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Lateral lumbar interbody fusion.  

Science.gov (United States)

Since its inception in the year 2001 the minimally invasive trans-psoas Lateral Lumbar Interbody Fusion (LLIF) approach has gained significant favor among spine surgeons. It is now routinely utilized to treat an array of spinal pathologies including degenerative disc disease, low grade spondylolisthesis, and adult spinal deformity. The intent of this video is to provide a step by step account of the basic procedural details when performing the LLIF procedure for a single level broad based degenerated lumbar disc with herniation. The video can be found here: http://youtu.be/dZFMqmCz6Q8 . PMID:23829851

Kanter, Adam S; Gandhoke, Gurpreet S

2013-07-01

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... lumbar laminectomy transforaminal lumbar interbody fusion. Surgeons take bone off the spine to make more room for ... re taking off the middle part of her bone as well. We’ve done this TLIF approach ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available LUMBAR LAMINECTOMY AND TRANSFORAMINAL LUMBAR INTERBODY FUSION THOMAS JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA, PENNSYLVANIA November 15, 2006 00:00:08 ANNOUNCER: During the next hour in a real-time Internet broadcast, spine ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... transforaminal lumbar interbody fusion, and that is to prop up the disc space and form a fusion. ... which you will see us place, helps to prop the spine open. So the surgical approach we ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... AND TRANSFORAMINAL LUMBAR INTERBODY FUSION THOMAS JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA, PENNSYLVANIA November 15, 2006 00:00:08 ... Internet broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate a surgical procedure to treat lower ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate ... lumbar interbody fusion. Surgeons take bone off the spine to make more room for the spinal canal, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... pain, or classic sciatica, due to compression of one or more nerves in the spinal canal. Now, ... for sciatica due to a herniated disc. Now, one might as why we’re doing an interbody ...

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Mini-open transforaminal lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

The potential advantages of a mini-open transforaminal interbody fusion (TLIF) operation are reduced blood loss, shorter length of stay, and less soft-tissue trauma compared to the standard open technique. Prior reports from our group and others have demonstrated successful outcomes using MIS techniques in lumbar fusion surgery. In this 3D video, we demonstrate the key steps of the mini-open technique for a transforaminal lumbar interbody fusion using an expandable tubular retractor and contralateral percutaneous screw fixation for the treatment of a multiple recurrent disc herniation. The video demonstrates patient positioning, surgical opening with development of the Wiltse plane, placement of the tubular retractor, pedicle screw placement through both a percutaneous technique and a mini-open technique, decompression of the neural elements, graft insertion, and wound closure. The video can be found here: http://youtu.be/LYRU9lbBdNg.

Amin BY; Tu TH; Mummaneni PV

2013-07-01

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Mini-open transforaminal lumbar interbody fusion.  

Science.gov (United States)

The potential advantages of a mini-open transforaminal interbody fusion (TLIF) operation are reduced blood loss, shorter length of stay, and less soft-tissue trauma compared to the standard open technique. Prior reports from our group and others have demonstrated successful outcomes using MIS techniques in lumbar fusion surgery. In this 3D video, we demonstrate the key steps of the mini-open technique for a transforaminal lumbar interbody fusion using an expandable tubular retractor and contralateral percutaneous screw fixation for the treatment of a multiple recurrent disc herniation. The video demonstrates patient positioning, surgical opening with development of the Wiltse plane, placement of the tubular retractor, pedicle screw placement through both a percutaneous technique and a mini-open technique, decompression of the neural elements, graft insertion, and wound closure. The video can be found here: http://youtu.be/LYRU9lbBdNg. PMID:23829850

Amin, Beejal Y; Tu, Tsung-Hsi; Mummaneni, Praveen V

2013-07-01

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... Hospital will demonstrate a surgical procedure to treat lower back pain. The procedure is called a lumbar laminectomy transforaminal ... from collapse of those disc spaces. Now, axial low back pain, which many patients complain of with back disorders, ...

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Treatment of large lumbar disc herniation with percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation.METHODS: Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography. Second injections were performed 5 d after the initial injection. All patients were followed up for 6-18 mo. A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy.RESULTS: Successful puncture was obtained in all patients. The overall efficacy was 91.4%; the outcome was the excellent in 37 cases (63.8%), good in 16 cases (27.6%) and fair/poor in 5 cases (8.6%) according to the Macnab criteria. No severe complications were found throughout this study.CONCLUSION: Percutaneous intradiscal ozone injection via the posterior-lateral route and inner margin of the facet joint is effective and safe for treatment of large lumbar disc herniation.

Wei Lu, Yan-Hao Li, Xiao-Feng He

2010-01-01

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Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability.  

UK PubMed Central (United Kingdom)

BACKGROUND: Transforaminal lumbar interbody fusion (TLIF) has been preferred to posterior lumbar interbody fusion (PLIF) for different spinal disorders but there had been no study comparing their outcome in lumbar instability. A comparative retrospective analysis of the early results of TLIF and PLIF in symptomatic lumbar instability was conducted between 2005 and 2011. MATERIALS AND METHODS: Review of the records of 102 operated cases of lumbar instability with minimum 1 year followup was done. A total of 52 cases (11 men and 41 women, mean age 46 years SD 05.88, range 40-59 years) underwent PLIF and 50 cases (14 men and 36 women, mean age 49 years SD 06.88, range 40-59 years) underwent TLIF. The surgical time, duration of hospital stay, intraoperative blood loss were compared. Self-evaluated low back pain and leg pain status (using Visual Analog Score), disability outcome (using Oswestry disability questionnaire) was analyzed. Radiological structural restoration (e.g., disc height, foraminal height, lordotic angle, and slip reduction), stability (using Posner criteria), fusion (using Hackenberg criteria), and overall functional outcome (using MacNab's criteria) were compared. RESULTS: Pain, disability, neurology, and overall functional status were significantly improved in both groups but PLIF required more operative time and caused more blood loss. Postoperative hospital stay, structural restoration, stability, and fusion had no significant difference but neural complications were relatively more with PLIF. CONCLUSIONS: Both methods were effective in relieving symptoms, achieving structural restoration, stability, and fusion, but TLIF had been associated with shorter operative time, less blood loss, and lesser complication rates for which it can be preferred for symptomatic lumbar instability.

Sakeb N; Ahsan K

2013-05-01

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Lumbar facet cyst resolution following anterior interbody fusion.  

UK PubMed Central (United Kingdom)

Facet cysts are a relatively common source of neural compression in the lumbar spine. Open decompression and fusion are frequently used to treat the stenosis and instability associated with this pathology. Recently, anterior lumbar interbody fusion (ALIF) has increased in popularity for the treatment of lumbar degenerative conditions. ALIF may achieve indirect decompression of the neural elements with less surgical morbidity than conventional open approaches. To date, there are no published reports describing the use of indirect decompression or interbody fusion for the treatment of facet cysts. We report a patient who developed an L4-L5 facet cyst secondary to degenerative changes and spondylolisthesis. ALIF with posterior instrumentation was used to address his condition. Six months after surgery, the patient had complete resolution of his symptoms. MRI revealed complete resolution of the facet cyst. This patient provides previously unreported evidence that interbody fusion alone may result in facet cyst resolution. Clinical studies are needed to evaluate if interbody fusion can consistently relieve the symptoms associated with facet cysts without the use of direct decompression.

Massey GM; Caputo AM; Michael KW; Isaacs RE; Brown CR

2013-07-01

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A technical modification of Cloward's posterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

The concept of interbody (intercorporal) fusion as a useful treatment for intervertebral disc disease in the cervical area has been well received. Thirty-two years have passed since Cloward first introduced his technique of posterior lumbar intervertebral fusion. The author believes that the delayed acceptance of this procedure is due to fear of technical difficulties. A technical modification of Cloward's posterior lumbar interbody fusion is introduced. It entails better technique in controlling epidural bleeding by careful positioning of the patient and the use of oxidized cellulose as a tampon in the epidural space. The integrity of the facet is preserved through a more limited interlaminal approach. Osteosynthesis of the grafts is assured by multiple perforations of the cortical plate in accordance with Robinson's principle utilized in cervical interbody fusion. The author believes that the modification simplifies the Cloward posterior lumbar interbody fusion. It also assures better stability after surgery by retention of the facet and lessening the dangers of settlement of the graft by preservation of the cortical plate. In a series of 75 cases, tomograms made 4 months after operation have shown a viable graft with active osteosynthesis between the graft and the adjoining vertebral bodies in 94%.

Lin PM

1977-09-01

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Extraforaminal lumbar interbody fusion for the treatment of isthmic spondylolisthesis.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: A preliminary study about extraforaminal lumbar interbody fusion (ELIF) technique for the treatment of isthmic spondylolisthesis. OBJECTIVE: To introduce a new surgical fusion technique for isthmic spondylolisthesis with minimally invasive procedure. SUMMARY OF BACKGROUND DATA: Posterolateral fusion, posterior lumbar interbody fusion, and anterior lumbar interbody fusion with posterior fixation are the options of the surgical treatment for isthmic spondylolisthesis. Still, complications can be related to these approaches. The authors tried to approach directly to lesion-the exiting nerve root, to decompress and to stabilize with minimally invasive procedure. Through extraforaminal approach, we can expose the exiting nerve root only to perform interbody fusion without intra-abdominal dissection or exposing central dura and traversing nerve root. METHODS: Five patients with isthmic spondylolisthesis underwent ELIF with percutaneous pedicle screw fixation (PPF) between August 2005 and April 2007. In all subjects, the 3-cm-long posterior skin incisions were made bilaterally about 6 to 8 cm lateral from the midline. The multifidus muscle was separated with blunt dissection from the longissimus muscles. We identified the isthmus and neural foramen, removed fibrocartilage and the lateral border of ligamentum flavum covering the exiting nerve root, separated the soft tissue attached to the root and the transverse process, and retracted the root to perform discectomy. We prepared the endplates, cages with allograft, inserted them under C-arm fluoroscopic guidance, and performed the procedures on the contralateral side. After the arthrodesis, posterior instrumentation was augmented with PPF. RESULTS: Five patients underwent ELIF+PPF; despite a small number of cases, the outcomes were satisfactory. CONCLUSIONS: ELIF technique makes exposing only the exiting nerve root easy to perform interbody fusion without violating either the abdominal cavity or the posterior musculoligamentous and the bony stabilizers of the spine. This may be considered as one of the minimally invasive surgical options for isthmic spondylolisthesis.

Baek OK; Lee SH

2009-05-01

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Clinical outcomes and considerations of the lumbar interbody fusion technique for lumbar disk disease in adolescents.  

UK PubMed Central (United Kingdom)

PURPOSE: The posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) techniques are commonly used surgical methods for wide indications such as degeneration or trauma. Although they are rarely required for lumbar disk disease in younger patients, there are a few children and adolescents who are indicated for PLIF or TLIF for other reasons, such as congenital severe stenosis with or without lumbar instability that requires wide decompression or severe bony spur that need to be removed. In such cases, different pathophysiology and outcomes are expected compared with adult patients. METHODS: We retrospectively reviewed data of 23 patients who underwent PLIF or TLIF surgery when less than 20 years old. Clinical and radiographic outcomes were assessed during a mean of 36.4 months follow-up period. The indications of lumbar interbody fusion, success of fusion, complications, and visual analog scale (VAS) were analyzed. RESULTS: Radiographs of all patients taken 6 months after the surgery showed fusion. Clinical outcome was also satisfactory, with improvement of VAS score from 7.7 preoperatively to 2.3 at 6 months after surgery. Only one patient had reoperation due to adjacent segment disease. CONCLUSIONS: For adolescent patients with severe bony spur, massive central disk rupture, or severe spondylolisthesis, lumbar interbody fusion surgery has good surgical outcome with few complications.

Kwon DW; Kim KH; Park JY; Chin DK; Kim KS; Cho YE; Kuh SU

2013-08-01

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Minimally invasive tubular surgery for transforaminal lumbar interbody fusion.  

Science.gov (United States)

Transforaminal lumbar interbody fusion (TLIF) was originally developed as a method for circumferential fusion via a single posterior approach and is now an extremely common procedure for the treatment of lumbar instability. More recently, minimally invasive techniques have been applied to this procedure with the goal of decreasing tissue disruption, blood loss and postoperative patient discomfort. Here we describe a minimally invasive tubular TLIF on a 60-year-old male with radiculopathy from an unstable L4-5 spondylolisthesis. The video can be found here: http://youtu.be/0BbxQiUmtRc . PMID:23829849

Kimball, Jon; Yew, Andrew; Getachew, Ruth; Lu, Daniel C

2013-07-01

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Minimally invasive tubular surgery for transforaminal lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

Transforaminal lumbar interbody fusion (TLIF) was originally developed as a method for circumferential fusion via a single posterior approach and is now an extremely common procedure for the treatment of lumbar instability. More recently, minimally invasive techniques have been applied to this procedure with the goal of decreasing tissue disruption, blood loss and postoperative patient discomfort. Here we describe a minimally invasive tubular TLIF on a 60-year-old male with radiculopathy from an unstable L4-5 spondylolisthesis. The video can be found here: http://youtu.be/0BbxQiUmtRc.

Kimball J; Yew A; Getachew R; Lu DC

2013-07-01

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[Transforaminal lumbar interbody fusion in the treatment of lumbar intervertebral disc herniation with lumbar instability].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To explore the surgical efficacy of transforminal lumbar interbody fusion (TLIF) technique in the treatment of lumbar intervertebral disc herniation with lumbar instability. METHODS: From November 2008 to August 2011, 47 patients of lumbar intervertebral disc herniation underwent TLIF. There were 25 males and 22 females with an average age of 52 years (range: 30 - 68). The preoperative diagnoses included lumber intervertebral disc herniation plus lumbar instability (n = 16); lumbar degenerative spondylolisthesis (n = 9); lumbar spinal stenosis (n = 15) and degenerative lumbar scoliosis (n = 7). A total of 63 levels were fused, including single level (n = 31) and double levels (n = 16). Posterolateral fixation was secured with pedicle screw. Unilateral resections of inferior articular facet of superior vertebra and superior articular facet of inferior vertebra were performed to expose unilateral intervertebral vertebral foramen. Decompression of vertebral canal was expanded to the opposite side if symptoms recurred when never root was decompressed satisfactorily. Finally TLIF was performed routinely. The standard criteria of JOA (Japanese Orthopedic Association) and ODI (Oswestry disability index) were applied for efficacy evaluations. And the intervertebral height and bone fusion were observed radiologically. RESULTS: All patients underwent surgery smoothly without severe complications. The average follow-up period was 19.6 months (range: 6 - 36). Significant differences existed in JOA score between preoperation (11.0 ± 2.8) and postoperation (15.4 ± 3.4) (P = 0.01) and ODI score between preoperation (37.8 ± 4.6) and postoperation (18.8 ± 3.8). At 6.5 months postoperatively, all operated segments achieved fusion and there was no broken screw. There was 1 case of cage dislocation. CONCLUSION: In select patients of lumbar intervertebral disc herniation with spinal instability, TLIF may be performed easily and safely with fewer complications and total root decompression.

Wang L; Liu C; Li GQ; Tian JW

2012-10-01

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Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Posterior lumbar interbody fusion (PLIF) restores disc height, the load bearing ability of anterior ligaments and muscles, root canal dimensions, and spinal balance. It immobilizes the painful degenerate spinal segment and decompresses the nerve roots. Anterior lumbar interbody fusion (ALIF) does th...

Madan, S. S.; Boeree, N. R.

 
 
 
 
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Bone graft substitutes for anterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

The procedure of anterior lumbar interbody fusion (ALIF) is commonly performed on patients suffering from pain and/or neurological symptoms associated with disorders of the lumbar spine caused by disc degeneration and trauma. Surgery is indicated when prolonged conservative management proves ineffective. Because an important objective of the ALIF procedure is solid arthrodesis of the degenerative spinal segment, bone graft selection is critical. Iliac crest bone grafts (ICBG) remain the "gold standard" for achieving lumbar fusion. However, patient dissatisfaction stemming from donor site morbidity, lengthier operating times and finite supply of ICBG has prompted a search for better alternatives. Here presented is a literature review evaluating available bone graft options assessed within the clinical setting. These options include autografts, allograft-based, synthetic and cell-based technologies. The emphasis is on the contentious use of recombinant human bone morphogenetic proteins, which is in widespread use and has demonstrated both significant osteogenic potential and risk of complications.

Mobbs RJ; Chung M; Rao PJ

2013-05-01

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Bone graft substitutes for anterior lumbar interbody fusion.  

Science.gov (United States)

The procedure of anterior lumbar interbody fusion (ALIF) is commonly performed on patients suffering from pain and/or neurological symptoms associated with disorders of the lumbar spine caused by disc degeneration and trauma. Surgery is indicated when prolonged conservative management proves ineffective. Because an important objective of the ALIF procedure is solid arthrodesis of the degenerative spinal segment, bone graft selection is critical. Iliac crest bone grafts (ICBG) remain the "gold standard" for achieving lumbar fusion. However, patient dissatisfaction stemming from donor site morbidity, lengthier operating times and finite supply of ICBG has prompted a search for better alternatives. Here presented is a literature review evaluating available bone graft options assessed within the clinical setting. These options include autografts, allograft-based, synthetic and cell-based technologies. The emphasis is on the contentious use of recombinant human bone morphogenetic proteins, which is in widespread use and has demonstrated both significant osteogenic potential and risk of complications. PMID:23658041

Mobbs, Ralph J; Chung, Mina; Rao, Prashanth J

2013-05-01

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Posterolateral lumbar fusion versus transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis.  

Science.gov (United States)

This study compares the safety and efficacy of posterolateral lumbar fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS). Forty DLS patients with Cobb angles of 20-60 degrees were randomized into either the PLF or TLIF treatment group, and were followed up for 2-5 years. Operating time, intraoperative blood loss, clinical outcomes, complications and imaging were compared between the two groups. There were significant differences between the PLF and TLIF treatment groups in operative time (187.8±63.5 minutes and 253.2±57.6 minutes, respectively; p=0.002) and intraoperative blood loss (1166.7±554.1 mL and 1673.7±922.4 mL, respectively; p=0.048). The occurrence rates of early complications in the two groups were 11.1% and 26.3%. The recovery rates of the lumbar lordotic angle and spinal sagittal balance were significantly different (36.7% versus 62.5% and 44.8% versus 64.1%, respectively). In various domains of the Scoliosis Research Society-22 (SRS-22) questionnaire, the scores for pain and satisfaction with the treatment showed significant differences between PLF and TLIF group (p=0.033 and p=0.006, for pain and satisfaction respectively), and the TLIF group showed better outcomes than the PLF group. There were no significant differences in the recovery rates in the Cobb angle and the spinal coronal balance, function, self-image, or mental health scores. Although TLIF increases the surgical trauma and occurrence of complications, it helps to improve lumbar lordosis and sagittal balance and shows better clinical outcomes. For patients without significant loss of lumbar lordosis and with good spinal sagittal balance preoperatively, PLF is still an option. PMID:23827174

Li, Fang-cai; Chen, Qi-xin; Chen, Wei-shan; Xu, Kan; Wu, Qiong-hua; Chen, Gang

2013-07-01

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Posterolateral lumbar fusion versus transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis.  

UK PubMed Central (United Kingdom)

This study compares the safety and efficacy of posterolateral lumbar fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS). Forty DLS patients with Cobb angles of 20-60 degrees were randomized into either the PLF or TLIF treatment group, and were followed up for 2-5 years. Operating time, intraoperative blood loss, clinical outcomes, complications and imaging were compared between the two groups. There were significant differences between the PLF and TLIF treatment groups in operative time (187.8±63.5 minutes and 253.2±57.6 minutes, respectively; p=0.002) and intraoperative blood loss (1166.7±554.1 mL and 1673.7±922.4 mL, respectively; p=0.048). The occurrence rates of early complications in the two groups were 11.1% and 26.3%. The recovery rates of the lumbar lordotic angle and spinal sagittal balance were significantly different (36.7% versus 62.5% and 44.8% versus 64.1%, respectively). In various domains of the Scoliosis Research Society-22 (SRS-22) questionnaire, the scores for pain and satisfaction with the treatment showed significant differences between PLF and TLIF group (p=0.033 and p=0.006, for pain and satisfaction respectively), and the TLIF group showed better outcomes than the PLF group. There were no significant differences in the recovery rates in the Cobb angle and the spinal coronal balance, function, self-image, or mental health scores. Although TLIF increases the surgical trauma and occurrence of complications, it helps to improve lumbar lordosis and sagittal balance and shows better clinical outcomes. For patients without significant loss of lumbar lordosis and with good spinal sagittal balance preoperatively, PLF is still an option.

Li FC; Chen QX; Chen WS; Xu K; Wu QH; Chen G

2013-09-01

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[Effect of posterior lumbar interbody fusion on the lumbar sagittal spinal profile  

UK PubMed Central (United Kingdom)

AIM: To determine the effect of different cage geometries and posterior instrumentation on the sagittal spinal profile after monosegmental lumbar interbody fusion. METHOD: The study is based on a retrospective analysis of 119 patients with segmental instability, who were surgically managed by monosegmental PLIF with PEEK-Cages and dorsal instrumentation. RESULTS: At radiographic follow-up after surgery we found a significant improvement of the lumbar sagittal spinal profile, independent of the cage geometry utilised. A marked discrepancy between 0 degrees -standard and 4 degrees -trapezoid implants concerning the radiographic parameters lumbar lordosis, disc height, correction of spondylolisthesis and sacral inclination was not found. With the use of 4 degrees optimised cages in segment L4/5 slightly better results for segmental lordosis were obtained. Reliability of the radiographic evaluation, expressed as intra-observer error, was satisfactory. Cage geometry did not have an effect on the clinical result. By combining interbody fusion with pedicular instrumentation the reposition of slipped vertebra and distraction of the interbody space could more effectively be achieved. Patients without dorsal instrumentation had a higher rate of pseudarthrosis as well as a less satisfactory clinical outcome. CONCLUSION: These results show that normal sagittal alignment after single-level lumbar fusion can be achieved with rectangular and 4 degrees -wedged cages. Although results after utilization of 4 degrees -wedged cages do not significantly differ, these implants offer the surgeon one more sizing variation with which physiological lumbar lordosis may be attained. The combination of intersomatic implants with dorsal instrumentation achieves a more precise realignment and has a lower rate of cage-associated complications. It therefore seems prudent that an interbody fusion for the surgical management of lumbar segmental instability should be combined with pedicular instrumentation.

Diedrich O; Lüring C; Pennekamp PH; Perlick L; Wallny T; Kraft CN

2003-07-01

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Posterior lumbar interbody fusion for aged patients with degenerative spondylolisthesis: is intentional surgical reduction essential?  

UK PubMed Central (United Kingdom)

CONCLUSIONS: Posterior lumbar interbody fusion with pedicle screws fixation, with or without intraoperative reduction, provides good outcomes in the surgical treatment of aged patients with degenerative spondylolisthesis. Better radiological outcomes by intentional reduction do not necessarily indicate better clinical outcomes.

Lian XF; Hou TS; Xu JG; Zeng BF; Zhao J; Liu XK; Zhao C; Li H

2013-10-01

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Comparison between minimally invasive and open transforaminal lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare the clinical and radiographic outcomes between minimally invasive and open transforaminal lumbar interbody fusion (TLIF) for treatment of lumbar spondylolisthesis MATERIAL AND METHOD: A retrospective clinical study of24 consecutive cases of lumbar spondylolisthesis treated by minimally invasive TLIF (n = 12) or open TLIF (n = 12) was done at Ramathibodi Hospital between June 2008 and December 2009. The following parameters were compared between the two groups, clinical and radiographic outcomes, blood loss, operative time, length of hospital stay, and complications. RESULTS: The average duration of follow-up was 28 months (range, 24 months to 38 months). There was significantly less intra-operative blood loss in minimally invasive TLIF group comparing to open TLIF group (317 cc vs. 645.83 cc: p-value = 0.04). No significant difference was observed in clinical outcomes (VAS or ODI at 2years), radiographic outcome (91.67% fusion rate in both groups), operative time (340 minutes vs. 324 minutes: p-value = 0.96) length of hospital stay (8.42 days vs. 8.33 days: p-value = 0.09) and major complication (8.33% in both groups) between the two groups. CONCLUSION: Minimally invasive TLIF has similar clinical outcomes and fusion rate compared to open TLIF with additional benefit of less intra-operative blood loss. However the operative field of this technique is limited so thorough knowledge of anatomy in this region is required

Saetia K; Phankhongsab A; Kuansongtham V; Paiboonsirijit S

2013-01-01

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TLIF: transforaminal lumbar interbody fusion/ TLIF: artrodese intersomática lombar transforaminal  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Artrodese lombar intersomática transforaminal (TLIF) é uma técnica relativamente nova de artrodese lombar intersomática via transforaminal posterior, indicada principalmente nos casos de doença discal degenerativa, espondilolistese (grau I e II) e reoperação para hérnia discal, especialmente quando existe indicação para fusão intersomática e descompressão posterior. A maior vantagem do TLIF é que ele permite remoção completa do disco através do forame, de (more) scompressão do canal e neuroforame, com mínimo risco de lesão neural, uma vez que o acesso é lateral aos nervos. Em nosso estudo, descrevemos os primeiros 24 casos de TLIF que realizamos, que se mostrou como cirurgia segura e eficiente em nossa série, com alívio da dor em 83,3% dos pacientes, melhora na qualidade de vida em 75% dos casos e satisfação com a cirurgia em 79,1% dos pacientes. Abstract in english Transforaminal lumbar interbody fusion (TLIF) is a relatively new technique of lumbar arthrodesis via posterior transforaminal approach to the disc, indicated mainly in cases of degenerative disc disease, low grade spondylolisthesis and reoperation for disc herniation, specially when there is indication for interbody fusion and posterior decompression. The main advantage of TLIF is that it allows the complete removal of the intervertebral disc through the vertebral forame (more) n, decompression of the spinal canal and vertebral foramen with minimum risk of neural lesion, due to the access being lateral to the nerve roots. In this study, we describe the first 24 cases of TLIF that we have done, wich shows to be very safe and efficient in our serie, with an relief of pain in 83.3% of patients, great improvements in the life quality in 75% of cases and satisfaction with the surgery in 79.1% of patients.

Figueiredo, Nicandro; Martins, Johnny Wesley G.; Arruda, Alfredo A.; Serra, Alexandre R.; Figueiredo, Marco Antônio A.; Diniz, Rodrigo C.; Cavicchioli, Alessandro A.

2004-09-01

29

TLIF: transforaminal lumbar interbody fusion TLIF: artrodese intersomática lombar transforaminal  

Directory of Open Access Journals (Sweden)

Full Text Available Transforaminal lumbar interbody fusion (TLIF) is a relatively new technique of lumbar arthrodesis via posterior transforaminal approach to the disc, indicated mainly in cases of degenerative disc disease, low grade spondylolisthesis and reoperation for disc herniation, specially when there is indication for interbody fusion and posterior decompression. The main advantage of TLIF is that it allows the complete removal of the intervertebral disc through the vertebral foramen, decompression of the spinal canal and vertebral foramen with minimum risk of neural lesion, due to the access being lateral to the nerve roots. In this study, we describe the first 24 cases of TLIF that we have done, wich shows to be very safe and efficient in our serie, with an relief of pain in 83.3% of patients, great improvements in the life quality in 75% of cases and satisfaction with the surgery in 79.1% of patients.Artrodese lombar intersomática transforaminal (TLIF) é uma técnica relativamente nova de artrodese lombar intersomática via transforaminal posterior, indicada principalmente nos casos de doença discal degenerativa, espondilolistese (grau I e II) e reoperação para hérnia discal, especialmente quando existe indicação para fusão intersomática e descompressão posterior. A maior vantagem do TLIF é que ele permite remoção completa do disco através do forame, descompressão do canal e neuroforame, com mínimo risco de lesão neural, uma vez que o acesso é lateral aos nervos. Em nosso estudo, descrevemos os primeiros 24 casos de TLIF que realizamos, que se mostrou como cirurgia segura e eficiente em nossa série, com alívio da dor em 83,3% dos pacientes, melhora na qualidade de vida em 75% dos casos e satisfação com a cirurgia em 79,1% dos pacientes.

Nicandro Figueiredo; Johnny Wesley G. Martins; Alfredo A. Arruda; Alexandre R. Serra; Marco Antônio A. Figueiredo; Rodrigo C. Diniz; Alessandro A. Cavicchioli

2004-01-01

30

Transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion as an adjunct to posterior instrumented correction of degenerative lumbar scoliosis: three year clinical and radiographic outcomes.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Prospective, nonrandomized consecutive single surgeon series. OBJECTIVE: To compare the clinical and radiographic outcomes in degenerative lumbar scoliosis (DLS) patients treated with posterior instrumented correction and fusion with additional anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) to help define whether anterior surgery should be routinely required in treating DLS. SUMMARY OF BACKGROUND DATA: The benefits of interbody support in promoting postoperative stability and arthrodesis are well established. Whether the interbody fusion is better performed from an anterior or posterior approach has not been studied for patients undergoing surgical correction for DLS. METHODS: Forty consecutive patients with DLS, stenosis, and olisthesis underwent posterior instrumented reduction/arthrodesis at average 7 levels (range: 4-9 levels). Additional ALIF was performed in 20 patients, TLIF in the other 20. Follow-up averaged 38 months (24-68 months). Oswestry Disability Index (ODI), visual analog pain scores (VAS) were evaluated preoperative, 1 and 2 years postoperative. Radiograph measurements included the scoliosis, T12 to S1 lordosis, coronal and sagittal balance, and pelvic incidence. CT evaluation of the fusion integrity was performed after 1 year. RESULTS: The ALIF group complications included 4 nonunions, 5 adjacent level fractures, 5 adjacent degeneration, 3 infections, and 1 footdrop. Revision surgery was performed in 8 of 20. Medical complications included 2 nonfatal pulmonary embolus, 1 ileus requiring colostomy, and 1 stroke. TLIF group complications included 3 adjacent segment degeneration, 2 adjacent fractures, 2 nonunions, and 1 infection and transient footdrop. Two of 20 required revision surgery. VAS and ODI improvements for both groups showed significant improvement from preoperative (P < 0.0019) but were not different. Deformity correction was also similar (70%) between ALIF and TLIF groups. CONCLUSION: With current deformity correction techniques, both ALIF and TLIF are effective in DLS surgery. Anterior surgery is not routinely required to treat all cases of DLS.

Crandall DG; Revella J

2009-09-01

31

Complications and Morbidities of Mini-open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: A retrospective study including 179 patients who underwent oblique lumbar interbody fusion (OLIF) at one institution. PURPOSE: To report the complications associated with a minimally invasive technique of a retroperitoneal anterolateral approach to the lumbar spine. OVERVIEW OF LITERATURE: Different approaches to the lumbar spine have been proposed, but they are associated with an increased risk of complications and a longer operation. METHODS: A total of 179 patients with previous posterior instrumented fusion undergoing OLIF were included. The technique is described in terms of: the number of levels fused, operative time and blood loss. Persurgical and postsurgical complications were noted. RESULTS: Patients were age 54.1 ± 10.6 with a BMI of 24.8 ± 4.1 kg/m(2). The procedure was performed in the lumbar spine at L1-L2 in 4, L2-L3 in 54, L3-L4 in 120, L4-L5 in 134, and L5-S1 in 6 patients. It was done at 1 level in 56, 2 levels in 107, and 3 levels in 16 patients. Surgery time and blood loss were, respectively, 32.5 ± 13.2 minutes and 57 ± 131 ml per level fused. There were 19 patients with a single complication and one with two complications, including two patients with postoperative radiculopathy after L3-5 OLIF. There was no abdominal weakness or herniation. CONCLUSIONS: Minimally invasive OLIF can be performed easily and safely in the lumbar spine from L2 to L5, and at L1-2 for selected cases. Up to 3 levels can be addressed through a 'sliding window'. It is associated with minimal blood loss and short operations, and with decreased risk of abdominal wall weakness or herniation.

Silvestre C; Mac-Thiong JM; Hilmi R; Roussouly P

2012-06-01

32

Endovascular embolization of iatrogenic lumbar artery pseudoaneurysm following extreme lateral interbody fusion (XLIF).  

UK PubMed Central (United Kingdom)

Iatrogenic lumbar artery pseudoaneurysm is a very rare complication of spinal surgery. To the best of our knowledge, this is the first report of a lumbar artery pseudoaneurysm after extreme lateral interbody fusion (XLIF). The lesion was diagnosed by catheter spinal angiography and was effectively treated with embolization.

Santillan A; Patsalides A; Gobin YP

2010-10-01

33

Oblique lumbar interbody fixation: a biomechanical study in human spines.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: In vitro spine biomechanics. OBJECTIVE: To determine the biomechanical properties of oblique lumbar interbody fixation (OLIF) in human cadaveric spines. SUMMARY OF BACKGROUND DATA: OLIF has been used for stabilization of degenerative spondylolisthesis at the lumbosacral junction. Biomechanical properties and mode of failure of OLIF as a standalone device for motion segments without sagittal deformity has not yet been investigated. We hypothesize that the biomechanical properties of OLIF will be comparable with the contemporary standard of pedicle screw (PS) fixation. METHOD: Randomly matched motion segments from L1 to L5 were allocated into 2 groups: (A) OLIF (group 1, n=5) or (B) PS (group 2, n=5). The intact and instrumented motion segments with and without anterior interbody graft were first tested under a combination of 200N axial compression and 5 Nm bending moments in flexion-extension and in lateral bending. Range of motion (ROM) and neutral zone were determined and compared between intact, OLIF and PS. A final load to failure test was carried out for each motion segment in either flexion or extension. RESULT: OLIF resulted in reduction of flexion-extension ROM to 36%±14% of intact whereas PS resulted in reduction to 27%±22% of intact. The reduction of lateral bending ROM were 32%±13% and 32%±24% of intact with OLIF and PS. There were no significant difference in ROM between OLIF and PS (P=0.39). The mean failure loads with OLIF and PS in flexion were 1284 and 1158N, and in extension were 1879 and 1934N, respectively. Failure occurred at the ventral screw bone interface without pedicle fracture. CONCLUSIONS: These results indicate that stiffness and load to failure of the OLIF is comparable with PS fixation. OLIF failure occurred ventrally through the anterior cortical rim without concomitant pedicle fracture.

St Clair S; Tan JS; Lieberman I

2012-06-01

34

Contralateral Motor Deficits Following Lateral Lumbar Interbody Fusion.  

UK PubMed Central (United Kingdom)

STRUCTURED ABSTRACT: Study Design. Retrospective Case SeriesObjective. To report on the rare finding of motor deficits contralateral to the transpsoas approach in patients who underwent lateral lumbar interbody fusion (LLIF).Summary of Background Data. While sensorimotor deficits occurring ipsilaterally to a transpsoas approach have more fully been elucidated, there seems to be a paucity of data on motor deficits contralateral to an LLIF approach.Methods. The electronic medical records and radiographic studies of 244 patients who underwent LLIF at a single institution between 2006 and 2009 were retrospectively reviewed for reports on motor deficits contralateral to the surgical approach.Results. Of the patients reviewed, 2.9% (7/244) presented with a postoperative contralateral motor deficit, the most severe of which was a 1/5 weakness of the quadriceps muscle. An average of 3 levels (range 2-4) was fused in the seven patients who developed a contralateral motor deficit, and in three of the seven patients an anterior decompression and interbody fusion (ALIF) was performed in addition to the LLIF. At one year follow-up, three patients presented with complete resolution of their muscle weakness, one patient still had mild weakness, one patient had decreased range of motion in the affected joint and one patient had a 2/5 foot drop. One patient was lost to follow-up.Conclusions. This data is among the largest reports of contralateral motor deficits following LLIF. Among possible underlying mechanisms are: entrapment of the contralateral nerve root through translational correction of spondylolisthesis, front-to-back misalignment of the cage resulting in contralateral nerve root impingement, pressure on the contralateral peroneal nerve during positioning, and over-distraction neurapraxia when employing ALIF at L5-S1 concomitantly. Awareness of the possibility of this rare complication can play an important role in surgical consideration and preoperative patient counseling.

Taher F; Hughes AP; Lebl DR; Sama AA; Pumberger M; Aichmair A; Huang RC; Cammisa FP; Girardi FP

2013-08-01

35

Surgical outcome of posterior lumbar interbody fusion with pedicle screw fixation for lumbar spondylolisthesis  

International Nuclear Information System (INIS)

Problems of lumbar spondylolisthesis treatment are many surgical tactics, elderly patient, osteoporosis, complications and recurrence of the symptoms. PLIF (posterior lumbar interbody fusion) and PS (pedicle screw) fixation technique for lumbar spondylolisthesis provide good patient satisfaction. Good outcome has been reported by only laminectomy alone, but patient satisfaction becomes worse year after year. The role of instrumentation for lumbar spondylolisthesis is decompression of the nerve root, correction of lumbar pathologies, bony fusion and early mobilization. We show our surgical technique and long term outcome of PLIF with PS for lumbar spondylolisthesis. Three hundred and fifty cases of lumbar spondylolisthesis were operated on in Department of Neurosurgery, Fujita Health University during the period of from December 1992 to August 2008. Patient background: age 16-84 years old (mean 62.5), Gender: male 153, female 197. Follow-up period 1-180 months (mean 61.2). Degenerative: 255, Isthmic: 63, Dysplastic: 10, Fracture: 5 and scoliosis 16 cases. Surgical procedure was PS with interbody fusion cage: 331, Hybrid cage (titanium cage with hydroxyapatite) 314, PS with Cerabone: 2 and PS with autograft: 17. CT was done to evaluate bony fusion postoperatively. Post operative improvements by JOA (Japan Orthopedic Association) score is 11.4 before surgery, 24.1 (post op. within 2 years), 25.4 (post op. 2-5 years), 25.0 (post op. 5-10 years) and 22.4 (post op. 10-15 years). Significant improvements were observed in %Slip and Slip angle but no remarkable change was observed in lumbar lordotic angle by postoperative X-ray evaluation. No root injury, and systemic complication except 4 cases of cerebrospinal fluid (CSF) leakage during surgery. Two cases were reoperated in whom cage with autograft migration due to pseudoarthrosis. Two cases had to undergo screw and cage system removal due to infection. Two cases of adjacent level stenosis had to undergo operation 10 tears after surgery in this study. Rigid fixation (PLIF+PS) technique for lumbar spondylolisthesis provide good surgical result for over 15 years. Minimum invasive surgery is popular but this technique achieved good satisfaction for patient and prevent malpractice. (author)

2009-01-01

36

Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

PURPOSE: Adjacent segment disease (ASD) is an increasing problematic complication following lumbar fusion surgeries. ASD requires appropriate treatment, although there are only few reports on surgery for ASD. This study aimed to clarify surgical outcomes of posterior lumbar interbody fusion (PLIF) for ASD. METHODS: Medical charts of 18 patients who underwent the second (repeat) PLIF for ASD were retrospectively investigated (average follow-up, 40 [27-66] months). Modified Japanese Orthopaedic Association (JOA) score and Whitecloud classification were used as outcome measures. RESULTS: Mean modified JOA score improved from 7.7 just before repeat PLIF to 11.4 at maximum recovery and declined to 10.2 at final follow-up. Mean recovery rate of modified JOA score was 52.9 % at maximum recovery and 31.6 % at final follow-up. According to Whitecloud classification, 17 patients (94 %) were excellent or good and only 1 was fair at maximum recovery, whereas 10 (56 %) were excellent or good, 6 were fair, and 2 were poor at final follow-up. Eight patients (44 %) deteriorated again because of recurrent ASD. Two poor patients underwent a third PLIF. CONCLUSION: PLIF is effective for ASD after PLIF in the short term, although it tends to lead to a high incidence of recurrent ASD.

Miwa T; Sakaura H; Yamashita T; Suzuki S; Ohwada T

2013-06-01

37

Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion.  

Science.gov (United States)

PURPOSE: Adjacent segment disease (ASD) is an increasing problematic complication following lumbar fusion surgeries. ASD requires appropriate treatment, although there are only few reports on surgery for ASD. This study aimed to clarify surgical outcomes of posterior lumbar interbody fusion (PLIF) for ASD. METHODS: Medical charts of 18 patients who underwent the second (repeat) PLIF for ASD were retrospectively investigated (average follow-up, 40 [27-66] months). Modified Japanese Orthopaedic Association (JOA) score and Whitecloud classification were used as outcome measures. RESULTS: Mean modified JOA score improved from 7.7 just before repeat PLIF to 11.4 at maximum recovery and declined to 10.2 at final follow-up. Mean recovery rate of modified JOA score was 52.9 % at maximum recovery and 31.6 % at final follow-up. According to Whitecloud classification, 17 patients (94 %) were excellent or good and only 1 was fair at maximum recovery, whereas 10 (56 %) were excellent or good, 6 were fair, and 2 were poor at final follow-up. Eight patients (44 %) deteriorated again because of recurrent ASD. Two poor patients underwent a third PLIF. CONCLUSION: PLIF is effective for ASD after PLIF in the short term, although it tends to lead to a high incidence of recurrent ASD. PMID:23775291

Miwa, Toshitada; Sakaura, Hironobu; Yamashita, Tomoya; Suzuki, Shozo; Ohwada, Tetsuo

2013-06-18

38

Posterior lumbar interbody fusion for the management of spondylolisthesis.  

Science.gov (United States)

The ideal surgical treatment of spondylolisthesis still remains controversial. There are several methods of treatment and posterior lumbar interbody fusion (PLIF) is one of them. We analyze the results of spondylolisthesis treated by PLIF in term of radiological union, improvement of pre-operative symptoms like back pain, radiating pain and return to normal activities including that of employment, by the review of the medical records. Total of 72 patients, 20 male and 52 female and the age ranges from 15 to 68 years with the mean age being 44.38 years were included in the study. Thirty (41.66%) patients had isthmic spondylolisthesis, 26 (36.12%) had congenital spondylolisthesis, and 16 (22.22%) cases had degenerative spondylolisthesis. There were 38 (52.77%) cases of grade I, 14 (19.44%) cases of grade II and 20 (27.77%) cases of grade III according to the grading criteria of Meyerding. According to the evaluation criteria used by Stauffer and Coventry, 59 patients (81.94%) got good results, eight patients (11.11%) belonged to the fair group and five cases (6.94%) had the poor results. This study showed that PLIF is one of the effective and reliable techniques for the management of spondylolisthesis. PMID:21991702

Devkota, P; Shrestha, S K; Krishnakumar, R; Renjithkumar, J

2011-03-01

39

Posterior lumbar interbody fusion for the management of spondylolisthesis.  

UK PubMed Central (United Kingdom)

The ideal surgical treatment of spondylolisthesis still remains controversial. There are several methods of treatment and posterior lumbar interbody fusion (PLIF) is one of them. We analyze the results of spondylolisthesis treated by PLIF in term of radiological union, improvement of pre-operative symptoms like back pain, radiating pain and return to normal activities including that of employment, by the review of the medical records. Total of 72 patients, 20 male and 52 female and the age ranges from 15 to 68 years with the mean age being 44.38 years were included in the study. Thirty (41.66%) patients had isthmic spondylolisthesis, 26 (36.12%) had congenital spondylolisthesis, and 16 (22.22%) cases had degenerative spondylolisthesis. There were 38 (52.77%) cases of grade I, 14 (19.44%) cases of grade II and 20 (27.77%) cases of grade III according to the grading criteria of Meyerding. According to the evaluation criteria used by Stauffer and Coventry, 59 patients (81.94%) got good results, eight patients (11.11%) belonged to the fair group and five cases (6.94%) had the poor results. This study showed that PLIF is one of the effective and reliable techniques for the management of spondylolisthesis.

Devkota P; Shrestha SK; Krishnakumar R; Renjithkumar J

2011-03-01

40

Retroperitoneal lymphatic cyst formation after anterior lumbar interbody fusion: a report of 3 cases.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Case report. OBJECTIVE: A retroperitoneal lymphocele is a very rare complication associated with anterior lumbar interbody fusion surgery. SUMMARY OF BACKGROUND DATA: We report the diagnosis and management of 3 retroperitoneal lymphoceles, which occurred after anterior left retroperitoneal approaches for lumbar interbody fusion. METHODS: As the radiologic examinations revealed the lymphoceles in all 3 cases laparoscopic fenestration was performed. RESULTS: The patients had good recovery and no recurrence of the lymphoceles occurred. CONCLUSIONS: If this rare complication occurs the primary intervention should be laparoscopic fenestration because of the high recurrence rate of other treatment modalities.

Thaler M; Achatz W; Liebensteiner M; Nehoda H; Bach CM

2010-04-01

 
 
 
 
41

Clinical study of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability.  

UK PubMed Central (United Kingdom)

The aim of this study was to observe the clinical effects of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability. The 48 patients comprised 27 males and 21 females, aged 47-72 years. Three cases had first and second degree lumbar spondylolisthesis and all received bilateral vertebral lamina fenestration for posterior lumbar interbody fusion (PLIF) using a threaded fusion cage (TFC), which maintains the three-column spinal stability. Attention was given to ensure the correct pre-operative fenestration, complete decompression and the prevention of adhesions. After an average follow-up of 26.4 months, the one year post-operative X-ray radiographs suggested that the successful fusion rate was 88.1%, and this was 100% in the two-year post-operative radiographs. Moreover, the functional recovery rate was 97.9%. Bilateral vertebral lamina fenestration for lumbar interbody fusion is an ideal surgical method for the treatment of lower lumbar instability. The surgical method retains the spinal posterior column and middle column and results in full decompression and reliable fusion by a limited yet effective surgical approach.

