbody fusion. Comput Biol Med 2021; 131:104291. [PMID: 33676337 DOI: 10.1016/j.compbiomed.2021.104291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/13/2021] [Accepted: 02/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transforaminal lumbar interbody fusion (TLIF) is a well-established surgical treatment for patients with lumbar degenerative disc disease; however, the optimal position for the interbody fusion cage in TLIF procedures for reducing cage-related complications remains uncertain. The present study aims to compare the biomechanical effects between different cage positions in TLIF and percutaneous endoscopic-TLIF (PE-TLIF). METHOD An intact finite element model of L3-L5 from computed tomography images of a 25-year-old healthy male without any lumbar disease was reconstructed and validated. TLIF and PE-TLIF were performed on L4-L5 with bilateral pedicle screws fixation. Two surgical finite element models were subjected to loads with six degrees of freedom. The range of motion (ROM) and von Mises stress of the implantations and endplates were measured for the anterior, middle, and posterior district and the traverse or oblique direction of the cage respectively. RESULTS As the cage was implanted forward, the ROMs in the fused L4-L5 segments and the von Mises stress of the cage and endplates decreased while the von Mises stress of the screws increased; this was also shown in the traverse cage when compared with the oblique cage (A-90-compared with A-45- had a 31.3%, 1.7%, 12.6%, and 5.7% decrease in FL, EX, LB and AR). The ROMs (TLIF A-45 increase of 80.8%, 23.8%, and 12.2% in FL, EX, and LB when compared with PE-TLIF), cage stress, and endplate stress of PE-TLIF were lower than those of TLIF. CONCLUSIONS Considering the ROM of the fusion segments, implanting the cage in the anterior district in the traverse direction can effectively enhance the fusion segment stiffness, thus contributing to the stability of the lumbar spine after fusion. It can also cause less cage stress and endplate stress, which indicates its beneficial effect in avoiding cage injury or subsidence. However, the higher stress of the pedicle screws and rods indicates higher failure risk. PE-TLIF had better biomechanical performance than TLIF. Therefore, it is recommended that the surgeon implant the cage in the anterior district of the L5 vertebra's upper endplate in the traverse direction using the PE-TLIF technique.
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Affiliation(s)
- Lei He
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China; College of Civil Engineering, Tongji University, Shanghai, 200082, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Tongji University School of Medicine, Shanghai, 200065, China
| | - Qingzhi Xiang
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Tongji University School of Medicine, Shanghai, 200065, China
| | - Yangyang Yang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yan Yu
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Tongji University School of Medicine, Shanghai, 200065, China.
| | - Liming Cheng
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Tongji University School of Medicine, Shanghai, 200065, China
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15
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Prinz V, Vajkoczy P. Surgical revision strategies for postoperative spinal implant infections (PSII). JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:777-784. [PMID: 33447683 PMCID: PMC7797799 DOI: 10.21037/jss-20-514] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Over the last years the number of spine surgeries with instrumentation has grown to an indispensable column in the treatment for different pathologies of the spine. A further increase in the incidence of instrumented spinal surgery is expected throughout the next years. Although the implementation and development of new techniques offer faster and more minimal invasive procedures, shortening surgery time, reducing soft tissue injury and revision due to hardware misplacement, the incidence of postoperative spinal implant infections (PSII) remains high. PSII related complications and revision procedures pose an enormous socioeconomic burden. Therefore, standardized strategies and protocols for treatment of PSII are urgently needed. While in former times hardware exchange or hardware removal was common practise in the field of spine surgery this approach has changed over the last years. Although the evidence from clinical studies in the field of PSII is of limited evidence, critical variables for revision strategies of PSII have been identified. Further, to quickly advance in the field of PSII it is certainly important to extrapolate and learn using data regarding the management from other fields of prosthetic joint infections. This should include clinical as well as experimental work in particular in the context of the biofilm, sonication as well as microbiological concepts. Over the last years, at our institution standardized procedures for diagnostic, surgical as well as antimicrobial treatment have been developed, based on the latest recommendations in peer-reviewed literature and our own data. Here we give an overview about surgical revision strategies for PSII and discuss the key points of our standardized protocol.
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Affiliation(s)
- Vincent Prinz
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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17
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Abstract
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.
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Telfeian AE, Moldovan K, Shaaya E, Syed S, Oyelese A, Fridley J, Gokaslan ZL. Awake, Endoscopic Revision Surgery for Lumbar Pseudarthrosis After Transforaminal Lumbar Interbody Fusion: Technical Notes. World Neurosurg 2020; 136:117-121. [DOI: 10.1016/j.wneu.2020.01.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/03/2023]
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Oh HC, Kim HS, Park JY. Abdominal compartment syndrome following posterior lumbar fusion in a patient with previous abdominal surgery. Spinal Cord Ser Cases 2019; 5:47. [PMID: 31632706 PMCID: PMC6786363 DOI: 10.1038/s41394-019-0191-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/28/2019] [Accepted: 04/21/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Perioperative complications associated with spinal fusion have been investigated steadily to reduce morbidity and mortality. Although there are several reports reviewing abdominal complications occurring with anterior spinal fusion, complications related to posterior spinal fusion (PSF) are rare. However, abdominal compartment syndrome (ACS) after PSF could be the most fatal and unpredictable complication in spinal surgery. Case presentation This 73-year-old man with body mass index (BMI) of 23.02, and surgical history of appendectomy 10 years prior complained of severe nausea and vomiting on the second postoperative day of L4-5 transforaminal lumbar interbody fusion (TLIF). By postoperative day 4, he presented with dyspnea and fever, and the first diagnostic impression suggested aspiration pneumonia due to vomiting. Physical examination revealed severe abdominal distention and tenderness to palpation at most of the abdomen. Computed tomography (CT) scan of abdomen and chest revealed left inguinal hernia of the small bowel with incarceration suggesting intra-abdominal hypertension (IAH), and multifocal peri-bronchial consolidation in both lungs, respectively. His respiratory symptoms progressed to respiratory failure, and he was finally mechanically ventilated in conjunction with antibiotics. After 2 weeks of intensive care, the patient's symptom had improved, and finally he was transferred to a nursing facility. Discussion IAH and ACS rarely occur as abdominal complications of PSF. We suggest several risk factors including body mass index, abdominal surgical history, and long segment fusion for development of abdominal complications.