Guo S; Sun J; Tang G

2013-03-01

42

Clinical study of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability  

Science.gov (United States)

The aim of this study was to observe the clinical effects of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability. The 48 patients comprised 27 males and 21 females, aged 47–72 years. Three cases had first and second degree lumbar spondylolisthesis and all received bilateral vertebral lamina fenestration for posterior lumbar interbody fusion (PLIF) using a threaded fusion cage (TFC), which maintains the three-column spinal stability. Attention was given to ensure the correct pre-operative fenestration, complete decompression and the prevention of adhesions. After an average follow-up of 26.4 months, the one year post-operative X-ray radiographs suggested that the successful fusion rate was 88.1%, and this was 100% in the two-year post-operative radiographs. Moreover, the functional recovery rate was 97.9%. Bilateral vertebral lamina fenestration for lumbar interbody fusion is an ideal surgical method for the treatment of lower lumbar instability. The surgical method retains the spinal posterior column and middle column and results in full decompression and reliable fusion by a limited yet effective surgical approach.

GUO, SHUGUANG; SUN, JUNYING; TANG, GENLIN

2013-01-01

43

Transforaminal lumbar interbody fusion and posterior lumbar interbody fusion utilizing BMP-2 in treatment of degenerative spondylolisthesis: neither safe nor cost effective  

Science.gov (United States)

Background: With the rise of health care costs, there is increased emphasis on evaluating the cost of a particular surgical procedure for quality adjusted life year (QALY) gained. Recent data have shown that surgical intervention for the treatment of degenerative spondylolisthesis (DS) is as cost-effective as total joint arthroplasty. Despite these excellent outcomes, some argue that the addition of interbody fusion supplemented with bone morphogenetic protein (BMP) enhances the value of this procedure. Methods: This review examines the current research regarding the cost-effectiveness of the surgical management of lumbar DS utilizing interbody fusion along with BMP. Results: Posterolateral spinal fusion with instrumentation for focal lumbar spinal stenosis with DS can provide and maintain improvement in self-reported quality of life. Based on the available literature, including nonrandomized comparative studies and case series, the addition of interbody fusion along with BMP does not lead to significantly better clinical outcomes and increases costs when compared with more routine posterolateral fusion techniques. Conclusions: To enhance the value of the surgical management for DS, costs must decrease or there should be substantial improvement in effectiveness as measured by clinical outcomes. To date, there is insufficient evidence to support the use of interbody fusion devices along with BMP to treat routine cases of focal stenosis accompanied by DS, which are routinely adequately treated utilizing posterolateral fusion techniques.

Moatz, Bradley; Tortolani, P. Justin

2013-01-01

44

[Transforaminal lumbar interbody fusion: Goals of the minimal invasive approach.  

UK PubMed Central (United Kingdom)

BACKGROUND AND PURPOSE: Transforaminal lumbar interbody fusion (TLIF) is an effective technique, which can achieve a fusion rate of up to 90%. The minimally invasive approach has become increasingly popular because it is able to minimize iatrogenic soft tissue and muscle injury. Although the minimally invasive TLIF technique has gained popularity, its effectiveness compared with open TLIF has yet to be established. The authors prospectively compared the outcomes of patients who underwent mini-open TLIF with patients who underwent open TLIF. METHODS: Between 2007 and 2008, 50 patients underwent TLIF for grade 1 spondylolisthesis; 25 mini-open TLIF and 25 open TLIF. The mean age in each group was 48years, and there was no statistically significant difference between the groups. Data were collected perioperatively. Pain and functional disability were measured using a visual analogue scale (VAS) and the Oswestry disability index (ODI) at 3months, 6months, 1year and 2years. In addition, foraminal and disc height were measured at the same intervals and the fusion was evaluated at 1year on CT-scan. Soft tissue damage was evaluated by measuring the serum myoglobin and creatine phosphokinase activity. RESULTS: The mean VAS improved from 7 to 2.8 and the ODI decreased from 30/50 to 15/50 and fusion rate at 1 year was 98%. There was no statistical difference for the clinical and radiological outcomes between the groups. The mean operative time was 186min for the open group, 170min for the mini-open group (P<0.05) and the mean blood loss was 486mL for the open group and 148mL for the mini-open group (P<0.01). CONCLUSION: The mini-open TLIF procedure for symptomatic low grade spondylolisthesis is an effective option which achieves similar clinical and radiological outcomes and reduces perioperative morbidity as well as soft tissue damage.

Zaïri F; Allaoui M; Thines L; Arikat A; Assaker R

2013-08-01

45

Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it?  

UK PubMed Central (United Kingdom)

PURPOSE: Interbody spine fusion with cages was first described by Bagby and has been performed for a long time now in a variety of different conditions. We developed a percutaneous endoscopic lumbar fusion technique based on the principles of Kambin and an original titanium cage. MATERIALS AND METHODS: From 2004 to 2010, 57 patients were operated on, 17 patients were male with a mean age of 50.29 years (range 34-71 years) and 40 were female with a mean age of 57.42 years (29-90 years). Nineteen patients had a previous operation. Patients were operated on under local anaesthesia in the prone position under image intensifier and a transforaminal percutaneous endoscopic approach. RESULTS: Fifty cases had a bilateral cage through a bilateral endoscopic approach, and seven cases had a unilateral endoscopic approach only; of those, three cases had only one cage. Eleven patients had a contemporary posterior plate fixation at the same time of the endoscopic cage fusion. Eight patients had a postoperative radicular pain with paresthesias. Asymptomatic migration of the cages occurred in two cases and symptomatic migration requiring a conventional secondary reoperation in 13 cases after a mean delay of eight months (range three to 36 months). The mean ODI after two years or more was 34.3 % (initial ODI 69.4 %). CONCLUSIONS: The technique was introduced in our practice to take care of difficult or grave co-morbidity patients, and some patients had excellent lasting results following a very short procedure and hospital stay. However, given the 36 % complication rate in this series, we do not recommend it unless decisive technical improvements are made.

Jacquot F; Gastambide D

2013-08-01

46

Microscopic anterior foraminal decompression combined with anterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: Anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PPF) provides successful surgical outcomes to isthmic spondylolisthesis patients with indirect decompression through foraminal volume expansion. However, indirect decompression through ALIF followed by PPF may not obtain a successful surgical outcome in patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by a posterior osteophyte or foraminal sequestrated disc herniation. Thus far, there has been no report of foraminal decompression through anterior direct access in the lumbar spine. PURPOSE: This study aims to describe the new surgical technique of microscopic anterior foraminal decompression and to analyze the clinical outcomes and radiologic results of the microscopic anterior decompression during ALIF followed by PPF. STUDY DESIGN/SETTING: We conducted a multisurgeon, retrospective, clinical series from a single institution. PATIENT SAMPLE: This study was carried out from March 2007 to July 2010 and included 40 consecutive patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by posterior osteophyte or foraminal sequestrated disc herniation undergoing microscopic anterior foraminal decompression during ALIF followed by PPF. OUTCOME MEASURES: The visual analog scales (VAS) of back and leg pain and the Oswestry disability index were measured preoperatively and at the last follow-up. METHODS: Postoperative computed tomography and magnetic resonance imaging measured whether decompression of neural structure had been made and morphometric change of the foramen and the amount of resected bone. Moreover, segmental lordosis, whole lumbar lordosis, disc height, and degree of listhesis were measured through X-ray examination before the operation and at the last follow-up; we also verified whether fusion had been achieved. RESULTS: Successful decompression was confirmed in both patients with foraminal stenosis caused by posterior osteophyte and those with foraminal sequestrated disc herniation. Clinically, compared with before the surgery, the VAS (leg and back) and the Oswestry disability index significantly decreased at the last follow-up (p=.000). With regard to radiology, at the last follow-up all patients had bone fusion on X-ray examination, and an increase in disc height, a reduction in the degree of listhesis, an increase in segmental lordosis, and an increase in whole lumbar lordosis were significant in both groups (p=.000) compared with before the surgery. Foraminal volume, foraminal width, and foraminal height also significantly increased postoperatively compared with before the operation (p=.000). The height, width, and dimension of resected body were 4.61±1.05 mm, 7.92±1.42 mm, 17.15±4.96 mm(2), respectively, in patients with foraminal stenosis caused by a posterior osteophyte, and 3.88±0.92 mm, 6.8±1.29 mm, and 13.12±2.25 mm(2), respectively, in patients with foraminal sequestrated disc. CONCLUSIONS: The microscopic anterior foraminal approach provides successful foraminal decompression. Combined with ALIF and PPF, this approach shows a good surgical outcome in patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by a posterior osteophyte or those with foraminal sequestrated disc herniation.

Shin SH; Choi WG; Hwang BW; Tsang YS; Chung ER; Lee HC; Lee SJ; Lee SH

2013-10-01

47

[Comparative study of dynamic neutralization system and posterior lumbar interbody fusion in treating lumbar degenerative disease].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare the short-term effectiveness between dynamic neutralization system (Dynesys) and posterior lumbar interbody fusion (PLIF) in the treatment of lumbar degenerative disease. METHODS: The clinical data were retrospectively analyzed, from 14 patients undergoing Dynesys and 18 patients undergoing PLIF to treat lumbar degenerative disease between February 2009 and March 2011. No significant difference in gender, age, duration of disease, and lesion segments was found between 2 groups (P > 0.05). The visual analogue scale (VAS) score, Oswestry disability index (ODI), and radiographic results were compared between 2 groups at preoperation and last follow-up. RESULTS: Thirty-one cases were followed up 12-21 months (mean, 17 months). No internal fixation loosening, broken screws, and broken rods was found during follow-up. The mean interbody fusion time was 15 months (range, 13-19 months) in PLIF group. The VAS score and ODI were significantly improved in 2 groups at last follow-up when compared with the preoperative ones (P < 0.05); but there was no signficant difference between 2 groups (P > 0.05). Imaging assessment: the range of motion (ROM) of operated segment in PLIF group was (0.1 +/- 0.4) degrees at last follow-up, showing significant difference when compared with preoperative ROM (7.8 +/- 0.6) degrees (t=28.500, P=0.004); the ROM in Dynesys group (5.0 +/- 1.5) degrees decreased, but showing no significant difference when compared with preoperative ROM (7.5 +/- 0.8) degrees (t=0.480, P=0.113); and significant difference was found between 2 groups (t=5.260, P=0.008) at last follow-up. The ROM of adjacent segment in Dynesys group at last follow-up (7.2 +/- 0.7) degrees decreased when compared with preoperative ROM (7.3 +/- 1.8) degrees, but showing no significant difference (t=0.510, P=0.108); however, ROM of adjacent segment in PLIF group (8.7 +/- 0.4) degrees increased significantly when compared with preoperative ROM (7.0 +/- 1.6) degrees, showing signifcant difference (t=3.440, P=0.042); and there was significant difference between 2 groups (t=2.100, P=0.047) at last follow- up. CONCLUSION: Dynesys and PLIF have equivalent short-term effectivness in the treatment of lumbar degenerative disease. However, the Dynesys could retain ROM of operated segment without increased ROM of the adjacent segment, which will promote the disc recovery of operated segment and prevent degeneration of adjacent segment.

Yang B; Jiang T

2013-02-01

48

Prospective Study of Posterior Lumbar Interbody Fusion and Posterolateral Fusion for Degenerative Spondylolisthesis.  

UK PubMed Central (United Kingdom)

STUDY DESIGN:: A prospective study of two different fusion techniques for the treatment of single level degenerative spondylolisthesis. OBJECTIVE:: To determine whether the addition of an intervertebral cage improves the clinical outcome and fusion rate of patients undergoing posterior lumbar interbody fusion after decompression for degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA:: The surgical approach that should be used for degenerative spondylolisthesis is a controversial issue. Decompression and posterior lumbar interbody fusion (PLIF) with an interbody cage is widely used. Theoretical advantages in favour of PLIF include anterior column support, indirect foraminal decompression, restoration of lordosis, and reduction of the slip via ligamentotaxis. Despite numerous publications, the scientific support for the PLIF method is, however weak. METHODS:: A prospective study was carried out including 59 patients with degenerative spondylolisthesis. Average age of patients was 66 years: 34 males and 25 females. Patients were divided into two treatment groups: Group1-32 patients with PLIF with interbody graft and Group 2-27 patients with PLIF with cage. Minimum two years follow-up. Outcomes were assessed by measuring pre- and post-operative lordotic angles. SF-12 physical and mental health scores were recorded along with visual analogue scores for pain. Complications were also recorded. RESULTS:: No significant difference in the post-operative lordotic angles achieved between the two techniques. Non-significant difference in the clinical outcomes between both techniques. CONCLUSION:: We have found the use of a cage to achieve lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis does not confer any significant advantages in terms of restoration of lumbar lordosis, improvement in clinical symptoms, or relief of pain post-operatively.

Sivaraman A; Altaf F; Jalgoankar A; Kakkar R; Sirigiri PB; Howieson A; Crawford PJ

2013-07-01

49

Comparison of open and minimally invasive techniques for posterior lumbar instrumentation and fusion after open anterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: Minimally invasive techniques for spinal fusion have theoretical advantages for the reduction of iatrogenic injury. Although this topic has been investigated previously for posterior-only interbody surgery, such as transforaminal lumbar interbody fusion, similar studies have not evaluated these techniques after anteroposterior spinal fusion, a study design that can more accurately determine the effect of pedicle screw placement and decompression via a minimally invasive technique without the confounding effect of simultaneous interbody cage placement. PURPOSE: To compare process measures that provide insight into the morbidity of surgery, such as surgical time and the length of postoperative hospital stay between open and minimally invasive anteroposterior lumbar fusion; and to compare the complications during the intraoperative and early postoperative period between open and minimally invasive anteroposterior lumbar fusion. STUDY DESIGN: Retrospective case-control study. PATIENT SAMPLE: One hundred sixty-two patients. OUTCOME MEASURES: Estimated blood loss, length of surgery, intraoperative fluoroscopy time, length of postoperative hospital stay, malpositioned instrumentation on postoperative imaging, and postoperative complications, including pulmonary embolus and surgical site infection. METHODS: Patients who underwent open anterior lumbar interbody fusion followed by either traditional open posterior fusion (Open group) or minimally invasive posterior fusion (minimally invasive surgery [MIS] group) were matched by the number of surgical levels. A chart review was performed to document the intraoperative and postoperative process measures and associated complications in the two groups. Secondary analyses were performed to compare the subgroups of patients, who did and did not undergo a posterior decompression at the time of posterior instrumentation to determine the effect of decompression. RESULTS: Baseline characteristics were similar between the Open and MIS groups. Estimated blood loss and postoperative transfusion rate were significantly higher in the Open group, differences that the subanalyses suggested were largely because of those patients who underwent concomitant decompression. Length of stay was not significantly different between the groups but was significantly shorter for MIS patients treated without decompression than for Open patients treated without decompression. Intraoperative fluoroscopy time was significantly longer in the MIS group. There was no difference in the infection or complication rates between the groups. CONCLUSIONS: Our case-control study comparing patients who underwent anterior lumbar interbody fusion followed by open posterior instrumentation with those who underwent anterior lumbar interbody fusion followed by minimally invasive posterior instrumentation demonstrated that patients undergoing MIS fusion without decompression had less blood loss, less need for transfusion in the perioperative period, and a shorter hospital stay. In contrast, most outcome measures were similar between MIS and Open groups for patients who underwent decompression.

Kepler CK; Yu AL; Gruskay JA; Delasotta LA; Radcliff KE; Rihn JA; Hilibrand AS; Anderson DG; Vaccaro AR

2013-05-01

50

Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis.  

UK PubMed Central (United Kingdom)

OBJECT: A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. METHODS: Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. RESULTS: The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). CONCLUSIONS: The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

Sakaura H; Yamashita T; Miwa T; Ohzono K; Ohwada T

2013-07-01

51

Sagittal Alignment After Lumbar Interbody Fusion: Comparing Anterior, Lateral, and Transforaminal Approaches.  

Science.gov (United States)

STUDY DESIGN:: Retrospective radiographic analysis. OBJECTIVE:: To determine which lumbar interbody technique is most effective for restoring lordosis, increasing disc height, and reducing spondylolisthesis. SUMMARY OF BACKGROUND DATA:: Lumbar interbody fusions are performed in hopes of increasing fusion potential, correcting deformity, and indirectly decompressing nerve roots. No published study has directly compared anterior, lateral, and transforaminal lumber interbody fusions in terms of ability to restore lordosis, increase disc height, and reduce spondylolisthesis. METHODS:: Lumbar interbody fusion techniques were retrospectively compared in terms of improvement of lordosis, disc height, and spondylolisthesis between preoperative and follow-up lateral radiographs. RESULTS:: Two hundred twenty consecutive patients with 309 operative levels were compared by surgery type: anterior (184 levels), lateral (86 levels) and transforaminal (39 levels). Average follow-up was 19.2 months. (range 1-56 mo), with no statistical difference between the groups. Intragroup analysis showed that the anterior (4.5°) and lateral (2.2°) groups significantly improved lordosis from preoperative to follow-up, while the transforaminal (0.8°) group did not. Intergroup analysis showed that the anterior group significantly improved lordosis more than both the lateral and transforaminal groups. The anterior (2.2 mm) and lateral (2.0 mm) groups both significantly improved disc height more than the transforaminal (0.5 mm) group. All three groups significantly reduced spondylolisthesis, with no difference between the groups. CONCLUSION:: After lumbar interbody fusion, improvement of lordosis was significant for both the anterior and lateral groups, but not the transforaminal group. Intergroup analysis showed the anterior group had significantly improved lordosis compared to both other groups. The anterior and lateral groups had significantly increased disc height compared to the transforaminal group. All three groups significantly reduced spondylolisthesis, with no difference between the groups. PMID:23511641

Watkins, Robert G; Hanna, Robert; Chang, David; Watkins, Robert G

2013-06-18

52

[Minimally invasive transforaminal lumbar interbody fusion for treatment of degenerative lumbar scoliosis stenosis].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To explore the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative lumbar scoliosis stenosis by expandable tubular retractor. METHODS: Between April 2009 and October 2010, 39 patients with degenerative lumbar scoliosis stenosis were treated. Of 39 patients, 20 underwent MI-TLIF (group A) and 19 underwent open surgery (group B). There was no significant differences in gender, age, disease duration, range of lumbar degenerative scoliosis, Cobb angle, Oswestry disability index (ODI), and visual analogue scale (VAS) between 2 groups (P > 0.05). The operation time, intraoperative blood loss, postoperative independently turning over time, postoperative complication rate, Cobb angle, fusion rates, ODI score, and VAS score were compared between 2 groups. RESULTS: The operation time of group A was significantly longer than that of group B (P < 0.05), and the intraoperative blood loss of group A was significantly less than that of group B (P < 0.05); no significant difference was found in postoperative independently turning over time between 2 groups (t=1.869, P=0.069). The complication rate was 20.0% (4/20) in group A and 26.3% (5/19) in group B, showing no significant difference (Chi2=0.219, P=0.640). All patients were followed up 2 years to 3 years and 6 months (mean, 2.9 years). At last follow-up, the fusion rate of bone graft was 92.9% (78/84) in group A and 95.2% (80/84) in group B, showing no significant difference (Chi2=0.425, P=0.514). According to the Macnab standard for effectiveness evaluation, the results were excellent in 12 cases, good in 6 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 90.0% in group A; the results were excellent in 12 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 89.5% in group B; there was no significant difference between 2 groups (Z= -0.258, P=0.835). The postoperative VAS score, ODI score, and Cobb angle were significantly improved when compared with preoperative ones in 2 groups (P < 0.05); and there was no significant differences between 2 groups at 2 weeks after operation and last follow-up (P > 0.05). CONCLUSION: MI-TLIF by expandable tubular retractor is an available clinical choice in treating degenerative lumbar scoliosis stenosis. It can obtain the same effectiveness as the open surgery.

Ding Y; He S; Zhang H

2013-04-01

53

Fresh-frozen femoral head allograft as lumbar interbody graft material allows high fusion rate without subsidence.  

UK PubMed Central (United Kingdom)

BACKGROUND: Circumferential lumbar spinal fusion is widely used to increase fusion rate, but little data is available using fresh-frozen femoral head allograft (FFFHA) as a structural interbody graft alternative. HYPOTHESIS: Circumferential lumbar arthrodesis using FFFHA as interbody graft material could be an alternative to achieve interbody fusion without graft subsidence. METHODS: A retrospective review of 47 patients (56 levels) treated with lumbar circumferential fusion using FFFHA as interbody material. Consolidation was independently assessed by the two authors using a 3-type scale; interbody bone graft subsidence was also evaluated. RESULTS: Forty-four of the 47 patients (93.6%), and 53 of the 56 levels (94.6%) obtained consolidation, without differences between smokers and nonsmokers. Three levels (in three patients) did not fuse; one of them (2.1%) required revision. No patient presented graft dislodgment, signs of infection or graft subsidence at the last follow-up. DISCUSSION: FFFHA use as lumbar interbody graft in circumferential arthrodesis exhibited a 94% fusion rate, without graft subsidence. FFFHA may be considered a valid alternative to achieve interbody fusion. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Urrutia J; Molina M

2013-06-01

54

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results.  

UK PubMed Central (United Kingdom)

BACKGROUND: Multiple studies have reported favorable short-term results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion. However, to our knowledge, results at a minimum of 5 years have not been reported. QUESTIONS/PURPOSES: We determined (1) changes to the Oswestry Disability Index, (2) frequency of radiographic fusion, (3) complications and reoperations, and (4) the learning curve associated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. METHODS: We reviewed our first 124 patients who underwent minimally invasive transforaminal lumbar interbody fusion to treat low-grade spondylolisthesis and degenerative lumbar diseases and did not need a major deformity correction. This represented 63% (124 of 198) of the transforaminal lumbar interbody fusion procedures we performed for those indications during the study period (2003-2007). Eighty-three (67%) patients had complete 5-year followup. Plain radiographs and CT scans were evaluated by two reviewers. Trends of surgical time, blood loss, and hospital stay over time were examined by logarithmic curve fit-regression analysis to evaluate the learning curve. RESULTS: At 5 years, mean Oswestry Disability Index improved from 60 points preoperatively to 24 points and 79 of 83 patients (95%) had improvement of greater than 10 points. At 5 years, 67 of 83 (81%) achieved radiographic fusion, including 64 of 72 patients (89%) who had single-level surgery. Perioperative complications occurred in 11 of 124 patients (9%), and another surgical procedure was performed in eight of 124 patients (6.5%) involving the index level and seven of 124 patients (5.6%) at adjacent levels. There were slowly decreasing trends of surgical time and hospital stay only in single-level surgery and almost no change in intraoperative blood loss over time, suggesting a challenging learning curve. CONCLUSIONS: Oswestry Disability Index scores improved for patients with spondylolisthesis and degenerative lumbar diseases treated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. We suggest this procedure is reasonable for properly selected patients with these indications; however, traditional approaches should still be performed for patients with high-grade spondylolisthesis, patients with a severely collapsed disc space and no motion seen on the dynamic radiographs, patients who need multilevel decompression and arthrodesis, and patients with kyphoscoliosis needing correction. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Park Y; Ha JW; Lee YT; Sung NY

2013-08-01

55

Biomechanical Comparison of Transforaminal Lumbar Interbody Fusion With One or Two Cages by Finite Element Analysis.  

UK PubMed Central (United Kingdom)

BACKGROUND:: Anterior lumbar interbody fusion (ALIF) and posterior lumbar interbody fusion (PLIF) surgery using one cage have been shown to have similar biomechanics compared to the use of two cages. However, there have been no reports on the biomechanical differences between using one versus two cages in transforaminal lumbar interbody fusion (TLIF) surgery. OBJECTIVE:: To determine the biomechanical differences between the use of one versus two cages in TLIF by finite element analysis. METHODS:: Three validated finite element models of L3-L5 lumbar segment were created [intact model (INT), single cage and paired cages TLIF models]. To study the biomechanics, a compressive preload of 400 N over 7.5 N-m was applied to the superior surfaces of the L3 vertebral body to simulate flexion, extension, rotation, and lateral bending. RESULTS:: There was no significant difference in the range of motion between single cage and paired cages TLIF models, less than 1° for all loading cases. Cage stress was high in the single cage TLIF model under all loading conditions. Bone graft stress was high in the single cage TLIF model. Pedicle screw stress was higher in single cage versus paired cages TLIF. CONCLUSION:: Single cage TLIF approximates biomechanical stability and increases the stress of the bone graft. The use of a single cage may simplify the standard TLIF procedure, shorten operative times, decrease cost, and provide satisfactory clinical outcomes. Thus, single cage TLIF is a useful alternative to traditional two cage TLIF.

Xu H; Ju W; Xu N; Zhang X; Zhu X; Zhu L; Qian X; Wen F; Wu W; Jiang F

2013-04-01

56

Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience.  

UK PubMed Central (United Kingdom)

The aim of this study was to compare our experience with minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open midline transforaminal lumbar interbody fusion (TLIF). A total of 36 patients suffering from isthmic spondylolisthesis or degenerative disc disease were operated with either a MITLIF (n = 18) or an open TLIF technique (n = 18) with an average follow-up of 22 and 24 months, respectively. Clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). There was no difference in length of surgery between the two groups. The MITLIF group resulted in a significant reduction of blood loss and had a shorter length of hospital stay. No difference was observed in postoperative pain, initial analgesia consumption, VAS or ODI between the groups. Three pseudarthroses were observed in the MITLIF group although this was not statistically significant. A steeper learning effect was observed for the MITLIF group.

Schizas C; Tzinieris N; Tsiridis E; Kosmopoulos V

2009-12-01

57

Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience.  

Science.gov (United States)

The aim of this study was to compare our experience with minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open midline transforaminal lumbar interbody fusion (TLIF). A total of 36 patients suffering from isthmic spondylolisthesis or degenerative disc disease were operated with either a MITLIF (n = 18) or an open TLIF technique (n = 18) with an average follow-up of 22 and 24 months, respectively. Clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). There was no difference in length of surgery between the two groups. The MITLIF group resulted in a significant reduction of blood loss and had a shorter length of hospital stay. No difference was observed in postoperative pain, initial analgesia consumption, VAS or ODI between the groups. Three pseudarthroses were observed in the MITLIF group although this was not statistically significant. A steeper learning effect was observed for the MITLIF group. PMID:19023571

Schizas, Constantin; Tzinieris, Nicolas; Tsiridis, Elefterios; Kosmopoulos, Victor

2008-11-21

58

Complications from minimally invasive lumbar interbody fusion: experience from 100 patients.  

UK PubMed Central (United Kingdom)

Minimally invasive lumbar fusion is well described and is reported to offer significant advantages to patients in terms of blood loss, a reduction in post-operative pain and a quicker recovery. However, this technique may expose patients to a greater risk of complications when compared to open lumbar instrumented fusion that may negate these advantages. Between January 2007 and March 2001, we conducted a prospective observational study of 100 consecutive patients (48 males and 52 females, mean age of 54 years) to investigate complications occurring from minimally invasive lumbar interbody fusion surgery using an image-guided technique. All patients underwent post-operative CT scans to assess implant placement. Scanning was repeated at 6 months to assess bony fusion. We observed the following complications: 2.5% (11/435) pedicle screw misplacement, 1.7% (2/120) interbody cage misplacement; 0.8% (1/120) interbody cage migration; 0.8% (1/120) patients requiring a post-operative blood transfusion; 2% (2/100) venous thrombo-embolism and 3% (3/100) patients with complications thought to be related to the use of bone morphogenic protein. There were no occurrences of infection and no cerebrospinal fluid leaks. We concluded that the rate of complications from minimally invasive lumbar interbody fusion is low, and compares favourably with the rates of complication from open procedures. Moreover, computerised navigation systems can be used in place of real-time fluoroscopy to guide implant placement, without an increase in the rate of complications.

Tsahtsarlis A; Efendy JL; Mannion RJ; Wood MJ

2013-06-01

59

Complications from minimally invasive lumbar interbody fusion: experience from 100 patients.  

Science.gov (United States)

Minimally invasive lumbar fusion is well described and is reported to offer significant advantages to patients in terms of blood loss, a reduction in post-operative pain and a quicker recovery. However, this technique may expose patients to a greater risk of complications when compared to open lumbar instrumented fusion that may negate these advantages. Between January 2007 and March 2001, we conducted a prospective observational study of 100 consecutive patients (48 males and 52 females, mean age of 54 years) to investigate complications occurring from minimally invasive lumbar interbody fusion surgery using an image-guided technique. All patients underwent post-operative CT scans to assess implant placement. Scanning was repeated at 6 months to assess bony fusion. We observed the following complications: 2.5% (11/435) pedicle screw misplacement, 1.7% (2/120) interbody cage misplacement; 0.8% (1/120) interbody cage migration; 0.8% (1/120) patients requiring a post-operative blood transfusion; 2% (2/100) venous thrombo-embolism and 3% (3/100) patients with complications thought to be related to the use of bone morphogenic protein. There were no occurrences of infection and no cerebrospinal fluid leaks. We concluded that the rate of complications from minimally invasive lumbar interbody fusion is low, and compares favourably with the rates of complication from open procedures. Moreover, computerised navigation systems can be used in place of real-time fluoroscopy to guide implant placement, without an increase in the rate of complications. PMID:23623657

Tsahtsarlis, Antonio; Efendy, Johnny L; Mannion, Richard J; Wood, Martin J

2013-04-25

60

Axial presacral lumbar interbody fusion and percutaneous posterior fixation for stabilization of lumbosacral isthmic spondylolisthesis.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Case series. OBJECTIVE: To describe a minimally invasive surgical technique for treatment of lumbosacral spondylolisthesis. SUMMARY OF BACKGROUND DATA: Traditional surgical management of lumbosacral spondylolisthesis is technically challenging and associated with significant complications. Minimally invasive surgical techniques offer patients treatment alternatives with lower operative morbidity risk. The combination of percutaneous pedicle screw reduction and an axial presacral approach for lumbosacral discectomy and fusion is an option for the surgical management of low-grade lumbosacral spondylolisthesis. METHODS: Twenty-six consecutive patients with symptomatic L5-S1 level isthmic spondylolisthesis (grade 1 or grade 2) underwent axial presacral lumbar interbody fusion and percutaneous posterior fixation. Study outcomes included visual analogue scale for axial pain severity, Odom criteria, and radiographic fusion. RESULTS: The procedure was successfully completed in all patients with no intraoperative complications reported. Intraoperative blood loss was minimal (range, 20-150 mL). Median hospital stay was 1 day (range, <1-2 d). Spondylolisthesis grade was improved after axial lumbar interbody fusion (P<0.001) with 50% (13 of 26) of patients showing a reduction of at least 1 grade. Axial pain severity improved from 8.1±1.4 at baseline to 2.8±2.3 after axial lumbar interbody fusion, representing a 66% reduction from baseline (95% confidence interval, 54.3%-77.9%). At 2-year posttreatment, all patients showed solid fusion. Using Odom criteria, 81% of patients were judged as excellent or good (16 excellent, 5 good, 3 fair, and 2 poor). There were no perioperative procedure-related complications including infection or bowel perforation. During postoperative follow-up, 4 patients required reintervention due to recurrent radicular (n=2) or screw-related (n=2) pain. CONCLUSIONS: The minimally invasive presacral axial interbody fusion and posterior instrumentation technique is a safe and effective treatment for low-grade isthmic spondylolisthesis.

Gerszten PC; Tobler W; Raley TJ; Miller LE; Block JE; Nasca RJ

2012-04-01

 
 
 
 
61

Which posterior instrumentation is better for two-level anterior lumbar interbody fusion: translaminar facet screw or pedicle screw?  

UK PubMed Central (United Kingdom)

PURPOSE: To determine whether translaminar facet screws can provide stability equivalent to pedicle screws and whether the two posterior instrumentations have the same influence on the adjacent segments in two-level anterior lumbar interbody fusion. METHODS: In a biomechanical study conducted, we used 12 fresh human lumbar spines and tested an intact spine with a stand-alone two-level anterior lumbar interbody fusion and anterior fusion augmented with pedicle screws or translaminar facet screws, under 400 N compressive preloads and 7.5 N m moments in flexion, extension, axial rotation and lateral bending, and measured the stiffness of the operated level, range of motion and intradiscal pressure at the adjacent levels. RESULTS: We found a significant increase in the stiffness of the segments operated, range of motion and intradiscal pressure at the adjacent superior segment in the stand-alone two-level anterior lumbar interbody fusion during flexion, axial rotation and lateral bending, but a decrease in extension, when compared with the intact spine. The stiffness of operated segments, range of motion and intradiscal pressure in the adjacent segment are significantly higher in the two-level anterior lumbar interbody fusion augmented with posterior instrumentation than in the stand-alone two-level anterior lumbar interbody fusion. There was no significant difference between the two augmented constructs except that, at the adjacent superior segment, the intradiscal pressure was more in the construction augmented with a pedicle screw than with a translaminar facet screw in flexion. CONCLUSIONS: Translaminar facet screws can provide stability equivalent to pedicle screws, but their influence on the adjacent segments is relatively lower; therefore, we suggest that translaminar facet screws be the choice in the optimal posterior instrumentation in a two-level anterior lumbar interbody fusion.

Hou Y; Shen Y; Liu Z; Nie Z

2013-01-01

62

Posterior migration of fusion cages in degenerative lumbar disease treated with transforaminal lumbar interbody fusion: a report of three patients.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: A case report of 3 patients with posterior migration of bullet-shaped fusion cages after transforaminal lumbar interbody fusion (TLIF). One patient required emergency revision surgery; the other 2 patients are being observed during conservative treatment. OBJECTIVE: To review cases of posterior migration of fusion cages and report ensuing clinical courses. SUMMARY OF BACKGROUND DATA: TLIF is a commonly used procedure; however, there are few reports describing cage migration after the procedure. In most cases, when posterior cage migration follows posterior lumbar interbody fusion, emergency revision surgery is required. One recent study reported a case of posterior cage migration after TLIF, which was treated conservatively. METHODS: Posterior migration of the bullet-shaped fusion cages occurred 1 to 2 months after TLIF in 3 patients. One of the 3 patients had isthmic spondylolisthesis treated by TLIF with bilateral pedicle screw fixation. The other 2 patients had degenerative scoliosis and were treated by TLIF with unilateral pedicle screw fixation. RESULTS: The patient with isthmic spondylolisthesis required revision surgery because the migrated cage caused nerve root irritation. The migrated cage was removed and a large-sized cage was employed to achieve stability. The other 2 patients had no pathologic symptoms after the posterior migration of the cage and were treated conservatively and observed. CONCLUSION: Revision surgery after TLIF appears relatively safe because the migrated cage tends to locate more laterally than in patients with cage migration after posterior lumbar interbody fusion. Cage migration subsequent to TLIF may not cause compression of neural tissues, so conservative treatment may suffice for these patients. Unilateral pedicle screw fixation may not provide sufficient stability to prevent cage migration in patients with degenerative scoliosis. Further study is needed to clarify surgical indications for unilateral pedicle screw fixation in TLIF.

Aoki Y; Yamagata M; Nakajima F; Ikeda Y; Takahashi K

2009-01-01

63

AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion  

Directory of Open Access Journals (Sweden)

Full Text Available Steven M Rapp1, Larry E Miller2,3, Jon E Block31Michigan Spine Institute, Waterford, MI, USA; 2Miller Scientific Consulting Inc, Biltmore Lake, NC, USA; 3Jon E. Block, Ph.D., Inc., San Francisco, CA, USAAbstract: Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF) system is a minimally invasive fusion device that accesses the lumbar (L4–S1) intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.Keywords: AxiaLIF, fusion, lumbar, minimally invasive, presacral

Rapp SM; Miller LE; Block JE

2011-01-01

64

Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion.  

Science.gov (United States)

The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts. PMID:23596239

Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

2013-04-17

65

Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

Maraki S; Bantouna V; Lianoudakis E; Stavrakakis I; Scoulica E

2013-07-01

66

A radiological and cadaveric study of oblique lumbar interbody fixation in patients with normal spinal anatomy.  

Science.gov (United States)

The purpose of this study was to determine whether it would be feasible to use oblique lumbar interbody fixation for patients with degenerative lumbar disease who required a fusion but did not have a spondylolisthesis. A series of CT digital images from 60 patients with abdominal disease were reconstructed in three dimensions (3D) using Mimics v10.01: a digital cylinder was superimposed on the reconstructed image to simulate the position of an interbody screw. The optimal entry point of the screw and measurements of its trajectory were recorded. Next, 26 cadaveric specimens were subjected to oblique lumbar interbody fixation on the basis of the measurements derived from the imaging studies. These were then compared with measurements derived directly from the cadaveric vertebrae. Our study suggested that it is easy to insert the screws for L1/2, L2/3 and L3/4 fixation: there was no significant difference in measurements between those of the 3-D digital images and the cadaveric specimens. For L4/5 fixation, part of L5 inferior articular process had to be removed to achieve the optimal trajectory of the screw. For L5/S1 fixation, the screw heads were blocked by iliac bone: consequently, the interior oblique angle of the cadaveric specimens was less than that seen in the 3D digital images. We suggest that CT scans should be carried out pre-operatively if this procedure is to be adopted in clinical practice. This will assist in determining the feasibility of the procedure and will provide accurate information to assist introduction of the screws. PMID:23814253

Wu, A M; Tian, N F; Wu, L J; He, W; Ni, W F; Wang, X Y; Xu, H Z; Chi, Y L

2013-07-01

67

A radiological and cadaveric study of oblique lumbar interbody fixation in patients with normal spinal anatomy.  

UK PubMed Central (United Kingdom)

The purpose of this study was to determine whether it would be feasible to use oblique lumbar interbody fixation for patients with degenerative lumbar disease who required a fusion but did not have a spondylolisthesis. A series of CT digital images from 60 patients with abdominal disease were reconstructed in three dimensions (3D) using Mimics v10.01: a digital cylinder was superimposed on the reconstructed image to simulate the position of an interbody screw. The optimal entry point of the screw and measurements of its trajectory were recorded. Next, 26 cadaveric specimens were subjected to oblique lumbar interbody fixation on the basis of the measurements derived from the imaging studies. These were then compared with measurements derived directly from the cadaveric vertebrae. Our study suggested that it is easy to insert the screws for L1/2, L2/3 and L3/4 fixation: there was no significant difference in measurements between those of the 3-D digital images and the cadaveric specimens. For L4/5 fixation, part of L5 inferior articular process had to be removed to achieve the optimal trajectory of the screw. For L5/S1 fixation, the screw heads were blocked by iliac bone: consequently, the interior oblique angle of the cadaveric specimens was less than that seen in the 3D digital images. We suggest that CT scans should be carried out pre-operatively if this procedure is to be adopted in clinical practice. This will assist in determining the feasibility of the procedure and will provide accurate information to assist introduction of the screws.

Wu AM; Tian NF; Wu LJ; He W; Ni WF; Wang XY; Xu HZ; Chi YL

2013-07-01

68

Excessive distraction of lumbar disc space induces early degeneration of the adjacent segment after posterior lumbar interbody fusion (PLIF)  

International Nuclear Information System (INIS)

Posterior lumbar interbody fusion (PLIF) for lumbar spondylolisthesis usually results in an excellent outcome, but the problem of so-called adjacent segment disease (ASD) remains unresolved. ASD at L3/4 was investigated in 85 patients with LA spondylolisthesis treated by L4/5 PLIF with uniform pedicle screws and interbody cages who had been followed up for more than two years (mean, 38.8±17.1 months). The patients were divided into three groups according to the final outcome: a group without ASD (n=58), a group with radiological ASD (n=14), and a group with clinical ASD (n=13). Eleven patients in the third group were reoperated to treat L3/4 lesions. L4-5 disc height distraction by cage insertion in the three groups was 3.1 mm, 4.4 mm, and 6.2 mm, respectively, and the latter two values were significantly higher than the first value. Excessive distraction of the L4/5 disc space proved to be a significant risk factor for radiological and clinical ASD at L3/4. (author)

2008-01-01

69

Would an anatomically shaped lumbar interbody cage provide better stability? An in vitro cadaveric biomechanical evaluation.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: A biomechanical cadaveric study of lumbar spine segments. OBJECTIVE: To compare the immediate stability provided by parallel-shaped and anatomically shaped carbon fiber interbody fusion I/F cages in posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) constructs with posterior pedicle screw instrumentation. SUMMARY OF BACKGROUND DATA: Few biomechanical data are available on the anatomically shaped cages in PLIF and TLIF constructs. METHODS: Twenty human lumbar segments were tested in flexion-extension (FE) (8 N m flexion, 6 N m extension), lateral bending (LB) (± 6 N m), and torsional loading (± 5 N m). Each segment was tested in the intact state and after insertion of interbody cages in one of 3 constructs: PLIF with 2 parallel-shaped or anatomically shaped cages and TLIF with 1 anatomically shaped cage. All cages received supplementary pedicle screw fixation. The range-of-motion (ROM) values after cage insertion and posterior fixation were compared with the intact specimen values using analysis of variance and multiple comparisons with Bonferroni correction. RESULTS: All constructs significantly reduced segmental motion relative to intact (P < 0.001). The motion reductions in FE, LB, and axial rotation were 85 ± 15%, 83 ± 18%, and 67 ± 6.8% for the PLIF construct using parallel cages, 79 ± 5.5%, 87 ± 10%, and 66 ± 20% for PLIF using anatomically shaped cages, and 90 ± 6.8%, 87 ± 12%, and 77 ± 22% for TLIF with an anatomically shaped cage. In FE and LB, the reductions in the ROM caused between the 3 constructs were equivalent (P > 0.05). In axial rotation, the TLIF cage provided significantly greater limitation in the ROM compared with the parallel-shaped PLIF cage (P = 0.01). CONCLUSIONS: The parallel-shaped and anatomically shaped I/F cages provided similar stability in a PLIF construct. The greater stability of the TLIF construct was likely due to a more anterior placement of the TLIF cage and preservation of the contralateral facet joint.

Tsitsopoulos PP; Serhan H; Voronov LI; Carandang G; Havey RM; Ghanayem AJ; Patwardhan AG

2012-12-01

70

Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease.  

Science.gov (United States)

There is increasing interest in the use of pelvic indices to evaluate sagittal balance and predict outcomes in patients with spinal disease. Conventional posterior lumbar fusion techniques may adversely affect lumbar lordosis and spinal balance. Minimally invasive fusion of the lumbar spine is rapidly becoming a mainstay of treatment of lumbar degenerative disc disease. To our knowledge there are no studies evaluating the effect of extreme lateral interbody fusion (XLIF) on pelvic indices. Hence, our aim was to study the effect of XLIF on pelvic indices related to sagittal balance, and report the results of a prospective longitudinal clinical study and retrospective radiographic analyses of patients undergoing XLIF in a single centre between January 2009 and July 2011. Clinical outcomes are reported for 30 patients and the retrospective analyses of radiographic data is reported for 22 of these patients to assess global and segmental lumbar lordosis and pelvic indices. Effect of XLIF on the correction of scoliotic deformity was assessed in 15 patients in this series. A significant improvement was seen in the visual analogue scale score, the Oswestry Disability Index and the Short Form-36 at 2months and 6months (p0.2). Global lumbar lordosis was not affected by XLIF (p>0.4). XLIF significantly increased segmental lumbar lordosis by 3.3° (p<0.0001) and significantly decreased the scoliotic Cobb angle by 5.9° (p=0.01). We found that XLIF improved scoliosis and segmental lordosis and was associated with significant clinical improvement in patients with lumbar degenerative disc disease. However, XLIF did not change overall lumbar lordosis or significantly alter pelvic indices associated with sagittal balance. Long-term follow-up with a larger cohort will be required to further evaluate the effects of XLIF on sagittal balance. PMID:23375396

Johnson, R D; Valore, A; Villaminar, A; Comisso, M; Balsano, M

2013-01-30

71

Contralateral psoas seroma after transpsoas lumbar interbody fusion with bone morphogenetic protein-2 implantation.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: The lateral transpsoas approach to interbody fusion of the lumbar spine (lateral lumbar interbody fusion [LLIF]) with recombinant human bone morphogenetic protein-2 (BMP-2) augmentation has been increasingly performed in recent years. Potential side effects and adverse sequelae of BMP-2 in the acute setting remain to be fully elucidated. PURPOSE: To review the literature for reports of complications related to BMP-2 implantation in lumbar spinal surgery and present a case of a contralateral psoas muscle seroma after LLIF with BMP-2 implantation. STUDY DESIGN: Case report and literature review. METHODS: The PubMed database was searched for articles related to adverse events to BMP-2 in lumbar spinal surgery. We report the case of a 57-year-old woman who underwent routine right-sided transpsoas approach for LLIF with the use of BMP-2 at our institution and developed a left-sided psoas muscle fluid accumulation 2 weeks postoperatively. RESULTS: No reports of complications contralateral to an LLIF approach attributable to an inflammatory response to BMP-2 were identified in the English literature. In the presented patient, a large (4.2×6.5×2.7 cm) left-sided sterile intramuscular psoas fluid collection was seen on a magnetic resonance imaging study obtained on postoperative day 14. At a 6-month follow-up, left-sided L5 radiculopathy resulting in 4/5 foot drop was confirmed by electromyography. The patient reported here represents the only case of a contralateral psoas seroma with suspected association to BMP-2 utilization in LLIF encountered at our institution. CONCLUSIONS: A serous psoas muscle fluid accumulation after BMP-2 implantation may rarely occur contralateral to the surgical approach for LLIF. Further characterization of complications related to BMP-2 implantation after lumbar spinal surgery will help guide preoperative informed decision making and the management of this unusual postoperative adverse event.

Taher F; Lebl DR; Hughes AP; Girardi FP

2013-02-01

72

[Experimental study of laparoscopical lumbar interbody fusion with polyporus composite phosphate calcium and rhBMP-2 compounds in sheep].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To study the efficacy of polyporus composite phosphate calcium and rhBMP-2 compounds with laparoscopical lumbar interbody fusion in sheep. METHODS: Fourteen uniform-weight adult sheep were randomly divided into three groups for LA-5 interbody fusion with titanium mesh. Autogenous bone and titanium mesh was applied with open anterior technique in group 1 (n=4). In group 2, 4 sheep were operated with laparoscope technique for LA-5 interbody fusion with composite phosphate calcium (CPC) and titanium mesh. In group 3, 6 sheep underwent laparoscopical L4-5 interbody fusion with titanium mesh as well as polyporus composite phosphate calcium and rhBMP-2 compounds. At Weeks 6 and 12 post-operation, the sheep were sacrificed for imaging, biomechanic and morphological examinations. RESULTS: Although there was no statistical difference between open and laparoscopical interbody fusion group when comparing the remaining disc and endplate decorticated, bone fusion occurred in 3 groups after 3 months. A much larger amount of bony callus was observed earlier in laparoscopical L4-5 interbody fusion group with titanium mesh as well as polyporus composite phosphate calcium and rhBMP-2 compounds than two other groups. CONCLUSION: Polyporus composite phosphate calcium and rhBMP-2 compounds are suitable prosthetic materials for clinical trials. When these materials are utilized with a laparoscopical technique, satisfactory interbody fusion may be achieved.

Zhu ZH; Cao P; Liang Y; Gong YC; Zheng T; Zhang XK; Wu WJ

2010-06-01

73

A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study was to compare posterior and anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. These approaches were compared in terms of the operation duration, intraoperative blood loss, bony fusion, intraoperative and postoperative complications, neurological status and the angle of kyphosis. METHODS: Forty-seven patients with thoracic and lumbar tuberculosis who underwent either the posterior or the anterior approach in combination with debridement, interbody autografting and instrumentation from January 2004 to March 2010 were reviewed retrospectively. In group A (n = 25), the posterior approach was combined with debridement, interbody autografting and instrumentation. In group B (n = 22), the anterior approach was performed in addition to debridement, interbody autografting and instrumentation. RESULTS: All cases were followed up for 12-62 months. There was no statistically significant difference between groups in terms of the operation duration, intraoperative blood loss, bony fusion, intraoperative and postoperative complications, neurological status and the angle of kyphosis (p > 0.05). Good clinical outcomes were achieved in both groups. CONCLUSIONS: The posterior approach combined with debridement, interbody autografting and instrumentation is an alternative procedure to treat thoracic and lumbar tuberculosis. The posterior approach is sufficient for lesion debridement. In addition, the posterior approach can maintain spinal stabilisation and prevent loss of corrected vertebral alignment as effectively as the anterior approach.

Pu X; Zhou Q; He Q; Dai F; Xu J; Zhang Z; Branko K

2012-02-01

74

Relaxation response of lumbar segments undergoing disc-space distraction: implications to the stability of anterior lumbar interbody implants.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: A biomechanical study of human cadaveric lumbar spine segments undergoing disc-space distraction for insertion of anterior lumbar interbody implants. OBJECTIVE: To measure the distraction force and its relaxation during a period of up to 3 hours after disc-space distraction as a function of the distraction magnitude and disc level. SUMMARY OF BACKGROUND DATA: Interbody implants depend on compressive preload produced by disc-space distraction (annular pretension) for initial stabilization of the implant-bone interface. However, the amount of preload produced by disc-space distraction due to insertion of the implant and its subsequent relaxation have not been quantified. METHODS: Twenty-two fresh human lumbar motion segments (age: 51 ± 14.8 years) were used. An anterior lumbar discectomy was performed. The distraction test battery consisted of a tension stiffness test performed before and after each relaxation test, 2 distraction magnitudes of 2 and 4 mm, and a recovery period before each distraction input. The distraction forces and lordosis angles were measured. RESULTS.: Peak distraction force was significantly larger for the 4-mm distraction (431.8 ± 116.4 N) than for the 2-mm distraction (204.9 ± 55.5 N) (P < 0.01). The distraction force significantly decreased over time (P < 0.01), approximating steady-state values of 146.1 ± 47.3 N at 2-mm distraction and 289.8 ± 92.8 N at 4-mm distraction, respectively. The distraction force reduced in magnitude by more than 20% of peak value in the first 15 minutes and reduced by approximately 30% of the peak value at the end of the testing period. The spine segment relaxed by the same amount of force, regardless of the disc level (P > 0.05). CONCLUSION: The "tightness of fit" that the surgeon notes immediately after interbody device insertion in the disc space degrades in the very early postoperative period, which could compromise the stability of the bone-implant interface.

Havey RM; Voronov LI; Tsitsopoulos PP; Carandang G; Ghanayem AJ; Lorenz MA; Zindrick MR; Patwardhan AG

2012-04-01

75

Influencing segmental balance in isthmic spondylolisthesis using transforaminal lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The objective of the study was to analyze segmental balance in patients with isthmic spondylolisthesis undergoing single-level transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA: Sagittal malalignment of the fused segment was suggested to be associated with degeneration of the adjacent segment. Meticulous surgical technique and particular attention to hardware positioning with the aim to restore segmental balance at the fusion level have been recommended to achieve better long-term clinical outcomes, but no single study addressed all proposed factors. METHODS: Standard lateral radiographs of the lumbosacral spine in the neutral standing position were retrospectively obtained for 32 patients undergoing single-level TLIF. Preoperative versus postoperative versus final follow-up (12 to 60 mo) values of translational slip (TS), posterior disc space height (PDSH), and segmental lordosis (SL) were compared using paired samples t test. Change in SL postoperatively between groups of next grouping variables: type and position of the interbody device, and rod contouring, was compared using 2-tailed independent samples t test. Association between position of the interbody device and immediate PDSH was addressed with regression analysis postoperatively and at final follow-up. RESULTS: Mean TS decreased (P<0.001) and mean PDSH increased (P=0.002), but no significant change in SL occurred postoperatively (P=0.811). Increase in SL was observed with ventral positioning of the interbody device (P=0.009) and with bending of connecting rods (P=0.023). During follow-up, there was increase in TS (P=0.002) and decrease in PDSH (P<0.001) and SL (P<0.001) compared with postoperative values. Lower PDSH was found to be associated with more ventral positioning of the interbody device, both postoperatively (P=0.035) and at final follow-up (P=0.029). CONCLUSIONS: This study demonstrates that reduction of TS and restoration of disc space height are readily achieved with single-level TLIF. However, to establish an increase in SL consistent rod contouring and meticulous anterior placement of the interbody device should be applied. Excessive ventral positioning of the cages might result in insufficient disc space height restoration.

Recnik G; Košak R; Vengust R

2013-07-01

76

Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for degenerative conditions of the lumbar spine.  

UK PubMed Central (United Kingdom)

This is a retrospective case series to evaluate clinical variables, complications and outcome of 50 patients who underwent anterior lumbar interbody fusion (ALIF) supplemented with posterior percutaneous pedicle screw fixation for degenerative conditions of the lumbar spine. Twenty-four patients underwent single-level fusion and 26 patients had a two-level fusion for a total of 76 levels fused. The mean lengths of the anterior and posterior (including repositioning) portions of the procedure were 131 and 102 min, respectively. The mean estimated blood loss for the entire procedure was 288 ml. The overall adverse event rate was 12%. The mean VAS score for leg pain, VAS score for back pain and mean ODI all improved postoperatively. This study found that ALIF using allograft bone and rhBMP-2 combined with percutaneous pedicle screw fixation had a high fusion rate and a low incidence of perioperative complications. Patient outcomes showed significant improvements in back and leg pain and physical functioning.

Anderson DG; Sayadipour A; Shelby K; Albert TJ; Vaccaro AR; Weinstein MS

2011-08-01

77

Assessment of bioplex interbody fusion device in a sheep lumbar fusion model.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The purpose of this study was to evaluate the bioPlex bioresorbable interbody device in a sheep lumbar fusion model and compare it to the concorde®, a standard carbon fiber interbody cage. BACKGROUND: Lumbar interbody fusion devices are made from a variety of materials, including titanium alloys, carbon-fiber, and PEEK. The BioPlex Continuous Phase Composite (CPC) is a unique bioresorbable material comprised of Pro Osteon 500R and 70:30 Poly (L/D, L-lactic acid). The BioPlex device is radiolucent, resorbable and due to its bulk nanoporosity of 8%, has a more consistent degradation profile as compared to a polymer alone. METHODS: A total of twenty five male Suffolk sheep were used in this study; nineteen of which were implanted with a bioPlex or concorde device at the L3-L4 and L5-L6 levels using a modified transforaminal/lateral approach. A discectomy was performed and each implant (filled with autologous bone) was placed within the disc space. The sheep were sacrificed at 6, 12, 24 months postimplantation. Fusion was assessed via motion, radiographic and histological data. RESULTS: The BioPlex and Concorde implanted levels had significantly less motion (p<0.05) than the normal controls in flexion/extension and lateral bending at 6, 12, and 24 months. No significant difference in motion was detected between the bioPlex and concorde implants. CT fusion scores correlated with the motion analysis in all the three cases. CONCLUSION: In comparison to the concorde device, the bioPlex implant appears to have equivalent radiographic and biomechanical fusion success.

Fredericks DC; Gandhi AA; Grosland NM; Smucker JD

2013-01-01

78

Beta-tricalcium phosphate as a substitute for autograft in interbody fusion cages in the canine lumbar spine.  

UK PubMed Central (United Kingdom)

OBJECT: An interbody fusion cage has been introduced for cervical anterior interbody fusion. Autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies. Thus, donor site-related complications can still occur. In this study a synthetic ceramic, beta-tricalcium phosphate (TCP), was examined as a substitute for autograft bone in a canine lumbar spine model. METHODS: In 12 dogs L-1 to L-4 vertebrae were exposed via a posterolateral approach, and discectomy and placement of interbody fusion cages were performed at two intervertebral disc spaces. One cage was filled with autograft (Group A) and the other with TCP (Group B). The lumbar spine was excised at 16 weeks postsurgery, and biomechanical, microradiographic, and histological examinations were performed. Both the microradiographic and histological examinations revealed that fusion occurred in five (41.7%) of 12 operations performed in Group A and in six (50%) of 12 operations performed in Group B. The mean percentage of trabecular bone area in the cages was 54.6% in Group A and 53.8% in Group B. There were no significant intergroup differences in functional unit stiffness. CONCLUSIONS: Good histological and biomechanical results were obtained for TCP-filled interbody fusion cages. The results were comparable with those obtained using autograft-filled cages, suggesting that there is no need to harvest iliac bone or to use allo- or xenografts to increase the interlocking strength between the cage and vertebral bone to achieve anterior cervical interbody fusion.

Ohyama T; Kubo Y; Iwata H; Taki W

2002-10-01

79

Minimally invasive unilateral pedicle screw fixation and lumbar interbody fusion for the treatment of lumbar degenerative disease.  

UK PubMed Central (United Kingdom)

Minimally invasive unilateral pedicle screw fixation for the treatment of degenerative lumbar diseases has won the support of many surgeons. However, few data are available regarding clinical research on unilateral pedicle screw fixation associated with minimally invasive techniques for the treatment of lumbar spinal diseases. The purpose of this study was to evaluate clinical outcomes in a selected series of patients with lumbar degenerative diseases treated with minimally invasive unilateral vs classic bilateral pedicle screw fixation and lumbar interbody fusion. Patients in the unilateral group (n=43) underwent minimally invasive unilateral pedicle screw fixation with the Quadrant system (Medtronic, Memphis, Tennessee). The bilateral group (n=42) underwent bilateral instrumentation via the classic approach. Visual analog scale pain scores, Oswestry Disability Index scores, fusion rate, operative time, blood loss, and complications were analyzed. Mean operative time was 75 minutes in the unilateral group and 95 minutes in the bilateral group. Mean blood loss was 220 mL in the unilateral group and 450 mL in the bilateral group. Mean postoperative visual analog scale pain score was 3.10±0.16 in the unilateral group and 3.30±1.10 in the bilateral group. Mean postoperative Oswestry Disability Index score was 15.67±2.3 in the unilateral group and 14.93±2.6 in the bilateral group. Successful fusion was achieved in 92.34% of patients in the unilateral group and 93.56% of patients in the bilateral group. Minimally invasive unilateral pedicle screw fixation is an effective and reliable option for the surgical treatment of lumbar degenerative disease. It causes less blood loss, requires less operative time, and has a fusion rate comparable with that of conventional bilateral fixation.

Lin B; Xu Y; He Y; Zhang B; Lin Q; He M

2013-08-01

80

Minimally invasive unilateral pedicle screw fixation and lumbar interbody fusion for the treatment of lumbar degenerative disease.  

Science.gov (United States)

Minimally invasive unilateral pedicle screw fixation for the treatment of degenerative lumbar diseases has won the support of many surgeons. However, few data are available regarding clinical research on unilateral pedicle screw fixation associated with minimally invasive techniques for the treatment of lumbar spinal diseases. The purpose of this study was to evaluate clinical outcomes in a selected series of patients with lumbar degenerative diseases treated with minimally invasive unilateral vs classic bilateral pedicle screw fixation and lumbar interbody fusion. Patients in the unilateral group (n=43) underwent minimally invasive unilateral pedicle screw fixation with the Quadrant system (Medtronic, Memphis, Tennessee). The bilateral group (n=42) underwent bilateral instrumentation via the classic approach. Visual analog scale pain scores, Oswestry Disability Index scores, fusion rate, operative time, blood loss, and complications were analyzed. Mean operative time was 75 minutes in the unilateral group and 95 minutes in the bilateral group. Mean blood loss was 220 mL in the unilateral group and 450 mL in the bilateral group. Mean postoperative visual analog scale pain score was 3.10±0.16 in the unilateral group and 3.30±1.10 in the bilateral group. Mean postoperative Oswestry Disability Index score was 15.67±2.3 in the unilateral group and 14.93±2.6 in the bilateral group. Successful fusion was achieved in 92.34% of patients in the unilateral group and 93.56% of patients in the bilateral group. Minimally invasive unilateral pedicle screw fixation is an effective and reliable option for the surgical treatment of lumbar degenerative disease. It causes less blood loss, requires less operative time, and has a fusion rate comparable with that of conventional bilateral fixation. PMID:23937756

Lin, Bin; Xu, Yang; He, Yong; Zhang, Bi; Lin, Qiuyan; He, Mingchang

2013-08-01

 
 
 
 
81

Comparison of lumbar interbody fusion performed with unilateral or bilateral pedicle screw.  

UK PubMed Central (United Kingdom)

Currently, bilateral pedicle screw fixation is the standard of instrumentation, providing rigid fixation and an increased fusion rate. However, due to the excessive rigidity of the system, this instrumentation has been suspected to cause degeneration of adjacent segments. Alternatively, less rigid unilateral pedicle fixation is considered to be as effective as bilateral constructs. Few studies have compared unilateral and bilateral constructs in the treatment of lumbar degenerative disease. The purpose of this retrospective study was to evaluate possible differences between unilateral and bilateral pedicle screw fixation for single-level lumbar degenerative disease.Between October 2006 and October 2010, sixty consecutive patients were treated with unilateral pedicle screw fixation (28 patients) or bilateral pedicle screw fixation (32 patients) at the authors' institution. Oswestry Disability Index and visual analog scale scores showed a statistical difference between preoperative values and 3- and 6-month postoperative values (P<.05). Unilateral fixation resulted in shorter operative times and less intraoperative blood loss. No significant difference was found between the 2 fixation methods in terms of fusion rate and complication rate (P>.05).Lumbar interbody fusion with unilateral pedicle screw fixation was an effective and convenient method of treatment of single-level lumbar degenerative disease, with little surgical trauma.

Mao L; Chen GD; Xu XM; Guo Z; Yang HL

2013-04-01

82

Differences in early osteogenesis and bone micro-architecture in anterior lumbar interbody fusion with rhBMP-2, equine bone protein extract, and autograft  

DEFF Research Database (Denmark)

To investigate the microstructural differences and responsible mechanisms in early bone formation in anterior lumbar interbody fusion (ALIF) in the spine using rhBMP-2 (INFUSE), equine bone protein extract (COLLOSS E) or autograft.

Foldager, Casper; Bendtsen, Michael

2009-01-01

83

Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

OBJECT: Clinical results for unilateral pedicle screw fixation after lumbar interbody fusion have been reported to be as good as those for bilateral instrumentation. However, no studies have directly compared unilateral and bilateral percutaneous pedicle screw fixation after minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to determine whether unilateral percutaneous pedicle screw fixation is comparable with bilateral percutaneous pedicle screw fixation in 1-segment MIS TLIF. METHODS: This was a prospective randomized study of 53 patients who underwent unilateral or bilateral percutaneous pedicle screw fixation after MIS TLIF for 1-segment lumbar degenerative disc disease. Twenty-six patients were assigned to a unilateral percutaneous pedicle screw fixation group and 27 patients were assigned to a bilateral percutaneous pedicle screw fixation group. Operative time, blood loss, clinical outcomes (that is, Oswestry Disability Index [ODI] and visual analog scale [VAS] scores), complication rates, and fusion rates were assessed using CT scanning 2 years after surgical treatment. RESULTS: The 2 groups were similar in age, sex, preoperative diagnosis, and operated level, and they did not differ significantly in the length of follow-up (27.5 [Group 1] vs 28.9 [Group 2] months) or clinical results. Both groups showed substantial improvements in VAS and ODI scores 2 years after surgical treatment. The groups differed significantly in operative time (unilateral 84.2 minutes; bilateral 137.6 minutes), blood loss (unilateral 92.7 ml; bilateral, 232.0 ml), fusion rate (unilateral 84.6%; bilateral 96.3%), and postoperative scoliotic change (unilateral 23.1%; bilateral 3.7%). CONCLUSIONS: Unilateral and bilateral screw fixation after MIS TLIF produced similar clinical results. Although perioperative results were better with unilateral screw fixation, the long-term results were better with bilateral screw fixation, suggesting bilateral screw fixation is a better choice after MIS TLIF.

Choi UY; Park JY; Kim KH; Kuh SU; Chin DK; Kim KS; Cho YE

2013-08-01

84

MRI measurement of neuroforaminal dimension at the index and supradjacent levels after anterior lumbar interbody fusion: a prospective study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Anterior interbody fusion has previously been demonstrated to increase neuroforaminal height in a cadaveric model using cages. No prior study has prospectively assessed the relative change in magnetic resonance imaging (MRI) demonstrated neuroforaminal dimensions at the index and supradjacent levels, after anterior interbody fusion with a corticocancellous allograft in a series of patients without posterior decompression. The objective of this study was to determine how much foraminal dimension can be increased with indirect foraminal decompression alone via anterior interbody fusion, and to determine the effect of anterior lumbar interbody fusion on the dimensions of the supradjacent neuroforamina. METHODS: A prospective study comparing pre- and postoperative neuroforaminal dimensions on MRI scan among 26 consecutive patients undergoing anterior lumbar interbody fusion without posterior decompression was performed. We studies 26 consecutive patients (50 index levels) that had undergone anterior interbody fusion followed by posterior pedicle screw fixation without distraction or foraminotomy. We used preoperative and postoperative MRI imaging to assess the foraminal dimensions at each operated level on which the lumbar spine had been operated. The relative indirect foraminal decompression achieved was calculated. The foraminal dimension of the 26 supradjacent untreated levels was measured pre- and postoperatively to serve as a control and to determine any effects after anterior interbody fusion. RESULTS: In this study, 8 patients underwent 1 level fusion (L5-S1), 12 patients had 2 levels (L4-S1) and 6 patients had 3 levels (L3-S1). The average increase in foraminal dimension was 43.3% (p < 0.05)-19.2% for L3-4, 57.1% for L4-5, and 40.1% for L5-S1. Mean pre- and postoperative supradjacent neuroforaminal dimension measurements were 125.84 mm(2) and 124.89 mm(2), respectively. No significant difference was noted (p > 0.05). CONCLUSIONS: Anterior interbody fusion with a coriticocancellous allograft can significantly increase neuroforaminal dimension even in the absence of formal posterior distraction or foraminotomy; anterior interbody fusion with a coriticocancellous allograft has little effect on supradjacent neuroforaminal dimensions.

Cho W; Sokolowski MJ; Mehbod AA; Denis F; Garvey TA; Perl J; Transfeldt EE

2013-03-01

85

Minimally invasive unilateral approach for bilateral decompression of spinal stenosis and modified transforaminal lumbar interbody fusion for degenerative spondylolisthesis.  

Science.gov (United States)

This video describes a minimally invasive approach for treatment of symptomatic grade I spondylolisthesis and high-grade spinal stenosis. In this procedure, a unilateral approach for bilateral decompression is utilized in conjunction with a modified transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation. The key steps in the procedure are outlined, and include positioning, fluoroscopic positioning/guidance, exposure with tubular retractor system, technique for ipsilateral and contra-lateral decompression, disc space preparation and interbody grafting, percutaneous pedicle screw and rod placement, and closure. The video can be found here: http://youtu.be/QTymO4Cu4B0. PMID:23829853

Chen, Kevin S; Than, Khoi D; Lamarca, Frank; Park, Paul

2013-07-01

86

Long-term follow-up of minimal-access and open posterior lumbar interbody fusion for spondylolisthesis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although posterior lumbar interbody fusion (PLIF) is regarded as an effective treatment for spondylolisthesis, few studies have reported comprehensive, long-term outcome data, and none has investigated the incidence of deterioration of outcomes. OBJECTIVE: To determine and compare the success rates and long-term stability of outcomes of open PLIF and minimal-access PLIF in the treatment of radicular pain and back pain in patients with spondylolisthesis. METHODS: Forty-three patients were followed for a minimum of 3 years. They completed a Short-Form Health Survey and visual analog scores for back pain and leg pain and underwent lumbar spine radiography. Outcomes were compared with baseline data and 12-month data. RESULTS: Surgery succeeded in reducing listhesis and increasing disc height, but had little effect on lumbar lordosis or the angulation of the segment treated. At 12 months after surgery, listhesis was reduced, disc height was increased, leg pain was reduced or eliminated, and physical functioning restored. Back pain was less often relieved. These outcomes were largely maintained over the ensuing 2 years. Only 5% to 10% of patients reported deterioration in their relief of pain. Depending on the definition adopted for success, the long-term success rate of PLIF may be as high as 70%. CONCLUSION: For the relief of leg pain, the success rates of open PLIF (70%) and minimal-access PLIF (67%) for spondylolisthesis are high and durable in the long-term. PLIF is less often successful in relieving back pain, but the outcomes are maintained. The outcomes of open PLIF and minimal-access PLIF were statistically indistinguishable. ABBREVIATIONS: MCIC, minimally clinically important changeMPLIF, minimal-access posterior lumbar interbody fusionOPLIF, open-access posterior lumbar interbody fusionPLIF, posterior lumbar interbody fusionSF-36, Short-Form Health Survey.

Cheung NK; Ferch RD; Ghahreman A; Bogduk N

2013-03-01

87

[Short-term effectiveness of nano-hydroxyapatite/polyamide-66 intervertebral cage for lumbar interbody fusion in patients with lower lumbar degenerative diseases].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate the short-term effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) intervertebral cage for lumbar interbody fusion in the patients with lower lumbar degenerative diseases. METHODS: Between January and October 2011, 20 patients with lower lumbar degenerative diseases underwent transforaminal lumbar interbody fusion with n-HA/PA66 intervertebral cage. There were 8 males and 12 females, aged 22-80 years (mean, 51 years). The disease duration was 1 to 24 months (mean, 4 months). L4,5 fusion was performed in 8 cases, L5, S1 fusion in 9 cases, and L4-S1 fusion in 3 cases. Among 20 cases, 3 were diagnosed as having recurrent lumbar disc protrusion, 5 as having lumbar degenerative spondylolisthesis, 9 as having lumbar isthmic spondylolisthesis, and 3 as having lumbar spinal stenosis. The intervertebral height and lordosis were measured on X-ray film to assess the surgical correction and postoperative sustain while osseous fusion was observed on 3-dimensional CT. The Oswestry disability index (ODI) and short-form 36 health survey scale (SF-36) scores were obtained to assess the status of clinical recovery. RESULTS: All patients had incision healing by first intention. The pain and numb were relieved in varying degrees after operation. No cerebrospinal leakage, nerve root injury, or wound infection was occurred. All patients were followed up 6-9 months (mean, 7 months). No cage displacement or collapse was found. The intervertebral height and lordosis of single fusion segment were significantly improved at 3 days and 3, 6 months after operation when compared with those at preoperation (P < 0.01); there was no significant difference among each time point after operation (P > 0.05). The fusion rate was 74% at 3 months after operation and 96% at 6 months after operation, with an average of 4 months (range, 3-9 months) for interbody fusion. The ODI and SF-36 scores were significantly improved at 3 days and 6 months after operation when compared with the scores at preoperation (P < 0.01); there was no significant difference among each time point after operation (P > 0.05). CONCLUSION: The interbody fusion with n-HA/PA intervertebral cage is effective and safe to treat the lower lumbar degenerative diseases. The n-HA/PA66 intervertebral cage is an ideal device of interbody fusion with high fusion rate, low subsidence rate, and high transmission X-ray, but the long-term effectiveness need further observation.

Yang X; Song Y; Kong Q; Gong Q; Pei F; Tu C

2012-12-01

88

Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease.  

UK PubMed Central (United Kingdom)

There is increasing interest in the use of pelvic indices to evaluate sagittal balance and predict outcomes in patients with spinal disease. Conventional posterior lumbar fusion techniques may adversely affect lumbar lordosis and spinal balance. Minimally invasive fusion of the lumbar spine is rapidly becoming a mainstay of treatment of lumbar degenerative disc disease. To our knowledge there are no studies evaluating the effect of extreme lateral interbody fusion (XLIF) on pelvic indices. Hence, our aim was to study the effect of XLIF on pelvic indices related to sagittal balance, and report the results of a prospective longitudinal clinical study and retrospective radiographic analyses of patients undergoing XLIF in a single centre between January 2009 and July 2011. Clinical outcomes are reported for 30 patients and the retrospective analyses of radiographic data is reported for 22 of these patients to assess global and segmental lumbar lordosis and pelvic indices. Effect of XLIF on the correction of scoliotic deformity was assessed in 15 patients in this series. A significant improvement was seen in the visual analogue scale score, the Oswestry Disability Index and the Short Form-36 at 2months and 6months (p<0.0001). The mean pelvic index was 48.6°±11.9° (± standard deviation, SD) with corresponding mean sacral slopes and pelvic tilt of 32.0°±10.6° (SD) and 18.0°±9.5 (SD), respectively. XLIF did not significantly affect sacral slope or pelvic tilt (p>0.2). Global lumbar lordosis was not affected by XLIF (p>0.4). XLIF significantly increased segmental lumbar lordosis by 3.3° (p<0.0001) and significantly decreased the scoliotic Cobb angle by 5.9° (p=0.01). We found that XLIF improved scoliosis and segmental lordosis and was associated with significant clinical improvement in patients with lumbar degenerative disc disease. However, XLIF did not change overall lumbar lordosis or significantly alter pelvic indices associated with sagittal balance. Long-term follow-up with a larger cohort will be required to further evaluate the effects of XLIF on sagittal balance.

Johnson RD; Valore A; Villaminar A; Comisso M; Balsano M

2013-04-01

89

Perioperative complications in patients undergoing open transforaminal lumbar interbody fusion as a revision surgery.  

UK PubMed Central (United Kingdom)

OBJECT: Transforaminal lumbar interbody fusion (TLIF) has been increasingly used to treat degenerative spine disease, including that in patients in whom earlier decompressive procedures have failed. Reexploration in these cases is always challenging and is thought to pose a higher risk of complications. To the best of the authors' knowledge, there are no current studies specifically analyzing the effects of previous lumbar decompressive surgeries on the complication rates of open TLIF. METHODS: The authors performed a retrospective study of surgeries performed by a single surgeon. A total of 187 consecutive patients, in whom the senior author (A.N.) had performed open TLIF between January 2007 and January 2011, met the inclusion criteria. The patients were divided into two groups (primary and revision TLIF) for the comparison of perioperative complications. RESULTS: Overall, the average age of the patients was 49.7 years (range 18-80 years). Of the 187 patients, 73 patients had no history of lumbar surgery and 114 were undergoing revision surgery. Fifty-four patients (28.9%) had a documented complication intraoperatively or postoperatively. There was no difference in the rate on perioperative complications between the two groups (overall, medical, wound related, inadvertent dural tears [DTs], or neural injury). Patients who had undergone more than one previous lumbar surgery were, however, more likely to have suffered from DTs (p = 0.054) and neural injuries (p = 0.007) compared with the rest. CONCLUSIONS: In the hands of an experienced surgeon, revision open TLIF does not necessarily increase the risk of perioperative complications compared with primary TLIF. Two or more previous lumbar decompressive procedures, however, increase the risk of inadvertent DTs and neural injury.

Khan IS; Sonig A; Thakur JD; Bollam P; Nanda A

2013-03-01

90

Biomechanical comparison of two different concepts for stand alone anterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

Segmental instability in degenerative disc disease is often treated with anterior lumbar interbody fusion (ALIF). Current techniques require an additional posterior approach to achieve sufficient stability. The test device is an implant which consists of a PEEK-body and an integrated anterior titanium plate hosting four diverging locking screws. The test device avoids posterior fixation by enhancing stability via the locking screws. The test device was compared to an already established stand alone interbody implant in a human cadaveric three-dimensional stiffness test. In the biomechanical test, the L4/5 motion segment of 16 human cadaveric lumbar spines were isolated and divided into two test groups. Tests were performed in flexion, extension, right and left lateral bending, right and left axial rotation. Each specimen was tested in native state first, then a discectomy was performed and either of the test implants was applied. Finite element analysis (FE) was also performed to investigate load and stress distribution within the implant in several loading conditions. The FE models simulated two load cases. These were flexion and extension with a moment of 5 Nm. The biomechanical testing revealed a greater stiffness in lateral bending for the SynFix-LR compared to the established implant. Both implants showed a significantly higher stiffness in all loading directions compared to the native segment. In flexion loading, the PEEK component takes on most of the load, whereas the majority of the extension load is put on the screws and the screw-plate junction. Clinical investigation of the test device seems reasonable based on the good results reported here.

Schleicher P; Gerlach R; Schär B; Cain CM; Achatz W; Pflugmacher R; Haas NP; Kandziora F

2008-12-01

91

Biomechanical comparison of two different concepts for stand alone anterior lumbar interbody fusion.  

Science.gov (United States)

Segmental instability in degenerative disc disease is often treated with anterior lumbar interbody fusion (ALIF). Current techniques require an additional posterior approach to achieve sufficient stability. The test device is an implant which consists of a PEEK-body and an integrated anterior titanium plate hosting four diverging locking screws. The test device avoids posterior fixation by enhancing stability via the locking screws. The test device was compared to an already established stand alone interbody implant in a human cadaveric three-dimensional stiffness test. In the biomechanical test, the L4/5 motion segment of 16 human cadaveric lumbar spines were isolated and divided into two test groups. Tests were performed in flexion, extension, right and left lateral bending, right and left axial rotation. Each specimen was tested in native state first, then a discectomy was performed and either of the test implants was applied. Finite element analysis (FE) was also performed to investigate load and stress distribution within the implant in several loading conditions. The FE models simulated two load cases. These were flexion and extension with a moment of 5 Nm. The biomechanical testing revealed a greater stiffness in lateral bending for the SynFix-LR compared to the established implant. Both implants showed a significantly higher stiffness in all loading directions compared to the native segment. In flexion loading, the PEEK component takes on most of the load, whereas the majority of the extension load is put on the screws and the screw-plate junction. Clinical investigation of the test device seems reasonable based on the good results reported here. PMID:18841399

Schleicher, Philipp; Gerlach, R; Schär, B; Cain, C M J; Achatz, W; Pflugmacher, R; Haas, N P; Kandziora, F

2008-10-08

92

Biomechanical evaluation of stand-alone lumbar polyether-ether-ketone interbody cage with integrated screws.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: Stand-alone interbody cages with integrated screws potentially provide a biomechanically stable solution for anterior lumbar interbody fusion (ALIF) that alleviates the need for additional exposure for supplemental fixation, thereby reducing the chance of additional complications and morbidity. PURPOSE: To compare the stability of a stand-alone anterior interbody fusion system with integrated fixation screws against traditional supplemental fixation methods and to evaluate the difference between three and four fixation screws in the stand-alone cage. STUDY DESIGN: In vitro cadaveric biomechanical study. METHODS: Eight cadaveric lumbar spines (L2-sacrum) were tested using a flexibility protocol consisting of three cycles to ±7.5 Nm in flexion-extension, lateral bending, and axial rotation. The conditions evaluated were intact spine; polyether-ether-ketone cage (zero integrated screws) at L4-L5; cage (zero screws)+bilateral pedicle screws (PS); cage (three screws); cage (four screws); cage (zero screws)+anterior plate; and cage (three screws)+spinous process plate. Motion at the index level was assessed using an optoelectronic system. RESULTS: The cage without integrated screws reduced the motion in flexion-extension and lateral bending (p<.001) compared with that in the intact spine. In axial rotation, mean range of motion (ROM) was 8% greater than in intact spine (p>.962). The addition of three integrated screws reduced ROM significantly compared with the cage without screws in all motion planes (p<.001). A fourth screw had no statistically significant effect on the ROM, although there was a trend toward less motion with four screws compared with three. In flexion-extension, the cage with three integrated screws and the spinous process plate was the most rigid condition. There was no significant difference from the bilateral PS (p=.537); however, this was more rigid than all other conditions (p<.024). The most stable condition in lateral bending and axial rotation was the cage with bilateral PS. In lateral bending, the cage (three or four screws) was not significantly different from the cage with anterior plate or the cage (three screws) with spinous process plate fixation; however, only the latter condition was statistically comparable with bilateral PS. In axial rotation, there were no significant differences between the conditions that included integrated screws or supplemental fixation (p>.081). CONCLUSIONS: Biomechanical testing revealed that the stand-alone cage with integrated screws provides more immediate stability than a cage alone and provides equivalent stability to ALIF constructs with supplemental fixation in lateral bending and axial rotation. Additional flexion-extension rigidity of the anterior cage maybe realized by the addition of a spinous process plate that was found to be as stable as supplemental bilateral PS.

Kornblum MB; Turner AW; Cornwall GB; Zatushevsky MA; Phillips FM

2013-01-01

93

Axial lumbar interbody fusion: a 6-year single-center experience  

Directory of Open Access Journals (Sweden)

Full Text Available Dick J Zeilstra,1 Larry E Miller,2,3 Jon E Block3 1Bergman Clinics, Naarden and NedSpine, Ede, The Netherlands; 2Miller Scientific Consulting, Inc, Arden, NC, USA; 3The Jon Block Group, San Francisco, CA, USA Introduction: The aim of this study is to report our 6-year single-center experience with L5–S1 axial lumbar interbody fusion (AxiaLIF). Methods: A total of 131 patients with symptomatic degenerative disc disease refractory to nonsurgical treatment were treated with AxiaLIF at L5–S1, and were followed for a minimum of 1 year (mean: 21 months). Main outcomes included back and leg pain severity, Oswestry Disability Index score, working status, analgesic medication use, patient satisfaction, and complications. Computed tomography was used to determine postoperative fusion status. Results: No intraoperative complications, including vascular, neural, urologic, or bowel injuries, were reported. Back and leg pain severity decreased by 51% and 42%, respectively, during the follow-up period (both P < 0.001). Back function scores improved 50% compared to baseline. Clinical success, defined as improvement ?30%, was 67% for back pain severity, 65% for leg pain severity, and 71% for back function. The employment rate increased from 47% before surgery to 64% at final follow-up (P < 0.001). Less than one in four patients regularly used analgesic medications postsurgery. Patient satisfaction with the AxiaLIF procedure was 83%. The fusion rate was 87.8% at final follow-up. During follow-up, 17 (13.0%) patients underwent 18 reoperations on the lumbar spine, including pedicle screw fixation (n = 10), total disc replacement of an uninvolved level (n = 3), facet screw fixation (n = 3), facet screw removal (n = 1), and interbody fusion at L4–L5 (n = 1). Eight (6.1%) reoperations were at the index level. Conclusion: Single-level AxiaLIF is a safe and effective means to achieve lumbosacral fusion in patients with symptomatic degenerative disc disease. Keywords: AxiaLIF, interbody, fusion, lumbosacral, minimally invasive, presacral

Zeilstra DJ; Miller LE; Block JE

2013-01-01

94

Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion (PLIF): a multicenter study.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study is to compare bone union rate between autologous iliac bone and local bone graft in patients treated by posterior lumbar interbody fusion (PLIF) using carbon cage for single level interbody fusion. METHODS: The subjects were 106 patients whose course could be observed for at least 2 years. The diagnosis was lumbar spinal canal stenosis in 46 patients, herniated lumbar disk in 12 patients and degenerative spondylolisthesis in 51 patients. Single interbody PLIF was done using iliac bone graft in 53 patients and local bone graft in 56 patients. Existence of pseudo-arthrosis on X-P (AP and lateral view) was investigated during the same follow up period. RESULTS: No significant differences were found in operation time and blood loss. Significant differences were also not observed in fusion grade at any follow up period or in fusion progression between the two groups. Donor site pain continued for more than 3 months in five cases (9%). The final fusion rate was 96.3 versus 98.3%. CONCLUSIONS: Almost the same results in fusion were obtained from both the local bone group and the autologous iliac bone group. Fusion progression was almost the same. Complications at donor sites were seen in 19% of the cases. From the above results, it was concluded that local bone graft is as beneficial as autologous iliac bone graft for PLIF at a single level.

Ito Z; Imagama S; Kanemura T; Hachiya Y; Miura Y; Kamiya M; Yukawa Y; Sakai Y; Katayama Y; Wakao N; Matsuyama Y; Ishiguro N

2013-05-01

95

Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for degenerative conditions of the lumbar spine.  

Science.gov (United States)

This is a retrospective case series to evaluate clinical variables, complications and outcome of 50 patients who underwent anterior lumbar interbody fusion (ALIF) supplemented with posterior percutaneous pedicle screw fixation for degenerative conditions of the lumbar spine. Twenty-four patients underwent single-level fusion and 26 patients had a two-level fusion for a total of 76 levels fused. The mean lengths of the anterior and posterior (including repositioning) portions of the procedure were 131 and 102 min, respectively. The mean estimated blood loss for the entire procedure was 288 ml. The overall adverse event rate was 12%. The mean VAS score for leg pain, VAS score for back pain and mean ODI all improved postoperatively. This study found that ALIF using allograft bone and rhBMP-2 combined with percutaneous pedicle screw fixation had a high fusion rate and a low incidence of perioperative complications. Patient outcomes showed significant improvements in back and leg pain and physical functioning. PMID:21484538

Anderson, D Greg; Sayadipour, Amirali; Shelby, Kevin; Albert, Todd J; Vaccaro, Alexander R; Weinstein, Michael S

2011-04-13

96

Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesis.  

UK PubMed Central (United Kingdom)

PURPOSE: Minimally invasive or "minimal access surgery" (MAS) is being utilized with increasing frequency to reduce approach-related morbidity in the lumbar spine. This paper describes our minimal access technique for posterior bilateral transforaminal lumbar interbody fusion (TLIF) and spinal instrumentation in a patient with high-grade spondylolisthesis grade (Myerding Grade III) with 5-year follow-up. METHODS: A 24-year-old lady presented with mechanical back pain and left leg L5 radiculopathy. On examination, she was a thin lady with an obvious step deformity in the lower lumbar spine and otherwise, a normal neurological examination. Imaging showed a grade III isthmic L5-S1 spondylolisthesis with foraminal stenosis and focal kyphotic alignment of 20° [slip angle (SA) = 70°]. Conservative measures had failed, and a decision was made to proceed with a MAS-TLIF approach. RESULTS: The estimated blood loss was less than 100 ml, operating time 150 min, and post-operative hospital stay was 4 days. Post-operatively the patient had significant improvement of back and radicular pain. Improvement in ODI was substantial and sustained at 5 years. A solid fusion was achieved at 8 months. The slip percentage improved from 68 % (pre-op) to 28 % (post-op) and the focal alignment to 20° lordosis (SA = 110°). CONCLUSIONS: A MAS approach for selected patients with a mobile high-grade spondylolisthesis is feasible, safe and clinically effective, with the added benefit of reduced soft-tissue disruption. Our result of this technique suggests that the ability to correct focal deformity, and achieve excellent radiographic and clinical outcome is similar to the open procedure.

Quraishi NA; Rampersaud YR

2013-08-01

97

Long Term Efficacy of Posterior Lumbar Interbody Fusion with Standard Cages alone in Lumbar Disc Diseases Combined with Modic Changes.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Posterior lumbar interbody fusion (PLIF) is considered to have the best theoretical potential in promoting bony fusion of unstable vertebral segments by way of a load sharing effect of the anterior column. This study was undertaken to investigate the efficacy of PLIF with cages in chronic degenerative disc disease with Modic degeneration (changes of vertebral end plate). METHODS: A total of 597 patients underwent a PLIF with threaded fusion cages (TFC) from 1993 to 2000. Three-hundred-fifty-one patients, who could be followed for more than 3 years, were enrolled in this study. Patients were grouped into 4 categories according to Modic classification (no degeneration : 259, type 1 : 26, type 2 : 55, type 3 : 11). Clinical and radiographic data were evaluated retrospectively. RESULTS: The clinical success rate according to the Prolo's functional and economic outcome scale was 86% in patients without degeneration and 83% in patients with Modic degeneration. The clinical outcomes in each group were 88% in type 1, 84% in type 2, and 73% in type 3. The bony fusion rate was 97% in patients without degeneration and 83% in patients with Modic degeneration. The bony fusion rate in each group was 81% in type 1, 84% in type 2, and 55% in type 3. The clinical success and fusion rates were significantly lower in patients with type 3 degeneration. CONCLUSION: The PLIF with TFC has been found to be an effective procedure for lumbar spine fusion. But, the clinical outcome and bony fusion rates were significantly low in the patients with Modic type 3. The authors suggest that PLIF combined with pedicle screw fixation would be the better for them.

Kwon YM; Chin DK; Jin BH; Kim KS; Cho YE; Kuh SU

2009-10-01

98

The role of Osteocel Plus as a fusion substrate in minimally invasive instrumented transforaminal lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

BACKGROUND: Instrumented lumbar fusion has become an accepted and effective surgical technique used to address a wide variety of conditions of the lumbar spine. Iliac crest autograft remains the gold standard with regards to bony fusion substrate. Unfortunately there are significant potential disadvantages associated with autograft harvest, including pain, infection, iatrogenic fracture and bleeding. Osteocel Plus (OC+) is an allograft cellular bone matrix containing mesenchymal stem cells (MSCs) and osteoprogenitor cells combined with DBM and cancellous bone. OC+ is designed to mimic the osteobiologic profile of human autograft bone, thereby eliminating the risks of autograft harvest. METHODS: A retrospective chart review was conducted to identify all patients who had undergone a MITLIF with OC+ for degenerative lumbar conditions. Patient demographics including age, sex, history of risk factors for nonunion including: osteoporosis documented on DEXA scanning, diabetes mellitus, smoking or steroid use were examined and recorded. Successful arthrodesis was judged based on post-operative X-ray imaging. RESULTS: 23 patients at 26 spinal levels underwent a MITLIF with OC+. Twenty-one patients (91.3%) and 24 levels (92.3%) went on to achieve radiographic evidence of solid bony arthrodesis by 12 months post-op. Six patients (26%) demonstrated clear evidence of early interbody bone growth within 6 months of surgery. CONCLUSION: OC+ results in robust and reproducible lumbar interbody fusion, in both young and older patients.

Ammerman JM; Libricz J; Ammerman MD

2013-07-01

99

Biomechanics of lateral plate and pedicle screw constructs in lumbar spines instrumented at two levels with laterally placed interbody cages.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: The lateral transpsoas approach to interbody fusion is gaining popularity because of its minimally invasive nature and resultant indirect neurologic decompression. The acute biomechanical stability of the lateral approach to interbody fusion is dependent on the type of supplemental internal fixation used. The two-hole lateral plate (LP) has been approved for clinical use for added stabilization after cage instrumentation. However, little biomechanical data exist comparing LP fixation with bilateral pedicle screw and rod (PSR) fixation. PURPOSE: To biomechanically compare the acute stabilizing effects of the two-hole LP and bilateral PSR fusion constructs in lumbar spines instrumented with a lateral cage at two contiguous levels. STUDY DESIGN: Biomechanical laboratory study of human cadaveric lumbar spines. METHODS: Eighteen L1-S1 cadaveric lumbar spines were instrumented with lateral cages at L3-L4 and L4-L5 after intact kinematic analysis. Specimens (n=9 each) were allocated for supplemental instrumentation with either LP or PSR. Intact versus instrumented range of motion was evaluated for all specimens by applying pure moments (±7.5 Nm) in flexion/extension, lateral bending (LB) (left+right), and axial rotation (AR) (left+right). Instrumented spines were later subjected to 500 cycles of loading in all three planes, and interbody cage translations were quantified using a nonradiographic technique. RESULTS: Lateral plate fixation significantly reduced ROM (p<.05) at both lumbar levels (flexion/extension: 49.5%; LB: 67.3%; AR: 48.2%) relative to the intact condition. Pedicle screw and rod fixation afforded the greatest ROM reductions (p<.05) relative to the intact condition (flexion/extension: 85.6%; LB: 91.4%; AR: 61.1%). On average, the largest interbody cage translations were measured in both fixation groups in the anterior-posterior direction during cyclic AR. CONCLUSIONS: Based on these biomechanical findings, PSR fixation maximizes stability after lateral interbody cage placement. The nonradiographic technique served to quantify migration of implanted hardware and may be implemented as an effective laboratory tool for surgeons and engineers to better understand mechanical behavior of spinal implants.