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Affiliation(s)
- Hyeong-Cheol Oh
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273 Korea
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Nanoori Gangnam Hospital, 731, Eonju-ro, Gangnam-gu, Seoul, 06048 Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273 Korea
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Ahn Y, Youn MS, Heo DH. Endoscopic transforaminal lumbar interbody fusion: a comprehensive review. Expert Rev Med Devices 2019; 16:373-380. [PMID: 31044627 DOI: 10.1080/17434440.2019.1610388] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Endoscopic spine surgery has been developed as a minimally invasive technique for decompression in patients with lumbar disc herniation or lumbar stenosis. Recent reports have described the use of endoscopic technology in lumbar fusion surgeries, especially for transforaminal lumbar interbody fusion (TLIF). This review aimed to summarize the current techniques of endoscopic TLIF and to discuss the benefits, limitations, and future perspectives of endoscopic lumbar fusion surgery. AREAS COVERED This review covered the English-language medical literature published in Medline and focused specifically on endoscopic technologies incorporated into minimally invasive TLIF. The endoscopic TLIF techniques are categorized here according to the properties of the endoscope: percutaneous endoscopic TLIF, biportal endoscopic TLIF, and microendoscopic TLIF. Even though most authors have reported favorable clinical and radiological outcomes of endoscopic TLIF, such evidence originates mainly from case series. EXPERT OPINION Although the current level of evidence is low and the technical relevance of the technique is controversial, the key concept and early results of endoscopic TLIF are promising. Technical advancements to improve safety and reduce technical complexity, as well as comparative cohort studies and randomized clinical trials with long-term follow-up are required to promote the adoption of endoscopic TLIF in clinical practice.
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Affiliation(s)
- Yong Ahn
- a Department of Neurosurgery , Gil Medical Center, Gachon University College of Medicine , Incheon , South Korea
| | - Myung Soo Youn
- b Department of Orthopedic Surgery , Myungeun Hospital , Busan , South Korea
| | - Dong Hwa Heo
- c Department of Neurosurgery , Spine Center, The Leon Wiltse Memorial Hospital , Suwon , South Korea
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Kyle A, Rowland A, Stirton J, Elgafy H. Fracture of allograft interbody spacer resulting in post-operative radiculopathy: A case report. World J Orthop 2019; 10:206-211. [PMID: 31041162 PMCID: PMC6475813 DOI: 10.5312/wjo.v10.i4.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/18/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Allograft interbody spacers are utilized during transforaminal lumbar interbody fusion (TLIF) to reestablish anterior column support and disc height. While the TLIF technique offers many improvements over previous surgical methods, instrumentation and bone graft-related complications such as spacer misplacement or migration, screw fracture or misplacement, or rod breakage continue to be reported. The objective of this manuscript is to report on a fractured allograft interbody spacer that displaced into the neural foramen and resulted in impingement on the exiting nerve root that required revision. CASE SUMMARY A 50-year-old male had two-level TLIF with immediate post-operative right L5 radiculopathy. Computed tomography scan demonstrated a fractured allograft interbody spacer that displaced into the right neural foramen and impinged on the exiting L5 nerve root. Revision surgery was performed to remove the broken allograft fragments from the right L5 foramen and the intact portion of the spacer was left in place. The right leg L5 radicular pain resolved. At the last follow up 12 mo after the index procedure, computed tomography scan confirmed sound interbody and posterolateral fusion. CONCLUSION Displacement of broken allograft interbody spacer following TLIF procedures can result in neurological sequelae that require revision. To avoid such an occurrence, the authors recommend allowing sufficient time for the reconstitution of the graft in saline prior to use to decrease brittleness, to use an impactor size that is as close as possible to the spacer size and meticulous inspection of the cortical allograft spacer for any visible imperfection prior to insertion.
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Affiliation(s)
- Andrews Kyle
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614-5807, United States
| | - Andrea Rowland
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614-5807, United States
| | - Jacob Stirton
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614-5807, United States
| | - Hossein Elgafy
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614-5807, United States
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Butler AJ, Alam M, Wiley K, Ghasem A, Rush Iii AJ, Wang JC. Endoscopic Lumbar Surgery: The State of the Art in 2019. Neurospine 2019; 16:15-23. [PMID: 30943703 PMCID: PMC6449826 DOI: 10.14245/ns.1938040.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/04/2019] [Indexed: 12/12/2022] Open
Abstract
This study was aimed to provide a brief historical perspective to facilitate appreciation of current techniques, describe outcomes of endoscopic lumbar surgery relative to those of existing techniques, and identify topics in need of study and future directions for the field of endoscopic lumbar surgery. Using the PubMed database, a comprehensive search was conducted to identify peer-reviewed English language articles pertaining to endoscopic lumbar surgery. Lack of focus on pertinent techniques or lack of outcome measures constituted exclusion criteria. A majority of included articles were published from 2015–2019. A context with which to appreciate the application of endoscopic lumbar techniques is established. An abundance of case series and several recent comparison studies have documented the benefits and potential pitfalls of these methods in the past two decades. The advantages of endoscopic lumbar spine surgery are widely touted to include reduced perioperative morbidity, including blood loss, operative time and immediate postoperative recovery, minimal structural trauma resulting from surgery, generally positive patient report outcome scores and the potential to contain costs. Additional high-quality research assessing outcomes of endoscopic lumbar surgery are certainly needed and currently expected given the rapid expansion of the field in recent years.
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Affiliation(s)
- Alexander J Butler
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | | | | | - Alexander Ghasem
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Augustus J Rush Iii
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
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Radiographic and Clinical Outcomes of Anterior and Transforaminal Lumbar Interbody Fusions: A Systematic Review and Meta-analysis of Comparative Studies. Clin Spine Surg 2018. [PMID: 28622187 DOI: 10.1097/bsd.0000000000000549] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Compare the radiographic and clinical outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA ALIF and TLIF are 2 methods of achieving spinal arthrodesis. There are conflicting reports with no consensus on the optimal interbody technique to achieve successful radiographic and clinical outcomes. The goal of this systematic review and meta-analysis was to compare the radiographic and clinical outcomes of ALIF to TLIF. MATERIALS AND METHODS A systematic search of multiple medical reference databases was conducted for studies comparing ALIF to TLIF. Studies that included stand-alone ALIFs were excluded. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcome measures included segmental and overall lumbar lordosis, and fusion rates. Clinical outcomes measures included Oswestry disability index (ODI) and visual analog scale (VAS) score for back pain. RESULTS The search yielded 7 studies totaling 811 patients (ALIF=448, TLIF=363). ALIF was superior to TLIF in restoring segmental lumbar lordosis at L4-L5 and L5-S1 (L4-L5; P=0.013, L5-S1; P<0.001). ALIF was also superior to TLIF in restoring overall lumbar lordosis (P<0.001). However, no significant differences in fusion rates were noted between both techniques [odds ratio=0.905; 95% confidence interval, 0.458-1.789; P=0.775]. In addition, ALIF and TLIF were comparable with regards to ODI and VAS scores (ODI; P=0.184, VAS; P=0.983). CONCLUSIONS For the restoration of lumbar lordosis, ALIF is superior to TLIF. However, TLIF is comparable to ALIF with regards to fusion rate and clinical outcomes.