Nayak AN; Gutierrez S; Billys JB; Santoni BG; Castellvi AE

2013-05-01

100

Minimally invasive presacral approach for revision of an Axial Lumbar Interbody Fusion rod due to fall-related lumbosacral instability: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction The purpose of this study was to describe procedural details of a minimally invasive presacral approach for revision of an L5-S1 Axial Lumbar Interbody Fusion rod. Case presentation A 70-year-old Caucasian man presented to our facility with marked thoracolumbar scoliosis, osteoarthritic changes characterized by high-grade osteophytes, and significant intervertebral disc collapse and calcification. Our patient required crutches during ambulation and reported intractable axial and radicular pain. Multi-level reconstruction of L1-4 was accomplished with extreme lateral interbody fusion, although focal lumbosacral symptoms persisted due to disc space collapse at L5-S1. Lumbosacral interbody distraction and stabilization was achieved four weeks later with the Axial Lumbar Interbody Fusion System (TranS1 Inc., Wilmington, NC, USA) and rod implantation via an axial presacral approach. Despite symptom resolution following this procedure, our patient suffered a fall six weeks postoperatively with direct sacral impaction resulting in symptom recurrence and loss of L5-S1 distraction. Following seven months of unsuccessful conservative care, a revision of the Axial Lumbar Interbody Fusion rod was performed that utilized the same presacral approach and used a larger diameter implant. Minimal adhesions were encountered upon presacral re-entry. A precise operative trajectory to the base of the previously implanted rod was achieved using fluoroscopic guidance. Surgical removal of the implant was successful with minimal bone resection required. A larger diameter Axial Lumbar Interbody Fusion rod was then implanted and joint distraction was re-established. The radicular symptoms resolved following revision surgery and our patient was ambulating without assistance on post-operative day one. No adverse events were reported. Conclusions The Axial Lumbar Interbody Fusion distraction rod may be revised and replaced with a larger diameter rod using the same presacral approach.

Cohen Anders; Miller Larry E; Block Jon E

2011-01-01

 
 
 
 
101

Minimally invasive lateral lumbar interbody fusion and transpsoas approach-related morbidity.  

UK PubMed Central (United Kingdom)

OBJECT: Recently, the minimally invasive, lateral retroperitoneal, transpsoas approach to the thoracolumbar spinal column has been described by various authors. This is known as the minimally invasive lateral lumbar interbody fusion. The purpose of this study is to elucidate the approach-related morbidity associated with the minimally invasive transpsoas approach to the lumbar spine. To date, there have been only a couple of reports regarding the morbidity of the transpsoas muscle approach. METHODS: A nonrandomized, prospective study utilizing a self-reported patient questionnaire was conducted between January 2006 and June 2008 at Northwestern University. Data were collected in 53 patients with a follow-up period ranging from 6 months to 3.5 years. Only 2 patients were lost to follow-up. RESULTS: Thirty-six percent (19 of 53) of patients reported subjective hip flexor weakness, 25% (13 of 53) anterior thigh numbness, and 23% (12 of 53) anterior thigh pain. However, 84% of the 19 patients reported complete resolution of their subjective hip flexor weakness by 6 months, and most experienced improved strength by 8 weeks. Of those reporting anterior thigh numbness and pain, 69% and 75% improved to their baseline function by the 6-month follow-up evaluations, respectively. All patients with self-reported subjective hip flexor weakness underwent examinations during subsequent clinic visits after surgery; however, these examinations did not confirm a motor deficit less than Grade 5. Subset analysis showed that the L3-4 and L4-5 levels were most often affected. CONCLUSIONS: The minimally invasive, transpsoas muscle approach to the lumbar spine has a number of advantages. The data show that a percentage of the patients undergoing the transpsoas approach will have temporary sensory and motor symptoms related to this approach. The majority of the symptoms are thought to be related to psoas muscle inflammation and/or stretch injury to the genitofemoral nerve due to the surgical corridor traversed during the operation. No major injuries to the lumbar plexus were encountered. It is important to educate patients prior to surgery of the possibility of these largely transient symptoms.

Moller DJ; Slimack NP; Acosta FL Jr; Koski TR; Fessler RG; Liu JC

2011-10-01

102

Short-term outcome of transforaminal lumbar interbody fusion for lytic and degenerative spondylolisthesis.  

Science.gov (United States)

PURPOSE. To compare early outcome of transforaminal lumbar interbody fusion (TLIF) for lytic versus degenerative spondylolisthesis. METHODS. 14 women and 8 men aged 20 to 60 (mean, 36) years underwent TLIF for lytic (n=15) or degenerative (n=7) spondylolisthesis. Of the 15 patients with lytic spondylolisthesis, 9 involved L4/ L5 and 6 L5/S1. Of the 7 patients with degenerative spondylolisthesis, 3 involved L4/L5, 2 L5/S1, one L2/L3, and one L3/L4. The spondylolistheses were classified as grade II (n=15), grade III (n=4), and retrolisthesis (n=3). 11 patients with lytic and 2 with degenerative spondylolisthesis had sensory deficits (n=12), motor deficits (n=9), and diminished reflexes (n=7). Visual analogue score (VAS) for pain and the Oswestry Disability Index (ODI) of each patient were assessed at months 3, 6, and 12, and 6 monthly thereafter. Fusion status was assessed by radiologists. Comprehensive outcome of each patient was graded as excellent, good, fair, or poor. RESULTS. The mean VAS score for low back pain improved significantly from 7.4 preoperatively to 2.1 at year 1 (pdegenerative spondylolisthesis. PMID:23255650

Ali, Y; Najmus-Sakeb, N; Rahman, M; Mhamud, S

2012-12-01

103

An analysis of fusion cage migration in unilateral and bilateral fixation with transforaminal lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

PURPOSE: To investigate if instrumentation (unilateral vs. bilateral fixation) has an effect on the rate of fusion cage migration. METHODS: This clinical study of transforaminal lumbar interbody fusion involved a prospective group of 116 patients who were randomly assigned to either unilateral (n = 57) or bilateral (n = 59) fixation. Fourteen were lost to follow-up (11 from the unilateral group and 3 from the bilateral group). RESULTS: The unilateral fixation group consisted of 20 male and 26 female patients. In the unilateral group, the mean age was 53.5 years (range, 18-77), and the preoperative diagnosis consisted of degenerative disc disease, with or without herniated disc (n = 44), and degenerative spondylolisthesis with spinal stenosis (n = 2). The bilateral fixation group consisted of 20 male and 36 female patients. In the bilateral group, the mean age was 55.7 years (range, 26-82), and the preoperative diagnosis consisted of degenerative disc disease, with or without herniated disc (n = 40), and degenerative spondylolisthesis with spinal stenosis (n = 16). A total of 17 cases of cage migration were found; of these, 11 were from the unilateral group and 6 from the bilateral group, resulting in rates of cage migration of 23 and 11 % (p = 0.03), respectively. In regard to migration cases, 5 were male and 12 were female. Ages ranged from 27 to 79 years (mean age, 55 years). CONCLUSION: We conclude that unilateral fixation is not stable enough to prevent fusion cage migration in some patients who undergo TLIF.

Duncan JW; Bailey RA

2013-02-01

104

Application of tridimensional intravertebral bone graft combined with AxiaLIF technique in lumbar interbody fusion  

Directory of Open Access Journals (Sweden)

Full Text Available "nLumbar interbody fusion techniques are becoming more and more minimally invasive. AxiaLIF technique can be used in low back pain caused by degenerative disc disease or minor spondylolisthesis, but there are risks for fusion failure. Intravertebral bone graft is performed in painful osteoporotic or posttraumatic vertebral compression fractures (VCFs). Until now, no attempt has been made to apply intravertebral bone graft with AxiaLIF technique."nSo first, we hypothesize a novel method for tridimensional intravertebral bone graft with a special designed bone grafting instrument and describe it vividly. The special instrument would mainly consist of a hollow tube and a rod, the distal parts of them would be shape into 45o slope, so the direction of grafting would be decided by the slope. By rotating the tube we can deliver cancellous bone granules in one plane, but by retreating the tube we can perform tridimensional intravertebral bone graft. Second, intravertebral bone graft is supposed to be performed combined with AxiaLIF technique in order to create biologic vertebral reconstruction and raise fusion rate. We believe this is the first description of such a method, future clinical studies are needed to validate these hypotheses.

Xiangdong Duan; Qingyong Hu; Zhiqiang Wang

2009-01-01

105

Single segment of posterior lumbar interbody fusion for adult isthmic spondylolisthesis: reduction or fusion in situ.  

UK PubMed Central (United Kingdom)

OBJECTIVE: We prospectively compared surgical reduction or fusion in situ with posterior lumbar interbody fusion (PLIF) for adult isthmic spondylolisthesis in terms of surgical invasiveness, clinical and radiographical outcomes, and complications. METHODS: From January 2006 to June 2008, 88 adult patients with isthmic spondylolisthesis who underwent surgical treatment in our unit were randomized to reduced group (group 1, n = 45) and in situ group (group 2, n = 43), and followed up for average 32.5 months (range 24-54 months). The clinical and radiographical outcomes were compared between the two groups. RESULTS: The average operative time and blood loss during surgery showed insignificant difference (p > 0.05) between two groups. The radiological outcomes were significantly better in group 1, but there was no significant difference between two groups of clinical outcomes, depicting as VAS, ODI, JOA and patients' satisfaction surveys. Incident rate of surgical complications was similar in two groups, but in group 1 the complication seemed more severe because of two patients with neurological symptoms. CONCLUSIONS: For the adult isthmic spondylolisthesis without degenerative disease in adjacent level, single segment of PLIF with pedicle screw fixation is an effective and safe surgical procedure regardless of whether additional reduction had been conducted or not. Better radiological outcome does not mean better clinical outcome.

Lian XF; Hou TS; Xu JG; Zeng BF; Zhao J; Liu XK; Yang EZ; Zhao C

2013-06-01

106

Single segment of posterior lumbar interbody fusion for adult isthmic spondylolisthesis: reduction or fusion in situ.  

Science.gov (United States)

OBJECTIVE: We prospectively compared surgical reduction or fusion in situ with posterior lumbar interbody fusion (PLIF) for adult isthmic spondylolisthesis in terms of surgical invasiveness, clinical and radiographical outcomes, and complications. METHODS: From January 2006 to June 2008, 88 adult patients with isthmic spondylolisthesis who underwent surgical treatment in our unit were randomized to reduced group (group 1, n = 45) and in situ group (group 2, n = 43), and followed up for average 32.5 months (range 24-54 months). The clinical and radiographical outcomes were compared between the two groups. RESULTS: The average operative time and blood loss during surgery showed insignificant difference (p > 0.05) between two groups. The radiological outcomes were significantly better in group 1, but there was no significant difference between two groups of clinical outcomes, depicting as VAS, ODI, JOA and patients' satisfaction surveys. Incident rate of surgical complications was similar in two groups, but in group 1 the complication seemed more severe because of two patients with neurological symptoms. CONCLUSIONS: For the adult isthmic spondylolisthesis without degenerative disease in adjacent level, single segment of PLIF with pedicle screw fixation is an effective and safe surgical procedure regardless of whether additional reduction had been conducted or not. Better radiological outcome does not mean better clinical outcome. PMID:23764766

Lian, Xiao-Feng; Hou, Tie-Sheng; Xu, Jian-Guang; Zeng, Bing-Fang; Zhao, Jie; Liu, Xiao-Kang; Yang, Er-Zhu; Zhao, Cheng

2013-06-14

107

Transforaminal lumbar interbody fusion: prognostic factors related to retention in an active duty military population.  

UK PubMed Central (United Kingdom)

Little information is available regarding patient-based factors that may influence results following transforaminal lumbar interbody fusion (TLIF) in younger, high-demand individuals. A query of all TLIF procedures performed on active duty military personnel at our institution was conducted for the time period 2005 to 2008. Data was abstracted, including age, gender, military rank, preoperative diagnosis, complications, and ability to remain in the military. Favorable outcome was defined as the ability of the patient receiving TLIF to remain on active duty, without medical separation (Medical Evaluation Board [MEB]), at a minimum of 1 year postsurgery. Univariate analysis was conducted to identify potential risk factors for MEB. Factors with a univariate p value <0.2 were included in multivariate analysis and sensitivity testing to identify independent predictors of outcome. The cohort included 143 patients with an average age of 36.3 years and mean follow-up of 34.9 months. Younger age (odds ratio 0.93 per year increase in age; 95% confidence interval 0.87, 0.98) and Junior Enlisted rank (odds ratio 6.42; 95% confidence interval 2.20, 18.74) were found to increase the risk of MEB, and these relationships were maintained in the sensitivity analyses. These findings highlight the potential role of activity level and sociodemographic status in outcomes after TLIF in a military population.

Schoenfeld AJ; Thomas D; Bader JO; Bono CM

2013-02-01

108

TranS1 VEO system: a novel psoas-sparing device for transpsoas lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

Minimally invasive approaches for lumbar interbody fusion have been popularized in recent years. The retroperitoneal transpsoas approach to the lumbar spine is a technique that allows direct lateral access to the intervertebral disc space while mitigating the complications associated with traditional anterior or posterior approaches. However, a common complication of this procedure is iatrogenic injury to the psoas muscle and surrounding nerves, resulting in postsurgical motor and sensory deficits. The TranS1 VEO system (TranS1 Inc, Raleigh, NC, USA) utilizes a novel, minimally invasive transpsoas approach to the lumbar spine that allows direct visualization of the psoas and proximal nerves, potentially minimizing iatrogenic injury risk and resulting clinical morbidity. This paper describes the clinical uses, procedural details, and indications for use of the TranS1 VEO system.

Hardenbrook MA; Miller LE; Block JE

2013-01-01

109

Minimally invasive transforaminal lumbar interbody fusion using a single interbody cage and a tubular retraction system : technical tips, and perioperative, radiologic and clinical outcomes.  

UK PubMed Central (United Kingdom)

OBJECTIVE: A minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has recently been introduced. However, MIS TLIF is a technically challenging procedure. The authors performed retrospective analysis about MIS TLIF using a single interbody cage. METHODS: Twenty-eight consecutive patients were treated by MIS TLIF. Of these 28 patients, 20 patients were included in this retrospective study. Perioperative, clinical, and radiologic outcomes were assessed. Clinical outcomes were assessed using Oswestry Disability Index (ODI) and Visual Analogue Scores (VAS). Fusion rates and cross-sections of operated spinal canals were assessed by CT. RESULTS: Twelve patients underwent MIS TLIF at one segment and 8 patients at two segments (L3/4: 4, L4/5: 17, L5/S1: 7). Operation time for a single segment was 131.7 min and for two segment was 201.4 min, and corresponding blood losses were 208.3 mL and 481.2 mL, respectively. ODI and VAS scores were significantly improved at 6 months postop (ODI from 30.32 to 15. 54, VAS from 7.80 to 2.20, p = 0.001). Twenty-two segments (78.6%) achieved grade I fusion, 4 segments (14.3%) achieved grade II, 2 segments (7.1%) achieved grade III and 0 segments achieved grade IV at 12 months. Postoperatively at 12 months, spinal canal cross sectional areas at disc spaces significantly increased from 157.5 to 294.3 mm(2) (p = 0.012). CONCLUSION: MIS TLIF achieved good clinical outcomes and high fusion rates. Our findings show that MIS TLIF performed with a single interbody cage and a tubular retractor system can be used as a standard MIS TLIF technique.

Lee CK; Park JY; Zhang HY

2010-09-01

110

Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up.  

UK PubMed Central (United Kingdom)

PURPOSE: The aim of the present study was to analyze outcome, with respect to functional disability, pain, fusion rate, and complications of patients treated with transforaminal lumbar interbody fusion (TLIF) in compared to instrumented poserolateral fusion (PLF) alone, in low back pain. Spinal fusion has become a major procedure worldwide. However, conflicting results exist. Theoretical circumferential fusion could improve functional outcome. However, the theoretical advantages lack scientific documentation. METHODS: Prospective randomized clinical study with a 2-year follow-up period. From November 2003 to November 2008 100 patients with severe low back pain and radicular pain were randomly selected for either posterolateral lumbar fusion [titanium TSRH (Medtronic)] or transforaminal lumbar interbody fusion [titanium TSRH (Medtronic)] with anterior intervertebral support by tantalum cage (Implex/Zimmer). The primary outcome scores were obtained using Dallas Pain Questionnaire (DPQ), Oswestry disability Index, SF-36, and low back pain Rating Scale. All measures assessed the endpoints at 2-year follow-up after surgery. RESULTS: The overall follow-up rate was 94 %. Sex ratio was 40/58. 51 patients had TLIF, 47 PLF. Mean age 49(TLIF)/45(PLF). No statistic difference in outcome between groups could be detected concerning daily activity, work leisure, anxiety/depression or social interest. We found no statistic difference concerning back pain or leg pain. In both the TLIF and the PLF groups the patients had significant improvement in functional outcome, back pain, and leg pain compared to preoperatively. Operation time and blood loss in the TLIF group were significantly higher than in the PLF group (p < 0.001). No statistic difference in fusion rates was detected. CONCLUSIONS: Transforaminal interbody fusion did not improve functional outcome in patients compared to posterolateral fusion. Both groups improved significantly in all categories compared to preoperatively. Operation time and blood loss were significantly higher in the TLIF group.

Høy K; Bünger C; Niederman B; Helmig P; Hansen ES; Li H; Andersen T

2013-04-01

111

Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up.  

UK PubMed Central (United Kingdom)

PURPOSE: The aim of the present study was to analyze outcome, with respect to functional disability, pain, fusion rate, and complications of patients treated with transforaminal lumbar interbody fusion (TLIF) in compared to instrumented poserolateral fusion (PLF) alone, in low back pain. Spinal fusion has become a major procedure worldwide. However, conflicting results exist. Theoretical circumferential fusion could improve functional outcome. However, the theoretical advantages lack scientific documentation. METHODS: Prospective randomized clinical study with a 2-year follow-up period. From November 2003 to November 2008 100 patients with severe low back pain and radicular pain were randomly selected for either posterolateral lumbar fusion [titanium TSRH (Medtronic)] or transforaminal lumbar interbody fusion [titanium TSRH (Medtronic)] with anterior intervertebral support by tantalum cage (Implex/Zimmer). The primary outcome scores were obtained using Dallas Pain Questionnaire (DPQ), Oswestry disability Index, SF-36, and low back pain Rating Scale. All measures assessed the endpoints at 2-year follow-up after surgery. RESULTS: The overall follow-up rate was 94 %. Sex ratio was 40/58. 51 patients had TLIF, 47 PLF. Mean age 49(TLIF)/45(PLF). No statistic difference in outcome between groups could be detected concerning daily activity, work leisure, anxiety/depression or social interest. We found no statistic difference concerning back pain or leg pain. In both the TLIF and the PLF groups the patients had significant improvement in functional outcome, back pain, and leg pain compared to preoperatively. Operation time and blood loss in the TLIF group were significantly higher than in the PLF group (p < 0.001). No statistic difference in fusion rates was detected. CONCLUSIONS: Transforaminal interbody fusion did not improve functional outcome in patients compared to posterolateral fusion. Both groups improved significantly in all categories compared to preoperatively. Operation time and blood loss were significantly higher in the TLIF group.

Høy K; Bünger C; Niederman B; Helmig P; Hansen ES; Li H; Andersen T

2013-09-01

112

Short-term outcome of transforaminal lumbar interbody fusion for lytic and degenerative spondylolisthesis.  

UK PubMed Central (United Kingdom)

PURPOSE. To compare early outcome of transforaminal lumbar interbody fusion (TLIF) for lytic versus degenerative spondylolisthesis. METHODS. 14 women and 8 men aged 20 to 60 (mean, 36) years underwent TLIF for lytic (n=15) or degenerative (n=7) spondylolisthesis. Of the 15 patients with lytic spondylolisthesis, 9 involved L4/ L5 and 6 L5/S1. Of the 7 patients with degenerative spondylolisthesis, 3 involved L4/L5, 2 L5/S1, one L2/L3, and one L3/L4. The spondylolistheses were classified as grade II (n=15), grade III (n=4), and retrolisthesis (n=3). 11 patients with lytic and 2 with degenerative spondylolisthesis had sensory deficits (n=12), motor deficits (n=9), and diminished reflexes (n=7). Visual analogue score (VAS) for pain and the Oswestry Disability Index (ODI) of each patient were assessed at months 3, 6, and 12, and 6 monthly thereafter. Fusion status was assessed by radiologists. Comprehensive outcome of each patient was graded as excellent, good, fair, or poor. RESULTS. The mean VAS score for low back pain improved significantly from 7.4 preoperatively to 2.1 at year 1 (p<0.001), as did the mean VAS score for leg pain from 6.7 to 1.4 (p<0.001) and the mean ODI from 67.8% to 11.8% (p<0.001). No patient had any residual neurological deficit, and all achieved radiological fusion. The comprehensive outcome was excellent in 16 patients, good in 5, and fair in one. 16 patients returned to their previous level of activity. CONCLUSION. TLIF is a safe and effective surgical procedure for the treatment of lytic and degenerative spondylolisthesis.

Ali Y; Najmus-Sakeb N; Rahman M; Mhamud S

2012-12-01

113

Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis in patients with significant obesity.  

UK PubMed Central (United Kingdom)

Comparative studies evaluating efficacy and safety of minimally invasive spinal fusion between patients with significant obesity (body mass index [BMI]?35 kg/m(2)) and those of normal weight are scarce. We examined complication rates and outcomes for minimally invasive transforaminal lumbar interbody fusion (MITLIF) in patients with significant obesity and those of normal weight undergoing treatment for symptomatic spondylolisthesis. Patients with a BMI?35 kg/m(2) or <25 kg/m(2) undergoing elective MITLIF for symptomatic spondylolisthesis for the period 2006-09 were identified. Of the 16 patients identified, nine patients with a mean BMI of 37.4 kg/m(2) were included in the obese group, while seven patients with a mean BMI of 23.4 kg/m(2) comprised the normal weight group. Estimated blood loss (EBL), operative time, complication rate, length of hospital stay, and clinical outcomes were assessed. Outcome measures included patient-reported visual analog scale (VAS) score for pain and the Oswestry Disability Index (ODI) questionnaire completed by the patient. No significant differences were found in blood loss (p=0.436), hospital stay (p=0.606), or number of surgical complications (p=0.920) between the two groups. Mean follow-up intervals were 15.0 months for patients with obesity, and 18.6 months for those of normal weight. Both groups had significant improvements in VAS (obese, p=0.003; normal, p=0.016) and ODI (obese, p=0.020; normal, p=0.034) scores. There were no statistically significant differences between normal weight and obese groups in postoperative VAS (p=0.728) and ODI (p=0.886) scores. Patients with significant obesity experienced clinical improvement similar to that of patients with normal weight, suggesting that obesity does not impact MITLIF outcomes. In addition, both groups experienced similar complication rates, operative times, EBL, and length of hospital stay.

Lau D; Ziewacz J; Park P

2013-01-01

114

The Ligamentotactic Effect on a Herniated Disc at the Level Adjacent to the Anterior Lumbar Interbody Fusion : Report of Two Cases  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The authors report two cases of spontaneous regression of disc herniation at the level adjacent to the anterior lumbar interbody fusion (ALIF) level. This phenomenon may be due to the increased tension on the posterior longitudinal ligament (PLL) by appropriate restoration of the disc height and lum...

Min, Jun-Hong; Jang, Jee-Soo; Kim, Seok-Kang; Maeng, Dae Hyeon; Lee, Sang-Ho

115

Porous biodegradable lumbar interbody fusion cage design and fabrication using integrated global-local topology optimization with laser sintering.  

Science.gov (United States)

Biodegradable cages have received increasing attention for their use in spinal procedures involving interbody fusion to resolve complications associated with the use of nondegradable cages, such as stress shielding and long-term foreign body reaction. However, the relatively weak initial material strength compared to permanent materials and subsequent reduction due to degradation may be problematic. To design a porous biodegradable interbody fusion cage for a preclinical large animal study that can withstand physiological loads while possessing sufficient interconnected porosity for bony bridging and fusion, we developed a multiscale topology optimization technique. Topology optimization at the macroscopic scale provides optimal structural layout that ensures mechanical strength, while optimally designed microstructures, which replace the macroscopic material layout, ensure maximum permeability. Optimally designed cages were fabricated using solid, freeform fabrication of poly(?-caprolactone) mixed with hydroxyapatite. Compression tests revealed that the yield strength of optimized fusion cages was two times that of typical human lumbar spine loads. Computational analysis further confirmed the mechanical integrity within the human lumbar spine, although the pore structure locally underwent higher stress than yield stress. This optimization technique may be utilized to balance the complex requirements of load-bearing, stress shielding, and interconnected porosity when using biodegradable materials for fusion cages. PMID:23897113

Kang, Heesuk; Hollister, Scott J; La Marca, Frank; Park, Paul; Lin, Chia-Ying

2013-10-01

116

Anterolateral Corrective Lumbar Corpectomy and Interbody Fusion by Using Extended Screw Fixation without Posterior Instrumentation for Posttraumatic Kyphosis.  

UK PubMed Central (United Kingdom)

A 26-year-old paraplegic schizophrenic Japanese woman suffered from severe kyphosis and back pain derived from lumbar burst fractures caused by jumping. She had already undergone resection of the L1 and L2 spinous processes for sharp angular kyphosis, but she still had severe kyphosis and back pain at the L1 and L2. Radiographical examination revealed fused anterior columns at L1 and L2 with severe local kyphosis and a significantly decreased percutaneous distance in the back. The patient underwent anterior instrumented bony resection including an L2 vertebral osteotomy: bilateral L2-L3 facetectomy and partial posterior osteotomy of the L2 vertebrae via a posterior approach followed by an anterior corpectomy of the L2 vertebrae and insertion of a cylindrical cage. No posterior instrumentation was used owing to the presence of atrophied paraspinal soft tissues. Lumbar interbody fusion was performed with vertebral body screws extending from T12 to L4 and corresponding anterior distension and posterior compression. The procedure corrected the kyphosis by 15° and enhanced local stability. Postsurgical visual analogue scale improved from 9.0 to 2.0 and Oswestry Disability Index from 40 to 17.8, respectively. In conclusion, we have demonstrated that anterolateral interbody fusion using extended fixation can compensate for posterior corrective surgery.

Yamazaki A; Orita S; Sainoh T; Yamauchi K; Suzuki M; Sakuma Y; Kubota G; Oikawa Y; Inage K; Nakata Y; Inoue G; Aoki Y; Toyone T; Nakamura J; Miyagi M; Takahashi K; Ohtori S

2013-01-01

117

Mini-transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion augmented by percutaneous pedicle screw fixation: a comparison of surgical outcomes in adult low-grade isthmic spondylolisthesis.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Retrospective clinical data analysis. OBJECTIVE: To compare clinical results with radiologic results of 2 fusion techniques for adult low-grade isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: There is clear evidence that lumbar interbody fusion using anterior and posterior approaches provides a high fusion rate, good sagittal alignment, and good clinical outcomes. However, there are no recent studies that compare these 2 fusion techniques. METHODS: Between March 2004 and December 2004, 48 patients underwent instrumented mini-anterior lumbar interbody fusion (ALIF) and 46 underwent instrumented mini-transforaminal lumbar interbody fusion (TLIF). The mean follow-up periods were 32.6 and 29.7 months, respectively. RESULTS: The mean visual analog scale (VAS) scores for back and leg pain decreased, respectively, from 7.7 and 7.5 to 2.9 and 2.7 in the ALIF group and from 7.0 and 6.3 to 2.3 and 2.2 in the TLIF group. The mean Oswestry disability index (ODI) scores improved from 51.4% to 23.2% in the ALIF group and from 52% to 14.4% in the TLIF group. In both groups, the VAS and ODI scores significantly changed preoperatively to postoperatively (P<0.001). However, statistical analysis showed no significant difference in postoperative VAS/ODI scores between groups. Radiologic evidence of fusion was noted in 95.8% and 92.3% of the patients in the ALIF group and the TLIF group, respectively. In both the groups, changes in the disc height, segmental lordosis, degree of listhesis, and whole lumbar lordosis (WL) between the preoperative and postoperative periods were significant except for WL in the TLIF group. The amount of change between preoperative and postoperative disc height, segmental lordosis, and WL demonstrated significant intergroup differences (P<0.05). CONCLUSIONS: The mini-ALIF group demonstrated key radiographic advantages compared with the mini-TLIF group for adult low-grade isthmic spondylolisthesis. However, clinical and functional outcomes did not demonstrate significant differences between groups.

Kim JS; Kang BU; Lee SH; Jung B; Choi YG; Jeon SH; Lee HY

2009-04-01

118

TranS1 VEO system: a novel psoas-sparing device for transpsoas lumbar interbody fusion  

Directory of Open Access Journals (Sweden)

Full Text Available Mitchell A Hardenbrook,1,2 Larry E Miller,3,4 Jon E Block4 1Advanced Spine Institute of Greater Boston, North Billerica, MA, 2Department of Orthopedic Surgery, Tufts University School of Medicine, Boston, MA, 3Miller Scientific Consulting Inc, Arden, NC, 4The Jon Block Group, San Francisco, CA, USA Abstract: Minimally invasive approaches for lumbar interbody fusion have been popularized in recent years. The retroperitoneal transpsoas approach to the lumbar spine is a technique that allows direct lateral access to the intervertebral disc space while mitigating the complications associated with traditional anterior or posterior approaches. However, a common complication of this procedure is iatrogenic injury to the psoas muscle and surrounding nerves, resulting in postsurgical motor and sensory deficits. The TranS1 VEO system (TranS1 Inc, Raleigh, NC, USA) utilizes a novel, minimally invasive transpsoas approach to the lumbar spine that allows direct visualization of the psoas and proximal nerves, potentially minimizing iatrogenic injury risk and resulting clinical morbidity. This paper describes the clinical uses, procedural details, and indications for use of the TranS1 VEO system. Keywords: fusion, lateral, lumbar, minimally invasive, transpsoas, VEO

Hardenbrook MA; Miller LE; Block JE

2013-01-01

119

Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders : a randomized clinical trial with 2-year follow-up  

DEFF Research Database (Denmark)

PURPOSE: The aim of the present study was to analyze outcome, with respect to functional disability, pain, fusion rate, and complications of patients treated with transforaminal lumbar interbody fusion (TLIF) in compared to instrumented poserolateral fusion (PLF) alone, in low back pain. Spinal fusion has become a major procedure worldwide. However, conflicting results exist. Theoretical circumferential fusion could improve functional outcome. However, the theoretical advantages lack scientific documentation. METHODS: Prospective randomized clinical study with a 2-year follow-up period. From November 2003 to November 2008 100 patients with severe low back pain and radicular pain were randomly selected for either posterolateral lumbar fusion [titanium TSRH (Medtronic)] or transforaminal lumbar interbody fusion [titanium TSRH (Medtronic)] with anterior intervertebral support by tantalum cage (Implex/Zimmer). The primary outcome scores were obtained using Dallas Pain Questionnaire (DPQ), Oswestry disability Index, SF-36, and low back pain Rating Scale. All measures assessed the endpoints at 2-year follow-up after surgery. RESULTS: The overall follow-up rate was 94 %. Sex ratio was 40/58. 51 patients had TLIF, 47 PLF. Mean age 49(TLIF)/45(PLF). No statistic difference in outcome between groups could be detected concerning daily activity, work leisure, anxiety/depression or social interest. We found no statistic difference concerning back pain or leg pain. In both the TLIF and the PLF groups the patients had significant improvement in functional outcome, back pain, and leg pain compared to preoperatively. Operation time and blood loss in the TLIF group were significantly higher than in the PLF group (p 

HØy, Kristian; Bünger, Cody

2013-01-01

120

Does alendronate disturb the healing process of posterior lumbar interbody fusion? A prospective randomized trial.  

UK PubMed Central (United Kingdom)

OBJECT: Bisphosphonate medications are widely used for the treatment of osteoporosis, but they might disturb the healing process of spinal fusion. The object of this prospective randomized controlled study was to evaluate the effect of bisphosphonate medication on spinal fusion through radiographic, clinical, and biological assessments. METHODS: A total of 40 patients with osteoporosis who were candidates for single-level posterior lumbar interbody fusion were randomly assigned to the alendronate group (alendronate sodium 35 mg/week) or the control group (vitamin D, alfacalcidol 1 ?g/day). Pedicle screw fixation and carbon polyetheretherketone cages were used for all the patients. Bone graft material was prepared as a mixture of local bone and ?-tricalcium phosphate in a ratio of 2:1. Functional radiography and CT scans were used to evaluate fusion status and cage subsidence. The incidence of vertebral compression fractures (VCFs) occurring after surgery (subsequent VCFs) was assessed by means of MR imaging. Bridging bone formation was graded into 3 categories: Grade A (bridging bone through bilateral cages), Grade B (bridging bone through a unilateral cage), or Grade C (incomplete bony bridging). A solid fusion was defined as less than 5° of angular motion in flexion-extension radiographs and the presence of bridging bone through the cage (Grade A or B). Clinical outcome was evaluated by means of the Oswestry Disability Index. Bone metabolic markers (serum bone alkaline phosphatase, serum and urine Type I collagen cross-linked N-telopeptides) were measured to investigate the biological effects of alendronate on spinal fusion. RESULTS: Bridging bone formation (Grade A or B) was more frequently observed in the alendronate group at all postoperative assessment periods. At 1-year postoperative follow-up, a solid fusion was achieved in 95% of the patients in the alendronate group and 65% of those in the control group. Cage subsidence (> 2 mm) was observed in 5% of the alendronate group and 29% of the control group. No vertebral fractures were observed in the alendronate group, whereas 24% of patients in the control group showed subsequent VCFs. There was no statistically significant between-groups difference in clinical outcomes, but poor clinical results in the control group were associated with pseudarthrosis and subsequent VCFs. Biochemical analysis of bone turnover demonstrated that alendronate inhibited bone resorption from the early phase of the fusion process and also suppressed bone formation after 6 months postoperatively. CONCLUSIONS: Favorable mechanical circumstances provided by alendronate overcame its detrimental biological effect on the healing process of spinal fusion. The authors recommend that osteoporosis patients undergoing spinal fusion take bisphosphonates throughout the postoperative period.

Nagahama K; Kanayama M; Togawa D; Hashimoto T; Minami A

2011-04-01

 
 
 
 
121

Radiographic and clinical outcomes after instrumented reduction and transforaminal lumbar interbody fusion of mid and high-grade isthmic spondylolisthesis.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The objective of this study is to document and review the surgical technique and the clinical and radiographic outcomes after instrumented reduction and transforaminal lumbar interbody fusion of mid and high-grade adult isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: Although high-grade slips make up a distinct minority of all patients afflicted with spondylolisthesis, approximately 2% in most series, the treatment of this small cohort of patients has been the topic of on going, and often heated debate. Recently, there has been a trend in the literature toward the combination of instrumented posterior spinal fusion (PSF) and interbody fusion with or without reduction. Although spine surgeons have used this procedure as a tool to treat patient's with spondylolisthesis of any cause, there is no report in the literature describing the results of neural element decompression, transforaminal interbody fusion (TLIF) reduction, and instrumented PSF of the listhetic vertebrae in the treatment of high and mid-grade isthmic spondylolisthesis. METHODS: From 1999 to 2003, 13 patients with mid and high-grade isthmic spondylolisthesis (Meyerding grades II, III, or IV) who failed conservative treatment were treated by posterior lumbar decompression, TLIF at the disk space of the level of the slip, instrumented PSF, and reduction of the listhetic vertebrae. Standing lumbar radiographs were taken preoperatively, at the time of the initial postoperative visit and at regular intervals thereafter. Several radiographic parameters were noted including degree of anterolisthesis, slip angle, sacral inclination, and disk height. Statistical comparisons were made with 2-tailed paired t tests. RESULTS: The average anterolisthesis, normalized to the superior endplate diameter, was 51.0%+/-16.6% preoperatively, 13.2%+/-11.8% immediately postoperative, and 17.0%+/-12.6% at final follow-up (Table 1). Of the 10 patients with sufficient radiographic follow-up, all but one had radiographic evidence of solid bony union at the time of final radiographic examination. Follow-up averaged 21.5 months and ranged from 11 to 48 months. CONCLUSIONS: This study represents a unified approach to the solitary diagnosis of mid and high-grade adult isthmic spondylolisthesis, adding further information to the growing body of literature for the TLIF procedure.

Goyal N; Wimberley DW; Hyatt A; Zeiller S; Vaccaro AR; Hilibrand AS; Albert TJ

2009-07-01

122

Sacral fractures following stand-alone L5-S1 anterior lumbar interbody fusion for isthmic spondylolisthesis.  

UK PubMed Central (United Kingdom)

Recent studies have demonstrated excellent results in treating isthmic spondylolisthesis via an anterior lumbar interbody fusion (ALIF). The authors describe 3 patients with isthmic spondylolisthesis at L5-S1 who experienced sacral fractures after insertion of a unique, stand-alone anterior interbody fixation device. Three consecutive patients at a single institution were treated for Grade I spondylolisthesis at L5-S1 via a standalone ALIF with insertion of a novel biomechanical interbody device. This device is made of polyetheretherketone and has an integrated system for internal fixation into the vertebral bodies. In each patient a bone morphogenetic protein-soaked sponge was placed for the fusion. The indications for treatment in each patient were back and radicular pain that had been unsuccessfully treated with conservative measures. All 3 patients had reduction of their spondylolisthesis and resolution of their unilateral radiculopathies immediately postoperatively. Within 1 month of surgery, all 3 patients had failure of the device and recurrence of their symptoms. In each case the failure was due to fracture of the anterior portion of the S-1 body. Each patient underwent reduction and pedicle screw fixation at L5-S1. In all cases, there was successful reduction in their recurrent spondylolisthesis and resolution of their radiculopathies. Treatment of Grade I isthmic spondylolisthesis at L5-S1 with stand-alone ALIF and fixation can lead to sacral fracture from high stress loads at that level in the spine, and consideration should be made either for supplemental pedicle screw fixation or a completely posterior approach.

Lastfogel JF; Altstadt TJ; Rodgers RB; Horn EM

2010-08-01

123

Sacral fractures following stand-alone L5-S1 anterior lumbar interbody fusion for isthmic spondylolisthesis.  

Science.gov (United States)

Recent studies have demonstrated excellent results in treating isthmic spondylolisthesis via an anterior lumbar interbody fusion (ALIF). The authors describe 3 patients with isthmic spondylolisthesis at L5-S1 who experienced sacral fractures after insertion of a unique, stand-alone anterior interbody fixation device. Three consecutive patients at a single institution were treated for Grade I spondylolisthesis at L5-S1 via a standalone ALIF with insertion of a novel biomechanical interbody device. This device is made of polyetheretherketone and has an integrated system for internal fixation into the vertebral bodies. In each patient a bone morphogenetic protein-soaked sponge was placed for the fusion. The indications for treatment in each patient were back and radicular pain that had been unsuccessfully treated with conservative measures. All 3 patients had reduction of their spondylolisthesis and resolution of their unilateral radiculopathies immediately postoperatively. Within 1 month of surgery, all 3 patients had failure of the device and recurrence of their symptoms. In each case the failure was due to fracture of the anterior portion of the S-1 body. Each patient underwent reduction and pedicle screw fixation at L5-S1. In all cases, there was successful reduction in their recurrent spondylolisthesis and resolution of their radiculopathies. Treatment of Grade I isthmic spondylolisthesis at L5-S1 with stand-alone ALIF and fixation can lead to sacral fracture from high stress loads at that level in the spine, and consideration should be made either for supplemental pedicle screw fixation or a completely posterior approach. PMID:20672968

Lastfogel, Jeffrey F; Altstadt, Thomas J; Rodgers, Richard B; Horn, Eric M

2010-08-01

124

Effects on clinical outcomes of grafts and spacers used in transforaminal lumbar interbody fusion: a critical review.  

UK PubMed Central (United Kingdom)

Transforaminal lumbar interbody fusion (TLIF) is a relatively new and popular spinal fusion technique that has proven very useful since its introduction. To date, fusion rates for different combinations of modalities and materials have not been thoroughly compared and assessed. In this review of published reports, 29 papers met criteria for assessing fusion rates for three different interbody spacers and four different combinations of bone grafts and extenders. The spacers included Capstone, polyether ether ketones and Telamon cages, and the grafting materials reviewed were locally harvested bone, iliac crest bone with local, local bone plus recombinant human bone morphogenetic protein 2 and a mixture of local and allograft bone. Of these, it was found that only the Capstone cage and locally harvested bone achieved statistically significant higher fusion rates (96.46% ± 2.89% and 97.07% ± 1.94% respectively) than the other modalities and materials studied. Oswestry Disability Index scores and visual pain scales were also examined as indicators of overall improvement after using each spacer and graft; the Telamon cage and local bone mixed with rhBMP-2 stood out as conferring statistically significant greater improvements according to these two scales. Our findings are that Capstone and locally harvested bone alone are relatively superior in terms of fusion rates.

Heida K Jr; Ebraheim M; Siddiqui S; Liu J

2013-02-01

125

Symptomatic calcified perineural cyst after use of bone morphogenetic protein in transforaminal lumbar interbody fusion: a case report.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: Human recombinant bone morphogenetic protein-2 (BMP-2) is commonly used in spinal surgery to augment arthrodesis, and a number of potential complications have been documented. PURPOSE: To present the case of a delayed radiculopathy that occurred because of a calcified perineural cyst that formed after an L4-L5 transforaminal lumbar interbody fusion (TLIF) in which BMP-2 was used. STUDY DESIGN/SETTING: Case report of a 70-year-old man presented with back and right lower extremity pain. METHODS: A 70-year-old man who had previously undergone a right L4-L5 TLIF presented 20 months after surgery with progressively radiating right leg pain. Imaging revealed a right-sided L4-L5 cystic lesion posterior to the interbody cage. The patient underwent reexploration, and a calcified mass was discovered. RESULTS: Histopathology revealed fragments of organized collagenous connective tissue, new collagen, and partially calcified fragments of fibrocartilage, bone, and ligament. CONCLUSIONS: This is the first reported case of a symptomatic calcified perineural cyst developing after a fusion procedure in which BMP-2 was used. The presence of connective tissue with metaplastic bone formation and maturation within the lesion suggests that formation of the cyst was secondary to application of BMP-2, as it possesses both osteogenic and chondrogenic capabilities.

Than KD; Rahman SU; McKeever PE; Wang AC; La Marca F; Park P

2013-08-01

126

[Clinical study on unilateral pedicle screw fixation and interbody fusion for the treatment of lumbar degenerative diseases under Quadrant system].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare the clinical effects of unilateral pedicle screw fixation (uni-PS) assisted by Quadrant system and bilateral pedicle screw fixation (bi-PS) for the treatment of lumbar degenerative diseases. METHODS: From October 2008 to October 2010,102 patients with lower back pain, unilateral lower limb radiating pain or paraesthesia were treated with pedicle screw fixation and lumbar interbody fusion. There were 67 males and 35 females with an average age of 51.5 years ranging from 34 to 69 years. The patients were randomly divided into two groups (group A and group B) according to the internal fixation type. The patients of group A (n=50) underwent with minimally transforaminal lumbar interbody fusion (TLIF) and unilateral pedicle screw fixation with one single cage placement assisted by Quadrant system;and the patients of group B (n = 52) underwent with posterior lumbar interbody fusion (PLIF) and bilateral pedicle screw fixation with one single cage placement. There were no significant differences between two groups in general information (P > 0.05). VAS score and ODI score system were used to evaluate the preoperative and postoperative pain and function recovery. Operative time, volume of blood loss, fusion rate and complication rate were compared and analyzed by statistical test. RESULTS: All the patients were followed up from 12 to 21 months with an average of 18.2 months. In the group A,operative time and volume of blood loss were (87.6 +/- 25.5) min and (105.7 +/- 27.2) ml, respectively; VAS score of low back pain and leg pain, ODI score decreased respectively from preoperative 7.2 +/- 1.4, 7.9 +/- 1.1, 42.2 +/- 11.8 to 3.2 +/- 0.6, 3.0 +/- 0.7,15.6 +/- 2.3 at one month after operation; the fusion rate was 96.0% (48/50) and the complication rate was 4.00% (2/50). In the group B,operative time and volume of blood loss were (160.3 +/- 20.5) min and (220.6 +/- 25.5) ml, respectively; VAS score of low back pain and leg pain, ODI score decreased respectively from preoperative 7.3 +/- 1.1, 8.1 +/- 0.9, 43.1 +/- 12.0 to 3.3 +/- 0.4, 3.2 +/- 0.3, 14.9 +/- 2.6; the fusion rate was 96.2% (50/52) and the compli- cation rate was 5.77% (3/52). There were no statistically significant differences between the two groups in fusion rate, complication rate, VAS pain and ODI score. Whereas the operative time and blood loss in group A were significantly lower than that of group B. CONCLUSION: Minimally invasive unilateral pedicle screw fixation is a safe and feasible method for the treatment of lumbar degenerative diseases. It is as effective as the bilateral fixation in lumbar spinal fusion. In addition, it has the advantages of short operative time, less volume of blood loss, high fusion rate, etc.

Lin B; Lin QY; He MC; Liu H; Guo ZM; Lin KS

2012-06-01

127

Augment bone graft products compare favorably with autologous bone graft in an ovine model of lumbar interbody spine fusion.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: This study was designed to determine whether Augment Bone Graft (Augment, Biomimetic Therapeutics, Inc., Franklin, TN) and Augment Injectable Bone Graft (Augment Injectable, Biomimetic Therapeutics, Inc., Franklin, TN), 2 combination devices comprising recombinant human platelet-derived growth factor-BB and ?-tricalcium phosphate-containing matrices, promote bone bridging in an ovine model of lumbar spine fusion. Autologous bone graft (autograft) was used as a positive control. OBJECTIVE: The purpose of this study was to determine the ability of Augment products to promote fusion of the L2-L3 and L4-L5 vertebral bodies in an ovine model. SUMMARY OF BACKGROUND DATA: In interbody spine fusion, the intervertebral disc is removed and a spacer is inserted for support and to facilitate bone growth. The fusion is commonly enhanced with grafts. Autograft is the "gold standard" but it has limitations including availability and donor-site morbidity. Synthetic graft substitutes eliminate these complications. Augment products are combination devices including recombinant human platelet-derived growth factor-BB, a well-characterized chemotactic, mitogenic, and proangiogenic protein essential in wound and bone healing. METHODS: Twenty-two sheep received an uninstrumented, double-level, interbody lumbar spinal fusion procedure using a polyetheretherketone spacer, which was either empty or packed with iliac crest autograft, Augment or Augment Injectable. The same treatment was used at both levels. Animals were 24 weeks after surgery, and fusion was assessed by micro-computed tomography (micro-CT) and histology. RESULTS: Micro-CT and histologic assessment of fusion revealed that empty controls had significantly lower fusion rates. No differences were detected among autografts, Augment, and Augment Injectable-treated specimens. Residual ?-tricalcium phosphate particles embedded in the newly formed bone were visible in Augment- and Augment Injectable-treated specimens. CONCLUSION: Augment-treated specimens had the highest fusion scores. Treatment with either of the Augment products significantly promoted interbody spine fusion compared with empty spacers and was equivalent to autograft-induced fusion. No adverse events were noted.

Solchaga LA; Hee CK; Aguiar DJ; Ratliff J; Turner AS; Seim HB 3rd; Hollinger JO; Snel LB; Lynch SE

2012-04-01

128

Comparison of perioperative outcomes following open versus minimally invasive transforaminal lumbar interbody fusion in obese patients.  

Science.gov (United States)

Object Minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) has proven to be effective in the treatment of spondylolisthesis and degenerative disc disease (DDD). Compared with the traditional open TLIF, the MI procedure has been associated with less blood loss, less postoperative pain, and a shorter hospital stay. However, it is uncertain whether the advantages of an MI TLIF also apply specifically to obese patients. This study was dedicated to evaluating whether obese patients reap the perioperative benefits similar to those seen in patients with normal body mass index (BMI) when undergoing MI TLIF. Methods Obese patients-that is, those with a BMI of at least 30 kg/m(2)-who had undergone single-level TLIF were retrospectively identified and categorized according to BMI: Class I obesity, BMI 30.0-34.9 kg/m(2); Class II obesity, BMI 35.0-39.9 kg/m(2); or Class III obesity, BMI ? 40.0 kg/m(2). In each obesity class, patients were stratified by TLIF approach, that is, open versus MI. Perioperative outcomes, including intraoperative estimated blood loss (EBL), complications (overall, intraoperative, and 30-day postoperative), and hospital length of stay (LOS), were compared. The chi-square test, Fisher exact test, or 2-tailed Student t-test were used when appropriate. Results One hundred twenty-seven patients were included in the final analysis; 49 underwent open TLIF and 78 underwent MI TLIF. Sixty-one patients had Class I obesity (23 open and 38 MI TLIF); 45 patients, Class II (19 open and 26 MI); and 21 patients, Class III (7 open and 14 MI). Overall, mean EBL was 397.2 ml and mean hospital LOS was 3.7 days. Minimally invasive TLIF was associated with significantly less EBL and a shorter hospital stay than open TLIF when all patients were evaluated as a single cohort and within individual obesity classes. Overall, the complication rate was 18.1%. Minimally invasive TLIF was associated with a significantly lower total complication rate (11.5% MI vs 28.6% open) and intraoperative complication rate (3.8% MI vs 16.3% open) as compared with open TLIF. When stratified by obesity class, MI TLIF was still associated with lower rates of total and intraoperative complications. This effect was most profound and statistically significant in patients with Class III obesity (42.9% open vs 7.1% MI). Conclusions Minimally invasive TLIF offers obese patients perioperative benefits similar to those seen in patients with normal BMI who undergo the same procedure. These benefits include less EBL, a shorter hospital stay, and potentially fewer complications compared with open TLIF. Additional large retrospective studies and randomized prospective studies are needed to verify these findings. PMID:23905948

Lau, Darryl; Khan, Adam; Terman, Samuel W; Yee, Timothy; La Marca, Frank; Park, Paul

2013-08-01

129

AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion  

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Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and trans...

Rapp, Steven M; Miller, Larry E; Block, Jon E

130

Fueling the debate: Are outcomes better after posterior lumbar interbody fusion (PLIF) or after posterolateral fusion (PLF) in adult patients with low-grade adult isthmic spondylolisthesis?  

UK PubMed Central (United Kingdom)

Study design: ?Retrospective cohort study. Clinical question: ?Do more adult patients affected by low grade isthmic spondylolisthesis have significant clinical and radiological improvement following posterior lumbar interbody fusion (PLIF) than those who receive posterolateral fusion (PLF)? Methods: ?One hundred and fourteen patients affected by adult low grade isthmic spondylolisthesis, treated with posterior lumbar interbody fusion or posterolateral fusion, were reviewed. Clinical outcome was assessed by means of the questionnaires ODI, RMDQ and VAS. Radiographic evaluation included CT, MRI, and x-rays. The results were analyzed using the Student t-test. Results: ?The two groups were similar with respect to demographic and surgical characteristics. At an average follow-up of 62.1 months, 71 patients were completely reviewed. Mean ODI, RMDQ and VAS scores didn't show statistically significant differences. Fusion rate was similar between the two groups (97% in PLIF group, 95% in PLF group). Major complications occurred in 5 of 71 patients reviewed (7%): one in the PLIF group (3.6%), four in the PLF group (9.3%). Pseudarthrosis occurred in one case in the PLIF group (3,6%) and in two cases in PLF group (4.6%). Conclusions: ?In our series, there does not appear to be a clear advantage of posterior lumbar interbody fusion (PLIF) over posterolateral fusion (PLF) in terms of clinical and radiological outcome for treatment of adult low grade isthmic spondylolisthesis.

Barbanti Bròdano G; Lolli F; Martikos K; Gasbarrini A; Bandiera S; Greggi T; Parisini P; Boriani S

2010-05-01

131

Fueling the debate: Are outcomes better after posterior lumbar interbody fusion (PLIF) or after posterolateral fusion (PLF) in adult patients with low-grade adult isthmic spondylolisthesis?  

Science.gov (United States)

Study design: ?Retrospective cohort study. Clinical question: ?Do more adult patients affected by low grade isthmic spondylolisthesis have significant clinical and radiological improvement following posterior lumbar interbody fusion (PLIF) than those who receive posterolateral fusion (PLF)? Methods: ?One hundred and fourteen patients affected by adult low grade isthmic spondylolisthesis, treated with posterior lumbar interbody fusion or posterolateral fusion, were reviewed. Clinical outcome was assessed by means of the questionnaires ODI, RMDQ and VAS. Radiographic evaluation included CT, MRI, and x-rays. The results were analyzed using the Student t-test. Results: ?The two groups were similar with respect to demographic and surgical characteristics. At an average follow-up of 62.1 months, 71 patients were completely reviewed. Mean ODI, RMDQ and VAS scores didn't show statistically significant differences. Fusion rate was similar between the two groups (97% in PLIF group, 95% in PLF group). Major complications occurred in 5 of 71 patients reviewed (7%): one in the PLIF group (3.6%), four in the PLF group (9.3%). Pseudarthrosis occurred in one case in the PLIF group (3,6%) and in two cases in PLF group (4.6%). Conclusions: ?In our series, there does not appear to be a clear advantage of posterior lumbar interbody fusion (PLIF) over posterolateral fusion (PLF) in terms of clinical and radiological outcome for treatment of adult low grade isthmic spondylolisthesis. PMID:23544021

Barbanti Bròdano, G; Lolli, F; Martikos, K; Gasbarrini, A; Bandiera, S; Greggi, T; Parisini, P; Boriani, S

2010-05-01

132

Nerve root anomalies: implications for transforaminal lumbar interbody fusion surgery and a review of the Neidre and Macnab classification system.  

Science.gov (United States)

Lumbar nerve root anomalies are uncommon phenomena that must be recognized to avoid neural injury during surgery. The authors describe 2 cases of nerve root anomalies encountered during mini-open transforaminal lumbar interbody fusion (TLIF) surgery. One anomaly was a confluent variant not previously classified; the authors suggest that this variant be reflected in an amendment to the Neidre and Macnab classification system. They also propose strategies for identifying these anomalies and avoiding injury to anomalous nerve roots during TLIF surgery. Case 1 involved a 68-year-old woman with a 2-year history of neurogenic claudication. An MR image demonstrated L4-5 stenosis and spondylolisthesis and an L-4 nerve root that appeared unusually low in the neural foramen. During a mini-open TLIF procedure, a nerve root anomaly was seen. Six months after surgery this patient was free of neurogenic claudication. Case 2 involved a 60-year-old woman with a 1-year history of left L-4 radicular pain. Both MR and CT images demonstrated severe left L-4 foraminal stenosis and focal scoliosis. Before surgery, a nerve root anomaly was not detected, but during a unilateral mini-open TLIF procedure, a confluent nerve root was identified. Two years after surgery, this patient was free of radicular pain. PMID:23905960

Burke, Shane M; Safain, Mina G; Kryzanski, James; Riesenburger, Ron I

2013-08-01

133

A systematic review with meta-analysis of posterior interbody fusion versus posterolateral fusion in lumbar spondylolisthesis.  

UK PubMed Central (United Kingdom)

PURPOSE: To compare the clinical effectiveness of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) for lumbar spondylolisthesis and to collect scientific evidence for determining which fusion method is better. METHODS: After systematic search, comparative studies were selected according to eligibility criteria. Checklists by Furlan and by Cowley were used to evaluate the risk of bias of the included randomized controlled trials (RCTs) and nonrandomized controlled studies, respectively. Weighed mean differences (WMDs) and risk differences were calculated for common outcomes. The final strength of evidence was expressed as different levels recommended by the GRADE Working Group. RESULTS: Four RCTs and five comparative observational studies were identified. Moderate-quality evidence indicated that PLIF was more effective than PLF for clinical satisfaction [odds ratios (OR) 0.49, 95 % confidence limits (95 % CI): (0.28, 0.88, P = 0.02)]. Moderate-quality evidence showed that no significant difference was found for the complication rate [OR 2.28, 95 % CI (0.97, 5.35), P = 0.06]. In secondary outcomes, moderate-quality evidence indicated that PLIF improved fusion rate [OR 0.32, 95 % CI (0.17, 0.61), P = 0.0006]. Low-quality evidence showed that PLIF resulted in a lower reoperation rate than PLF [OR 5.30, 95 % CI (1.47, 19.11), P = 0.01]. No statistical difference was found between the two groups with regard to blood loss [WMD = 76.52, 95 % CI (-310.68, 463.73), P = 0.70] and operating time [WMD = -1.20, 95 % CI (-40.36, 37.97), P = 0.95]. CONCLUSIONS: Moderate-quality evidence indicates that PLIF can improve the clinical satisfaction and increase the fusion rate compared to PLF. No superiority was found between the two fusion methods in terms of complication rate, amount of blood loss, and operating time for the treatment of lumbar spondylolisthesis.

Liu X; Wang Y; Qiu G; Weng X; Yu B

2013-06-01

134

Preventive effect of artificial ligamentous stabilization on the upper adjacent segment impairment following posterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: A retrospective, comparative study. OBJECTIVE: To assess the effects of soft stabilization with artificial ligamentous bands placed on the upper segment adjacent to posterior lumbar interbody fusion (PLIF) for prevention of transition syndrome compared with patients who underwent PLIF without soft stabilization. SUMMARY OF BACKGROUND DATA: Spine fusion increases mechanical stress and can cause other spinal problems adjacent to the fusion level. Soft stabilization using artificial ligamentous bands has been reported to decrease the flexion instability and this iatrogenic problems. There is no report concerning the effect of soft stabilization to transition syndrome following PLIF. METHODS: In 225 patients undergoing L4/5 PLIF, 70 consecutive patients who were treated concomitantly with decompression of L3/4 with minimum 2-year follow-up were included. Thirty-five patients underwent soft stabilization of L3/4 (soft stabilization [S] group) with natural neutral concept rods, and 35 patients did not (decompression [D] group). Radiographic changes in the disc height, vertebral slip, intervertebral angle, range of motion, lumbar lordosis, and L3 tilt angle were measured. On magnetic resonance imaging (MRI), postoperative progression of the disc degeneration and spinal canal stenosis were evaluated. RESULTS.: In the S group, significant posterior intervertebral expansion on radiograph was less advanced at the final follow-up (P < 0.005). MRI images demonstrated less significant aggravation of disc degeneration (P < 0.001) and progression of adjacent stenosis (P < 0.01), at L3/4 in the S group. Adjacent intervertebral changes on MRI occurred relatively early after surgery, suggesting that changes were due to transition syndrome, but not age-related changes. CONCLUSION: These results demonstrated an effect of soft stabilization for the prevention of transition syndrome in lumbar spine fusion. Although the postoperative follow-up periods in this study were not sufficiently long to reach a definitive conclusion, intervertebral breakdown adjacent to the rigid spine fusion could be diminished by the application of soft stabilization.

Imagama S; Kawakami N; Matsubara Y; Kanemura T; Tsuji T; Ohara T

2009-12-01

135

Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion (TLIF) for Degenerative Spondylolisthesis: Comparative Effectiveness and Cost-Utility Analysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for lumbar spondylolisthesis allows for the surgical treatment of back/leg pain while minimizing tissue injury and accelerating the patient's recovery. Although previous results have shown shorter hospital stays and decreased intraoperative blood loss for MIS versus open TLIF, short- and long-term outcomes have been similar. Therefore, we performed comparative effectiveness and cost-utility analysis for MIS versus open TLIF. METHODS: A total of 100 patients (50 MIS, 50 open) undergoing TLIF for lumbar spondylolisthesis were prospectively studied. Back-related medical resource use, missed work, and quality-adjusted life years were assessed. Cost of in-patient care, direct cost (2-year resource use × unit costs based on Medicare national allowable payment amounts), and indirect cost (work-day losses × self-reported gross-of-tax wage rate) were recorded, and the incremental cost-effectiveness ratio was calculated. RESULTS: Length of hospitalization and time to return to work were less for MIS versus open TLIF (P = 0.006 and P = 0.03, respectively). MIS versus open TLIF demonstrated similar improvement in patient-reported outcomes assessed. MIS versus open TLIF was associated with a reduction in mean hospital cost of $1758, indirect cost of $8474, and total 2-year societal cost of $9295 (P = 0.03) but similar 2-year direct health care cost and quality-adjusted life years gained. CONCLUSIONS: MIS TLIF resulted in reduced operative blood loss, hospital stay and 2-year cost, and accelerated return to work. Surgical morbidity, hospital readmission, and short- and long-term clinical effectiveness were similar between MIS and open TLIF. MIS TLIF may represent a valuable and cost-saving advancement from a societal and hospital perspective.

Parker SL; Mendenhall SK; Shau DN; Zuckerman SL; Godil SS; Cheng JS; McGirt MJ

2013-01-01

136

Influence of the Posterior Lumbar Interbody Fusion on the Sagittal Spinopelvic Parameters in Isthmic L5-S1 Spondylolisthesis.  

UK PubMed Central (United Kingdom)

STUDY DESIGN:: Prospective study of the sagittal spinopelvic parameters and deformity parameters in low grade isthmic spondylolisthesis pre- and post-operation. OBJECTIVE:: To better understand how the surgery influence saittal spino-pelvic alignment in low grade spondylolisthesis. SUMMARY OF BACKGROUND DATA:: Over the past decade, the importance of the sagittal spinopelvic parameters was recognized. However, the postoperative change of sagittal balance parameters in low grade spondylolisthesis was still unclear. METHODS:: 49 patients (mean age, 53.2±7.2) with low grade L5-S1 isthmic spondylolisthesis and 60 normal volunteers (mean age, 44.5±8.4) were included in the study. Each subject had a radiograph that allowed measurement of sagittal spinopelvic parameters before and after operation. The follow up duration was at least 2 years. Sagittal spinopelvic parameters and deformity parameters were measured for comparison. RESULTS: Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), lumbar 5 incidence (L5I), lumbosacral angle (LSA) of normal volunteers were smaller than the spondylolisthesis patients. All of the parameters changed significantly after the posterior lumbar interbody fusion (PLIF). Postoperative PT was decreased by 4.9 degrees, which had no significant difference with the control group (P=0.601). The changes of SD and HOD revealed correlation with the increase of LL (r=-0.483, P=0.003; r=0.365, P=0.010). CONCLUSION: The improvement of PT may play an important role in the reconstruction of the sagittal alignment and therapeutic outcome. The restoration of the SD and HOD would increase the LL with a wedged cage. To get a better LL, the size and geometry of the cage was recommended to evaluate before surgical treatment.

Feng Y; Chen L; Gu Y; Zhang ZM; Yang HL; Tang TS

2013-03-01

137

Influence of the Posterior Lumbar Interbody Fusion on the Sagittal Spinopelvic Parameters in Isthmic L5-S1 Spondylolisthesis.  

Science.gov (United States)

STUDY DESIGN:: Prospective study of the sagittal spinopelvic parameters and deformity parameters in low grade isthmic spondylolisthesis pre- and post-operation. OBJECTIVE:: To better understand how the surgery influence saittal spino-pelvic alignment in low grade spondylolisthesis. SUMMARY OF BACKGROUND DATA:: Over the past decade, the importance of the sagittal spinopelvic parameters was recognized. However, the postoperative change of sagittal balance parameters in low grade spondylolisthesis was still unclear. METHODS:: 49 patients (mean age, 53.2±7.2) with low grade L5-S1 isthmic spondylolisthesis and 60 normal volunteers (mean age, 44.5±8.4) were included in the study. Each subject had a radiograph that allowed measurement of sagittal spinopelvic parameters before and after operation. The follow up duration was at least 2 years. Sagittal spinopelvic parameters and deformity parameters were measured for comparison. RESULTS: Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), lumbar 5 incidence (L5I), lumbosacral angle (LSA) of normal volunteers were smaller than the spondylolisthesis patients. All of the parameters changed significantly after the posterior lumbar interbody fusion (PLIF). Postoperative PT was decreased by 4.9 degrees, which had no significant difference with the control group (P=0.601). The changes of SD and HOD revealed correlation with the increase of LL (r=-0.483, P=0.003; r=0.365, P=0.010). CONCLUSION: The improvement of PT may play an important role in the reconstruction of the sagittal alignment and therapeutic outcome. The restoration of the SD and HOD would increase the LL with a wedged cage. To get a better LL, the size and geometry of the cage was recommended to evaluate before surgical treatment. PMID:23511643

Feng, Yu; Chen, Liang; Gu, Yong; Zhang, Zhi-Ming; Yang, Hui-Lin; Tang, Tian-Si

2013-03-18

138

Posterior interbody spondylodesis with cage in the system of lumbar osteochondrosis treatment  

Directory of Open Access Journals (Sweden)

Full Text Available Titanic cage in combination with autobone can be used successfully for the different types of interbody spondilodesis additionally to the other known implants. Owing to the holes located in the corpus of titanic cage there is contact between autobone and osseous tissue of the adjacent vertebrae. The favaourable conditions have been created for formation of bone-metallic spondylodesis. The application of titanium cage has reduced traumatic effect of operation and has not required additional use of autobone tissue from the iliac crest.

Khusniddin Nuraliev

2012-01-01

139

Changes in the Adjacent Segment 10 Years After Anterior Lumbar Interbody Fusion for Low-Grade Isthmic Spondylolisthesis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Adjacent segment degeneration is a long-term complication of arthrodesis. However, the incidence of adjacent segment degeneration varies widely depending on the patient's age and underlying disease and the fusion techniques and diagnostic methods used. QUESTIONS/PURPOSES: We determined (1) the frequency of adjacent segment degeneration and increased lordosis on imaging tests, (2) the frequency and severity of clinical sequelae of these findings, including revision surgery, and (3) the sequence of degeneration and risk factors for degeneration. METHODS: Seventy-three patients underwent anterior lumbar interbody fusion for low-grade isthmic spondylolisthesis at one institution between October 2000 and February 2002. Forty-nine (67%) of the original patients had complete radiographic and clinical followup for 10 years. CT and MRI were performed at 5 years and 10 years in all cases. The disc height, sagittal profiles, and facet and disc degeneration at adjacent levels were examined to identify radiographic and clinical adjacent segment degeneration. Mean followup was 134.2 months (range, 120-148 months). RESULTS: Cranial segment lordosis increased (from 14.8° to 18.5°; p < 0.001), while caudal segment lordosis changed little (from 16.4° to 17.3°). Radiographic and clinical adjacent segment degeneration occurred in 19 (38.8%) and six (12.2%) patients, respectively, and two patients (4.1%) underwent revision surgery. Patients with adjacent segment degeneration had more advanced preexisting facet degeneration than patients without adjacent segment degeneration (odds ratio: 18.6; 95% CI, 1.97-175.54, p = 0.01). Acceleration of disc and facet degeneration occurred in 4.1% and 10.2%, respectively. CONCLUSIONS: Adjacent segment degeneration requiring surgery is rare, although radiographic adjacent segment degeneration is common after anterior lumbar interbody fusion for isthmic spondylolisthesis. The only risk factor we found was preexisting facet degeneration of the cranial segment. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Choi KC; Kim JS; Shim HK; Ahn Y; Lee SH

2013-08-01

140

Fusão intersomática lombar transforaminal: experiência de uma instituição Fusión intersomática lumbar transforaminal: la experiencia de una institución Transforaminal lumbar interbody fusion: a single-center experience  

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Full Text Available OBJETIVO: Relatar a experiência inicial de um serviço de referência em cirurgia da coluna em São Paulo, Brasil com a técnica de fusão intersomática lombar transforaminal (TLIF) nas suas mais variadas indicações. MÉTODOS: Avaliamos retrospectivamente os dados gravados em prontuário de 25 pacientes que foram submetidos à cirurgia com a técnica de TLIF no ano de 2011. Um paciente foi excluído porque não consideramos que a TLIF foi a principal técnica empregada. As indicações incluíram nove casos de hérnia de disco lombar, sete espondilolisteses, quatro cirurgias de revisão, sendo duas por pseudoartrose e duas por lombalgias e, finalmente, quatro pacientes com estenose espinhal lombar. RESULTADOS: Todos os pacientes referiram melhora da dor e/ou claudicação neurológica em comparação com o estado pré-operatório. Apenas cinco pacientes continuaram usando alguma medicação analgésica. Cinco pacientes apresentaram alguma complicação, mas somente duas delas estão relacionadas diretamente com o procedimento. CONCLUSÕES: Trata-se de uma técnica segura, possível de ser realizada em todos os níveis da coluna lombar e aplicável a grande parte das doenças que acometem essa região da coluna.OBJETIVO: Relatar la experiencia de un servicio de referencia en cirugía de la columna en São Paulo, Brasil con la técnica de fusión intersomática lumbar transforaminal (TLIF) en sus más variables indicaciones. MÉTODOS: Valoramos retrospectivamente el historial médico de 25 pacientes que fueron sometidos a la cirugía con la técnica de TLIF en el año de 2011. Un paciente fue excluido porque no consideramos que la TLIF fue la principal técnica empleada. Las indicaciones incluyeron nueve casos de hernia de disco lumbar, siete espondilolistesis, cuatro cirugías de revisión siendo dos por pseudoartrosis y dos por lumbalgias y, finalmente, cuatro pacientes con estenosis espinal. RESULTADOS: Todos los pacientes presentaron mejora del dolor y/o claudicación neurogénicas en comparación con el status preoperatorio. Solamente cinco pacientes continuaron usando alguna medicación analgésica. Cinco pacientes presentaran alguna complicación, pero sólo dos de ellas están relacionadas directamente al procedimiento. CONCLUSIONES: Es una técnica segura, posible de ser realizada en todos los niveles de la columna lumbar y es aplicable a la mayoría de las enfermedades que afectan a esta región de la columna.OBJECTIVE: Describe the early results and experience from a reference center in spine surgery in São Paulo, Brazil with transforaminal lumbar interbody fusion (TLIF) technique in its various indications. METHODS: We retrospectively reviewed the medical records of 25 patients who underwent surgery with TLIF technique in 2011. One patient was excluded because we considered that TLIF was not the most important technique used. The indications were 9 lumbar disc herniations, 7 spondylolistheses, 4 revision surgeries of which 2 were for pseudoarthroses and 2 for low back pain, and finally, 4 lumbar spinal stenoses. RESULTS: All the patients reported low back pain and/or neurologic claudication improvement when comparing to preoperative status. Only five patients continued using analgesics. Five patients presented some complication, but only two of them were related to the procedure. CONCLUSIONS: TLIF is a safe technique which can be performed at any lumbar level of the lumbar spine and is applicable to the majority of diseases that affect this region.

Vinicius de Meldau Benites; Eduardo Augusto Iunes; Alexandre José dos Reis Elias; Rodrigo Miziara Yunes; Franz Jooji Onishi; Sérgio Cavalheiro

2012-01-01

 
 
 
 
141

Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2.  

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Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody fusion in low-grade spondylolisthesis performed with an independent blade retractor system or a traditional open approach. A prospective clinical study of 85 consecutive cases of degenerative and isthmic lower grade spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion (MiTLIF) or open transforaminal lumbar interbody fusion (OTLIF) was done. A total of 85 patients suffering from degenerative spondylolisthesis (n = 46) and isthmic spondylolisthesis (n = 39) underwent one-level MiTLIF (n = 42) and OTLIF (n = 43) by two experienced surgeons at one hospital, from June 2006 to March 2008 (minimum 13-month follow-up). The following data were compared between the two groups: the clinical and radiographic results, operative time, blood loss, transfusion needs, X-ray exposure time, postoperative back pain, length of hospital stay, and complications. Clinical outcome was assessed using the visual analog scale (VAS) and the Oswestry disability index. The operative time, clinical and radiographic results were basically identical in both groups. Comparing with the OTLIF group, the MiTLIF group had significantly lesser blood loss, lesser need for transfusion, lesser postoperative back pain, and shorter length of hospital stay. The radiation time was significantly longer in MiTLIF group. One case of nonunion was observed from each group. Minimally invasive TLIF has similar surgical efficacy with the traditional open TLIF in treating one-level lower grade degenerative or isthmic spondylolisthesis. The minimally invasive technique offers several potential advantages including smaller incisions, less tissue trauma and quicker recovery. However, this technique needs longer X-ray exposure time. PMID:20411281

Wang, Jian; Zhou, Yue; Zhang, Zheng Feng; Li, Chang Qing; Zheng, Wen Jie; Liu, Jie

2010-04-22

142

Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2.  

UK PubMed Central (United Kingdom)

Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody fusion in low-grade spondylolisthesis performed with an independent blade retractor system or a traditional open approach. A prospective clinical study of 85 consecutive cases of degenerative and isthmic lower grade spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion (MiTLIF) or open transforaminal lumbar interbody fusion (OTLIF) was done. A total of 85 patients suffering from degenerative spondylolisthesis (n = 46) and isthmic spondylolisthesis (n = 39) underwent one-level MiTLIF (n = 42) and OTLIF (n = 43) by two experienced surgeons at one hospital, from June 2006 to March 2008 (minimum 13-month follow-up). The following data were compared between the two groups: the clinical and radiographic results, operative time, blood loss, transfusion needs, X-ray exposure time, postoperative back pain, length of hospital stay, and complications. Clinical outcome was assessed using the visual analog scale (VAS) and the Oswestry disability index. The operative time, clinical and radiographic results were basically identical in both groups. Comparing with the OTLIF group, the MiTLIF group had significantly lesser blood loss, lesser need for transfusion, lesser postoperative back pain, and shorter length of hospital stay. The radiation time was significantly longer in MiTLIF group. One case of nonunion was observed from each group. Minimally invasive TLIF has similar surgical efficacy with the traditional open TLIF in treating one-level lower grade degenerative or isthmic spondylolisthesis. The minimally invasive technique offers several potential advantages including smaller incisions, less tissue trauma and quicker recovery. However, this technique needs longer X-ray exposure time.

Wang J; Zhou Y; Zhang ZF; Li CQ; Zheng WJ; Liu J

2010-10-01

143

Comparison of Clinical Outcome in Overweight or Obese Patients After Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion.  

UK PubMed Central (United Kingdom)

STUDY DESIGN:: This is a prospective single-center nonrandomized control clinical study involving 81 overweight or obese patients who underwent minimally invasive or open transforaminal lumbar interbody fusion. OBJECTIVE:: The objective of this study is to evaluate the safety and efficacy of minimally invasive TLIF as an alternative technique in overweight or obese patients. SUMMARY OF BACKGROUND DATA:: Spinal surgery in obese patients is associated with increased complications, blood loss, and operative times. The potential benefits of minimally invasive lumbar surgery in obese patients are discussed in few studies. However, there have been no prospective clinical reports published on the comparison of minimally invasive or open TLIF in obese patients. METHODS:: Eighty-one patients, 25 males and 56 females with an average age of 55.3 (43 to 81) were prospectively evaluated. The main inclusion criteria were a body mass index (BMI) equal to or greater than 25. The mean body mass index (BMI) was 28.9±3.2. All patients suffering from lumbar canal stenosis (n=43), spondylolisthesis (n=29), or post laminectomy instability (n=9) underwent 1-level minimally invasive LTIF (MiTLIF, n=43) or open TLIF (OTLIF, n=39). The following data were compared between two groups: operative time, blood loss, X-ray exposure time, clinical and radiographic outcomes, and perioperative complications. Clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). Radiographic evaluation of the lumbar spine was performed at 12 months postoperatively. RESULTS:: In comparison to the OTLIF group, the MiTLIF group had significantly less operating time, less blood loss and less postoperative back pain. The radiation time was significantly longer in the MiTLIF group. The clinical outcomes (ODI scores) were basically identical in two groups. Radiographic evaluation showed satisfactory bony union at the fixed level in both MiTLIF group (42/43 cases) and OTLIF group (38/39 cases). Overall complication rates were slightly higher in the OTLIF group, with 17.9% of overweight or obese patients having perioperative complications. CONCLUSIONS:: Minimally invasive TLIF is a safe and reliable procedure for treatment of overweight or obese patients. The minimally invasive technique offers several potential advantages when compared to open procedure. Although this technique needs longer X-ray exposure time, it may still be a good option for overweight or obese patients.

Wang J; Zhou Y; Feng Zhang Z; Qing Li C; Jie Zheng W; Liu J

2012-05-01

144

Two-level anterior lumbar interbody fusion with percutaneous pedicle screw fixation. A minimum 3-year follow-up study  

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The clinical and radiological outcomes of two-level anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PSF) were evaluated in 24 consecutive patients who underwent two level ALIF with percutaneous PSF for segmental instability and were followed up for more than 3 years. Clinical outcomes were assessed using a visual analogue scale (VAS) score and the Oswestry Disability Index (ODI). Sagittal alignment, bone union, and adjacent segment degeneration (ASD) were assessed using radiography and magnetic resonance imaging. The mean age of the patients at the time of operation was 56.3 years (range 39-70 years). Minor complications occurred in 2 patients in the perioperative period. At a mean follow-up duration of 39.4 months (range 36-42 months), VAS scores for back pain and leg pain, and ODI score decreased significantly (from 6.5, 6.8, and 46.9% to 3.0, 1.9, and 16.3%, respectively). Clinical success was achieved in 22 of the 24 patients. The mean segmental lordosis, whole lumbar lordosis, and sacral tilt significantly increased after surgery (from 25.1deg, 39.2deg, and 32.6deg to 32.9deg, 44.5deg, and 36.6deg, respectively). Solid fusion was achieved in 21 patients. ASD was found in 8 of the 24 patients. No patient underwent revision surgery due to nonunion or ASD. Two-level ALIF with percutaneous PSF yielded satisfactory clinical and radiological outcomes and could be a useful alternative to posterior fusion surgery. (author)

2010-01-01

145

Which lumbar interbody fusion technique is better in terms of level for the treatment of unstable isthmic spondylolisthesis?  

UK PubMed Central (United Kingdom)

OBJECT: The purpose of this study was to investigate and compare clinical and radiographic outcomes of 2 kinds of lumbar interbody fusion (LIF) for the treatment of adult low-grade isthmic spondylolisthesis at L4-5 and L5-S1 levels. METHODS: The medical records and radiographs of 86 patients who underwent anterior LIF (ALIF) (L4-5, 42 patients; L5-S1, 44 patients) and 42 patients who underwent transforaminal LIF (TLIF) (L4-5, 22 patients; L5-S1, 20 patients) between 2001 and 2004 were retrospectively reviewed. Clinical results were investigated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, and using radiographic measurements, including disc height (DH), degree of spondylolisthesis, segmental lordosis, whole lumbar lordosis (WL), sacral slope (SS), and pelvic tilt; the L-1 axis S-1 distance (LASD) and pelvic incidence were also obtained. RESULTS: In both groups, VAS and ODI scores had significantly improved at both treatment levels. Statistical analysis showed no significant difference in postoperative VAS scores between groups at the L4-5 level and in postoperative VAS/ODI scores at the L5-S1 level. However, ODI scores were better in the TLIF than in the ALIF group at the L4-5 level. In terms of radiological changes, there were no significant differences between the 2 groups at the L4-5 level; however, at the L5-S1 level, radiographic results indicated that ALIF was superior to TLIF in its capacity to restore DH, WL, SS, and LASD. The radiological evidence of fusion shows no intergroup difference and no interlevel difference. CONCLUSIONS: Considering the clinical and radiological outcomes in both groups, the authors recommend that instrumented mini-TLIF is preferable at the L4-5 level, whereas instrumented mini-ALIF might be preferable at the L5-S1 level for the treatment of unstable isthmic spondylolisthesis.

Kim JS; Lee KY; Lee SH; Lee HY

2010-02-01

146

Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: A case series  

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Full Text Available Abstract Introduction Traditional surgical management of lumbosacral spondylolisthesis is technically challenging and is associated with significant complications. The advent of minimally invasive surgical techniques offers patients treatment alternatives with lower operative morbidity risk. The combination of percutaneous pedicle screw reduction and an axial presacral approach for lumbosacral discectomy and fusion offers an alternative procedure for the surgical management of low-grade lumbosacral spondylolisthesis. Case presentation Three patients who had L5-S1 grade 2 spondylolisthesis and who presented with axial pain and lumbar radiculopathy were treated with a minimally invasive surgical technique. The patients-a 51-year-old woman and two men (ages 46 and 50)-were Caucasian. Under fluoroscopic guidance, spondylolisthesis was reduced with a percutaneous pedicle screw system, resulting in interspace distraction. Then, an axial presacral approach with the AxiaLIF System (TranS1, Inc., Wilmington, NC, USA) was used to perform the discectomy and anterior fixation. Once the axial rod was engaged in the L5 vertebral body, further distraction of the spinal interspace was made possible by partially loosening the pedicle screw caps, advancing the AxiaLIF rod to its final position in the vertebrae, and retightening the screw caps. The operative time ranged from 173 to 323 minutes, and blood loss was minimal (50 mL). Indirect foraminal decompression and adequate fixation were achieved in all cases. All patients were ambulatory after surgery and reported relief from pain and resolution of radicular symptoms. No perioperative complications were reported, and patients were discharged in two to three days. Fusion was demonstrated radiographically in all patients at one-year follow-up. Conclusions Percutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management of lumbosacral spondylolisthesis.

Tender Gabriel C; Miller Larry E; Block Jon E

2011-01-01

147

Rectocutaneous fistula and nonunion after TranS1 axial lumbar interbody fusion L5-S1 fixation: case report.  

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The authors report a case of rectal injury, rectocutaneous fistula, and pseudarthrosis after a TranS1 axial lumbar interbody fusion (AxiaLIF) L5-S1 fixation. The TranS1 AxiaLIF procedure is a percutaneous minimally invasive approach to transsacral fusion of the L4-S1 vertebral levels. It is gaining popularity due to the ease of access to the sacrum through the presacral space, which is relatively free from intraabdominal and neurovascular structures. This 35-year-old man had undergone the procedure for the treatment of degenerative disc disease. The patient subsequently presented with fever, syncope, and foul-smelling gas and bloody drainage from the surgical site. A CT fistulagram and flexible sigmoidoscopy showed evidence of rectocutaneous fistula, which was managed with intravenous antibiotic therapy and bowel rest with total parenteral nutrition. Subsequent studies performed 6 months postoperatively revealed evidence of pseudarthrosis. The patient's rectocutaneous fistula symptoms gradually subsided, but his preoperative back pain recurred prompting a revision of his L5-S1 spinal fusion. PMID:23790047

Siegel, Geoffrey; Patel, Nilesh; Ramakrishnan, Rakesh

2013-06-21

148

Rectocutaneous fistula and nonunion after TranS1 axial lumbar interbody fusion L5-S1 fixation: case report.  

UK PubMed Central (United Kingdom)

The authors report a case of rectal injury, rectocutaneous fistula, and pseudarthrosis after a TranS1 axial lumbar interbody fusion (AxiaLIF) L5-S1 fixation. The TranS1 AxiaLIF procedure is a percutaneous minimally invasive approach to transsacral fusion of the L4-S1 vertebral levels. It is gaining popularity due to the ease of access to the sacrum through the presacral space, which is relatively free from intraabdominal and neurovascular structures. This 35-year-old man had undergone the procedure for the treatment of degenerative disc disease. The patient subsequently presented with fever, syncope, and foul-smelling gas and bloody drainage from the surgical site. A CT fistulagram and flexible sigmoidoscopy showed evidence of rectocutaneous fistula, which was managed with intravenous antibiotic therapy and bowel rest with total parenteral nutrition. Subsequent studies performed 6 months postoperatively revealed evidence of pseudarthrosis. The patient's rectocutaneous fistula symptoms gradually subsided, but his preoperative back pain recurred prompting a revision of his L5-S1 spinal fusion.

Siegel G; Patel N; Ramakrishnan R

2013-08-01

149

Hybrid technique for posterior lumbar interbody fusion: a combination of open decompression and percutaneous pedicle screw fixation.  

UK PubMed Central (United Kingdom)

The authors describe a hybrid technique that involves a combination of open decompression and posterior lumbar interbody fusion (PLIF) and percutaneously inserted pedicle screws. This technique allows performance of PLIF and decompression via a midline incision and approach without compromising operative time and visualization. Furthermore, compared to standard open decompression, this approach reduces post-operative wound pain because the small midline incision significantly reduces muscle trauma by obviating the need to dissect the paraspinal muscles off the facet joint complex and by avoiding posterolateral fusion, thus requiring limited lateral muscle dissection off the transverse processes. A series of patients with Grade I-II spondylolisthesis at L4-5 and moderate-severe canal/foraminal stenosis underwent midline PLIF at L4-5, with closure of the midline incision. Percutaneous pedicle screws were inserted, thereby minimizing local muscle trauma, reduction of the spondylolisthesis being performed by using a pedicle screw construct. Rods were inserted percutaneously to link the L4 and L5 pedicle screws. Image intensification was used to confirmed satisfactory screw placement and reduction of spondylolisthesis. The results of a prospective study comparing a standard open decompression and fusion technique for spondylolisthesis versus the minimally invasive hybrid technique are discussed. The minimally invasive technique resulted in shorter hospital stay, earlier mobilization and reduced postoperative narcotic usage. The long-term clinical outcomes were equivalent in the two groups.

Mobbs RJ; Sivabalan P; Li J; Wilson P; Rao PJ

2013-05-01

150

Hybrid technique for posterior lumbar interbody fusion: a combination of open decompression and percutaneous pedicle screw fixation.  

Science.gov (United States)

The authors describe a hybrid technique that involves a combination of open decompression and posterior lumbar interbody fusion (PLIF) and percutaneously inserted pedicle screws. This technique allows performance of PLIF and decompression via a midline incision and approach without compromising operative time and visualization. Furthermore, compared to standard open decompression, this approach reduces post-operative wound pain because the small midline incision significantly reduces muscle trauma by obviating the need to dissect the paraspinal muscles off the facet joint complex and by avoiding posterolateral fusion, thus requiring limited lateral muscle dissection off the transverse processes. A series of patients with Grade I-II spondylolisthesis at L4-5 and moderate-severe canal/foraminal stenosis underwent midline PLIF at L4-5, with closure of the midline incision. Percutaneous pedicle screws were inserted, thereby minimizing local muscle trauma, reduction of the spondylolisthesis being performed by using a pedicle screw construct. Rods were inserted percutaneously to link the L4 and L5 pedicle screws. Image intensification was used to confirmed satisfactory screw placement and reduction of spondylolisthesis. The results of a prospective study comparing a standard open decompression and fusion technique for spondylolisthesis versus the minimally invasive hybrid technique are discussed. The minimally invasive technique resulted in shorter hospital stay, earlier mobilization and reduced postoperative narcotic usage. The long-term clinical outcomes were equivalent in the two groups. PMID:23658050

Mobbs, Ralph J; Sivabalan, Praveenan; Li, Jane; Wilson, Peter; Rao, Prashanth J

2013-05-01

151

Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion: a clinical and radiographic follow-up.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: Both open and minimally invasive lumbar fusion surgeries (MIS) are used to treat patients with symptomatic degenerative spinal pathologies. Open lumbar fusion surgery studies have reported excellent short-term safety and long-term clinical outcomes. MIS has shown excellent safety and short-term clinical success, but there is very little information on its long-term clinical durability. PURPOSE: The purpose of this study was to document the long-term clinical durability and safety of patients treated with minimally invasive surgery--transforaminal lumbar interbody fusion (MIS TLIF). Secondary purposes were to evaluate the clinical outcomes of patients receiving fusion in 2 sequential lumbar disc segments (2-level) as compared with a single-level lumbar disc segment (1-level), and as an aside, to determine whether or not there were any differences in clinical outcomes in patients treated over the age of 60 years as compared with those under 60 years. STUDY DESIGN: This study was a retrospective review of prospective collected outcomes data. PATIENT SAMPLE: One hundred sixty-nine consecutive patients, with either isolated single-level or 2-level lumbar intervertebral segment pain manifested by back pain alone or back pain with leg pain associated with a primary diagnosis of degenerative spondylolisthesis, central herniated disc, central stenosis, Foraminal-lateral herniation of disc, Foraminal/lateral stenosis, or isolated degenerative disc or joint disease. OUTCOMES MEASURES: Hospital stay time postoperative, return to work time, Oswestry Disability Index (ODI), visual analog pain scores (VAS), pain medicine (narcotic) use, fusion status, and reoperation rate. METHODS: Patients treated with 1or 2-level MIS TLIF were evaluated based on clinical outcomes, reoperation rates, and fusion status out to an average of 49 months postoperative (range, 36 to 60 mo). Effect of the number of levels fused, patient age, and worker compensation status on outcome was also assessed. RESULTS: Average surgery time was 183 minutes, with no difference between older and younger patients. Hospital stay averaged 15 hours with a median return to work time of 8 weeks. Return to work for patients working before surgery was 97%. ODI improved 36% at the first follow-up and was improved 41% at 49 months postoperative (P < 0.001). Eighty-six percent of patients reached a 20% clinical improvement in ODI at the last follow-up. Every primary diagnostic group increased significantly over time (P < 0.001). VAS pain scores improved in a similar pattern as ODI (P < 0.001). Patients with 2-level fusions improved comparably in both ODI and VAS scores as 1-level fusion patients. Worker compensation patients improved in both ODI and pain scores, although a little less than nonworkers compensation patients. Neither smoking, nor obesity status impacted clinical outcomes. Narcotic use for spine related pain went from 100% to 31% 6 months postoperative. Fusion rates were 96% at the 1-year follow-up. When reviewing surgical revisions as a consequence of surgical technique, and omitting unanticipated adverse events, 99% of patients maintained a successful fusion at their last average follow-up. CONCLUSIONS: The results of this study support the long-term clinical effectiveness of MIS TLIF for varying diagnoses. These results suggest that those undergoing a 1-level or 2-level lumbar fusion improve equally, and that older patients do well with MIS surgery long term. Reoperation rates were acceptable, with excellent surgical durability at 49 months. The benefit of decompression was not assessed in this study, and future studies should assess its impact long term.

Rouben D; Casnellie M; Ferguson M

2011-07-01

152

Minimally invasive transforaminal lumbar interbody fusions and fluoroscopy: a low-dose protocol to minimize ionizing radiation.  

Science.gov (United States)

Object There is an increasing awareness of radiation exposure to surgeons and the lifelong implications of such exposure. One of the main criticisms of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is the amount of ionizing radiation required to perform the procedure. The goal in this study was to develop a protocol that would minimize the fluoroscopy time and radiation exposure needed to perform an MIS TLIF without compromising visualization of the anatomy or efficiency of the procedure. Methods A retrospective review of a prospectively collected database was performed to review the development of a low-dose protocol for MIS TLIFs in which a combination of low-dose pulsed fluoroscopy and digital spot images was used. Total fluoroscopy time and radiation dose were reviewed for 50 patients who underwent single-level MIS TLIFs. Results Fifty patients underwent single-level MIS TLIFs, resulting in the placement of 200 pedicle screws and 57 interbody spacers. There were 28 women and 22 men with an average age of 58.3 years (range 32-78 years). The mean body mass index was 26.2 kg/m(2) (range 17.1-37.6 kg/m(2)). Indications for surgery included spondylolisthesis (32 patients), degenerative disc disease with radiculopathy (12 patients), and recurrent disc herniation (6 patients). Operative levels included 7 at L3-4, 40 at L4-5, and 3 at L5-S1. The mean operative time was 177 minutes (range 139-241 minutes). The mean fluoroscopic time was 18.72 seconds (range 7-29 seconds). The mean radiation dose was 0.247 mGy*m(2) (range 0.06046-0.84054 mGy*m(2)). No revision surgery was required for any of the patients in this series. Conclusions Altering the fluoroscopic technique to low-dose pulse images or digital spot images can dramatically decrease fluoroscopy times and radiation doses in patients undergoing MIS TLIFs, without compromising image quality, accuracy of pedicle screw placement, or efficiency of the procedure. PMID:23905959

Clark, Justin C; Jasmer, Gary; Marciano, Frederick F; Tumialán, Luis M

2013-08-01

153

CT navigated lateral interbody fusion.  

UK PubMed Central (United Kingdom)

Lateral interbody fusion techniques are heavily reliant on fluoroscopy for retractor docking and graft placement, which expose both the patient and surgeon to high doses of radiation. Use of image-guided technologies with CT-based images, however, can eliminate this radiation exposure for the surgeon. We describe the surgical technique of performing lateral lumbar interbody fusion using CT navigation.