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Sleem A, Marzouk A. Transforaminal Lumbar Interbody Fusion With Local Bone Graft Alone for Single-Level Isthmic Spondylolisthesis. Int J Spine Surg 2018; 12:70-75. [PMID: 30280086 DOI: 10.14444/5012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A retrospective study of patients treated by transforaminal lumbar interbody fusion (TLIF) with local bone graft alone for single-level isthmic spondylolisthesis (IS) between April 2009 and July 2014 in a single facility. Methods Demographic and operative data, complications, preoperative and postoperative clinical records, and radiographs were revised. The Visual Analogue Scale (VAS) and Denis Work Scale were used for clinical and functional assessment. Modified Lee et al. classification was used for assessment of union. Results Twenty-three patients with mean age of 45.04 ± 7.19 years had single-level TLIF with local bone graft alone for symptomatic IS with mean follow-up period of 28.39 ± 4.01 months and mean operative time of 170.09 ± 11.22 minutes. The VAS and Denis Work Scale improved from 8.48 ± 0.58 and 4.67 ± 0.47 preoperative to 2.91 ± 1.25 and 1.33 ± 0.58 at the latest follow up, respectively. Anterior vertebral translation improved from 27.22 ± 9.54% preoperatively to 8.38 ± 3.63% postoperatively and 10.39 ± 3.49 at the latest follow up. Disc space height was 9.67 ± 5.55% preoperatively, 21.60 ± 4.11% postoperative, and 16.24 ± 4.02% at the latest follow up. Lumbar lordosis improved from 29.39 ± 10.33° to 45.13 ± 6.84° postoperatively and 39.96 ± 7.52° at the latest follow up. Eighteen patients had definitive union, 4 patients with possible union, 1 patient with possible pseudoarthrosis. Conclusions Transforaminal lumbar interbody fusion with local bone graft alone is an appropriate option for single-level IS, yet we do not recommend it for higher grades of slippage with anterior vertebral translation more than 25%.
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Affiliation(s)
- Ahmed Sleem
- Orthopedic Department, Sohag University Hospital, Egypt
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Shillingford JN, Laratta JL, Lombardi JM, Mueller JD, Cerpa M, Reddy HP, Saifi C, Fischer CR, Lehman RA. Complications following single-level interbody fusion procedures: an ACS-NSQIP study. JOURNAL OF SPINE SURGERY (HONG KONG) 2018; 4:17-27. [PMID: 29732419 PMCID: PMC5911766 DOI: 10.21037/jss.2018.03.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/20/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Controversy exists over the ability of various lumbar interbody fusion techniques to realign global and regional balance and their effect on patient outcomes. This is a retrospective cohort study to compare thirty-day postoperative outcomes between anterior and posterior interbody fusion techniques within a large national database. METHODS A retrospective cohort study utilizing the National Surgical Quality Improvement Program (NSQIP) database included 2,372 (29.9%) single-level anterior/direct lateral interbody fusions (ALIF/DLIF) and 5,563 (70.1%) single-level posterior/transforaminal lateral interbody fusions (PLIF/TLIF) between 2013 and 2014. Emergent cases, fracture cases, and preoperative compromised wounds were not analyzed. Primary thirty-day outcomes included mortality, return to operating room, readmission, length of stay, and other major complications. Minor outcomes included urinary tract infection, superficial incisional site infection, and perioperative blood transfusion within 72 hours. RESULTS ALIF/DLIF was performed more for degenerative lumbar disc disease (31.0% vs. 13.9%, P<0.001), whereas PLIF/TLIF was utilized more for spondylolisthesis (19.1% vs. 24.4%, P<0.001). Thirty-day mortality was significantly higher with ALIF/DLIF (0.3% vs. 0.1%, P=0.021) in the univariate analysis and persisted in the multivariate analysis (OR =12.8; 95% CI, 1.37-119.6; P=0.025). Significantly more PLIF/TLIF patients required blood transfusions within 72 hours of surgery (9.6% vs. 7.6%, P=0.005). This difference did not persist in the multivariate analysis after controlling for covariates. Elevated ASA physical status classification, age >60, prior bleeding disorder, and preoperative anemia were significantly associated with blood transfusion requirement. More deep venous thrombosis occurred (DVT) with ALIF/DLIF compared to PLIF/TLIF (1.0% vs. 0.6%, P=0.025), which persisted in the multivariate analysis (OR =2.03; 95% CI, 1.13-3.65; P=0.017). CONCLUSIONS Although numerous techniques can be utilized in the treatment approach to various lumbar pathologies, anterior approaches have an increased risk of developing a perioperative DVT and early mortality. Transfusion risk is more strongly associated with elevated American Society of Anesthesiologists (ASA) class, increased age, preoperative anemia, and patients with bleeding disorders.
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Affiliation(s)
- Jamal N. Shillingford
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | | | - Joseph M. Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - John D. Mueller
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Meghan Cerpa
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Hemant P. Reddy
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Comron Saifi
- Penn Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Charla R. Fischer
- Department of Orthopaedic Surgery, Hospital for Joint Diseases at New York University, New York, NY, USA
| | - Ronald A. Lehman
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
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Reoperation within 2 years after lumbar interbody fusion: a multicenter study. 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 2018; 27:1972-1980. [DOI: 10.1007/s00586-018-5508-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/16/2018] [Accepted: 01/30/2018] [Indexed: 11/26/2022]
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Georg Schmorl Prize of the German Spine Society (DWG) 2017: correction of spino-pelvic alignment with relordosing mono- and bisegmental TLIF spondylodesis. 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 2018; 27:789-796. [DOI: 10.1007/s00586-018-5503-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/27/2018] [Indexed: 11/26/2022]
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Zhang H, Jiang Y, Wang B, Zhao Q, He S, Hao D. Direction-changeable lumbar cage versus traditional lumbar cage for treating lumbar spondylolisthesis: A retrospective study. Medicine (Baltimore) 2018; 97:e9984. [PMID: 29443791 PMCID: PMC5839855 DOI: 10.1097/md.0000000000009984] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Despite the diverse designs for the lumbar interbody fusion cage, there is no consensus on the optimal design to date. The current study aimed to compare the efficacy and complications associated with the direction-changeable and traditional lumbar cages for treating lumbar spondylolisthesis.We conducted a retrospective study including 109 patients with lumbar spondylolisthesis, who were admitted to our hospital from January 2013 to December 2014. The patients were divided into the direction-changeable (group A) and traditional (group B) lumbar cage group.All patients underwent single-level transforaminal lumbar interbody fusion and were followed up for 12 to 24 months. There were 52 cases in group A and 57 cases in group B. Surgery-related parameters, including operation time, bleeding volume, and hospitalization time, were recorded; there was no significant difference between the 2 groups regarding these parameters. The visual analog scale and Oswestry disability index at the last follow-up showed significant improvement compared with preoperative values in both groups (P < .05). Patients in group A demonstrated more intervertebral space height maintenance postoperatively than patients in group B but the difference was not statistically significant (P > .05). In group A, complications included 3 cases of nonunion (5.77%) and 1 case of cerebrospinal fluid leakage (1.92%). In group B, complications included 9 cases of nonunion (15.79%) and 1 case of postoperative infection (1.75%). There was a significant difference between both groups in terms of the nonunion rate and total complication rate (P < .05).The direction-changeable lumbar cage has merits such as a higher bone fusion rate and fewer postoperative complications compared to the traditional lumbar cage.
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Affiliation(s)
| | - Yonghong Jiang
- Department of Radiology, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shanxi, China
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A Comparison of Anterior and Posterior Lumbar Interbody Fusions: Complications, Readmissions, Discharge Dispositions, and Costs. Spine (Phila Pa 1976) 2017; 42:1865-1870. [PMID: 28549000 DOI: 10.1097/brs.0000000000002248] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective database review. OBJECTIVE To understand medical complication rates, readmission rates, costs, and discharge dispositions in anterior lumbar interbody fusion (ALIFs) versus transforaminal lumbar interbody fusions (TLIFs)/posterior lumbar interbody fusions (PLIFs) for lumbar degenerative disease. SUMMARY OF BACKGROUND DATA Indications for ALIFs versus PLIFs can vary, though benefits of anterior approach surgery include full access to the anterior column and ability to place fusion devices. METHODS The PearlDiver Database of Medicare records was utilized for this retrospective database review. A study group consisting solely of ALIF procedure patients was selected for. Similarly, a TLIF/PLIF group was selected for. Both groups were queried for comorbidities, 30 and 90-day complication and readmission rates. Additionally, discharge dispositions, and in-hospital/30-day/90-day Medicare reimbursements were determined. RESULTS At both 30 and 90 days postoperatively odds of ileus, wound infection, and lower extremity deep venous thrombosis were significantly increased in the ALIF. However, unadjusted rates and adjusted odds of transfusion or dural tear were significantly decreased in the ALIF patients. Odds of 30-day readmission were 4 times higher in ALIF patients. Additionally, 30 and 90-day total costs of care in ALIF patients were significantly increased by approximately $4800 and $5800 respectively, as compared with patients undergoing TLIF/PLIF. CONCLUSION Despite higher initial routine discharge rates, readmissions and costs of postoperative care were significantly increased in ALIF procedures. It is necessary to evaluate etiology of degenerative pathology as ALIFs are successful solutions to anterior translational instability and anterior disc slippage, but may not have the best long-term outcomes and may not be cost-effective compared with a TLIF/PLIF. In light of our data, it is important to assess the risks and benefits of the varying approaches, and the necessity to access the anterior column, when deciding on surgical technique to treat lumbar degenerative pathology. LEVEL OF EVIDENCE 4.
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de Kunder SL, van Kuijk SMJ, Rijkers K, Caelers IJMH, van Hemert WLW, de Bie RA, van Santbrink H. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J 2017. [PMID: 28647584 DOI: 10.1016/j.spinee.2017.06.018] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are both frequently used as a surgical treatment for lumbar spondylolisthesis. Because of the unilateral transforaminal route to the intervertebral space used in TLIF, as opposed to the bilateral route used in PLIF, TLIF could be associated with fewer complications, shorter duration of surgery, and less blood loss, whereas the effectiveness of both techniques on back or leg pain is equal. PURPOSE The objective of this study was to compare the effectiveness of both TLIF and PLIF in reducing disability, and to compare the intra- and postoperative complications of both techniques in patients with lumbar spondylolisthesis. STUDY DESIGN/SETTING A systematic literature review and meta-analysis were carried out. METHODS We conducted a Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov and NHS Centre for Review and Dissemination search for studies reporting TLIF, PLIF, lumbar spondylolisthesis and disability, pain, complications, duration of surgery, and estimated blood loss. A meta-analysis was performed to compute pooled estimates of the differences between TLIF and PLIF. Forest plots were constructed for each analysis group. RESULTS A total of 192 studies were identified; nine studies were included (one randomized controlled trial and eight case series), including 990 patients (450 TLIF and 540 PLIF). The pooled mean difference in postoperative Oswestry Disability Index (ODI) scores between TLIF and PLIF was -3.46 (95% confidence interval [CI] -4.72 to -2.20, p≤.001). The pooled mean difference in the postoperative VAS scores was -0.05 (95% CI -0.18 to 0.09, p=.480). The overall complication rate was 8.7% (range 0%-25%) for TLIF and 17.0% (range 4.7-28.8%) for PLIF; the pooled odds ratio was 0.47 (95% CI 0.28-0.81, p=.006). The average duration of surgery was 169 minutes for TLIF and 190 minutes for PLIF (mean difference -20.1, 95% CI -33.5 to -6.6, p=.003). The estimated blood loss was 350 mL for TLIF and 418 mL for PLIF (mean difference -43.9 mL, 95% CI -71.2 to -16.6, p=.002). CONCLUSIONS TLIF has advantages over PLIF in the complication rate, blood loss, and operation duration. The clinical outcome is similar, with a slightly lower postoperative ODI score for TLIF.
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Affiliation(s)
- Suzanne L de Kunder
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, PO box 616, 6200 MD, Maastricht, The Netherlands.
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Kim Rijkers
- Department of Neurosurgery, Zuyderland Medical Center, PO box 4446, 6401 CX, Heerlen, The Netherlands
| | - Inge J M H Caelers
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Wouter L W van Hemert
- Department of Orthopedic Surgery, Zuyderland Medical Center, PO box 4446, 6401 CX, Heerlen, The Netherlands
| | - Rob A de Bie
- CAPHRI School for Public Health and Primary Care, Maastricht University, PO box 616, 6200 MD, Maastricht, The Netherlands; Department of Epidemiology, Maastricht University, PO box 616, 6200 MD, Maastricht, The Netherlands
| | - Henk van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, PO box 616, 6200 MD, Maastricht, The Netherlands; Department of Neurosurgery, Zuyderland Medical Center, PO box 4446, 6401 CX, Heerlen, The Netherlands
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Owens RK, Djurasovic M, Crawford CH, Glassman SD, Dimar JR, Carreon LY. Impact of Surgical Approach on Clinical Outcomes in the Treatment of Lumbar Pseudarthrosis. Global Spine J 2016; 6:786-791. [PMID: 27853663 PMCID: PMC5110356 DOI: 10.1055/s-0036-1582390] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 02/25/2016] [Indexed: 11/06/2022] Open
Abstract
Study Design Retrospective comparative cohort. Objective Pseudarthrosis following fusion for degenerative lumbar spine pathologies remains a substantial problem. Current data shows that patients who develop a pseudarthrosis have suboptimal outcomes. This study evaluates if treatment of pseudarthrosis can be affected by surgical approach. Methods Medical records of 63 female and 65 male patients (mean age 50.37) who were treated for nonunion following lumbar fusion were reviewed. Sixty patients underwent posterolateral fusion (PSF), 18 underwent PSF with transforaminal interbody fusion (TLIF), 32 underwent anterior and posterior spinal fusion (AP), and 24 underwent anterior lumbar interbody fusion (ALIF). Results Significant differences between the treatment groups were observed in length of stay (p = 0.000), blood loss (p = 0.000), and operative time (p = 0.000). In the AP fusion group, minimal clinically important difference (MCID) was reached in 47% of patients for back pain, 28% for leg pain, and 28% for Oswestry Disability Index (ODI). PSF had the highest percentage of patients reaching MCID for Short Form-36 (SF-36) physical composite score at 25%. ALIF and TLIF subgroups reached MCID for ODI in 17% of patients. Linear regression analysis showed that type of surgical approach did not impact change in ODI scores. Conclusion Although not statistically significant, the AP fusion group reached MCID more frequently in all outcomes except SF-36 Physical Component Summary. All surgical approaches examined for treatment of lumbar pseudarthrosis resulted in only poor to modest improvement in ODI. This result further emphasizes the importance of achieving a solid fusion with the index surgery.