Drazin D; Liu JC; Acosta Jr FL

2013-08-01

154

Femoral nerve palsy. An unusual complication of anterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

SUMMARY OF BACKGROUND DATA: Compression neuropathy of the femoral nerve has been reported as an uncommon complication of bleeding into the iliopsoas muscle. OBJECTIVE: The authors detected anatomic reasons of direct injury to the femoral nerve at the lower lumbar level. METHODS: Keeping the hip in extension during the course of carrying out anterior fusion on a previously failed posterior fusion was considered another causative factor of femoral nerve injury. Anatomical dissection confirmed the likelihood of this injury being produced in this situation. RESULTS: Femoral nerve traction and compression can occur after prolonged compression of the nerve within the psoas muscle stretched between an immobile lower lumbar spine and the lesser trochanter when the hip is kept in extension. In the patients described no other reasons for direct or indirect injury were identified. CONCLUSION: Although uncommon, the complication should be kept in mind. It can be avoided by intraoperative hip flexion.

Papastefanou SL; Stevens K; Mulholland RC

1994-12-01

155

Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis.  

UK PubMed Central (United Kingdom)

BACKGROUND: AxiaLIF was initially advocated as a minimally invasive, presacral lumbar fusion approach. Its use has expanded in to adult scoliosis surgeries. METHODS: Current literature about AxiaLIF for degenerative lumbar surgery and adult scoliosis surgery were reviewed. Anatomy, biomechanical properties, clinical results, and complications were summarized. RESULTS: Anatomically, AxiaLIF is relatively safe even though traversing blood vessels, and the pelvic splanchnic nerve can be at risk. AxiaLIF can provide significant stiffness compared to the intact spine, but posterior supplementation is recommended. AxiaLIF in the long construct for adult scoliosis surgeries can protect the S1 screw as effectively as pelvic fixation. Successful clinical outcomes after AxiaLIF were reported in the degenerative lumbar spine, adult scoliosis, and spondylolisthesis. It can facilitate a high fusion rate up to 96 % without BMP. Complications include pseudarthrosis, rectal injury, transient nerve irritation, and intrapelvic hematoma. CONCLUSION: AxiaLIF is a relatively safe procedure, and it provides good clinical results in both short constructs and long constructs for adult scoliosis surgery. For a safer procedure, surgeons should seek out prior colorectal surgical history and review preoperative imaging studies carefully.

Boachie-Adjei O; Cho W; King AB

2013-03-01

156

Anterior Dislodgement of a Fusion Cage after Transforaminal Lumbar Interbody Fusion for the Treatment of Isthmic Spondylolisthesis  

Science.gov (United States)

Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks postoperatively, imaging studies demonstrated that banana-shaped cage migrated anteriorly and anterolisthesis recurred at the index level with pseudoarthrosis. The cage was removed and exchanged by new cage through anterior approach, and screws were replaced with larger size ones and cement augmentation was added. At postoperative 2 days of revision surgery, computed tomography (CT) showed fracture on lateral pedicle and body wall of L5 vertebra. He underwent surgery again for paraspinal decompression at L4-5 and extension of instrumentation to S1 vertebra. His back and leg pains improved significantly after final revision surgery and symptom relief was maintained during follow-up period. At 6 months follow-up, CT images showed solid fusion at L4-5 level. Careful cage selection for TLIF must be done for treatment of spondylolisthesis accompanied with deformed LSTV, especially when reduction will be attempted. Banana-shaped cage should be positioned anteriorly, but anterior dislodgement of cage and reduction failure may occur in case of a highly unstable spine. Revision surgery for the treatment of an anteriorly dislodged cage may be effectively performed using an anterior approach.

Oh, Hyeong Seok; Lee, Sang-Ho

2013-01-01

157

Comparative Study of Lumbopelvic Sagittal Alignment Between Patients With and Without Sacroiliac Joint Pain After Lumbar Interbody Fusion.  

UK PubMed Central (United Kingdom)

Study Design. A retrospective case-control studyObjective. To elucidate the role of changes of lumbopelvic sagittal alignment in the pathogenesis of sacroiliac joint (SIJ) pain after posterior lumbar interbody fusion (PLIF) by comparing these values with the control, patients without SIJ pain.Summary of Background Data. There has been no study specifically addressing the relation between lumbopelvic sagittal alignment and SIJ pain after PLIF.Methods. Among 346 patients who underwent PLIF between June 2009 and April 2012, patients with postoperative SIJ pain, which was responded to SIJ block were enrolled. For a control group, patients who were matched for sex, age group, the number of fused level and fusion to sacrum were randomly selected. The patients were assessed using clinical and radiologic parameters including age, sex, diagnosis, BMD, BMI, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Target LL (PI + 9°), achieved rate of LL (postop LL/target LL*100) and LL-PI mismatch ([INCREMENT]) were also calculated and compared between two groups.Results. 23 patients (9 males and 14 females) with SIJ pain and 46 patients (18 males and 28 females) without SIJ pain were assessed. Postoperatively, SIJ pain group showed significantly greater PT (19.88 ± 10.42°, p = 0.03), smaller achieved rate of LL (64.3%, p = 0.02) and substantial residual LL-PI mismatch (-14.45 ± 12.16°, p = 0.03) than non-SIJ pain group (14.25 ± 7.68°, 73.2%, and -8.26 ± 9.12°, respectively). The degree of correlation between LL and PI in both SIJ pain and non-SIJ pain group was positive preoperatively (r = 0.569; p = 0.003, r = 0.591; p = 0.000, respectively). However, while this correlation of SIJ pain group remained positive postoperatively (r = 0.601, p = 0.002), it became strongly positive in non-SIJ pain group (r = 0.856, p = 0.000).Conclusion. This study indicates that lumbopelvic sagittal imbalance inferred from greater PT and inadequately restored LL may play a central role for the development of SIJ pain after PLIF. Thus it is important to restore lumbopelvic sagittal balance and to evaluate PI when determine the ideal LL that is needed to restored to prevent postoperative SIJ pain.

Shin MH; Ryu KS; Hur JW; Kim JS; Park CK

2013-06-01

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The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis  

Science.gov (United States)

The “off label” use of rhBMP-2 in the transforaminal lumbar interbody fusion (TLIF) procedure has become increasingly popular. Although several studies have demonstrated the successful use of rhBMP-2 for this indication, uncertainties remain regarding its safety and efficacy. The purpose of this study is to evaluate the clinical and radiographic outcomes of the single-level TLIF procedure using rhBMP-2. Patients who underwent a single-level TLIF between January 2004 and May 2006 with rhBMP-2 were identified. A retrospective evaluation of these patients included operative report(s), pre- and postoperative medical records, and dynamic and static lumbar radiographs. Patient-reported clinical outcome measures were obtained from a telephone questionnaire and included a modification of the Odom’s criteria, a patient satisfaction score, and back and leg pain numeric rating scale scores. Forty-eight patients met the study criteria and were available for follow-up (avg. radiographic and clinical follow-up of 19.4 and 27.4 months, respectively). Radiographic fusion was achieved in 95.8% of patients. Good to excellent results were achieved in 71% of patients. On most recent clinical follow-up, 83% of patients reported improvement in their symptoms and 84% reported satisfaction with their surgery. Twenty-nine patients (60.4%) reported that they still had some back pain, with an average back pain numeric rating score of 2.8. Twenty patients (41.7%) reported that they still had some leg pain, with an average leg pain numeric rating score was 2.4. Thirteen patients (27.1%) had one or more complications, including transient postoperative radiculitis (8/48), vertebral osteolysis (3/48), nonunion (2/48), and symptomatic ectopic bone formation (1/48). The use of rhBMP-2 in the TLIF procedure produces a high rate of fusion, symptomatic improvement and patient satisfaction. Although its use eliminates the risk of harvesting autograft, rhBMP-2 is associated with other complications that raise concern, including a high rate of postoperative radiculitis.

Makda, Junaid; Hong, Joseph; Patel, Ravi; Hilibrand, Alan S.; Anderson, David G.; Vaccaro, Alexander R.; Albert, Todd J.

2009-01-01

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The European multicenter trial on the safety and efficacy of guided oblique lumbar interbody fusion (GO-LIF)  

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Full Text Available Abstract Background Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO-LIF procedure and it will assess safety and efficacy. Methods/Design Multicentric prospective study with n = 40 patients to undergo single level instrumented spinal arthrodesis of the lumbar or the lumbosacral spine, based on a diagnosis of: painful disc degeneration, painful erosive osteochondrosis, segmental instability, recurrent disc herniation, spinal canal stenosis or foraminal stenosis. The primary target criteria with regards to safety are: The number, severity and cause of intra- and perioperative complications. The number of significant penetrations of the cortical layer of the vertebral body by the implant as recognized on postoperative CT. The primary target parameters with regards to feasibility are: Performance of the procedure according to the preoperative plan. The planned follow-up is 12 months and the following scores will be evaluated as secondary target parameters with regards to clinical improvement: VAS back pain, VAS leg pain, Oswestry Disability Index, short form - 12 health questionnaire and the Swiss spinal stenosis questionnaire for patients with spinal claudication. The secondary parameters with regards to construct stability are visible fusion or lack thereof and signs of implant loosening, implant migration or pseudarthrosis on plain and functional radiographs. Discussion This trial will for the first time assess the safety and efficacy of guided oblique lumbar interbody fusion. There is no control group, but the results, the outcome and the rate of any complications will be analyzed on the background of the literature on instrumented spinal fusion. Despite its limitations, we expect that this study will serve as the key step in deciding whether a direct comparative trial with another fusion technique is warranted. Trial Registration Clinical Trials NCT00810433

Birkenmaier Christof; Suess Olaf; Pfeiffer Michael; Burger Ralf; Schmieder Kirsten; Wegener Bernd

2010-01-01

160

Clinical and radiographic outcomes with L4–S1 axial lumbar interbody fusion (AxiaLIF) and posterior instrumentation: a multicenter study  

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Full Text Available William D Tobler,1 Miguel A Melgar,2 Thomas J Raley,3 Neel Anand,4 Larry E Miller,5 Richard J Nasca6 1Department of Neurosurgery, University of Cincinnati College of Medicine, Mayfield Clinic, and The Christ Hospital, Cincinnati, OH, USA; 2Department of Neurosurgery, Tulane University, New Orleans, LA, USA; 3Advanced Spine and Pain, Arlington, VA, USA; 4Spine Trauma, Minimally Invasive Spine Surgery Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 5Miller Scientific Consulting, Inc, Arden, NC, USA; 6Orthopaedic and Spine Surgery, Wilmington, NC, USA Introduction: Previous studies have confirmed the benefits and limitations of the presacral retroperitoneal approach for L5–S1 interbody fusion. The purpose of this study was to determine the safety and effectiveness of the minimally invasive axial lumbar interbody approach (AxiaLIF) for L4–S1 fusion. Methods: In this retrospective series, 52 patients from four clinical sites underwent L4–S1 interbody fusion with the AxiaLIF two-level system with minimum 2-year clinical and radiographic follow-up (range: 24–51 months). Outcomes included back pain severity (on a 10-point scale), the Oswestry Disability Index (ODI), and Odom's criteria. Flexion and extension radiographs, as well as computed tomography scans, were evaluated to determine fusion status. Longitudinal outcomes were assessed with repeated measures analysis of variance. Results: Mean subject age was 52 ± 11 years and the male:female ratio was 1:1. Patients sustained no intraoperative bowel or vascular injury, deep infection, or neurologic complication. Median procedural blood loss was 220 cc and median length of hospital stay was 3 days. At 2-year follow-up, mean back pain had improved 56%, from 7.7 ± 1.6 at baseline to 3.4 ± 2.7 (P < 0.001). Back pain clinical success (ie, ?30% improvement from baseline) was achieved in 39 (75%) patients at 2 years. Mean ODI scores improved 42%, from 60% ± 16% at baseline to 35% ± 27% at 2 years (P < 0.001). ODI clinical success (ie, ?30% improvement from baseline) was achieved in 26 (50%) patients. At final follow-up, 45 (87%) patients were rated as good or excellent, five as fair, and two as poor by Odom's criteria. Interbody fusion observed on imaging was achieved in 97 (93%) of 104 treated interspaces. During follow-up, five patients underwent reoperation on the lumbar spine, including facet screw removal (two), laminectomy (two), and transforaminal lumbar interbody fusion (one). Conclusion: The AxiaLIF two-level device is a safe, effective treatment adjunct for patients with L4–S1 disc pathology resistant to conservative treatments. Keywords: AxiaLIF, axial presacral fusion, interbody, outcomes, two-level fusion

Tobler WD; Melgar MA; Raley TJ; An; N; Miller LE; Nasca RJ

2013-01-01

 
 
 
 
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Five Year outcomes of Minimally Invasive versus Open Transforaminal Lumbar Interbody Fusion: A Matched Pair Comparison Study.  

UK PubMed Central (United Kingdom)

STRUCTURED ABSTRACT: Study Design. Retrospective analysis of prospectively collected data.Objective. To compare mid-term clinical and radiologic outcomes of minimally invasive(MIS) versus open transforaminal lumbar interbody fusion(TLIF).Summary of Background Data. Open TLIF is a proven technique to achieve fusion in symptomatic spinal deformities and instabilities. The possible advantages of MIS TLIF include reduced blood loss, less pain and shorter hospitalization. To date, there is no published data comparing their mid-term outcomes.Methods. From 2004-2007, 40 cases of open TLIF were matched paired with 40 cases of MIS TLIF for age, gender, BMI and spinal levels operated on. Oswestry Disability Index(ODI), neurogenic symptom score(NSS), SF-36 and Visual Analogue scores(VAS) for back and leg pain were performed before surgery, 6 months, 2 and 5 years after surgery. Fusion rates were assessed using Bridwell classification.Results. Fluoroscopic time(MIS: 55.2 seconds, Open: 16.4 seconds, p< 0.001) was longer in MIS cases. Operative time(MIS: 185 minutes, Open: 166 minutes, p = 0.085) was not significantly longer in MIS cases. MIS had less blood loss(127 mL) versus Open(405 mL, p< 0.001) procedures. Morphine use for MIS cases(8.5 mg) was less compared to Open(24.2 mg, p = 0.006). MIS patients(1.5 days) ambulated earlier compared to open(3 days, p< 0.001). MIS(3.6 days) patients have shorter hospitalization compared to open(5.9 days, p< 0.001). Both groups showed significant improvement in ODI, NSS, back and leg pain, SF-36 scores at 6 months till 5 years with no significant differences between them. Grade 1 fusion was achieved in 97.5% of both groups at 5 years. Overall complication rate was 20% for open group and 15% for MIS group(p = 0.774) including 4 cases of adjacent segment disease for each group.Conclusion. MIS TLIF is comparable to Open TLIF in terms of mid term clinical outcomes and fusion rates with the additional benefits of less initial postoperative pain, less blood loss, earlier rehabilitation and shorter hospitalization.

Seng C; Siddiqui MA; Wong KP; Zhang K; Yeo W; Tan SB; Yue WM

2013-08-01

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Adjacent segment degeneration after lumbar interbody fusion with percutaneous pedicle screw fixation for adult low-grade isthmic spondylolisthesis: minimum 3 years of follow-up.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although favorable clinical outcomes have been reported for instrumented lumbar interbody fusion (LIF), adjacent segment degeneration (ASD) has been reported as a long-term complication after LIF. OBJECTIVE: To investigate ASD after instrumented LIF performed at a single level and only for the homogeneous disease of adult low-grade isthmic spondylolisthesis. METHODS: A total of 128 patients who had undergone LIF for the treatment of adult low-grade isthmic spondylolisthesis involving the lower lumbar spine at our institution between February 2001 and December 2004 were retrospectively reviewed by chart review and telephone survey. Of them, 103 patients with a minimum of a 36-month follow-up period were enrolled in this study. The mean age was 48.5 years. The average follow-up period was 59 months. Clinical and radiological data related to segmental lordosis (SL), whole lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence, and L1 axis S1 distance were analyzed to identify significant risk factors for ASD. RESULTS: The overall incidence of ASD was 10.6% (11/103). The incidences of radiographic and symptomatic ASD were 8.7% (9/103) and 1.9% (2/103), respectively. All patients improved clinically and functionally during the follow-up period. Postoperative SL, preoperative SL, whole lumbar lordosis, and L1 axis S1 distance were significant risk factors for ASD. Only SL was a significant risk factor for both the preoperative and postoperative states. CONCLUSION: ASD may occur at a relatively lower incidence in adult low-grade isthmic spondylolisthesis compared with other degenerative lumbar spinal diseases. SL is significantly correlated with ASD, whereas mechanical alterations caused by LIF are less likely to affect the adjacent segment. Restoration of normal SL is important for preventing ASD, and long-term follow-up is necessary.

Bae JS; Lee SH; Kim JS; Jung B; Choi G

2010-12-01

163

Different mechanisms of spinal fusion using equine bone protein extract, rhBMP-2 and autograft during the process of anterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

To elucidate the molecular mechanisms of spinal fusion with different graft materials during an anterior lumbar interbody fusion, we examined the gene-expression profiles after implantation of equine bone protein extract, rhBMP-2 and autograft using microarray technology and data analysis, including hierarchical clustering, self-organizing maps (SOM), KEGG pathway and Biological process GO analyses in a porcine model. The results suggest that equine bone protein extract exhibited a more similar expression pattern with autograft than that of rhBMP-2. rhBMP-2 recruits progenitor cells, proliferation and differentiation possibly by inducing various factors including PGHS-2, IFGBP-2, VEGF and chemokines and then leads to preferable membranous ossification and bone remodeling. Conversely, equine bone protein extract results in endochondral ossification via upregulation of cartilage-related genes. Ossification by inducing direct osteoblastic differentiation and obviating the cartilaginous intermediate phases may increase spinal fusion rate.

Zou X; Zou L; Foldager C; Bendtsen M; Feng W; Bünger CE

2009-02-01

164

Clinical and radiological outcome of anterior-posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients.  

UK PubMed Central (United Kingdom)

Abundant data are available for direct anterior/posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre- and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups.

Faundez AA; Schwender JD; Safriel Y; Gilbert TJ; Mehbod AA; Denis F; Transfeldt EE; Wroblewski JM

2009-02-01

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A prospective randomized controlled study comparing transforaminal lumbar interbody fusion techniques for degenerative spondylolisthesis: unilateral pedicle screw and 1 cage versus bilateral pedicle screws and 2 cages.  

UK PubMed Central (United Kingdom)

OBJECT: Many surgeons currently prefer to use transforaminal lumbar interbody fusion (TLIF), placing 1 unilateral pedicle screw (PS) and 1 cage. However, no study has examined whether unilateral fixation improves surgical outcome. The authors conducted a prospective randomized controlled trial with a minimum 2-year follow-up to analyze TLIF outcomes for 2 techniques: placement of a unilateral PS and a cage compared with placement of bilateral PSs and 2 cages. METHODS: Fifty patients with degenerative spondylolisthesis undergoing single-level TLIF were randomly assigned to receive either unilateral or bilateral fixation. Parameters compared between the groups were surgical invasiveness, severity of intermittent claudication, pre- and postoperative visual analog scale (VAS) scores (from 0 to 10 for back pain, lower-extremity pain, and lower-extremity numbness), postoperative disability scores for lumbar spinal disorders (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire [JOABPEQ]), and fusion rates. RESULTS: The mean operative time for TLIF was significantly (p = 0.05) shorter and mean estimated blood loss was significantly lower in the unilateral than in the bilateral group. Intermittent claudication improved in response to each technique, but there was no significant intergroup difference. The unilateral group had a nonsignificant tendency toward less improvement in VAS score for back pain (1.5 vs 3.7 for the bilateral group) and exhibited significantly less improvement in VAS score for lower-extremity pain (2.1 vs 5.1, respectively) and numbness (1.7 vs 4.4). There were no significant differences between the groups in postsurgical scores for all 5 items of the JOABPEQ. The fusion rates were 87.5% (21 of 24 patients) in the unilateral group and 95.7% (22 of 23) in the bilateral group. CONCLUSIONS: Transforaminal lumbar interbody fusion involving unilateral PS fixation and a single-cage technique is less invasive than a 2-cage technique and bilateral fixation, and it improved patients' symptoms. However, it resulted in less improvement in back pain, lower-extremity pain, and lower-extremity numbness. When considering unilateral PS fixation and a single cage, the surgeon should be aware of the potential limitations of this technique. Clinical trial registration no.: UMIN000007833 (UMIN).

Aoki Y; Yamagata M; Ikeda Y; Nakajima F; Ohtori S; Nakagawa K; Nakajima A; Toyone T; Orita S; Takahashi K

2012-08-01

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Fusion and subsidence rate of stand alone anterior lumbar interbody fusion using PEEK cage with recombinant human bone morphogenetic protein-2.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Anterior lumbar interbody fusion (ALIF) is an established treatment for structural instability associated with symptomatic disk degeneration (SDD). Stand-alone ALIF offers many advantages, however, it may increase the risk of non-union. Recombinant human bone morphogenetic protein-2 (BMP-2) may enhance fusion rate but is associated with postoperative complication. The optimal dose of BMP-2 remains unclear. This study assessed the fusion and subsidence rates of stand-alone ALIF using the SynFix-LR interbody cage with 6 ml/level of BMP-2. METHODS: Thirty-two ALIF procedures were performed by a single surgeon in 25 patients. Twenty-five procedures were performed for SDD without spondylolisthesis (SDD group) and seven procedures were performed for SDD with grade-I olisthesis (SDD-olisthesis group). Patients were followed-up for a mean of 17 ± 6 months. RESULTS: Solid fusion was achieved in 29 cases (90.6 %) within 6 months postoperatively. Five cases of implant subsidence were observed (16 %). Four of these occurred in the SDD-olisthesis group and one occurred in the SDD group (57 % vs. 4 % respectively; p = 0.004). Three cases of subsidence failed to fuse and required revision. The body mass index of patients with olisthesis who developed subsidence was higher than those who did not develop subsidence (29 ± 2.6 vs. 22 ± 6.5 respectively; p = 0.04). No BMP-2 related complications occurred. CONCLUSION: The overall fusion rate of stand-alone ALIF using the SynFix-LR system with BMP-2 was 90.6 %, comparable with other published series. No BMP-2 related complication occurred at a dose of 6 mg/level. Degenerative spondylolisthesis and obesity seemed to increase the rate of implant subsidence, and thus we believe that adding posterior fusion for these cases should be considered.

Behrbalk E; Uri O; Parks RM; Musson R; Soh RC; Boszczyk BM

2013-08-01

167

Clinical Results of a Single Central Interbody Fusion Cage and Transpedicle Screws Fixation for Recurrent Herniated Lumbar Disc and Low-Grade Spondylolisthesis  

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Full Text Available Background: The posterior lumbar interbody fusion (PLIF) procedure allows restoration ofthe weight-bearing capacity to a more physiological ventral position andmaintenance of disc space height. However, the procedure can be technicallydifficult and may cause complications. It has always been performed bilaterallywith paired cages; a single central cage has not been commonly used.Methods: Twenty-eight patients who met the interbody fusion criteria from March1999 through November 2001 were included in the study. Surgery was performedfrom the posterior with a single central cage supplemented withtranspedicle screws. The follow-up period ranged from 8 to 39 months with amean of 14.4 months. Clinical outcomes were assessed. Dynamic radiographyfor fusion mass was interpreted by an independent radiologist.Results: Overall, 92.86% of the patients were satisfied with their conditions aftersurgery. Radiography study showed the rate of bony fusion being 82.14%.Fibrous union was noted in five patients. No migration of the cage wasobserved. One patient experienced laceration of the dura without clinicalsequelae. One patient had transient paresthesia and recovered within 2weeks. One patient had transient bladder atony and recovered within 3 days.Overall, the complications were negligible and none of the patients sustaineda motor deficit and permanent complication.Conclusions: The PLIF procedure using a single, central cage combined with bilateralpedicle screws fixation obtained satisfactory outcome within a short-term orlong-term follow-up period. Since the implant-related complications haveseldom been observed, it may be used as an alternative option for recurrentlumbar disc herniation or low grade spondylolisthesis with apparent degenerativedisc disease.

Kuo-Feng Huang; Tzu-Yung Chen

2003-01-01

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Avaliação clínica radiológica da artrodese lombar transforaminal aberta versus minimamente invasiva Evaluación clínica radiológica de la artrodesis lumbar transforaminal abierta versus mínimamente invasiva Clinical and radiological evaluation of open transforaminal lumbar interbody fusion versus minimally invasive  

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Full Text Available OBJETIVO: a proposta deste trabalho é comparar os resultados clínicos e radiológicos dos pacientes submetidos à artrodese transforaminal aberta e minimamente invasiva. MÉTODOS: quarenta e cinco pacientes foram submetidos à artrodese lombar transforaminal pelo Grupo de Cirurgia Espinhal do Hospital Lifecenter/Ortopédico de Belo Horizonte, no período de Dezembro de 2005 a Maio de 2007, sendo 15 no grupo de artrodese aberta e 30 pacientes do grupo de artrodese minimamente invasiva (MIS). As indicações para a artrodese intersomática foram: doença degenerativa do disco, associada ou não a hérnia de disco ou estenose do canal; espondilolistese de baixo grau espondilolítica ou degenerativa; e síndrome pós-laminectomia/discectomia. As variáveis analisadas foram: tempo de cirurgia, tempo de internação hospitalar, necessidade de hemotransfusão, escala analógica visual de dor (VAS) lombar e dos membros inferiores, Oswestry, índice de consolidação da artrodese e retorno ao trabalho. RESULTADOS: o seguimento mínimo foi de 24 meses. Havia oito homens e sete mulheres no Grupo Aberto e 17 homens e 13 mulheres no Grupo MIS. O tempo cirúrgico médio foi de 222 minutos e 221 minutos, respectivamente. Houve melhora significativa da VAS e Oswestry no pós-operatório em ambos os grupos. O tempo de internação hospitalar variou de 3,3 dias para o Grupo Aberto e 1,8 dias para o Grupo MIS. O índice de fusão obtido foi de 93,3% em ambos os grupos. Houve necessidade de hemotransfusão em três pacientes no Grupo Aberto (20%) e nenhum caso MIS. CONCLUSÕES: a transforaminal lumbar interbody fusion (TLIF) minimamente invasiva apresenta resultados similares em longo prazo quando comparado à TLIF aberta, com os benefícios adicionais de menor morbidade pós-operatória, menor período de internação e reabilitação precoce.OBJETIVO: la propuesta de este trabajo es comparar los resultados clínicos y radiológicos de los pacientes sometidos a la artrodesis transforaminal abierta y mínimamente invasiva. MÉTODOS: cuarenta y cinco pacientes fueron sometidos a la artrodesis lumbar transforaminal por el Grupo de Cirugía Espinal del Hospital Lifecenter/Ortopédico de Belo Horizonte, en el periodo de Diciembre de 2005 a Mayo de 2007, siendo 15 en el grupo de artrodesis abierta y 30 pacientes del grupo de artrodesis mínimamente invasiva (MIS). Las indicaciones para la artrodesis intersomática fueron: enfermedad degenerativa de disco, asociada o no a hernia de disco o estenosis del canal; espondilolistesis de bajo grado espondilolítica o degenerativa; y síndrome post-laminectomía/discectomía. Las variables analizadas fueron: tiempo de cirugía, tiempo de internación hospitalar, necesidad de hemotransfusión, escala analógica visual de dolor (VAS) lumbar y de los miembros inferiores, Oswestry, índice de consolidación de la artrodesis y regreso al trabajo. RESULTADOS: el seguimiento mínimo fue de 24 meses. Fueron ocho hombres y siete mujeres en el Grupo Abierto y 17 hombres y 13 mujeres en el Grupo MIS. El tiempo quirúrgico promedio fue de 222 minutos y 221 minutos, respectivamente. Hubo mejora significativa del VAS y Oswestry en el postoperatorio en ambos grupos. El tiempo de internación hospitalar varió de 3.3 días para el Grupo Abierto y 1.8 días para el Grupo MIS. El índice de fusión obtenido fue de 93.3% en ambos grupos. Hubo necesidad de hemotransfusión en tres pacientes en el Grupo Abierto (20%) y ningún caso MIS. CONCLUSIONES: la TLIF mínimamente invasiva presenta resultados similares a largo plazo cuando comparada con TLIF abierta, con los beneficios adicionales de menor morbilidad postoperatoria, menor periodo de internación y rehabilitación precoz.OBJECTIVE: the aim of this article is to compare the clinical and radiological results of patients who underwent open and minimally invasive transforaminal lumbar interbody fusion. METHODS: forty-five patients underwent transforaminal lumbar interbody fusion by the Department of Spine Surgery of Hospital Lifecenter/Ortopédico, be

Cristiano Magalhães Menezes; Roberto Sakamoto Falcon; Marcos Antônio Ferreira Júnior; Johmeson Alencar

2009-01-01

169

Minimally invasive anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis: minimum 5-year follow-up.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: We previously reported the preliminary results of minimally invasive anterior lumbar interbody fusion (mini-ALIF) with percutaneous pedicle screw fixation (PPF) in 2004. PURPOSE: To investigate the long-term results of mini-ALIF followed by PPF for the treatment of back and leg pain in adult isthmic spondylolisthesis. STUDY DESIGN: Retrospective study with a minimum 5-year follow-up. Sixty-three patients with a mean age of 49 years were included in this study. Each patient had mini-ALIF followed by PPF. Visual analog scale pain and intensity (back and leg), Oswestry Disability Index scores, and the patient's return-to-work status. METHODS: Of the initial 73 patients who underwent mini-ALIF with PPF between October 2000 and February 2002, 63 patients could be contacted after 5 to 7 years. Clinical follow-up and radiological follow-up with dynamic lumbar X-ray, three-dimensional computed tomography scans, and lumbar magnetic resonance imaging for checking the adjacent segmental disease (ASD) were completed in patients. Radiological results including the intervertebral disc height, the degree of listhesis, segmental lumbar lordosis, and whole lumbar lordosis were analyzed by statistical analysis. RESULTS: The mean follow-up period was 72 months. Among the 63 patients, 56 (88.9%) had an excellent or good clinical result and five (7.9%) had a fair result based on the Macnab criteria. Two (3.2%) patients had a poor result. The last scores of visual analog scale and Oswestry Disability Index were significantly decreased compared with the preoperative baseline. Radiographs of all patients at the last follow-up showed solid fusion. There was one case of screw fracture. However, last follow-up study showed solid fusion state. ASD was proven to be progressing in 6 out of 63 (9.5%) patients, but only two patients (3.2%) had symptoms associated with ASD. CONCLUSIONS: The long-term outcome after mini-ALIF with PPF in patients with low-grade isthmic spondylolisthesis was successful. Furthermore, in terms of ASD, there is low incidence of ASD after the procedure.

Kim JS; Choi WG; Lee SH

2010-05-01

170

Posterior lumbar interbody fusion versus posterolateral fusion with instrumentation in the treatment of low-grade isthmic spondylolisthesis: midterm clinical outcomes.  

UK PubMed Central (United Kingdom)

OBJECT: The purpose of this study was to compare the methods of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in cases of isthmic Grades 1 and 2 lumbar spondylolisthesis, and to evaluate the clinical efficacy of the procedures. METHODS: Operations were performed in 50 patients with lumbar spondylolisthesis in the authors' clinics between 2001 and 2007. Indications for surgery were low-back pain with or without sciatica and neurogenic claudication that had not improved after at least 6 months of conservative treatment. The study included 33 female and 17 male patients, with mean ages of 50.6 years in the PLIF group and 47.3 years in the PLF group. These patients were randomly allocated into 2 groups: decompression, posterior transpedicular instrumentation, and PLF (Group 1; 25 patients) and decompression, posterior transpedicular instrumentation, and PLIF (Group 2; 25 patients). In the PLIF group, titanium cages were used, and autograft material was obtained from the decompression. In the PLF group, bone fragments collected from the iliac crest were used as autografts. A minimum 18-month follow-up was available in all patients. For clinical evaluation, a visual analog scale, Oswestry Disability Index, and the 36-Item Short Form Health Survey were used. Improvements in pre- and postoperative spondylolisthesis, segmental angles, fusion ratios, and postoperative complications were evaluated radiologically. RESULTS: The average follow-up period was 3.3 years. Based on the etiologies, isthmic spondylolisthesis was detected in all patients. The spondylolisthesis levels in the patients who underwent PLIF were located at L3-4 (5 patients, 20%); L4-5 (14, 56%); and L5-S1 (6, 24%), whereas the levels in the ones treated with PLF were located at L3-4 (4 patients, 16%); L4-5 (13, 52%); and L5-S1 (8, 32%). In the clinical evaluations, good or excellent results were obtained in 22 (88%) cases in the PLIF group and 19 (76%) cases in the PLF group. Fusion ratios were 100% in the PLIF group and 84% in the PLF group. Both lumbar lordosis and the segmental angle showed greater improvement in the PLIF group. There was no difference in the complication rates for each group. CONCLUSIONS: Based on early clinical outcomes and the fusion ratios of adult isthmic spondylolisthesis, the authors found PLIF to be superior to PLF.

Müslüman AM; Y?lmaz A; Cansever T; Cavu?o?lu H; Colak I; Genç HA; Ayd?n Y

2011-04-01

171

Minimum 10-Year Follow-up Study of Anterior Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Progressive Pattern of the Adjacent Disc Degeneration.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Retrospective study. PURPOSE: The aims of the current study are to evaluate the minimum 10-year follow-up clinical results of anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. OVERVIEW OF LITERATURE: ALIF has been widely used as a treatment regimen in the management of lumbar spondylolisthesis. Still much controversy exists regarding the factors that affect the postoperative clinical outcomes. METHODS: The author performed a retrospective review of 20 patients with degenerative spondylolisthesis treated with ALIF (follow-up, 16.4 years). The clinical results were assessed by the Japanese Orthopaedic Association (JOA) score for low back pain, vertebral slip and disc height index on the radiographs. RESULTS: The mean preoperative JOA score was 7.1 ± 1.8 points (15-point-method). At 1 year, 5 years, and 10 years or more after surgery, the JOA scores were assessed as 12.4 ± 2.2 points, 12.7 ± 2.6 points, 12.0 ± 2.5 points, respectively (excluding the data of reoperated cases). The adjacent disc degeneration developed in all cases during the long-term follow-up. The progressive pattern of disc degeneration was divided into three types. Initially, disc degeneration occurred due to disc space narrowing. After that, the intervertebral discs showed segmental instability with translation at the upper level. But the lower discs showed osteophyte formation, and occasionally lead to the collapse or spontaneous union. CONCLUSIONS: The clinical results of the long-term follow-up data after ALIF became worse due to the adjacent disc degeneration. The progressive pattern of disc degeneration was different according to the adjacent levels.

Kanamori M; Yasuda T; Hori T; Suzuki K; Kawaguchi Y

2012-06-01

172

Intramuscular pressure of the multifidus muscle and low-back pain after posterior lumbar interbody fusion: comparison of mini-open and conventional approaches.  

UK PubMed Central (United Kingdom)

Object This randomized study was designed to elucidate the time course of the perioperative development of intramuscular multifidus muscle pressure after posterior lumbar interbody fusion (PLIF) and to investigate whether the route of pedicle screw insertion affects this pressure and resultant low-back pain. Although several studies have focused on intramuscular pressure associated with posterior lumbar surgery, those studies examined intramuscular pressure generated by the muscle retractors during surgery. No study has investigated the intramuscular pressure after PLIF. Methods Forty patients with L4-5 degenerative spondylolisthesis were randomly assigned to undergo either the mini-open PLIF procedure with pedicle screw insertion between the multifidus and longissimus muscles (n = 20) or the conventional PLIF procedure via a midline approach only (n = 20). Intramuscular pressure was measured 5 times (at 30 minutes and at 6, 12, 24, and 48 hours after surgery) with an intraoperatively installed sensor. Concurrently, the FACES Pain Rating Scale score for low-back pain and the total dose of postoperative analgesics were recorded. Results With the patients in the supine position, for both groups the mean pressure values were consistently 40-50 mm Hg, which exceeded the critical capillary pressure of the muscle. With the patients in the lateral decubitus position, the pressure decreased over time (from 14 to 9 mm Hg in the mini-open group and from 20 to 10 mm Hg in the conventional group). Among patients in the mini-open group, the pressure was lower, but the difference was not statistically significant. Postoperative pain and postoperative analgesic dosages were also lower . Conclusions To the authors' knowledge, this is the first study to evaluate postoperative intramuscular pressure after PLIF. Although the results did not demonstrate a significant difference in the intramuscular pressure between the 2 types of PLIF, mini-open PLIF was associated with less pain after surgery. Clinical trial registration no.: UMIN000010069 ( www.umin.ac.jp/ctr/index.htm ).

Mukai Y; Takenaka S; Hosono N; Miwa T; Fuji T

2013-09-01

173

Recombinant Human Bone Morphogenetic Protein-2-Augmented Transforaminal Lumbar Interbody Fusion for the Treatment of Chronic Low Back Pain Secondary to the Homogeneous Diagnosis of Discogenic Pain Syndrome.  

Science.gov (United States)

Study Design: A retrospective observational study.Objective: To assess clinical outcomes; perioperative complications; revision surgery rates; and BMP-2-related osteolysis, heterotopic bone, and unexplained postoperative radiculitis (BMPP) in a group of patients treated with BMP-2-augmented transforaminal lumbar interbody fusion (bTLIF) for the homogeneous diagnosis of discogenic pain syndrome (DPS) and to put forth the algorithm used to make the diagnosis.Summary of Background Data: There is a paucity of literature describing outcomes of TLIF for the homogeneous diagnosis of DPS, an old but controversial member of the lumbar degenerative disease family.Methods: The registry from a single-surgeon was queried for patients who had undergone bTLIF for the homogeneous diagnosis of DPS, which was made via specific diagnostic algorithm. Clinical outcomes were determined by analyzing point-improvement from typical outcome questionnaires (OQs) and the data from Patient Satisfaction and Return to Work (RTW) questionnaires. Independent record review was employed to assess all outcomes.Results: 80% of the cohort (36/45) completed pre-op and post-op OQs at an average follow-up of 41.9 ± 11.9 months, which demonstrated significant clinical improvement: ODI = 16.4 (p0.17), preoperative depression (15/36, P >0.19), nor prior discectomy/decompression (14/36, P<0.37) were predictors of outcomes.Conclusions: Although limited by retrospective design and small cohort, the results of this investigation suggest that bTLIF is a reasonable treatment option for patients who suffer DPS and affords high patient satisfaction. A larger study is needed to confirm these findings. PMID:24042711

Corenman, Donald S; Gillard, Douglas M; Dornan, Grant; Strauch, Eric

2013-09-15

174

Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive transforaminal lumbar interbody fusion: a single-center randomized prospective study.  

UK PubMed Central (United Kingdom)

Object Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is used to treat a wide variety of lumbar degenerative disorders. Although there are some reports showing efficacy of unilateral instrumentation during MIS-TLIF, a controlled randomized prospective study has not been done. Methods Forty-one patients were randomly assigned to receive either bilateral or unilateral instrumentation following 1-level unilateral MIS-TLIF. Four patients were lost to follow-up in the unilateral group and 1 patient was lost to follow-up in the bilateral group. Preoperative and postoperative scores on a visual analog scale (VAS) for back pain and leg pain (VAS-BP and VAS-LP, respectively), Oswestry Disability Index (ODI), and 36-Item Short Form Healthy Survey version 2 (SF-36v2) were collected. Additionally, preoperative and postoperative segmental Cobb angles and radiographic evidence of fusion were analyzed. Results There was no statistically significant difference in baseline demographic characteristics between the 2 groups. The VAS-BP, VAS-LP, ODI, and SF-36v2 physical component scores improved significantly after surgery in both groups (p < 0.05); there was no statistically significant between-groups difference in the degree of improvement. Blood loss was significantly higher in the bilateral instrumentation group and hospital stay was longer in the unilateral instrumentation group. There was no statistically significant between-groups difference with respect to change in segmental lordosis or fusion rate. The average duration of follow-up was 12.4 months for the bilateral instrumentation group and 11.4 months for the unilateral instrumentation group. Conclusions Clinical and radiographic outcomes of unilateral and bilateral instrumentation for unilateral MISTLIF are similar 1 year after surgery.

Dahdaleh NS; Nixon AT; Lawton CD; Wong AP; Smith ZA; Fessler RG

2013-08-01

175

Urological complications following use of recombinant human bone morphogenetic protein-2 in anterior lumbar interbody fusion: presented at the 2012 Joint Spine Section Meeting: clinical article.  

UK PubMed Central (United Kingdom)

OBJECT: The goal of this study was to compare the urological complications in patients after anterior lumbar interbody fusion (ALIF) with and without the use of recombinant human bone morphogenetic protein-2 (rhBMP-2). METHODS: The authors retrospectively reviewed the medical records of all patients who underwent ALIF with and without rhBMP-2 between January 2002 and August 2010. Patient demographic, operative, and complication information was analyzed. Male patients who underwent ALIF between L-4 and S-1 were contacted to assess postoperative urological complications. RESULTS: Of the 110 male patients who underwent ALIF and were included in this study, 59 were treated with rhBMP-2 and 51 did not receive rhBMP-2. The mean follow-up duration was 17.5 months for the rhBMP-2 group and 30.8 months for the control group. No difference was found regarding the total number of urological complications in the rhBMP-2 group versus the control group (22% vs 20%, respectively; p = 1.0) or for retrograde ejaculation specifically (8% vs 8%, respectively; p = 1.0). CONCLUSIONS: In this study, the use of rhBMP-2 with ALIF surgery was not associated with an increased incidence of urological complications and retrograde ejaculation when compared with control ALIF without rhBMP-2. Further prospective analyses that specifically look at these complications are warranted.

Lubelski D; Abdullah KG; Nowacki AS; Alvin MD; Steinmetz MP; Chakka S; Li Y; Gajewski N; Benzel EC; Mroz TE

2013-02-01

176

Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar spondylolisthesis allows for surgical treatment of back and leg pain while theoretically minimizing tissue injury and accelerating overall recovery. Although the authors of previous studies have demonstrated shorter length of hospital stay and reduced blood loss with MIS versus open-TLIF, short- and long-term outcomes have been similar. No studies to date have evaluated the comprehensive health care costs associated with TLIF procedures or assessed the cost-utility of MIS- versus open-TLIF. As such, we set out to assess previously unstudied end points of health care cost and cost-utility associated with MIS- versus open-TLIF. METHODS: Thirty patients undergoing MIS-TLIF (n=15) or open-TLIF (n=15) for grade I degenerative spondylolisthesis associated back and leg pain were prospectively studied. Total back-related medical resource use, missed work, and health-state values (quality-adjusted life years [QALYs], calculated from EQ-5D with U.S. valuation) were assessed after two-year follow-up. Two-year resource use was multiplied by unit costs on the basis of Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS- versus open-TLIF was assessed as incremental cost-effectiveness ratio (ICER: COSTmis-COSTopen/QALYmis-QALYopen). RESULTS: MIS versus open-TLIF cohorts were similar at baseline. By two years postoperatively, patients undergoing MIS- versus open-TLIF reported similar mean QALYs gained (0.50 vs. 0.41, P=0.17). Mean total two-year cost of MIS- and open-TLIF was $35,996 and $44,727, respectively. The $8,731 two-year cost savings of MIS- versus open-TLIF did not reach statistical significance (P=0.18) for this sample size. CONCLUSIONS: Although our limited sample size prevented statistical significance, MIS- versus open-TLIF was associated with reduced costs over two years while providing equivalent improvement in QALYs. MIS-TLIF allows patients to leave the hospital sooner, achieve narcotic independence sooner, and return to work sooner than open-TLIF. In our experience, MIS- versus open-TLIF is a cost reducing technology in the surgical treatment of medically refractory low-back and leg pain from grade I lumbar spondylolisthesis.

Parker SL; Adogwa O; Bydon A; Cheng J; McGirt MJ

2012-07-01

177

A Prospective, Randomized, Controlled Trial Comparing Radiographic and Clinical Outcomes between Stand-Alone Lateral Interbody Lumbar Fusion with either Silicate Calcium Phosphate or rh-BMP2.  

UK PubMed Central (United Kingdom)

Object Iliac crest autograft has traditionally been considered the gold standard for lumbar spine fusion, though it is not without drawbacks related to harvesting site pain and other complications. Bone graft alternatives, such as recombinant human bone morphogenetic protein 2 (rh-BMP2), are now widely used but also have unique risk profiles and substantially increase costs. The purpose of the current study was to compare the efficacy of rh-BMP2 and synthetic silicate calcium phosphate (SiCaP) as bone graft substitutes on fusion rates and clinical outcomes in patients undergoing single-level lumbar stand-alone extreme lateral interbody fusion (XLIF).Methods A prospective, randomized, controlled, clinical, and radiographic study was performed at a single institution. Thirty patients with L4-L5 degenerative disc disease (DDD) were enrolled. Patients were randomized into one of two groups, 15 underwent lumbar single-level stand-alone XLIF using SiCaP, and 15 using rh-BMP2. Clinical and radiographic results were compared between the study groups. Pain (visual analogue scale) and disability (Oswestry disability index) were assessed preoperatively and at postoperative weeks 1 and 6 and postoperative months 3, 6, 12, 24, and 36. Radiographic evaluations were performed at 6, 12, 24, and 36 months. Neurological examinations and adverse events were recorded at each visit.Results No intraoperative complications were observed in either treatment group, and clinical outcomes were similarly improved between bone graft substitutes from baseline to 36 months postoperative. Complications were transient hip flexion weakness (13%), insufficient indirect decompression (7%), subsidence (17%), excessive bone formation (4%), and adjacent segment disease (14%). Complication rates between the groups were similar, though with slightly more instances of subsidence in the SiCaP group and higher rates of excessive bone formation and adjacent segment disease in the rh-BMP2 group. Rates of fusion at different time points were different between the groups, with the SiCaP patients progressing more slowly toward solid fusion. However, at 36 months, 100% of patients undergoing XLIF achieved solid fusion.Conclusions In stand-alone XLIF, SiCaP and rhBMP-2 bone graft substitutes both resulted in complete long-term fusion. rhBMP-2, however, seemed to result in more rapid early postoperative fusion, though with one instance of excessive bone formation in one patient that required subsequent surgical intervention.