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Affiliation(s)
- R. Kirk Owens
- Norton Leatherman Spine Center, Louisville, Kentucky, United States
| | | | | | | | - John R. Dimar
- Norton Leatherman Spine Center, Louisville, Kentucky, United States
| | - Leah Y. Carreon
- Norton Leatherman Spine Center, Louisville, Kentucky, United States,Address for correspondence Leah Y. Carreon, MD, MSc Norton Leatherman Spine Center210 East Gray Street, Suite 900, Louisville, KY 40202United States
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Weimer JM, Marinov M, Avitsian R. Dural Traction a Possible Cause of Hemodynamic Changes During Single-Level Transforaminal Lumbar Interbody Fusion. World Neurosurg 2016; 97:761.e1-761.e3. [PMID: 27725296 DOI: 10.1016/j.wneu.2016.09.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lumbar spinal surgery may be associated with electrophysiologic and hemodynamic abnormalities during the procedure. CASE DESCRIPTION A 58-year-old man with grade II L4-5 spondylolisthesis and degenerative changes underwent single-level transforaminal lumbar interbody fusion. During decompression of the L4 foramina, distraction of the disc space, and placement of the interbody cage and pedicle screws, episodes of extreme bradycardia with up to 5 seconds of asystole were detected on electrocardiogram and invasive hemodynamic monitoring. The events correlated with and possibly could have been a result of traction on the dura mater. CONCLUSIONS Anesthesia providers should be aware of electrophysiologic and hemodynamic abnormalities during lumbar spinal surgery and the need to respond appropriately with sympathomimetic or vagolytic interventions.
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Affiliation(s)
- Jonathan M Weimer
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Martin Marinov
- Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Rafi Avitsian
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.
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de Kunder S, Rijkers K, van Hemert W, Willems P, ter Laak - Poort M, van Santbrink H. Transforaminal versus posterior lumbar interbody fusion as operative treatment of lumbar spondylolisthesis, a retrospective case series. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2016. [DOI: 10.1016/j.inat.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Comparison of Clinical and Radiographic Outcomes in Patients Receiving Single-Level Transforaminal Lumbar Interbody Fusion With Removal of Unilateral or Bilateral Facet Joints. Spine (Phila Pa 1976) 2016; 41:E1039-E1045. [PMID: 26926356 DOI: 10.1097/brs.0000000000001535] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The objective of this study is to compare the radiographic and clinical outcomes of transforaminal lumbar interbody fusion (TLIF) with bilateral facetectomy (BF) versus unilateral facetectomy (UF). SUMMARY OF BACKGROUND DATA BF is a surgical technique utilized with the intent of creating a greater degree of segmental lordosis than UF alone. However, the clinical benefits of this technique have not been defined. We seek to determine whether a difference exists between bilateral versus UF during TLIF by utilizing both clinical and radiographic outcome measures. METHODS The electronic medical records of 57 patients who underwent single-level TLIF with either a UF (n = 28) or BF (n = 29) were reviewed. Clinical outcomes were measured through Patient Health Questionnaire-9 (PHQ-9), Pain Disability Questionnaire (PDQ), EuroQol 5 Dimensions (EQ-5D) Health State, and Quality Adjusted Life Year (QALY). Radiographic parameters including disc height and sagittal balance were measured on plain radiographs at 1 year following operation. RESULTS All radiographic parameters showed no significant differences between the UF and BF cohorts. Segmental lordosis increased significantly in both cohorts. However, there was no significant difference in the increase of segmental lordosis between cohorts. Overall lumbar lordosis did not increase significantly in either cohort. Perioperative complications were also similar between cohorts. PDQ and EQ-5D scores improved significantly in both cohorts at 1 year postoperatively. The BF cohort showed a significantly greater improvement in both EQ-5D (0.1 ± 0.2 vs. 0.3 ± 0.2, P = 0.01) and PHQ-9 scores (-0.8 ± 4.6 vs. 4.6 ± 5.2, P = 0.03) than the UF cohort. The PDQ score improved over the minimally clinical important difference (MCID) of 26 in only the BF cohort. CONCLUSION The findings in the present study demonstrate that BF during single-level TLIF improves clinical outcomes to a greater degree than UF without any notable differences in perioperative complications or radiographic measurements. LEVEL OF EVIDENCE 3.
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Kulkarni AG, Bohra H, Dhruv A, Sarraf A, Bassi A, Patil VM. Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion. Indian J Orthop 2016; 50:464-472. [PMID: 27746487 PMCID: PMC5017166 DOI: 10.4103/0019-5413.189607] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF. MATERIALS AND METHODS All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM® SPSS® Statistics version 17). RESULTS 129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, P < 0.05) was shorter in MI-TLIF cases. There was less blood loss (open 358.8 ml, MI 111.81 ml, P < 0.05) in MI-TLIF cases. The operative time (O-TLIF 2.96 h + 0.57, MI-TLIF 3.40 h + 0.54, P < 0.05) was longer in MI group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower (P < 0.000) in MI-TLIF group than in O-TLIF group, indicating lesser tissue trauma. CONCLUSION The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are lesser blood loss, shorter hospital stay, lesser tissue trauma, and early mobilization. The challenges of MI-TLIF lie in the steep learning curve and significant radiation exposure. The ultimate success of TLIF lies in the execution of the procedure, and in this respect the ability to achieve similar results using a minimally invasive technique makes MI-TLIF an attractive alternative.
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Affiliation(s)
- Arvind G Kulkarni
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India,Address for correspondence: Dr. Arvind G Kulkarni, Mumbai Spine Scoliosis and Disc Replacement Centre, New Marine Lines, Bombay Hospital, Mumbai - 400 020, Maharashtra, India. E-mail:
| | - Hussain Bohra
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
| | - Abhilash Dhruv
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
| | - Abhishek Sarraf
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
| | - Anupreet Bassi
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
| | - Vishwanath M Patil
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
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Comer GC, Behn A, Ravi S, Cheng I. A Biomechanical Comparison of Shape Design and Positioning of Transforaminal Lumbar Interbody Fusion Cages. Global Spine J 2016; 6:432-8. [PMID: 27433426 PMCID: PMC4947403 DOI: 10.1055/s-0035-1564568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 08/12/2015] [Indexed: 10/24/2022] Open
Abstract
STUDY DESIGN Cadaveric biomechanical analysis. OBJECTIVE The aim of this study was to compare three interbody cage shapes and their position within the interbody space with regards to construct stability for transforaminal lumbar interbody fusion. METHODS Twenty L2-L3 and L4-L5 lumbar motion segments from fresh cadavers were potted in polymethyl methacrylate and subjected to testing with a materials testing machine before and after unilateral facetectomy, diskectomy, and interbody cage insertion. The three cage types were kidney-shaped, articulated, and straight bullet-shaped. Each cage type was placed in a common anatomic area within the interbody space before testing: kidney, center; kidney, anterior; articulated, center; articulated, anterior; bullet, center; bullet, lateral. Load-deformation curves were generated for axial compression, flexion, extension, right bending, left bending, right torsion, and left torsion. Finally, load to failure was tested. RESULTS For all applied loads, there was a statistically significant decrease in the slope of the load-displacement curves for instrumented specimens compared with the intact state (p < 0.05) with the exception of right axial torsion (p = 0.062). Among all instrumented groups, there was no statistically significant difference in stiffness for any of the loading conditions or load to failure. CONCLUSIONS Our results failed to show a clearly superior cage shape design or location within the interbody space for use in transforaminal lumbar interbody fusion.
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Affiliation(s)
- Garet C. Comer
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States
| | - Anthony Behn
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States
| | - Shashank Ravi
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Ivan Cheng
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States,Address for correspondence Ivan Cheng, MD Department of Orthopaedic Surgery, Stanford University450 Broadway Street, Redwood City, CA 94063United States
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Kleiner JB, Kleiner HM, Grimberg EJ, Throlson SJ. Evaluation of a novel tool for bone graft delivery in minimally invasive transforaminal lumbar interbody fusion. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:105-14. [PMID: 27274320 PMCID: PMC4876849 DOI: 10.2147/mder.s100098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Study design Disk material removed (DMR) during L4-5 and L5-S1 transforaminal lumbar interbody fusion (T-LIF) surgery was compared to the corresponding bone graft (BG) volumes inserted at the time of fusion. A novel BG delivery tool (BGDT) was used to apply the BG. In order to establish the percentage of DMR during T-LIF, it was compared to DMR during anterior diskectomy (AD). This study was performed prospectively. Summary of background data Minimal information is available as to the volume of DMR during a T-LIF procedure, and the relationship between DMR and BG delivered is unknown. BG insertion has been empiric and technically challenging. Since the volume of BG applied to the prepared disk space likely impacts the probability of arthrodesis, an investigation is justified. Methods A total of 65 patients with pathology at L4-5 and/or L5-S1 necessitating fusion were treated with a minimally invasive T-LIF procedure. DMR was volumetrically measured during disk space preparation. BG material consisting of local autograft, BG extender, and bone marrow aspirate were mixed to form a slurry. BG slurry was injected into the disk space using a novel BGDT and measured volumetrically. An additional 29 patients who were treated with L5-S1 AD were compared to L5-S1 T-LIF DMR to determine the percent of T-LIF DMR relative to AD. Results DMR volumes averaged 3.6±2.2 mL. This represented 34% of the disk space relative to AD. The amount of BG delivered to the disk spaces was 9.3±3.2 mL, which is 2.6±2.2 times the amount of DMR. The BGDT allowed uncomplicated filling of the disk space in <1 minute. Conclusion The volume of DMR during T-LIF allows for a predictable volume of BG delivery. The BGDT allowed complete filling of the entire prepared disk space. The T-LIF diskectomy debrides 34% of the disk relative to AD.
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Affiliation(s)
- Jeffrey B Kleiner
- The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA
| | - Hannah M Kleiner
- The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA
| | - E John Grimberg
- The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA
| | - Stefanie J Throlson
- The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA
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Carreon LY, Glassman SD, Ghogawala Z, Mummaneni PV, McGirt MJ, Asher AL. Modeled cost-effectiveness of transforaminal lumbar interbody fusion compared with posterolateral fusion for spondylolisthesis using N2QOD data. J Neurosurg Spine 2016; 24:916-21. [DOI: 10.3171/2015.10.spine15917] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Transforaminal lumbar interbody fusion (TLIF) has become the most commonly used fusion technique for lumbar degenerative disorders. This suggests an expectation of better clinical outcomes with this technique, but this has not been validated consistently. How surgical variables and choice of health utility measures drive the cost-effectiveness of TLIF relative to posterolateral fusion (PSF) has not been established. The authors used health utility values derived from Short Form-6D (SF-6D) and EQ-5D and different cost-effectiveness thresholds to evaluate the relative cost-effectiveness of TLIF compared with PSF.
METHODS
From the National Neurosurgery Quality and Outcomes Database (N2QOD), 101 patients with spondylolisthesis who underwent PSF were propensity matched to patients who underwent TLIF. Health-related quality of life measures and perioperative parameters were compared. Because health utility values derived from the SF-6D and EQ-5D questionnaires have been shown to vary in patients with low-back pain, quality-adjusted life years (QALYs) were derived from both measures. On the basis of these matched cases, a sensitivity analysis for the relative cost per QALY of TLIF versus PSF was performed in a series of cost-assumption models.
RESULTS
Operative time, blood loss, hospital stay, and 30-day and 90-day readmission rates were similar for the TLIF and PSF groups. Both TLIF and PSF significantly improved back and leg pain, Oswestry Disability Index (ODI) scores, and EQ-5D and SF-6D scores at 3 and 12 months postoperatively. At 12 months postoperatively, patients who had undergone TLIF had greater improvements in mean ODI scores (30.4 vs 21.1, p = 0.001) and mean SF-6D scores (0.16 vs 0.11, p = 0.001) but similar improvements in mean EQ-5D scores (0.25 vs 0.22, p = 0.415) as patients treated with PSF. At a cost per QALY threshold of $100,000 and using SF-6D–based QALYs, the authors found that TLIF would be cost-prohibitive compared with PSF at a surgical cost of $4830 above that of PSF. However, with EQ-5D–based QALYs, TLIF would become cost-prohibitive at an increased surgical cost of $2960 relative to that of PSF. With the 2014 US per capita gross domestic product of $53,042 as a more stringent cost-effectiveness threshold, TLIF would become cost-prohibitive at surgical costs $2562 above that of PSF with SF-6D–based QALYs or at a surgical cost exceeding that of PSF by $1570 with EQ-5D–derived QALYs.