Pimenta L; Marchi L; Oliveira L; Coutinho E; Amaral R

2013-02-01

178

A Prospective, Randomized, Controlled Trial Comparing Radiographic and Clinical Outcomes between Stand-Alone Lateral Interbody Lumbar Fusion with either Silicate Calcium Phosphate or rh-BMP2.  

Science.gov (United States)

Object Iliac crest autograft has traditionally been considered the gold standard for lumbar spine fusion, though it is not without drawbacks related to harvesting site pain and other complications. Bone graft alternatives, such as recombinant human bone morphogenetic protein 2 (rh-BMP2), are now widely used but also have unique risk profiles and substantially increase costs. The purpose of the current study was to compare the efficacy of rh-BMP2 and synthetic silicate calcium phosphate (SiCaP) as bone graft substitutes on fusion rates and clinical outcomes in patients undergoing single-level lumbar stand-alone extreme lateral interbody fusion (XLIF).Methods A prospective, randomized, controlled, clinical, and radiographic study was performed at a single institution. Thirty patients with L4-L5 degenerative disc disease (DDD) were enrolled. Patients were randomized into one of two groups, 15 underwent lumbar single-level stand-alone XLIF using SiCaP, and 15 using rh-BMP2. Clinical and radiographic results were compared between the study groups. Pain (visual analogue scale) and disability (Oswestry disability index) were assessed preoperatively and at postoperative weeks 1 and 6 and postoperative months 3, 6, 12, 24, and 36. Radiographic evaluations were performed at 6, 12, 24, and 36 months. Neurological examinations and adverse events were recorded at each visit.Results No intraoperative complications were observed in either treatment group, and clinical outcomes were similarly improved between bone graft substitutes from baseline to 36 months postoperative. Complications were transient hip flexion weakness (13%), insufficient indirect decompression (7%), subsidence (17%), excessive bone formation (4%), and adjacent segment disease (14%). Complication rates between the groups were similar, though with slightly more instances of subsidence in the SiCaP group and higher rates of excessive bone formation and adjacent segment disease in the rh-BMP2 group. Rates of fusion at different time points were different between the groups, with the SiCaP patients progressing more slowly toward solid fusion. However, at 36 months, 100% of patients undergoing XLIF achieved solid fusion.Conclusions In stand-alone XLIF, SiCaP and rhBMP-2 bone graft substitutes both resulted in complete long-term fusion. rhBMP-2, however, seemed to result in more rapid early postoperative fusion, though with one instance of excessive bone formation in one patient that required subsequent surgical intervention. PMID:23444134

Pimenta, Luiz; Marchi, Luis; Oliveira, Leonardo; Coutinho, Etevaldo; Amaral, Rodrigo

2013-02-26

179

Minimally invasive or open transforaminal lumbar interbody fusion as revision surgery for patients previously treated by open discectomy and decompression of the lumbar spine  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Minimally invasive lumbar fusion techniques have been developed in recent 20 years. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain, and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective cl...

Wang, Jian; Zhou, Yue; Zhang, Zheng Feng; Li, Chang Qing; Zheng, Wen Jie; Liu, Jie

180

Expert's comment concerning Grand Rounds case entitled "Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesis" (by Nasir A. Quraishi and Y. Raja Rampersaud; doi:10.1007/s00586-012-2623-2).  

Science.gov (United States)

This Expert's Comment discusses the Grand Rounds Case entitled "Minimal Access Bilateral Transforaminal Lumbar Interbody Fusion for High-Grade Isthmic Spondylolisthesis" by Nasir A Quraishi and Raja Y Rampersaud. It puts a technically elegant surgical method for minimally invasive reduction and arthrodesis of isthmic spondylolistheses into the context of short and long term outcomes and questions the motivations for performing such minimally invasive procedures in the absence of any proven mid or long term advantages over more traditional techniques. In addition, the use of BMP in spinal arthrodesis is discussed on the background of recently published IPD metaanalyses from the Infuse spinal FDA trials. PMID:23868222

Birkenmaier, Christof

2013-07-19

 
 
 
 
181

Expert's comment concerning Grand Rounds case entitled "Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesis" (by Nasir A. Quraishi and Y. Raja Rampersaud; doi:10.1007/s00586-012-2623-2).  

UK PubMed Central (United Kingdom)

This Expert's Comment discusses the Grand Rounds Case entitled "Minimal Access Bilateral Transforaminal Lumbar Interbody Fusion for High-Grade Isthmic Spondylolisthesis" by Nasir A Quraishi and Raja Y Rampersaud. It puts a technically elegant surgical method for minimally invasive reduction and arthrodesis of isthmic spondylolistheses into the context of short and long term outcomes and questions the motivations for performing such minimally invasive procedures in the absence of any proven mid or long term advantages over more traditional techniques. In addition, the use of BMP in spinal arthrodesis is discussed on the background of recently published IPD metaanalyses from the Infuse spinal FDA trials.

Birkenmaier C

2013-08-01

182

Risk Factors for Adjacent Segment Disease After Posterior Lumbar Interbody Fusion and Efficacy of Simultaneous Decompression Surgery for Symptomatic Adjacent Segment Disease.  

UK PubMed Central (United Kingdom)

STUDY DESIGN:: A retrospective study. SUMMARY OF BACKGROUND DATA:: Posterior lumbar interbody fusion (PLIF) increases mechanical stress and can cause degenerative changes at the adjacent segment. However, the precise causes of adjacent segment disease (ASD) after PLIF are not known, and it is unclear whether simultaneous decompression surgery for symptomatic ASD is effective. OBJECTIVE:: To study, radiographically and symptomatically, the risk factors for adjacent segment disease (ASD) in the lumbar spine after L4/5 PLIF and to examine whether decompression surgery for the adjacent segment (L3/4) reduces the occurrence of symptomatic ASD. METHODS:: Fifty-four patients who underwent L4/5 PLIF for L4 degenerative spondylolisthesis and could be followed up for at least 2 years were included. Of these, 37 were treated simultaneously with decompression surgery at L3/4. We measured radiographic changes and assessed symptoms from the cranial adjacent segment. RESULTS:: Thirty-one patients (57.4%) met radiologic criteria for ASD. The length of follow-up (P=0.004) and simultaneous decompression surgery at L3/4 (P=0.009) were statistically significant factors for radiologic diagnosis of ASD. Seven patients (13.0%) had symptomatic ASD: 6 in the decompression group (16.2%) and 1 in the PLIF-only group (5.9%). Simultaneous decompression surgery did not reduce the incidence of symptomatic ASD (P=0.256). Local lordosis at the fused segment (P=0.005) and the sagittal angle of the facet joint at L3/4 (P=0.024) were statistically significant predictors of symptomatic ASD, which was accompanied by postoperative anterior listhesis above the fused segment (S group, 8.4%±8.0%; nonsymptomatic group: -0.7%±5.0%, P=0.024). CONCLUSIONS:: Patients whose facet joint at the adjacent segment had a more sagittal orientation had postoperative anterior listhesis, which caused symptomatic ASD. Simultaneous decompression surgery without fusion at the adjacent level was not effective for these patients, but rather, there was a possibility that it induced symptomatic ASD.

Hikata T; Kamata M; Furukawa M

2012-03-01

183

Risk Factors for Adjacent Segment Disease After Posterior Lumbar Interbody Fusion and Efficacy of Simultaneous Decompression Surgery for Symptomatic Adjacent Segment Disease.  

Science.gov (United States)

STUDY DESIGN:: A retrospective study. SUMMARY OF BACKGROUND DATA:: Posterior lumbar interbody fusion (PLIF) increases mechanical stress and can cause degenerative changes at the adjacent segment. However, the precise causes of adjacent segment disease (ASD) after PLIF are not known, and it is unclear whether simultaneous decompression surgery for symptomatic ASD is effective. OBJECTIVE:: To study, radiographically and symptomatically, the risk factors for adjacent segment disease (ASD) in the lumbar spine after L4/5 PLIF and to examine whether decompression surgery for the adjacent segment (L3/4) reduces the occurrence of symptomatic ASD. METHODS:: Fifty-four patients who underwent L4/5 PLIF for L4 degenerative spondylolisthesis and could be followed up for at least 2 years were included. Of these, 37 were treated simultaneously with decompression surgery at L3/4. We measured radiographic changes and assessed symptoms from the cranial adjacent segment. RESULTS:: Thirty-one patients (57.4%) met radiologic criteria for ASD. The length of follow-up (P=0.004) and simultaneous decompression surgery at L3/4 (P=0.009) were statistically significant factors for radiologic diagnosis of ASD. Seven patients (13.0%) had symptomatic ASD: 6 in the decompression group (16.2%) and 1 in the PLIF-only group (5.9%). Simultaneous decompression surgery did not reduce the incidence of symptomatic ASD (P=0.256). Local lordosis at the fused segment (P=0.005) and the sagittal angle of the facet joint at L3/4 (P=0.024) were statistically significant predictors of symptomatic ASD, which was accompanied by postoperative anterior listhesis above the fused segment (S group, 8.4%±8.0%; nonsymptomatic group: -0.7%±5.0%, P=0.024). CONCLUSIONS:: Patients whose facet joint at the adjacent segment had a more sagittal orientation had postoperative anterior listhesis, which caused symptomatic ASD. Simultaneous decompression surgery without fusion at the adjacent level was not effective for these patients, but rather, there was a possibility that it induced symptomatic ASD. PMID:22460400

Hikata, Tomohiro; Kamata, Michihiro; Furukawa, Mitsuru

2012-03-28

184

Recombinant Human Bone Morphogenetic Protein-2-Augmented Transforaminal Lumbar Interbody Fusion for the Treatment of Chronic Low Back Pain Secondary to the Homogeneous Diagnosis of Discogenic Pain Syndrome.  

UK PubMed Central (United Kingdom)

Study Design: A retrospective observational study.Objective: To assess clinical outcomes; perioperative complications; revision surgery rates; and BMP-2-related osteolysis, heterotopic bone, and unexplained postoperative radiculitis (BMPP) in a group of patients treated with BMP-2-augmented transforaminal lumbar interbody fusion (bTLIF) for the homogeneous diagnosis of discogenic pain syndrome (DPS) and to put forth the algorithm used to make the diagnosis.Summary of Background Data: There is a paucity of literature describing outcomes of TLIF for the homogeneous diagnosis of DPS, an old but controversial member of the lumbar degenerative disease family.Methods: The registry from a single-surgeon was queried for patients who had undergone bTLIF for the homogeneous diagnosis of DPS, which was made via specific diagnostic algorithm. Clinical outcomes were determined by analyzing point-improvement from typical outcome questionnaires (OQs) and the data from Patient Satisfaction and Return to Work (RTW) questionnaires. Independent record review was employed to assess all outcomes.Results: 80% of the cohort (36/45) completed pre-op and post-op OQs at an average follow-up of 41.9 ± 11.9 months, which demonstrated significant clinical improvement: ODI = 16.4 (p<0.0001), SF12-PCS = 10.0 (p<0.0001), and a Numeric Rating Scale for back pain = 2.3 (p<0.0001). The median patient satisfaction score was 9.0 (10 = complete satisfaction), and 84.4% (27/32) of the cohort were able to return to their pre-op job, with or without modification. There were 3 perioperative complications; 4 revision surgeries; and 11 cases of benign BMPP. There were no incidents of the intraoperative dural tears or nerve root injury, and neither litigation involvement (11/36, P>0.17), preoperative depression (15/36, P >0.19), nor prior discectomy/decompression (14/36, P<0.37) were predictors of outcomes.Conclusions: Although limited by retrospective design and small cohort, the results of this investigation suggest that bTLIF is a reasonable treatment option for patients who suffer DPS and affords high patient satisfaction. A larger study is needed to confirm these findings.

Corenman DS; Gillard DM; Dornan G; Strauch E

2013-09-01

185

Comparison study of the instrumented circumferential fusion with instrumented anterior lumbar interbody fusion as a surgical procedure for adult low-grade isthmic spondylolisthesis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Instrumented circumferential fusion has been used as a primary and salvage procedure in lumbar spine fusion, especially for adult low-grade isthmic spondylolisthesis. Recently, instrumented anterior lumbar interbody fusion (ALIF) has been shown to provide good clinical and radiologic results that are comparable with those attained with traditional lumbar fusion. However, there have been no reports available that compare instrumented circumferential fusion with instrumented ALIF. METHODS: Between January 2003 and November 2004, a total of 43 consecutive patients underwent instrumented ALIF (group I) at one hospital of the authors. Between February 2003 and October 2006, a total of 32 consecutive patients underwent instrumented circumferential fusion (group II) at the other hospital of the authors. The authors retrospectively reviewed clinical and radiologic data from patients. The time spent on the operation, blood loss, blood transfusions, the length of hospital stay, complications, clinical results, and radiologic results, including disc height (DH), degree of listhesis, segmental lordosis (SL), and whole lumbar lordosis (WL), were analyzed and compared. Clinical outcomes were graded using visual analog scale (VAS) scores. Functional outcomes were measured using Oswestry Disability Index (ODI) scores and return-to-work status. RESULTS: The mean follow-up period was 41.1 and 32.9 months in group I and group II, respectively. Radiologic evidence of fusion was noted in 42 of 43 patients in group I and in 32 of 32 patients in group II. In both groups, all of the radiologic data, including the DH, degree of listhesis, SL, and WL significantly changed from the preoperative to postoperative period except for WL in group II. In both groups, VAS scores for back and leg pain and ODI scores significantly changed from the preoperative to postoperative period. There was no significant difference for VAS scores for back ODI scores in the two treatment groups after surgery. The mean time until return to work was 3.7 months in group I and 3.6 months in group II (p < .05). The mean hospital stay for group I (7.4 days) was shorter than that for group II (15.2 days) (p < .05). The mean operation time in group I (190 minutes) was shorter than that in group II (260.8 minutes) (p < .05). The mean blood loss in group I (300 mL) was less than that in group II (379 mL) (p < .05). CONCLUSIONS: According to the present clinical outcome, instrumented ALIF is at least as effective as instrumented circumferential fusion for the treatment of back pain in adult patients with low-grade isthmic spondylolisthesis. Moreover, in terms of operative data including the duration of operation and hospital stay, as well as blood loss, instrumented ALIF demonstrates better results.

Kim JS; Kim DH; Lee SH; Park CK; Hwang JH; Cheh G; Choi YG; Kang BU; Lee HY

2010-05-01

186

Spontaneous slip reduction of low-grade isthmic spondylolisthesis following circumferential release via bilateral minimally invasive transforaminal lumbar interbody fusion: technical note and short-term outcome.  

Science.gov (United States)

STUDY DESIGN.: Retrospective clinical data analysis. OBJECTIVE.: To investigate and verify our philosophy of spontaneous slip reduction following circumferential release via bilateral minimally invasive transforaminal lumbar interbody fusion (Mini-TLIF) for treatment of low-grade symptomatic isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA.: Symptomatic isthmic spondylolisthesis usually requires surgical intervention, and the most currently controversial focus is on method and degree of reduction; and Mini-TLIF is an attractive surgical procedure for isthmic spondylolisthesis. METHODS.: Between February 2004 and June 2008, 21 patients with low-grade isthmic spondylolisthesis underwent Mini-TLIF in our institute. Total resection of the scar around the pars interarticularis liberated the nerve roots, achieving posterior release as well. The disc was thoroughly resected, and the disc space was gradually distracted and thoroughly released with sequential disc shavers until rupture of anulus conjunct with anterior longitudinal ligament, accomplishing anterior release, so as to insert Cages. Because of circumferential release, the slipped vertebrae would tend to obtain spontaneous reduction, and with pedicle screw fixation, additional reduction would be achieved without any application of posterior translation force. Radiographs, Visual Analogue Scale, and Oswestry Disability Index were documented. All the cases were followed up for 10 to 26 months. RESULTS.: Slip percentage was reduced from 24.2% ± 6.9% to 10.5% ± 4.0%, and foraminal area percentage increased from 89.1% ± 3.0% to 93.6% ± 2.1%. Visual Analogue Scale and Oswestry Disability Index decreased from 7.8 ± 1.5 to 2.1 ± 1.1 and from 53.3 ± 16.2 to 17.0 ± 7.8, respectively. No neurologic complications were encountered. There were no signs of instrumentation failure. The fusion rate approached 100%. CONCLUSION.: Slip reduction is based on circumferential release. The procedure can be well performed via Mini-TLIF, the outcome of which is equally gratifying to that of instrumented slip reduction and traditional midline approach. There is no need to fully reduce the slipped vertebrae. Circumferential release contributes to achieving spontaneous slip reduction partially, which aids sufficiently in the surgical treatment of low-grade isthmic spondylolisthesis. PMID:20714277

Pan, Jie; Li, Lijun; Qian, Lie; Zhou, Wei; Tan, Jun; Zou, Le; Yang, Mingjie

2011-02-15

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Spontaneous slip reduction of low-grade isthmic spondylolisthesis following circumferential release via bilateral minimally invasive transforaminal lumbar interbody fusion: technical note and short-term outcome.  

UK PubMed Central (United Kingdom)

STUDY DESIGN.: Retrospective clinical data analysis. OBJECTIVE.: To investigate and verify our philosophy of spontaneous slip reduction following circumferential release via bilateral minimally invasive transforaminal lumbar interbody fusion (Mini-TLIF) for treatment of low-grade symptomatic isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA.: Symptomatic isthmic spondylolisthesis usually requires surgical intervention, and the most currently controversial focus is on method and degree of reduction; and Mini-TLIF is an attractive surgical procedure for isthmic spondylolisthesis. METHODS.: Between February 2004 and June 2008, 21 patients with low-grade isthmic spondylolisthesis underwent Mini-TLIF in our institute. Total resection of the scar around the pars interarticularis liberated the nerve roots, achieving posterior release as well. The disc was thoroughly resected, and the disc space was gradually distracted and thoroughly released with sequential disc shavers until rupture of anulus conjunct with anterior longitudinal ligament, accomplishing anterior release, so as to insert Cages. Because of circumferential release, the slipped vertebrae would tend to obtain spontaneous reduction, and with pedicle screw fixation, additional reduction would be achieved without any application of posterior translation force. Radiographs, Visual Analogue Scale, and Oswestry Disability Index were documented. All the cases were followed up for 10 to 26 months. RESULTS.: Slip percentage was reduced from 24.2% ± 6.9% to 10.5% ± 4.0%, and foraminal area percentage increased from 89.1% ± 3.0% to 93.6% ± 2.1%. Visual Analogue Scale and Oswestry Disability Index decreased from 7.8 ± 1.5 to 2.1 ± 1.1 and from 53.3 ± 16.2 to 17.0 ± 7.8, respectively. No neurologic complications were encountered. There were no signs of instrumentation failure. The fusion rate approached 100%. CONCLUSION.: Slip reduction is based on circumferential release. The procedure can be well performed via Mini-TLIF, the outcome of which is equally gratifying to that of instrumented slip reduction and traditional midline approach. There is no need to fully reduce the slipped vertebrae. Circumferential release contributes to achieving spontaneous slip reduction partially, which aids sufficiently in the surgical treatment of low-grade isthmic spondylolisthesis.

Pan J; Li L; Qian L; Zhou W; Tan J; Zou L; Yang M

2011-02-01

188

The effect of surgical level on self-reported clinical outcomes following minimally invasive transforaminal lumbar interbody fusion: L4-L5 vs. L5-S1.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The anatomical and biomechanical aspects of the L5-S1 level present unique operative challenges compared to the L4-L5 level. However, it has not been determined if self-reported outcomes and complications are different between patients treated with a minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) at these specific levels. METHODS: Thirty-six consecutive patients were identified who were treated with a MI-TLIF procedure. Surgical indications included spondylolisthesis (grade 1 or 2) or degenerative disc disease with associated clinical symptomatology. Patients completed a Visual Analogue Scale (VAS) for their back and leg and Oswestry Disability Index (ODI) pre- and post-operatively. Outcomes were compared between patients with L4-L5 involvement to those with L5-S1 involvement. In all patients, fusion was evaluated by dynamic view flexion and extension views at 1 year. In all patients with indeterminate results or incomplete imaging, CT imaging was undertaken to evaluate for bridging bone and stable hardware positioning. RESULTS: The surgical indications between the two groups were similar (?(2) = 0.089, df = 2, p = 0.956). There was no significant difference in mean operating time, intra-operative blood loss, and hospital stay (p-values = 0.937; 0.627; and 0.587 respectively). There was no significant difference in the long-term post-operative questionnaire results (p-value = 0.819 for VAS [back], p-value = 0.626 for VAS [leg], and p-value = 0.962 for ODI) or the mean pre- to post-operative change in cobb angle (p-value =0.626) between the two groups. Two complications, one in each group, included a rash from an antibiotic, and a case of post-operative nausea. CONCLUSIONS: Despite differences in biomechanics and unique anatomic challenges at the L5-S1 interspace, there is no difference in self-reported outcomes for patients treated with an MI-TLIF at the L4-L5 level compared to the L5-S1 level.

Lawton CD; Smith ZA; Nixon AT; Dahdaleh NS; Wong AP; Khanna R; Barnawi A; Fessler RG

2013-08-01

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Comparison of the effect of posterior lumbar interbody fusion with pedicle screw fixation and interspinous fixation on the stiffness of adjacent segments.  

UK PubMed Central (United Kingdom)

BACKGROUND: Adjacent segment degeneration could seriously affect the long-term prognosis of lumbar fusion. Dynamic fixation such as the interspinous fixation, which is characterized by retaining the motion function of the spinal segment, has obtained satisfactory short-term effects in the clinical setting. But there are few reports about the biomechanical experiments on whether dynamic fixation could prevent adjacent segment degeneration. METHODS: The surgical segments of all 23 patients were L4/5. Thirteen patients with disc herniation of L4/5 underwent Wallis implantation surgery, and 10 patients with spinal stenosis of L4/5 underwent posterior lumbar interbody fusion (PLIF). L3-S1 segmental stiffness and displacement were measured by a spine stiffness gauge (SSG) device during surgery when the vertebral plate was exposed or during spinal decompression or internal fixation. Five fresh, frozen cadavers were used in the self control experiment, which was carried out in four steps: exposure of the vertebral plate, decompression of the spinal canal, implantation of a Wallis fixing device, and PLIF of L4/5 after removing the Wallis fixing device. Then, L3-S1 segment stiffness was measured by an SSG device. RESULTS: The experiments showed that the average stiffness of the L4/5 segment was (37.1 ± 8.9) N/mm after exposure of the vertebral plate, while after spinal decompression, the average stiffness fell to (26.2 ± 7.1) N/mm, decreasing by 25.8% (P < 0.05). For the adjacent segments L3/4 and L5/S1, their stiffness showed no significant difference between the L4/5 segment decompression and the exposure of the vertebral plate (P > 0.05). After Wallis implantation of L4/5, the stiffness of the cephalic adjacent segment L3/4 was (45.8 ± 10.7) N/mm, which was 20.5% more than that after the exposure of the vertebral plate (P < 0.05); after L4/5 PLIF surgery, the stiffness of L3/4 was (35.3 ± 10.7) N/mm and was decreased by 12.4% more than that after the exposure of the vertebral plate (P < 0.05). The stiffness of the cephalic adjacent segment L3/4 after fixation in the Wallis group was significantly higher than that of the PLIF group (P < 0.05). Cadaver experiments showed that the stiffness of the cephalic adjacent segment in the Wallis group was significantly higher than that of the PLIF group after L4/5 segment fixation (P < 0.05); the stiffness of the L5/S1 segment showed no significant difference between PLIF surgery and Wallis implantation (P > 0.05). CONCLUSIONS: After interspinous (Wallis) fixation, the stiffness of the cephalic adjacent segment increased. After PLIF with pedicle screw fixation, the stiffness of the cephalic adjacent segment decreased. An interspinous fixation system (Wallis) has a protective effect for cephalic adjacent segments for the immediate post-operative state.

Li CD; Sun HL; Lu HZ

2013-01-01

190

Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period.  

UK PubMed Central (United Kingdom)

OBJECT: There are no published reports of unilateral transforaminal lumbar interbody fusion (TLIF) in which two Brantigan I/F cages were placed per level through a single portal to achieve bilateral anterior-column support. The authors describe such a surgical technique and evaluate the clinical outcomes of this procedure. METHODS: Data obtained in 86 (93.5%) of the first 92 consecutive patients who underwent the procedure were retrospectively reviewed; the minimum follow-up duration was 2 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Disc height, disc angle, cage positioning in the axial plane, and fusion status were radiographically evaluated. The mean follow-up period was 33.8 months. The mean improvement in the JOA score was 77.2%. Fusion was successful in 93% of the cases. According to the Farfan method, the mean anterior and posterior disc heights increased from 20.2 and 16.9% preoperatively to 35.9 and 22.7% at follow up, respectively (p < 0.01). The mean disc angle increased from 4.8degrees preoperatively to 7.5degrees at last follow-up examination (p < 0.01). Two cages were correctly placed to achieve bilateral anterior-column support in greater than 85% of the cases. The following complications occurred: hardware migration in two patients and deep infection cured by intravenous antibiotic therapy in one patient. CONCLUSIONS: Unilateral TLIF involving the placement of two Brantigan cages per level led to good clinical results. Two Brantigan cages were adequately placed via a single portal, and reliable bilateral anterior-column support was achieved. Although the less invasive unilateral approach was used, the outcomes were as good as those in many reported series of posterior lumbar interbody fusion in which the Brantigan cages were placed via the bilateral approach.

Taneichi H; Suda K; Kajino T; Matsumura A; Moridaira H; Kaneda K

2006-03-01

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... you can just run the “Identification of the Anatomy” video now. Thank you. So now the next ... to show you is the identification of the anatomy. After we’ve done that skin incision and ...

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Full Text Available ... to return to normal activities and an improved quality of life. You may participate in the program ... this, their bone—even though this patient’s bone quality isn’t terrific, the bone gets very, very ...

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Full Text Available ... stops. Similarly, a patient is worse in spinal extension, which occurs when you walk downhill or when ... and their symptoms get much worse with spinal extension. So the idea of the X-Stop is ...

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Full Text Available ... my co-surgeon, Dr. Harrop, associate professor of neurosurgery. He’s at the table holding the instrument right ... So the symptoms of spinal stenosis are called neurogenic claudication. That means weakness and symptoms when walking, ...

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Full Text Available ... and bending over, where vascular claudication will only get better when a patient stops. Similarly, a patient ... to do this procedure minimally invasively and see—get the access and see the nerves in the ...

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Full Text Available ... this procedure minimally invasively and see—get the access and see the nerves in the way that ... removed that entire facet, and that gives me access to the transforaminal area. And there’s—you see ...

 
 
 
 
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Full Text Available ... we use what’s called osteotomes, which are bone-cutting instruments, to take down this bone. And we ... sharp instrument—you’re going to see it cutting through the bone and then removing what we ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... following diagnosis that you see on your screen: spondylolisthesis, or a slippage of one vertebrae on another; ... we’ve done it for called an isthmus spondylolisthesis, and you can see at the lowest level ...

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Full Text Available ... ANNOUNCER: During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University ... in the program by sending questions at any time; just click the MDirectAccess button on the screen. ...

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Full Text Available ... is a sponge and bone marrow, or sometimes bone morphogenic protein, which is not really approved for use in ... In addition, we’re using a material called bone morphogenic protein. Now, I should spend a moment speaking about ...

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Full Text Available ... a ground to make a full circle. 00:43:36 ASSISTANT: How do these heights look to you? 00:43:42 JAMES S. HARROP, MD: I need a rod bender. 00:43:45 ASSISTANT: How do these heights look to ...

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Full Text Available ... in anterior spacers, so technically this is an off-label use. However, it is in an anterior spacer, but ... discretion to use it; however, this is an off-label use of the bone morphogenic protein we’re using. ...

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Full Text Available ... and squeezing and strangling you— this is the effect on the nerve roots. And here is a ... cartoon that runs on your screen, showing the effect of placing these paddle dilators into the disc ...

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Full Text Available ... some—what you’re doing? 00:22:17 JAMES S. HARROP, MD: Absolutely. 00:22:19 TODD J. ... of where you are here? 00:22:31 JAMES S. HARROP, MD: Here we are. We actually—skipping ...

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Full Text Available ... Harrop, associate professor of neurosurgery. He’s at the table holding the instrument right now, and two of ... as well. I’ve stepped away from the table so I can introduce the procedure to you. ...

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Full Text Available ... nerves in a sac of water, the cerebrospinal fluid, and each of those white lines with the ... heard—or watching audience has heard—about cerebrospinal fluid. Cerebrospinal fluid is inside it, and he’s pushing ...

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Full Text Available ... ALBERT, MD: I want to thank the Jefferson media marketing group that’s put this— helped us put ... the surgery: our spine fellows and all the media crew that was here. They did a great ...

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Full Text Available ... to it. You can see there’s a counter-torque piece while we twist it—and you hear ... means it’s tight enough. It has a tightening torque to know that it’s tightened enough. Well, here’s ...

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Full Text Available ... cartoon that runs on your screen, showing the effect of placing these paddle dilators into the disc space. ... spine was as collapses 2 mm. And the effect of spreading that out, of opening it up, does ...

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Full Text Available ... survey at the end of the program for CME credit. 00:00:55 TODD J. ALBERT, MD: ... much. That’s terrific. So I want to remind CME viewers that they can receive CME credit by ...

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Full Text Available ... through a catch to leads in the patient’s lower extremities at different muscles enervated by L4. And depending ... amount of voltage that we read in the lower extremity, we will know that the screw is okay ...

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Full Text Available ... have to try to operate on patients within six hours. It’s not always possible because they don’ ... We typically brace patients after this operation for six weeks. We hope to fix her well enough ...

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Full Text Available ... So the plan for the operation is exposure, instrumentation, neural decompression, or opening up the nerve roots, ... largest inconvenience or limitation, in terms of surgical instrumentation or devices for spinal surgery?” 00:49:42 ...

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Full Text Available ... bone on one side of the spine. If pathology is only on one side of the spine, ... your diagnosis is. We think for this particular pathology and problem that—which is not a simple ...

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Full Text Available ... critical portion—part of our team as well. Craig Matsumoto, who will help us monitor the pedicle ... screw and put an electrical current through it. Craig’s going to then ramp up the current and ...

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Full Text Available ... when they arch their back. That doesn’t help for vascular claudication, and it is worse when ... but it is rare. The things we can help much better are sciatica, or nerve pinching, much ...

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Full Text Available ... 09 JAMES S. HARROP, MD: Do you have a joystick? 00:40:13 TODD ALBERT, MD: So Dr. ... going to put that joy—that’s called the joystick that we probe the pedicle with. And then ...

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Full Text Available ... TODD J. ALBERT, MD: Hello. Good afternoon, I’m Dr. Todd Albert, professor and vicechairman of orthopedics at Thomas Jefferson University. I’m at the operating room at Thomas Jefferson University ...

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Full Text Available ... tour of where you are here? 00:22:31 JAMES S. HARROP, MD: Here we are. We actually— ... It’s completely free, looks very relaxed. 00:28:31 TODD J. ALBERT, MD: Jim, we have a ...

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Full Text Available ... the table holding the instrument right now, and two of our spine fellows, Andrew Wight and David ... you. You can see the dots. The bottom two dots are L5, the middle two dots are ...

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Full Text Available ... performing the operation and then give you a few tidbits and pictures of what we do, catching ... that. Now, I’m going to spend a few minutes talking about the TLIF so you understand ...

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Full Text Available ... through a slight distraction. Now, there is a negative that comes along with distraction. If you remember ... would take 6 to 7 hours, and there’s negatives associated with that. But it really—to answer ...

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Biomechanical comparison of a new stand-alone anterior lumbar interbody fusion cage with established fixation techniques – a three-dimensional finite element analysis  

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Full Text Available Abstract Background Initial promise of a stand-alone interbody fusion cage to treat chronic back pain and restore disc height has not been realized. In some instances, a posterior spinal fixation has been used to enhance stability and increase fusion rate. In this manuscript, a new stand-alone cage is compared with conventional fixation methods based on the finite element analysis, with a focus on investigating cage-bone interface mechanics and stress distribution on the adjacent tissues. Methods Three trapezoid 8° interbody fusion cage models (dual paralleled cages, a single large cage, or a two-part cage consisting of a trapezoid box and threaded cylinder) were created with or without pedicle screws fixation to investigate the relative importance of the screws on the spinal segmental response. The contact stress on the facet joint, slip displacement of the cage on the endplate, and rotational angle of the upper vertebra were measured under different loading conditions. Results Simulation results demonstrated less facet stress and slip displacement with the maximal contact on the cage-bone interface. A stand-alone two-part cage had good slip behavior under compression, flexion, extension, lateral bending and torsion, as compared with the other two interbody cages, even with the additional posterior fixation. However, the two-part cage had the lowest rotational angles under flexion and torsion, but had no differences under extension and lateral bending. Conclusion The biomechanical benefit of a stand-alone two-part fusion cage can be justified. This device provided the stability required for interbody fusion, which supports clinical trials of the cage as an alternative to circumferential fixations.

Chen Shih-Hao; Tai Ching-Lung; Lin Chien-Yu; Hsieh Pang-Hsing; Chen Weng-Pin

2008-01-01

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Reduction and transforaminal lumbar interbody fusion with posterior fixation versus transsacral cage fusion in situ with posterior fixation in the treatment of Grade 2 adult isthmic spondylolisthesis in the lumbosacral spine.  

UK PubMed Central (United Kingdom)

OBJECT: In situ transsacral fusion in the treatment of low-grade isthmic spondylolisthesis has rarely been reported. The authors treated 13 cases of L-5 Grade 2 isthmic spondylolisthesis associated with collapsed disc space and osteoporosis by using transsacral fusion and fixation, and compared its clinical and radiological outcomes with the results of transforaminal lumbar interbody fusion (TLIF) and instrumental reduction in 21 patients. METHODS: The authors retrospectively analyzed 21 patients in Group A who were treated with reduction and TLIF, and 13 patients in Group B who were treated with transsacral cage fusion. Oswestry Disability Index and visual analog scale scores of back and leg pain were used to evaluate clinical outcomes. Radiological parameters for assessment included the percentage of slippage, whole lumbar lordosis, and lumbosacral angle. Operative data, fusion rate, and perioperative complications were recorded as well. RESULTS: The mean operation time and blood loss in Group B was less than that in Group A. Both groups realized good recovery from previous symptoms. The decrease in back and leg pain after surgery was significant within each group, without much difference between the 2 groups. No significant differences were found in lumbosacral angle, whole lumbar lordosis, visual analog scale score, and Oswestry Disability Index score between the 2 groups after surgery. The solid fusion rate was 95.2% in Group A and 92.3% in Group B. In Group A, 2 patients suffered from graft site pain, 1 had a superficial infection, and 1 had screw loosening; in Group B, dural tears were found in 2 patients, transient S-1 paresthesia in 2, and extensor hallucis longus muscle weakness in 1. CONCLUSIONS: For patients with a collapsed disc space and poor bone quality, posterior in situ transsacral cage fusion may be used as an alternative to the TLIF procedure. The short-term clinical and radiological outcomes in the transsacral cage group were comparable with those in the TLIF group, although with a relatively higher neurological complication rate.

Gong K; Wang Z; Luo Z

2010-09-01

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Transforaminal lumbar interbody fusion with rhBMP-2 in spinal deformity, spondylolisthesis, and degenerative disease--part 1: Large series diagnosis related outcomes and complications with 2- to 9-year follow-up.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To evaluate long-term clinical outcomes and complications of the transforaminal lumbar interbody fusion (TLIF) procedure from a large consecutive series, without industry funding. Clinical outcomes and complications are analyzed by diagnosis and primary versus revision surgery to assess whether TLIF with bone morphogenic protein (BMP) is appropriate for common use in deformity, spondylolisthesis, and degenerative disease. SUMMARY OF BACKGROUND DATA: A common method for achieving spinal arthrodesis includes TLIF with a cage and off-label interbody BMP-2, supported by posterior arthrodesis and a pedicle screw construct. There are no large studies analyzing outcomes and complications after TLIF in different diagnoses, for primary and revision surgery, leading some to question the widespread use of TLIF. METHODS: A total of 509 consecutive adults underwent open posterior instrumented fusion, augmented with TLIF at 872 discs using a cage and rhBMP-2, with minimum 2-year follow-up. Cohort diagnoses included 179 degenerative, 207 spondylolisthesis, and 123 deformity patients. Patient age averaged 61 years, 207 had undergone prior decompression or fusion surgery. All patients underwent posterior instrumented fusion and pedicle screw instrumentation at average 3.6 levels (range, 1-16); all patients had TLIF 1.7 levels (range, 1-4 levels) with BMP and autograft, stabilized with an interbody cage. RESULTS: At average 59 months follow-up, 12 patients developed pseudoarthrosis, 8 at TLIF levels (8/872 discs, 0.92%) most commonly at L5-S1 (6/8). Significant clinical improvement was noted in patients with deformity, spondylolisthesis, and degenerative disease undergoing primary and revision surgery. Overall, visual analogue scale preoperative score was 6.6, at 1 year 3.8, at 2 years 3.5 (P < 0.001) and the preoperative ODI was 50.9, at 1 year 36.1, and at 2 years 35.0 (P < 0 0.001). Pain medication requirements also declined. CONCLUSION: The efficacy of TLIF with BMP is supported in this large series with long-term follow-up, independent of industry. Reliable fusion and improved outcomes can be expected in adults undergoing TLIF for deformity, spondylolisthesis, and degenerative disease. Most complications occurred in patients with deformity.Level of Evidence: 3.

Crandall DG; Revella J; Patterson J; Huish E; Chang M; McLemore R

2013-06-01

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Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF  

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Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TL...

Hey Hwee Weng; Hee Hwan

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Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) versus open TLIF, addressing lumbar degenerative disc disease (DDD) or grade I spondylolisthesis (DS), are associated with shorter hospital stays, decreased blood loss, quicker return to work, and equivalent short- and long-term outcomes. However, no prospective study has assessed whether the extent of intraoperative muscle trauma utilizing creatinine phosphokinase levels (CPK) differently impacts long-term outcomes. METHODS: Twenty-one patients underwent MIS-TLIF (n = 14) versus open-TLIF (n = 7) for DDD or DS. Serum CPK levels were measured at baseline, and postoperatively (days 1, 7, and 1.5, 3 and 6 months). The correlation between the extent of intraoperative muscle trauma and two-year improvement in functional disability was evaluated (multivariate regression analysis). Additionally, baseline and two-year changes in Visual Analog Scale (VAS)-leg pain (LP), VAS-back pain (BP), Oswestry Disability Index (ODI), Short-Form-36 (SF-36) Physical Component Score (PCS) and SF-36 Mental Component Score (MCS), and postoperative satisfaction with surgical care were assessed. RESULTS: Although the mean change from baseline in the serum creatine phosphokinase level on POD 1 was greater for MIS-TLIF (628.07) versus open-TLF (291.42), this did not correlate with lesser two-year improvement in functional disability. Both cohorts also showed similar two-year improvement in VAS-LP, ODI, and SF-36 PCS/MCS. CONCLUSION: Increased intraoperative muscle trauma unexpectedly observed in higher postoperative CPK levels for MIS-TLIF versus open-TLIF did not correlate with any differences in two-year improvement in pain and functional disability.

Adogwa O; Johnson K; Min ET; Issar N; Carr KR; Huang K; Cheng J

2012-01-01

239

Radiographic Adjacent Segment Degeneration at Five Years After L4/5 Posterior Lumbar Interbody Fusion With Pedicle Screw Instrumentation: Evaluation by Computed Tomography and Annual Screening With Magnetic Resonance Imaging.  

Science.gov (United States)

STUDY DESIGN:: Retrospective clinical study. OBJECTIVE:: To investigate adjacent segment degeneration (ASD) at 5 years after L4/5 posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation and L4/5 decompression surgery using plain radiographs, CT and MRI, with evaluation of annual changes on MRI. SUMMARY OF BACKGROUND DATA:: Methods of evaluation have been inconsistent among studies of ASD. There is no report that ASD in the lumbar spine after PLIF at the same level is thoroughly evaluated on radiographs, CT, annual MRI changes, and the impact of decompression procedures. METHODS:: ASD was evaluated in 52 patients. Disc height, vertebral slip, intervertebral angle, and intervertebral range of motion were examined on plain radiographs. Facet joint degeneration on CT, and disc degradation and spinal stenosis on MRI were classified into categories, and facet sagittalization and tropism were measured on CT. The incidence of ASD was compared between decompression procedures. RESULTS:: The radiographic changes observed in the study were defined as radiographic ASD (R-ASD) without reoperation, since no patient required reoperation. R-ASD was rarely detected by radiography. At the L3/4 and L5/S1 levels, the incidences of facet joint degeneration, MRI-detected disc degeneration, and spinal stenosis were 21% and 23%, 27% and 17%, and 35% and 4%, respectively. Progressive disc degeneration at L3/4 was found significantly more frequently in patients with aggravation of facet degeneration (Plumbar spine fusion, rather than aging degeneration. Decompression with preservation of posterior connective components is recommended to prevent R-ASD. PMID:23429323

Imagama, Shiro; Kawakami, Noriaki; Kanemura, Tokumi; Matsubara, Yuji; Tsuji, Taichi; Ohara, Tetsuya; Katayama, Yoshito; Ishiguro, Naoki

2013-02-19

240

Transforaminal lumbar interbody fusion with rhBMP-2 in spinal deformity, spondylolisthesis, and degenerative disease--part 2: BMP dosage-related complications and long-term outcomes in 509 patients.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: Without industry funding, the study evaluated short- and long-term complications related to off-label bone morphogenetic protein (BMP) used with transforaminal lumbar interbody fusion (TLIF) from a large consecutive series. Complications and results were analyzed by BMP dose, fusion length, and primary versus revision surgery. Based on the results, surgical technique and BMP dose recommendations were proposed. SUMMARY OF BACKGROUND DATA: Off-label use of BMP in TLIF, although common, has only been studied in small series and case reports using various techniques, cage types, and doses of BMP. Several of these studies have reported minimal complications. Others report problems related to BMP, which has led to questions regarding current widespread use of TLIF with BMP. METHOD: TLIF with rhBMP-2 was performed at 872 discs in 509 consecutive adults who underwent open posterior instrumented fusion and had minimum 2-year follow-up; diagnoses included degenerative disease (179), spondylolisthesis (207), deformity (123). Patient age averaged 61 years: 12% were smokers and 41% had revision surgery. TLIF was performed at 1.7 levels: single level: 229, 2 levels: 201, 3 levels: 74, 4 levels: 5. Local autograft was used for backfill around and behind each rectangular cage. Varying doses of interbody BMP were used at an average 7.3 mg per disc (range: 2-12 mg per disc). RESULTS: At 5 years average follow-up, 8 patients developed pseudoarthrosis at levels of TLIF (8 of 872 discs, 0.92%). Seroma (0.4%) and ectopic bone growth (0.6%) were too infrequent to be associated with a particular BMP dose. Deep infection was 2.6% overall (1.7% of the degenerative group). Symptomatic osteolysis or cage subsidence did not occur. Significant long-term improvement was noted in clinical and functional outcomes compared with preoperation. CONCLUSION: Five-year follow-up after TLIF with BMP, independent of industry, confirms effective arthrodesis in short and long fusions, both primary and revision. Most complications occurred in deformity patients. BMP-related complications (seroma, ectopic bone) were rare.Level of Evidence: 3.

Crandall DG; Revella J; Patterson J; Huish E; Chang M; McLemore R

2013-06-01

 
 
 
 
241

Radiographic Adjacent Segment Degeneration at Five Years After L4/5 Posterior Lumbar Interbody Fusion With Pedicle Screw Instrumentation: Evaluation by Computed Tomography and Annual Screening With Magnetic Resonance Imaging.  

UK PubMed Central (United Kingdom)

STUDY DESIGN:: Retrospective clinical study. OBJECTIVE:: To investigate adjacent segment degeneration (ASD) at 5 years after L4/5 posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation and L4/5 decompression surgery using plain radiographs, CT and MRI, with evaluation of annual changes on MRI. SUMMARY OF BACKGROUND DATA:: Methods of evaluation have been inconsistent among studies of ASD. There is no report that ASD in the lumbar spine after PLIF at the same level is thoroughly evaluated on radiographs, CT, annual MRI changes, and the impact of decompression procedures. METHODS:: ASD was evaluated in 52 patients. Disc height, vertebral slip, intervertebral angle, and intervertebral range of motion were examined on plain radiographs. Facet joint degeneration on CT, and disc degradation and spinal stenosis on MRI were classified into categories, and facet sagittalization and tropism were measured on CT. The incidence of ASD was compared between decompression procedures. RESULTS:: The radiographic changes observed in the study were defined as radiographic ASD (R-ASD) without reoperation, since no patient required reoperation. R-ASD was rarely detected by radiography. At the L3/4 and L5/S1 levels, the incidences of facet joint degeneration, MRI-detected disc degeneration, and spinal stenosis were 21% and 23%, 27% and 17%, and 35% and 4%, respectively. Progressive disc degeneration at L3/4 was found significantly more frequently in patients with aggravation of facet degeneration (P<0.01); however, the severities of preoperative facet degeneration, facet sagittalization and tropism were not associated with progressive disc degeneration or spinal stenosis. In annual MRI, most R-ASD cases were detected within 3 years after surgery. Patients who underwent L4 total laminectomy had significantly more frequent R-ASD compared to those who received bilateral fenestration at L4/5 (P<0.01). CONCLUSION:: R-ASD was detected more frequently by CT and MRI than radiography. Preoperative facet joint degeneration and morphology were not always related to progressive disc degeneration or spinal stenosis. Annual MRI suggested that accelerated degeneration was due to lumbar spine fusion, rather than aging degeneration. Decompression with preservation of posterior connective components is recommended to prevent R-ASD.

Imagama S; Kawakami N; Kanemura T; Matsubara Y; Tsuji T; Ohara T; Katayama Y; Ishiguro N

2013-02-01

242

Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical...