CONCLUSIONS
As with all cost-effectiveness studies, cost per QALY depended on the measure of health utility selected, durability of the intervention, readmission rates, and the accuracy of the cost assumptions.
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Affiliation(s)
| | | | - Zoher Ghogawala
- 2Alan and Jacqueline Stuart Spine Center, Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Praveen V. Mummaneni
- 3Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Matthew J. McGirt
- 4Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Anthony L. Asher
- 4Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
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Anterior retroperitoneal approach for removal of L5-S1 foraminal nerve sheath tumor-case report. Spine J 2016; 16:e283-6. [PMID: 26698652 DOI: 10.1016/j.spinee.2015.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 11/24/2015] [Accepted: 12/02/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Extradural lumbar schwannomas are a rare form of nerve sheath tumors (NSTs). The typical management approach for extradural foraminal NSTs is total gross resection, which involves a midline incision and muscle exposure, followed by laminectomy and facetectomy to access the tumor for resection. Following tumor removal, spinal fusion is often indicated to reduce postoperative deformity, pain, and neurologic deficits. PURPOSE We report the case of a 34-year-old woman who presented with a 2-year history of progressive dysesthesia and left foot drop. Magnetic resonance imaging revealed a lesion in the lateral L5/S1 foramen. A novel anterior-retroperitoneal approach was used to access the tumor, via muscle splitting, retraction of peritoneum medially and psoas muscle or iliac vessels laterally. STUDY DESIGN/SETTING This study is a case report of a novel approach for extradural lumbar schwannomas. METHODS The methods involve a description of the approach and reporting of clinical findings. RESULTS The schwannoma was successfully resected without requiring additional fusion surgery. The patient recovered uneventfully and was discharged on day 2 post operation. CONCLUSION We propose that the anterior-retroperitoneal approach is a viable technique for resection of lumbar foraminal NSTs without the need for fusion surgery.
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Saville PA, Anari JB, Smith HE, Arlet V. Vertebral body fracture after TLIF: a new complication. 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 2016; 25 Suppl 1:230-8. [PMID: 26984878 DOI: 10.1007/s00586-016-4517-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The transforaminal posterior approach (TLIF) procedure was first described in 1982. Current literature indicates its equality in outcomes for fusion constructs as other anterior-posterior procedures. As a procedure becomes more popular and is more frequently performed the types and number of complications that occur increase. We report on a two case series that underwent TLIF. Both patients had satisfactory postoperative imaging, but presented later with coronal plane vertebral body fractures in the caudal vertebral body of the TLIF construct. We believe the complication may be related to: (a) unrecognized fracture of the endplate during cage impaction; (b) overloading the endplates by maximizing the lordosis achieved by using the reverse jackknife position on a Jackson table; (c) underlying mineral bone disease in patients. As the TLIF procedure increases in popularity, caution should be exercised to avoid the same potential complications. PURPOSE To describe a potential complication with the TLIF procedure. STUDY DESIGN Case report. PATIENT SAMPLE 2. OUTCOME MEASURE Revision surgery. METHODS Case series. RESULTS Caudal vertebral body fracture is a potential complication after TLIF. CONCLUSION TLIF procedures can result in an unstable vertebral body fracture potentially necessitating revision decompression & stabilization. We recommend extra caution in patients with mineral bone disease, as technical errors can be magnified.
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Affiliation(s)
- Philip A Saville
- Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street 2 Silverstein, Philadelphia, PA, 19104, USA
| | - Jason B Anari
- Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street 2 Silverstein, Philadelphia, PA, 19104, USA
| | - Harvey E Smith
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street- 7th Floor, Philadelphia, PA, 19104, USA.,Department of Neurologic Surgery, University of Pennsylvania, 3737 Market Street- 7th Floor, Philadelphia, PA, 19104, USA
| | - Vincent Arlet
- Department of Orthopaedic Surgery, Comprehensive Spine Center, University of Pennsylvania, 235 South 8th Street, Philadelphia, PA, 19107, USA. .,Department of Neurologic Surgery, University of Pennsylvania, 235 South 8th Street, Philadelphia, PA, 19107, USA.
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Maruenda JI, Barrios C, Garibo F, Maruenda B. Adjacent segment degeneration and revision surgery after circumferential lumbar fusion: outcomes throughout 15 years of follow-up. 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 2016; 25:1550-1557. [DOI: 10.1007/s00586-016-4469-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 11/30/2022]
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Comparison of Results of 4 Methods of Surgery in Grade 1 Lumbosacral Spondylolisthesis. ACTA ACUST UNITED AC 2016. [DOI: 10.1097/wnq.0000000000000197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Li YC, Yang SC, Chen HS, Kao YH, Tu YK. Impact of lumbar instrumented circumferential fusion on the development of adjacent vertebral compression fracture. Bone Joint J 2016; 97-B:1411-6. [PMID: 26430018 DOI: 10.1302/0301-620x.97b10.34927] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We evaluated the impact of lumbar instrumented circumferential fusion on the development of adjacent level vertebral compression fractures (VCFs). Instrumented posterior lumbar interbody fusion (PLIF) has become a popular procedure for degenerative lumbar spine disease. The immediate rigidity produced by PLIF may cause more stress and lead to greater risk of adjacent VCFs. However, few studies have investigated the relationship between PLIF and the development of subsequent adjacent level VCFs. Between January 2005 and December 2009, a total of 1936 patients were enrolled. Of these 224 patients had a new VCF and the incidence was statistically analysed with other covariants. In total 150 (11.1%) of 1348 patients developed new VCFs with PLIF, with 108 (72%) cases at adjacent segment. Of 588 patients, 74 (12.5%) developed new subsequent VCFs with conventional posterolateral fusion (PLF), with 37 (50%) patients at an adjacent level. Short-segment fusion, female and age older than 65 years also increased the development of new adjacent VCFs in patients undergoing PLIF. In the osteoporotic patient, more rigid fusion and a higher stress gradient after PLIF will cause a higher adjacent VCF rate.
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Affiliation(s)
- Y-C Li
- E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - S-C Yang
- E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - H-S Chen
- E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Y-H Kao
- E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Y-K Tu
- E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
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Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations. BIOMED RESEARCH INTERNATIONAL 2015; 2015:458284. [PMID: 26649303 PMCID: PMC4663280 DOI: 10.1155/2015/458284] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/25/2015] [Indexed: 11/18/2022]
Abstract
Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes; p = 0.009) and lower intraoperative blood loss: 108 mL (versus 93 mL; NS). Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS). There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.
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Passias PG, Poorman CE, Yang S, Boniello AJ, Jalai CM, Worley N, Lafage V. Surgical Treatment Strategies for High-Grade Spondylolisthesis: A Systematic Review. Int J Spine Surg 2015; 9:50. [PMID: 26512344 DOI: 10.14444/2050] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND HGS is a severe deformity most commonly affecting L5-S1 vertebral segment. Treatment available for HGS includes a range of different surgical options: full or partial reduction of translation and/or abnormal alignment and in situ fusion with or without decompression. Various instrumented or non-instrumented constructs are available, and surgical approach varies from anterior/posterior to combined depending on surgeon preference and experience. The aim of this systematic review was to review the literature on lumbosacral high-grade spondylolisthesis (HGS), identify patients at risk for progression to higher-grade slip and evaluate various surgical strategies to report on complications and radiographic and clinical outcomes. METHODS Systematic search of PubMed, Cochrane and Google Scholar for papers relevant to HGS was performed. 19 articles were included after title, abstract, and full-text review and grouped to analyze baseline radiographic parameters and the effect of surgical approach, instrumentation, reduction and decompression on patient radiographic and clinical outcomes. RESULTS There is a lack of high-quality studies pertaining to surgical treatment for HGS, and a majority of included papers were Level III or IV based on the JBJS Levels of Evidence Criteria. CONCLUSIONS Surgical treatment for HGS can vary depending on patient age. There is strong evidence of an association between increased pelvic incidence (PI) and presence of HGS and moderately strong evidence that patients with unbalanced pelvis can benefit from correction of lumbopelvic parameters with partial reduction. Surgeons need to weigh the benefits of fixing the deformity with the risks of potential complications, assessing patient satisfaction as well as their understanding of the possible complications. However, further research is necessary to make more definitive conclusions on surgical treatment guidelines for HGS. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Peter G Passias
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York City, New York, USA
| | - Caroline E Poorman
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York City, New York, USA
| | - Sun Yang
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York City, New York, USA
| | - Anthony J Boniello
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York City, New York, USA
| | - Cyrus M Jalai
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York City, New York, USA
| | - Nancy Worley
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York City, New York, USA
| | - Virginie Lafage
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York City, New York, USA
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Adogwa O, Elsamadicy AA, Han J, Cheng J, Bagley C. WITHDRAWN: Outcomes After Anterior Lumbar Interbody Fusion Versus Transforaminal Lumbar Interbody Fusion for the Treatment of Symptomatic L5-S1 Spondylolisthesis: A Prospective, Multi-Institutional Comparative Effectiveness Study. World Neurosurg 2015:S1878-8750(15)01214-0. [PMID: 26409090 DOI: 10.1016/j.wneu.2015.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/07/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Owoicho Adogwa
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Aladine A Elsamadicy
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jing Han
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph Cheng
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos Bagley
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Vialle E, Vialle LR, Contreras W, Jacob C. Anatomical study on the relationship between the dorsal root ganglion and the intervertebral disc in the lumbar spine. Rev Bras Ortop 2015; 50:450-4. [PMID: 26401504 PMCID: PMC4563044 DOI: 10.1016/j.rboe.2015.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/01/2014] [Indexed: 11/30/2022] Open
Abstract
Objective To describe the location of the dorsal root ganglion in relation to the intervertebral disc, including the “triangular” safety zone for minimally invasive surgery in the lumbar spine. Methods Eight adult cadavers were dissected bilaterally in the lumbar region, using a posterolateral approach, so as to expose the L3L4 and L4L5 spaces, thereby obtaining measurements relating to the space between the intervertebral disc, pedicles cranial and caudal to the disc, path of the nerve root, dorsal ganglion and safety triangle. Results The measurements obtained were constant, without significant differences between levels or any laterality. The dorsal ganglion occupied the lateral border of the triangular safety zone in all the specimens analyzed. Conclusion Precise localization of the ganglion shows that the safety margin for minimally invasive procedures is less than what is presented in studies that only involve measurements of the nerve root, thus perhaps explaining the presence of neuropathic pain after some of these procedures.
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Affiliation(s)
- Emiliano Vialle
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Luiz Roberto Vialle
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - William Contreras
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Chárbel Jacob
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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Scheer JK, Auffinger B, Wong RH, Lam SK, Lawton CD, Nixon AT, Dahdaleh NS, Smith ZA, Fessler RG. Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) for Spondylolisthesis in 282 Patients: In Situ Arthrodesis versus Reduction. World Neurosurg 2015; 84:108-13. [DOI: 10.1016/j.wneu.2015.02.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/25/2022]
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Vialle E, Vialle LR, Contreras W, Junior CJ. Estudo anatômico da relação do gânglio da raiz dorsal com o disco intervertebral na coluna lombar. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Chedid MK, Tundo KM, Block JE, Muir JM. Hybrid Biosynthetic Autograft Extender for Use in Posterior Lumbar Interbody Fusion: Safety and Clinical Effectiveness. Open Orthop J 2015. [PMID: 26161161 PMCID: PMC4493627 DOI: 10.2174/1874325001509010218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Autologous iliac crest bone graft is the preferred option for spinal fusion, but the morbidity associated with bone harvest and the need for graft augmentation in more demanding cases necessitates combining local bone with bone substitutes. The purpose of this study was to document the clinical effectiveness and safety of a novel hybrid biosynthetic scaffold material consisting of poly(D,L-lactide-co-glycolide) (PLGA, 75:25) combined by lyophilization with unmodified high molecular weight hyaluronic acid (10-12% wt:wt) as an extender for a broad range of spinal fusion procedures. We retrospectively evaluated all patients undergoing single- and multi-level posterior lumbar interbody fusion at an academic medical center over a 3-year period. A total of 108 patients underwent 109 procedures (245 individual vertebral levels). Patient-related outcomes included pain measured on a Visual Analog Scale. Radiographic outcomes were assessed at 6 weeks, 3-6 months, and 1 year postoperatively. Radiographic fusion or progression of fusion was documented in 221 of 236 index levels (93.6%) at a mean (±SD) time to fusion of 10.2+4.1 months. Single and multi-level fusions were not associated with significantly different success rates. Mean pain scores (+SD) for all patients improved from 6.8+2.5 at baseline to 3.6+2.9 at approximately 12 months. Improvements in VAS were greatest in patients undergoing one- or two-level fusion, with patients undergoing multi-level fusion demonstrating lesser but still statistically significant improvements. Overall, stable fusion was observed in 64.8% of vertebral levels; partial fusion was demonstrated in 28.8% of vertebral levels. Only 15 of 236 levels (6.4%) were non-fused at final follow-up
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