Wang, Jian; Zhou, Yue; Zhang, Zheng Feng; Li, Chang Qing; Zheng, Wen Jie; Liu, Jie

243

Outcomes of anterior lumbar interbody fusion in low-grade isthmic spondylolisthesis in adults: a continuous series of 65 cases with an average follow-up of 6.6 years.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Surgical treatment of isthmic spondylolisthesis continues to be controversial. The fusion procedure can either be instrumented using a posterior and/or anterior approach or non-instrumented. The role of associated decompression, reduction of the slippage, disc height restoration and lordosis restoration has not definitely been established. The goal of this study was to evaluate the efficacy of anterior approach for interbody fusion (ALIF) without any reduction maneuver. MATERIALS AND METHODS: Sixty-five patients with isthmic spondylolisthesis were operated on, using an ALIF. The average patient age was 40 years. The preoperative maximum walking time was 20 minutes. Ten patients had radiculopathy. The average preoperative Beaujon Hospital disability index was 9/20. Standard static and dynamic X-rays were evaluated in all patients; a CT scan was performed in 33 patients 1 year after the surgery. The olisthetic vertebra had slipped by an average of 12 mm. Thirty-five of the spondylolisthesis cases had abnormal vertebral motion. RESULTS: At an average follow-up of 6.6 years, lumbar pain and radicular pain had been reduced by 4.6 and 5 points on the visual analogue scale, respectively. Twenty-seven patients could walk for an unlimited amount of time. Three patients still had radiculopathy. The Beaujon Hospital disability index had improved by an average of 7.3 points. The fusion rate was 91%. The slippage had decreased by 30%, despite no specific reduction maneuvers at the time of surgery. The disc height had increased by 177%. On the sagittal plane, lordosis had improved by 5°, without any changes in the pelvic parameters. CONCLUSION: In situ ALIF provides results that are comparable to those obtained with other techniques. This study confirms the essential role of fusion in achieving good functional results, given that hypermobility of the olisthetic level contributes to the symptoms generation. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Riouallon G; Lachaniette CH; Poignard A; Allain J

2013-04-01

244

Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis Estudo comparativo entre fusão lombar posterior com parafuso pedicular e fusão intersomática lombar posterior associada com parafuso pedicular em espondilolistese no adulto  

Directory of Open Access Journals (Sweden)

Full Text Available The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espondilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida.

Fernando Luiz Rolemberg Dantas; Mirto Nelso Prandini; Mauro A.T. Ferreira

2007-01-01

245

Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis/ Estudo comparativo entre fusão lombar posterior com parafuso pedicular e fusão intersomática lombar posterior associada com parafuso pedicular em espondilolistese no adulto  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espondilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisado (more) s prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida. Abstract in english The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group (more) I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.

Dantas, Fernando Luiz Rolemberg; Prandini, Mirto Nelso; Ferreira, Mauro A.T.

2007-09-01

246

[Analysis of results on minimum 4-year follow-up of modified posterior lumbar interbody fusion for the treatment of isthmic spondylolisthesis].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate the long-term results of modified Jaslow technique to treat isthmic spondylolisthesis. METHODS: From April 2000 to January 2002, 75 patients with isthmic spondylolisthesis (Meyerding grade I had 24 cases, grade II had 35, grade III had 16)were treated with a modified Jaslow technique using one single fusion cage on the symptomatic side. There were 35 males and 40 females with an average age of 40 years old, ranging from 23 to 71 years. Clinical symptoms included intermittent claudication, radicular pain and low back pain. Pre- and postoperative percentage slip, lumbar lordosis, height ratio of intervertebral space and the fusion ratio were analyzed according to radiographic conditions; Visual Analogue Pain Score (VAS), Oswestry Disability Index (ODI), Houshuxun criterion were applied to assess the pain and the conventional functions. RESULTS: All patients were followed up from 48 to 62 months with an average of 50.2 months. The percentage slip reduced from 35.6% preoperative to 9.7% at the last follow-up (corrected 72.8%), lumbar lordosis from (53.6 +/- 15.7) degrees to (51.2 +/- 17.1) degrees and the height ratio increased from (58.6 +/- 12.3)% to (91.5 +/- 11.2)%, the rate of fusion was 97.3% (73/75) at the last follow-up. The mean VAS and ODI before operation was (6.2 +/- 2.5) scores and (47.8 +/- 10.3)%, respectively, decreased to (2.5 +/- 1.9) scores and (10.3 +/- 3.0)% at the last follow-up. There was statistical significance in all items except for lumbar lordosis. According to Houshuxun criterion, the results was excellent in 53 cases, good in 12, fair in 8 and poor in 2, the rate of excellent and good was 86.7%. Complication included 2 case internal fixation failure, 3 cases transient neurologic deficits and 3 cases pseudoarticulation formation. CONCLUSION: The modified Jaslow technique is suitable for isthmic spondylolisthesis (Meyerding I - III), which has advantage of sufficient decompression, solid fixation and can obtain satisfactory clinical results with long-term follow-up.

Yuan JD; Wang J; Zhou HB; Fu Q; Chen ZM; Zhao J

2010-07-01

247

Instrumented Minimally Invasive spinal-Transforaminal Lumbar Interbody Fusion (MIS-TLIF); Minimum 5-years Follow-up With Clinical and Radiologic Outcomes.  

Science.gov (United States)

STUDY DESIGN:: A retrospective study. OBJECTIVE:: To determine the clinical and radiological outcomes of the long-term results of instrumented MIS-TLIF in unstable, single level, low-grade, isthmic spondylolisthesis (IS) or degenerative spondylosis (DS) including degenerative spondylolisthesis, foraminal stenosis with central stenosis, degenerative disc disease, and recurrent disc herniation. SUMMARY OF BACKGROUND DATA:: MIS-TLIF is a common surgical procedure to treat lumbar spondylolisthesis. However, there are no studies that have documented the long-term results of MIS-TLIF. METHODS:: Forty-four patients who had undergone instrumented MIS-TLIF between July 2003 and January 2005, were retrospectively reviewed. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), patient satisfaction rate (PSR), and the patient's return-to-work status were used to assess clinical and functional outcomes. Radiological follow-up were carried out in patients to check for adjacent segmental degeneration (ASD). The plain radiographs, CT and MRI were used in all patients in last follow-up period. RESULTS:: The mean VAS scores for back and leg pain decreased from 5.8 and 7 to 3.5 and 3.7 respectively in the DS group (n=19) and from 6.8 and 6.9 to 1.8 and 2.0 respectively in the IS group (n=25) (P<0.001). The mean ODI scores improved from 61.7% to 21.5% in the DS group and from 53.9% to 16% in the IS group (P<0.001). PSR was 80% and 81% in the DS and IS groups, respectively. Evidence of fusion was observed radiologically in 24 (96%) and 19 (100%) of the patients in the IS and the DS group respectively, giving an overall fusion rate of 97.7% (43/44). The final ASD rate, observed using radiography, was 68.4% (13/19) in the DS, and 40% (10/25) in the IS group. However, 15.8% (3/19) in the DS and 4% (1/25) in the IS group had symptoms associated with ASD. CONCLUSIONS:: The long-term clinical and radiologic outcomes after instrumented MIS-TLIF in patients with unstable single-level spine are favorable. PMID:23027364

Kim, Jin-Sung; Jung, Byungjoo; Lee, Sang-Ho

2012-09-28

248

Instrumented Minimally Invasive spinal-Transforaminal Lumbar Interbody Fusion (MIS-TLIF); Minimum 5-years Follow-up With Clinical and Radiologic Outcomes.  

UK PubMed Central (United Kingdom)

STUDY DESIGN:: A retrospective study. OBJECTIVE:: To determine the clinical and radiological outcomes of the long-term results of instrumented MIS-TLIF in unstable, single level, low-grade, isthmic spondylolisthesis (IS) or degenerative spondylosis (DS) including degenerative spondylolisthesis, foraminal stenosis with central stenosis, degenerative disc disease, and recurrent disc herniation. SUMMARY OF BACKGROUND DATA:: MIS-TLIF is a common surgical procedure to treat lumbar spondylolisthesis. However, there are no studies that have documented the long-term results of MIS-TLIF. METHODS:: Forty-four patients who had undergone instrumented MIS-TLIF between July 2003 and January 2005, were retrospectively reviewed. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), patient satisfaction rate (PSR), and the patient's return-to-work status were used to assess clinical and functional outcomes. Radiological follow-up were carried out in patients to check for adjacent segmental degeneration (ASD). The plain radiographs, CT and MRI were used in all patients in last follow-up period. RESULTS:: The mean VAS scores for back and leg pain decreased from 5.8 and 7 to 3.5 and 3.7 respectively in the DS group (n=19) and from 6.8 and 6.9 to 1.8 and 2.0 respectively in the IS group (n=25) (P<0.001). The mean ODI scores improved from 61.7% to 21.5% in the DS group and from 53.9% to 16% in the IS group (P<0.001). PSR was 80% and 81% in the DS and IS groups, respectively. Evidence of fusion was observed radiologically in 24 (96%) and 19 (100%) of the patients in the IS and the DS group respectively, giving an overall fusion rate of 97.7% (43/44). The final ASD rate, observed using radiography, was 68.4% (13/19) in the DS, and 40% (10/25) in the IS group. However, 15.8% (3/19) in the DS and 4% (1/25) in the IS group had symptoms associated with ASD. CONCLUSIONS:: The long-term clinical and radiologic outcomes after instrumented MIS-TLIF in patients with unstable single-level spine are favorable.

Kim JS; Jung B; Lee SH

2012-09-01

249

Activity-independent specification of synaptic targets in the posterior lateral line of the larval zebrafish.  

UK PubMed Central (United Kingdom)

The development of functional neural circuits requires that connections between neurons be established in a precise manner. The mechanisms by which complex nervous systems perform this daunting task remain largely unknown. In the posterior lateral line of larval zebrafish, each afferent neuron forms synaptic contacts with hair cells of a common hair-bundle polarity. We investigated whether afferent neurons distinguish hair-cell polarities by analyzing differences in the synaptic signaling between oppositely polarized hair cells. By examining two mutant zebrafish lines with defects in mechanoelectrical transduction, and by blocking transduction during the development of wild-type fish, we found that afferent neurons could form specific synapses in the absence of stimulus-evoked patterns of synaptic release. Asking next whether this specificity arises through intrinsically generated patterns of synaptic release, we found that the polarity preference persisted in two mutant lines lacking essential synaptic proteins. These results indicate that lateral-line afferent neurons do not require synaptic activity to distinguish hair-cell polarities and suggest that molecular labels of hair-cell polarity guide prepatterned afferents to form the appropriate synapses.

Nagiel A; Patel SH; Andor-Ardó D; Hudspeth AJ

2009-12-01

250

Comparison of instrumented posterolateral fusion versus percutaneous pedicle screw fixation combined with anterior lumbar interbody fusion in elderly patients with L5-S1 isthmic spondylolisthesis and foraminal stenosis.  

UK PubMed Central (United Kingdom)

OBJECT: The purpose of this study was to compare the clinical and radiological outcomes of treating L5-S1 isthmic spondylolisthesis and foraminal stenosis in elderly patients with instrumented posterolateral fusion (PLF) versus percutaneous pedicle screw fixation (PSF) combined with anterior lumbar interbody fusion (ALIF). METHODS: Forty-nine patients older than 65 years of age with L5-S1 isthmic spondylolisthesis and symptomatic foraminal stenosis who underwent ALIF were retrospectively analyzed. An ALIF with instrumented PLF (Group A) was performed in 23 patients, and ALIF with percutaneous PSF (Group B) was performed in 26 patients. Data were collected preoperatively and at 3 months, 6 months, 1 year, and every subsequent year. A comparative analysis was made between the 2 groups using clinical (visual analog pain scale [VAS] and modified MacNab criteria) and radiological (dynamic plain radiographs and CT scans) measures. RESULTS: The mean follow-up duration was 30.3 months (range 24-47 months). The mean preoperative scores on the VAS for low-back pain in Groups A and B were 5.9 and 5.7, respectively, decreasing to 1.4 and 3.6, respectively, at 6 months after surgery (p = 0.001), whereas VAS scores for low-back pain in Groups A and B at 2 years postoperatively were 1.3 and 2.3, respectively (p = 0.005). The mean preoperative scores on the VAS for leg pain in Groups A and B were 7.5 and 7.8, respectively, decreasing at 6 months after surgery to 1.2 and 1.6, respectively (p = 0.201), whereas VAS scores for leg pain in Groups A and B at 2 years postoperatively were 1.3 and 1.4, respectively (p = 0.803). The rates of patients with excellent or good outcomes in terms of the modified MacNab criteria in Groups A and B were 91.3% and 69.2%, respectively, at 6 months after surgery (p = 0.010). Those rates in Groups A and B at 2 years after the operation were 91.3% and 84.6%, respectively (p = 0.203). The fusion rates in Groups A and B were 91.3% and 57.7%, respectively, at 6 months after surgery (p = 0.008), whereas the fusion rates in Groups A and B were 91.3% and 76.9%, respectively, at 2 years after surgery (p = 0.103). There was no significant difference in terms of the complication rate between Group A (4.3%) and B (3.8%) (p = 0.691). CONCLUSIONS: A relatively longer time until, and lower rate for, fusion in the patients treated with ALIF and percutaneous PSF were noted, which may be correlated with a relatively lower rate of patients with excellent or good outcomes. These results seem to favor ALIF with instrumented PLF rather than ALIF with percutaneous PSF in the treatment of elderly patients with L5-S1 isthmic spondylolisthesis and foraminal stenosis. However, additional long-term follow-up, a larger number of patients, and well-designed studies are necessary for a more rigorous evaluation of the outcome of patients treated using these surgical techniques.

Shim JH; Kim WS; Kim JH; Kim DH; Hwang JH; Park CK

2011-09-01

251

Radiographic and CT evaluation of recombinant human bone morphogenetic protein-2-assisted spinal interbody fusion.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Bone morphogenetic proteins BMPs, when used in spinal fusion, hasten healing and initiate distinct imaging features. We undertook a study to record and analyze the radiographic and CT changes after the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in spinal fusion surgery. MATERIALS AND METHODS: This study included 95 patients who underwent spinal interbody fusion using rhBMP-2. The lumbar spine fusion cohort consisted of 23 patients who underwent anterior lumbar interbody fusion, 36 patients who underwent transforaminal lumbar interbody fusion, and two patients who underwent posterior lumbar interbody fusion. The remaining 34 patients underwent anterior cervical decompression and fusion. RESULTS: A polyetheretherketone cage was used as an interbody spacer in 59 patients (82 levels) and an allograft bone was the spacer in 36 patients (55 levels). Patients were evaluated 2 and 6 weeks after the procedure and then 3, 6, 12, and 24 months after the procedure. All patients underwent radiography at every follow-up visit, and CT evaluation was performed in 32 patients. CONCLUSION: Features observed on imaging that we attributed to the use of rhBMP-2 included an enhanced fusion rate and an increased incidence of prevertebral soft-tissue swelling in patients who underwent cervical fusion. Endplate resorption was observed in 100% of patients who underwent cervical fusion and in 82% of the lumbar levels. Subsidence of the cage resulting in narrowing of the disk space was seen in more than 50% of cases. Cage migration and heterotopic bone formation in the spinal canal and neural foramen occurred maximally in the lumbar spine of patients in whom a polyetheretherketone cage was placed using a transforaminal approach.

Sethi A; Craig J; Bartol S; Chen W; Jacobson M; Jacobsen M; Coe C; Vaidya R

2011-07-01

252

Technique of cervical interbody fusion.  

UK PubMed Central (United Kingdom)

A dovetail autogeneic graft is demonstrated for anterior interbody fusion of the cervical spine for degenerated or protruded intervertebral discs. The method is applicable for one or more levels and has been successfully combined with vertebral body resection for metastatic tumors and trauma. The procedure provides secure initial interbody immobilization and prevents interbody collapse. None of the 58 cases had grafts slip from their original position. The union rate has been 100%.

Gore DR

1984-09-01

253

Sagittal Alignment After Lumber Interbody Fusion: Comparing Anterior, Lateral, and Transforaminal Approaches.  

UK PubMed Central (United Kingdom)

STUDY DESIGN:: Retrospective radiographic analysis. OBJECTIVE:: To determine which lumbar interbody technique is most effective for restoring lordosis, increasing disc height, and reducing spondylolisthesis. SUMMARY OF BACKGROUND DATA:: Lumbar interbody fusions are performed in hopes of increasing fusion potential, correcting deformity, and indirectly decompressing nerve roots. No published study has directly compared anterior, lateral, and transforaminal lumber interbody fusions in terms of ability to restore lordosis, increase disc height, and reduce spondylolisthesis. METHODS:: Lumbar interbody fusion techniques were retrospectively compared in terms of improvement of lordosis, disc height, and spondylolisthesis between preoperative and follow-up lateral radiographs. RESULTS:: Two hundred twenty consecutive patients with 309 operative levels were compared by surgery type: anterior (184 levels), lateral (86 levels) and transforaminal (39 levels). Average follow-up was 19.2 months. (range 1-56 mo), with no statistical difference between the groups. Intragroup analysis showed that the anterior (4.5°) and lateral (2.2°) groups significantly improved lordosis from preoperative to follow-up, while the transforaminal (0.8°) group did not. Intergroup analysis showed that the anterior group significantly improved lordosis more than both the lateral and transforaminal groups. The anterior (2.2 mm) and lateral (2.0 mm) groups both significantly improved disc height more than the transforaminal (0.5 mm) group. All three groups significantly reduced spondylolisthesis, with no difference between the groups. CONCLUSION:: After lumbar interbody fusion, improvement of lordosis was significant for both the anterior and lateral groups, but not the transforaminal group. Intergroup analysis showed the anterior group had significantly improved lordosis compared to both other groups. The anterior and lateral groups had significantly increased disc height compared to the transforaminal group. All three groups significantly reduced spondylolisthesis, with no difference between the groups.

Watkins RG 4th; Hanna R; Chang D; Watkins RG 3rd

2013-03-01

254

Postoperative Changes in Paraspinal Muscle Volume: Comparison between Paramedian Interfascial and Midline Approaches for Lumbar Fusion  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In this study, we compared the paramedian interfascial approach (PIA) and the traditional midline approach (MA) for lumbar fusion to determine which approach resulted in the least amount of postoperative back muscle atrophy. We performed unilateral transforaminal posterior lumbar interbody fusion vi...

Hyun, Seung Jae; Kim, Young Baeg; Kim, Yang Soo; Park, Seung Won; Nam, Taek Kyun; Hong, Hyun Jong; Kwon, Jeong Taik

255

Extreme Lateral Interbody Fusion Procedure  

Medline Plus

Full Text Available ... surgery called XLIF, extreme lateral interbody fusion. Dr. Juan Uribe will perform the procedure. Dr. Uribe is ... this procedure. I would like to present Dr. Juan Uribe, assistant professor at the University of South ...

256

Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This randomized controlled health economic study assesses the cost-effectiveness of the concept of total disc replacement (TDR) (Charité/Prodisc/Maverick) when compared with the concept of instrumented lumbar fusion (FUS) [posterior lumbar fusion (PLF) /posterior lumbar interbody fusion (PLIF)]. Soc...

Fritzell, Peter; Berg, Svante; Borgström, Fredrik; Tullberg, Tycho; Tropp, Hans

257

Fluoroscopy-guided injection of lumbar and the first sacral intervertebral foramina  

International Nuclear Information System (INIS)

Lumbar foramen injection under fluoroscopic guidance is indicated either for a diagnostic purpose to determine which nerve root is painful or for a selective steroid injection. Lumbar foramen approach is based on that of the posterior-lateral extradural discography. Selective puncture of the first sacral foramen under fluoroscopic guidance may be indicated for the treatment of sacral symptomatic meningeal cysts, a very unfrequent lesion. (authors). 4 refs., 3 figs.

1995-01-01

258

Lef1 regulates Dusp6 to influence neuromast formation and spacing in the zebrafish posterior lateral line primordium.  

UK PubMed Central (United Kingdom)

The posterior lateral line primordium (PLLp) migrates caudally and periodically deposits neuromasts. Coupled, but mutually inhibitory, Wnt-FGF signaling systems regulate proto-neuromast formation in the PLLp: FGF ligands expressed in response to Wnt signaling activate FGF receptors and initiate proto-neuromast formation. FGF receptor signaling, in turn, inhibits Wnt signaling. However, mechanisms that determine periodic neuromast formation and deposition in the PLLp remain poorly understood. Previous studies showed that neuromasts are deposited closer together and the PLLp terminates prematurely in lef1-deficient zebrafish embryos. It was suggested that this results from reduced proliferation in the leading domain of the PLLp and/or premature incorporation of progenitors into proto-neuromasts. We found that rspo3 knockdown reduces proliferation in a manner similar to that seen in lef1 morphants. However, it does not cause closer neuromast deposition or premature termination of the PLLp, suggesting that such changes in lef1-deficient embryos are not linked to changes in proliferation. Instead, we suggest that they are related to the role of Lef1 in regulating the balance of Wnt and FGF functions in the PLLp. Lef1 determines expression of the FGF signaling inhibitor Dusp6 in leading cells and regulates incorporation of cells into neuromasts; reduction of Dusp6 in leading cells in lef1-deficient embryos allows new proto-neuromasts to form closer to the leading edge. This is associated with progressively slower PLLp migration, reduced spacing between deposited neuromasts and premature termination of the PLLp system.

Matsuda M; Nogare DD; Somers K; Martin K; Wang C; Chitnis AB

2013-06-01

259

Reamed transacral interbody fusion for L5-s1 pseudoarthrosis: a novel salvage technique in 10 patients.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To present the technique, radiographic, and clinical outcomes of a series of patients who underwent a novel method for revision L5-S1 interbody fusion. SUMMARY OF BACKGROUND DATA: Pseudoarthrosis at L5-S1 is a relatively common problem after long fusion to the sacrum. Revision approach to L5-S1 for cage or graft removal by anterior lumbar interbody fusion, posterior lumbar interbody fusion, or transforaminal interbody fusion is challenging and potentially dangerous which makes salvage by a posterior reamed transacral technique appealing. METHODS: Consecutive patients with symptomatic pseudoarthrosis at L5-S1, who underwent posterior reamed fluoroscopically guided fusion were identified over a 3-year period. Operative notes, medical records, preoperative and postoperative plain radiographs, computed tomography scans, Visual Analog Scores (VAS) (lower extremity and low back) preoperatively, and at most recent follow-up were studied. RESULTS: Ten patients (age, 53±2.8 y) with prior lumbar spinal operations (mean, 3.5±0.6) met the inclusion criteria. Prior procedures at L5-S1 were anterior lumbar interbody fusion (n=4), posterior lumbar interbody fusion (n=3), and posterolateral fusion (n=3). Mean Meyerding grade was 1.41 (range, 0-4). Reaming was performed between the S1 and S2 (n=9) or S2 and S3 (n=1) nerve roots and allowed fragmentation/removal of polyetheretherketone interbody grafts (n=3) or femoral ring allografts (n=3). Transacral Harms cage (n=8) or autograft (n=1) was passed through the reamed channel or a carbon fiber-reinforced polyetheretherketone directly into the interspace (n=1). VAS scores lower extremity (P=0.003) and low back (P=0.001) were improved at a mean follow-up of 13.5±3.6 months. No neurologic sequelae occurred and solid fusion was achieved in 9/10 (90%). CONCLUSIONS: We report a series of patients who underwent a novel revision technique for symptomatic lumbosacral pseudoarthrosis. Despite the small numbers in this cohort, a salvage technique is presented that permitted fusion as confirmed by computed tomography scan and improved VAS scores in the majority of patients. The data suggest that this technique should be considered as an alternative to the revision anterior or posterior approaches to L5-S1 and merits further investigation.

Lebl DR; Sama AA; Pumberger M; Kotwal S; Cammisa FP Jr; Girardi FP

2013-08-01

260

Extreme Lateral Interbody Fusion Procedure  

Science.gov (United States)

... will serve as fusion. Because this is a lumbar spine fusion done through a minimal lateral access approach. And ... it's considered a lumber -- it's considered a standard lumbar spine fusion. The difference is the approach, it's not the ...

 
 
 
 
261

Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF.  

UK PubMed Central (United Kingdom)

Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar degenerative spinal deformities, which include symptomatic spondylolisthesis and degenerative scoliosis. Through a description of each procedure, we hope to illustrate the potential benefits of TLIF over PLIF. In a retrospective study of 53 ALIF/PLIF patients and 111 TLIF patients we found reduced risk of vessel and nerve injury in TLIF patients due to less exposure of these structures, shortened operative time and reduced intra-operative bleeding. These advantages could be translated to shortened hospital stay, faster recovery period and earlier return to work. The disadvantages of TLIF such as incomplete intervertebral disc and vertebral end-plate removal and potential occult injury to exiting nerve root when under experienced hands are rare. Hence TLIF remains the mainstay of treatment in degenerative deformities of the lumbar spine. However, TLIF being a unilateral transforaminal approach, is unable to decompress the opposite nerve root. This may require contralateral laminotomy, which is a fairly simple procedure. The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to treat degenerative lumbar spinal deformity is still in its early stages. Although the initial results appear promising, it remains a difficult operative procedure to master with a steep learning curve. In a recent study comparing 29 MI-TLIF patients and 29 open TLIF, MI-TLIF was associated with longer operative time, less blood loss, shorter hospital stay, with no difference in SF-36 scores at six months and two years. Whether it can replace traditional TLIF as the surgery of choice for degenerative lumbar deformity remains unknown and more studies are required to validate the safety and efficiency.

Hey HW; Hee HT

2010-04-01

262

Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF.  

Science.gov (United States)

Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar degenerative spinal deformities, which include symptomatic spondylolisthesis and degenerative scoliosis. Through a description of each procedure, we hope to illustrate the potential benefits of TLIF over PLIF. In a retrospective study of 53 ALIF/PLIF patients and 111 TLIF patients we found reduced risk of vessel and nerve injury in TLIF patients due to less exposure of these structures, shortened operative time and reduced intra-operative bleeding. These advantages could be translated to shortened hospital stay, faster recovery period and earlier return to work. The disadvantages of TLIF such as incomplete intervertebral disc and vertebral end-plate removal and potential occult injury to exiting nerve root when under experienced hands are rare. Hence TLIF remains the mainstay of treatment in degenerative deformities of the lumbar spine. However, TLIF being a unilateral transforaminal approach, is unable to decompress the opposite nerve root. This may require contralateral laminotomy, which is a fairly simple procedure. The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to treat degenerative lumbar spinal deformity is still in its early stages. Although the initial results appear promising, it remains a difficult operative procedure to master with a steep learning curve. In a recent study comparing 29 MI-TLIF patients and 29 open TLIF, MI-TLIF was associated with longer operative time, less blood loss, shorter hospital stay, with no difference in SF-36 scores at six months and two years. Whether it can replace traditional TLIF as the surgery of choice for degenerative lumbar deformity remains unknown and more studies are required to validate the safety and efficiency. PMID:20419002

Hey, Hwee Weng Dennis; Hee, Hwan Tak

2010-04-01

263

Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF  

Directory of Open Access Journals (Sweden)

Full Text Available Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar degenerative spinal deformities, which include symptomatic spondylolisthesis and degenerative scoliosis. Through a description of each procedure, we hope to illustrate the potential benefits of TLIF over PLIF. In a retrospective study of 53 ALIF/PLIF patients and 111 TLIF patients we found reduced risk of vessel and nerve injury in TLIF patients due to less exposure of these structures, shortened operative time and reduced intra-operative bleeding. These advantages could be translated to shortened hospital stay, faster recovery period and earlier return to work. The disadvantages of TLIF such as incomplete intervertebral disc and vertebral end-plate removal and potential occult injury to exiting nerve root when under experienced hands are rare. Hence TLIF remains the mainstay of treatment in degenerative deformities of the lumbar spine. However, TLIF being a unilateral transforaminal approach, is unable to decompress the opposite nerve root. This may require contralateral laminotomy, which is a fairly simple procedure.The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to treat degenerative lumbar spinal deformity is still in its early stages. Although the initial results appear promising, it remains a difficult operative procedure to master with a steep learning curve. In a recent study comparing 29 MI-TLIF patients and 29 open TLIF, MI-TLIF was associated with longer operative time, less blood loss, shorter hospital stay, with no difference in SF-36 scores at six months and two years. Whether it can replace traditional TLIF as the surgery of choice for degenerative lumbar deformity remains unknown and more studies are required to validate the safety and efficiency.

Hey Hwee Weng; Hee Hwan

2010-01-01

264

Lumbar hemivertebra in an adult treated by transpedicular osteotomy.  

UK PubMed Central (United Kingdom)

BACKGROUND: Hemivertebra frequently occurs in pediatric patients and is treated with vertebral excision to stop the progression of the deformity. A case of L3 hemivertebra associated with lumbar kyphoscoliosis in an adult is reported. CASE DESCRIPTION: A 46-year-old woman presented with severe chronic back pain of 6 years' duration. Radiologic examinations showed that the L3 vertebra had a trapezoidal shape revealing a partially segmented hemivertebra. RESULTS: The patient underwent a two-stage corrective surgery. The first stage consisted of a transpedicular osteotomy (TPO) with posterior instrumentation from L1 to L5 and a bone graft; 1 month later, anterior interbody fusions were performed at L2-3 and L3-4 using interbody cages and bone morphogenetic protein. No postoperative complication was reported after 2 years of follow-up. CONCLUSIONS: TPO improved clinical symptoms, corrected the spinal deformity, and reduced the lumbar kyphosis.

Khan A; Barrey C; Massourides H; Perrin G

2012-03-01

265

Biomechanical evaluation of a new AxiaLIF technique for two-level lumbar fusion  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Single level axial lumbar interbody fusion (AxiaLIF) using a transsacral rod through a paracoccygeal approach has been developed with promising early clinical results and biomechanical stability. Recently, the transsacral rod has been extended to perform a two-level fusion at both L4–L5 and L5–S1 le...

Erkan, Serkan; Wu, Chunhui; Mehbod, Amir A.; Hsu, Brian; Pahl, Douglas W.; Transfeldt, Ensor E.

266

Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The current gold standard in lumbar fusion consists of transpedicular fixation in combination with an interbody interponate of autologous bone from iliac crest. Because of the limited availability of autologous bone as well as the still relevant donor site morbidity after iliac crest grafting the ne...

Putzier, Michael; Strube, Patrick; Funk, Julia F.; Gross, Christian; Mönig, Hans-Joachim; Perka, Carsten; Pruss, Axel

267

Extreme Lateral Interbody Fusion Procedure  

Medline Plus

Full Text Available ... will serve as fusion. Because this is a lumbar spine fusion done through a minimal lateral access approach. And ... it's considered a lumber -- it's considered a standard lumbar spine fusion. The difference is the approach, it's not the ...

268

[Percutaneous lumbar interbody fusion using autogenous osteoblasts in vivo].  

UK PubMed Central (United Kingdom)

AIM: In the present study we have investigated the potential of autogenous osteoblasts for osteoinduction in a spinal arthrodesis model. METHOD: After posterolateral instrumentation of 3 segments of a sheep spine the intervertebral space was filled with cancellous bone, osteoblasts or left empty after nucleotomy and elimination of cartilage. RESULTS: Radiological and histological analyses proved a significant osseous reaction in segments treated with cancellous bone or osteoblasts in contrast to the control segment. This outcome provides evidence of spondylodeses by spinal instrumentation in combination with osteoblasts in a sheep model. CONCLUSION: The results suggest a possible application of autologous osteoblasts as an osteoinductor after percutaneous nucleotomy in spinal fusion. The possible application in a human model should be examined.

Berghof L; Bolle I; Schulz A; Grifka J; Quint U

2008-01-01

269

Microscopic anterior foraminal decompression combined with anterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

CONCLUSIONS: The microscopic anterior foraminal approach provides successful foraminal decompression. Combined with ALIF and PPF, this approach shows a good surgical outcome in patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by a posterior osteophyte or those with foraminal sequestrated disc herniation.

Shin SH; Choi WG; Hwang BW; Tsang YS; Chung ER; Lee HC; Lee SJ; Lee SH

2013-10-01

270

Correction of lumbar coronal plane deformity using unilateral cage placement.  

UK PubMed Central (United Kingdom)

The authors describe a surgical technique for the correction of symptomatic degenerative lumbar scoliosis. Using a single, unilateral, interbody cage placed on the concave side of the coronal deformity, combined with a dorsal decompression and instrumented posterolateral fusion, this technique has resulted in excellent curve correction, fusion results, and clinical outcomes in a series of 4 patients. Each of these patients presented with intractable, axial low-back pain and symptomatic unilateral nerve root compression on the concave side of a lumbar scoliotic deformity. The management is described in detail.

Heary RF; Karimi RJ

2010-03-01

271

Long-term Follow-up of Cervical Facet Medial Branch Radiofrequency Treatment With the Single Posterior-lateral Approach: An Exploratory Study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Over 50% of patients presenting to pain clinic with neck pain have the cervical facet joints as the source of pain. Radiofrequency (RF) treatment of the medial branch, innervating the facet joint, is a therapeutic option. The objectives of this study were to evaluate the therapeutic effect and its duration of RF treatment, using the single posterior-lateral approach in patients suffering from facet joint degeneration and to identify predictors for a long-term effect. METHODS: Of the 130 consecutive patients with axial neck pain referred to the University Pain Center Maastricht, 67 fulfilled the inclusion criteria. The therapeutic effect was measured using the Patients' Global Impression of Change (PGIC) scale. Retrospective data were made complete using newly collected PGIC follow-up data. A Kaplan-Meier curve evaluated the long-term therapeutic effect. Possible predictors of outcome were evaluated. RESULTS: Two patients refused to participate and in the remaining 65 patients, overall pain relief was reported in 55.4% at 2-month follow-up. Moderately, important change of improvement and substantial change of improvement were seen in 50.8% of patients. At 3-year follow-up, 30% still reported pain reduction. Spinal treatment level was the only predictor found. CONCLUSIONS: Radiofrequency treatment of the cervical facet joints using a single posterior-lateral approach is a promising technique in patients with chronic neck pain due to facet degeneration. The short-term and long-term therapeutic effects of this intervention justify a randomized controlled trial to estimate the efficacy of cervical facet joint RF treatment in a chronic neck pain population.

van Eerd M; de Meij N; Dortangs E; Kessels A; van Zundert J; Lataster A; Patijn J; van Kleef M

2013-03-01

272

Extreme Lateral Interbody Fusion Procedure  

Medline Plus

Full Text Available ... severe facet disease. These are all stages of arthritis. And it will happen to anybody. It will ... suffering from severe lumbar spondylosis. Again, spondylosis means arthritis, which results in pain, nerve damage, and all ...

273

Extreme Lateral Interbody Fusion Procedure  

Medline Plus

Full Text Available ... with an open procedure, what we call a standard open procedure, it is always a potential for ... and it's considered a lumber -- it's considered a standard lumbar spine fusion. The difference is the approach, ...

274

Revision surgery after interbody fusion with rhBMP-2: a cautionary tale for spine surgeons.  

Science.gov (United States)

Recombinant human bone morphogenetic protein-2 (rhBMP-2) promotes the induction of bone growth and is widely used in spine surgery to enhance arthrodesis. Recombinant human BMP-2 has been associated with a variety of complications including ectopic bone formation, adjacent-level fusion, local bone resorption, osteolysis, and radiculitis. Some of the complications associated with rhBMP-2 may be the result of rhBMP-2 induction of the inflammatory host response. In this paper the authors report on a patient with prior transforaminal lumbar interbody fusion (TLIF) using an interbody cage packed with rhBMP-2, in which rhBMP-2 possibly contributed to vascular injury during an attempted anterior lumbar interbody fusion. This 63-year-old man presented with a 1-year history of worsening refractory low-back pain and radiculopathy caused by a Grade 1 spondylolisthesis at L4-5. He underwent an uncomplicated L4-5 TLIF using an rhBMP-2-packed interbody cage. Postoperatively, he experienced marginal improvement of his symptoms. Within the next year and a half the patient returned with unremitting low-back pain and neurogenic claudication that failed to respond to conservative measures. Radiological imaging of the patient revealed screw loosening and pseudarthrosis. He underwent an anterior retroperitoneal approach with a plan for removal of the previous cage, complete discectomy, and placement of a femoral ring. During the retroperitoneal approach the iliac vein was adhered with scarring and fibrosis to the underlying previously operated L4-5 interbody space. During mobilization the left iliac vein was torn, resulting in significant blood loss and cardiac arrest requiring chest compression, defibrillator shocks, and blood transfusion. The patient was stabilized, the operation was terminated, and he was transferred to the intensive care unit. He recovered over the next several days and was discharged at his neurological baseline. The authors propose that the rhBMP-2-induced host inflammatory response partially contributed to vessel fibrosis and scarring, resulting in the life-threatening vascular injury during the reoperation. Spine surgeons should be aware of this potential inflammatory fibrosis in addition to other reported complications related to rhBMP-2. PMID:23560709

Rodgers, Shaun D; Marascalchi, Bryan J; Grobelny, Bartosz T; Smith, Michael L; Samadani, Uzma

2013-04-05

275

[Relationship between low back pain and lumbar sagittal alignment after lumbar fusion].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate retrospectively the relationship between low back pain and changes of lumbar spine sagittal alignment after lumbar spine fusion. METHODS: During January-December 2008, a total of 182 consecutive patients with degenerative lumbar spine diseases underwent posterior lumbar interbody fusion (PLIF) and the follow-up period was over 24 months. Standing lumbar spine anterioposterior and lateral radiography were taken during the follow-up and the lumbar lordosis Cobb angles were measured on radiography. Pain degrees were assessed by visual analog scale (VAS) and Oswestry disability index (ODI). The relationship between the changes of Cobb angle and lumbar sagittal plane curve was analyzed by the SPSS software. Also the relationship between back pain degree and Cobb angle was examined. RESULTS: Among them, 42 cases with postoperative back pain were followed up for 24 months. There were 19 males and 23 females with a mean age of 59.6 years (range: 40 - 77). Lumbar spine sagittal Cobb angles were measured from radiographic images:lumbar lordosis angle: (1) mean angle at 12-month follow-up: 40.1° ± 10.6°, range: 20° - 60°; (2) mean angle at 24-month follow-up: 40.8° ± 10°, range: 24° - 60°. Back pain of 42 patients: VAS: (1) mean at 12-month follow-up: 29.4 ± 11.5, range: 5 - 50; (2) mean at 24-month follow-up: 27.6 ± 11.7, range: 25 - 48. Lumbar spine function of 42 patients: ODI: (1) mean at 12-month follow-up: 15.1 ± 5.4, range: 0 - 25; (2) mean at 24-month follow-up: 13.9 ± 5.2, range: 0 - 24. Difference between lumbar lordosis angle and standard score: (1) mean angle at 12-month follow-up: 19.9° ± 10.6°, range:0°-40°; (2) mean angle at 24-month follow-up:19.2° ± 10.0°, range:0°-36°. Angle difference versus back pain VAS: (1) at 12-month follow-up:P < 0.001, positive correlation; (2) 24-month follow-up: P < 0.001, positive correlation; angle difference versus back pain ODI: (1) 12-month follow-up:P < 0.001, positive correlation; (2) 24-month follow-up: P < 0.001, positive correlation. CONCLUSION: There is a close relationship between back pain after fusion and loss of lumbar sagittal lordosis. And reconstruction of lumbar lordosis should be one important goal for lumbar fusion.

Hai Y; Zhao H; Shao N; Lu SB; Yang JC; Liu YZ

2013-04-01

276

Case report: incisional hernia as a complication of extreme lateral interbody fusion.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: Minimal access surgery is becoming more popular for spinal fusion because of a lower theoretical risk of complications and shorter postoperative recovery period, compared with the traditional open approach. The lateral approach uses retroperitoneal transpsoas access to the vertebra, obviating the need for an approach surgeon and minimizing muscular disruption, thus allowing a quicker recovery. Initial reports of the lateral transpsoas procedure described few complications. However, a number of complications have subsequently been documented. To our knowledge, there has not been a description of an incisional hernia after this approach. PURPOSE: To report the rare complication of an incisional hernia after a minimal access lateral transpsoas approach for lumbar interbody fusion. STUDY DESIGN: Case report. METHODS: We reviewed the hospital charts, radiographs, and intraoperative photographs of a patient who underwent a minimally invasive lateral approach lumbar spine fusion with a subsequent incisional hernia that necessitated laparoscopic repair. RESULTS: A 75-year-old woman with a history of low back and left lower extremity pain with radiographic evidence of foraminal stenosis and degenerative spondylolisthesis underwent a successful L4-L5 discectomy with an extreme lateral interbody fusion via a retroperitoneal transpsoas approach. This was supplemented with a posterior minimally invasive surgery instrumented fusion from L4 to L5. The patient reported significant improvement in symptoms on initial follow-up, however, complained of a prominence over her incision 4 weeks later. An incisional hernia was diagnosed and subsequently repaired laparoscopically, from which the patient recovered uneventfully. CONCLUSIONS: Postoperative incisional hernia after extreme lateral interbody fusion is a complication that has not been previously described in the literature but is one that spine surgeons must recognize. This case may prompt surgeons to use a more posterior approach to avoid this complication. Additionally, direct repair of the transversalis fascia is critical to avoiding this complication.

Galan TV; Mohan V; Klineberg EO; Gupta MC; Roberto RF; Ellwitz JP

2012-04-01

277

Recovery Room Radiographs Not Found to Have Incremental Utility Above: Intraoperative Images after Lumbar Fusion Procedures.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Retrospective case series.OBJECTIVE: To characterize the clinical utility of imaging in the recovery room after lumbar fusion procedures.SUMMARY OF BACKGROUND DATA: Two sets of images are commonly obtained at the end of lumbar fusion procedures: intraoperative fluoroscopic images near the time of wound closure and plain film images after the procedure in the recovery room. The latter may have low clinical utility.METHODS: We identified a consecutive series of lumbar fusion procedures. A panel of three reviewers assessed intraoperative and recovery room series both for radiographic adequacy and for issues with the surgical construct.RESULTS: 190 cases were reviewed, of which 92 were posterolateral lumbar fusions, 42 were anterior lumbar interbody fusions (ALIFs), 24 were transforaminal lumbar interbody fusions (TLIFs), and 32 were anterior-posterior fusions. All intraoperative series were adequate, while only 90% of recovery room series were adequate. Recovery room series had visible issues with construct placement in 4 cases. In each of these cases, however, the issue was also clearly visible on the intraoperative series, was found to be acceptable clinically, and did not alter management in any way.CONCLUSION: This study demonstrates that recovery room images are inferior to intraoperative images and offer little or no incremental clinical utility for detecting issues with surgical constructs after lumbar fusion procedures. In settings where it is still performed, recovery room imaging might be discontinued to realize savings in cost, radiation exposure, and time.

Bohl DD; Gruskay JA; Miller CP; Varthi A; Ruiz FK; Whang PG; Grauer JN

2013-07-01

278

Cervical spinal interbody fusion with Kiel bone.  

UK PubMed Central (United Kingdom)

Experience with the use of the Kiel bone graft in anterior cervical interbody fusion in cervical spondylosis is reported. The survey reviews the results of operations on 73 disc spaces in 65 consecutive patients, from 2 to 5 years after the operation. We have failed to confirm that any bony fusion in the true sense occurs with Kiel bone in anterior cervical interbody fusion. However, the aims of the operations are achieved, namely removal of the disc and osteophyte, fixation of the spine to prevent compression of the neural tissues, distraction of the adjacent vertebral bodies providing increased room in the intervertebral foramina and stability of the spine.

Ramani PS; Kalbag RM; Sengupta RP

1975-02-01

279

An economic analysis of using rhBMP-2 for lumbar fusion in Germany, France and UK from a societal perspective  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) can replace autogenous bone grafting in single-level lumbar interbody fusion. Its use is associated with a higher initial price for the intervention; 2,970€ in Germany, 2,950€ in France and 2,266€ (£1,790) in UK. The aim of this study was to c...

Alt, Volker; Chhabra, Amit; Franke, Jörg; Cuche, Matthieu; Schnettler, Reinhard; Le Huec, Jean-Charles

280

A Comparative Biomechanical Analysis of Stand Alone Versus Facet Screw and Pedicle Screw Augmented Lateral Interbody Arthrodesis: An In Vitro Human Cadaveric Model.  

UK PubMed Central (United Kingdom)

STUDY DESIGN:: Cadaveric biomechanical study. OBJECTIVE:: To investigate the kinematic response of a stand-alone lateral lumbar interbody cage compared with supplemental posterior fixation with either facet or pedicle screws after lateral discectomy. SUMMARY OF BACKGROUND DATA:: Lateral interbody fusion is a promising minimally invasive fixation technique for lumbar interbody arthrodesis. The biomechanical stability of stand-alone cage placement compared with supplemental posterior fixation with either facet or bilateral pedicle screws remains unclear. METHODS:: A 6-degree of freedom spine simulator was used to test flexibility in 7 human cadaveric specimens. Flexion-extension, lateral-bending, and axial-rotation were tested in the intact condition, followed by destabilization through a lateral discectomy at L2-L3 and L4-L5. Specimens were then reconstructed at both operative segments in the following sequence: (1) lateral interbody cage placement; (2) either Discovery facet screws or the Viper F2 system using a transfacet-pedicular trajectory randomized to L2-L3 or L4-L5; and (3) removal of facet screw fixation followed by placement of bilateral pedicle screw instrumentation. Acute range of motion (ROM) was quantified and analyzed. RESULTS:: All 4 reconstruction groups, including stand-alone interbody cage placement, bilateral Discovery facet screws, the Viper F2 system, and bilateral pedicle screw-rod stabilization, resulted in a significant decrease in acute ROM in all loading modes tested (P<0.05). There were no significant differences observed between the 4 instrumentation groups (P>0.05). Although not statistically significant, the Viper F2 system resulted in greatest reduction of acute ROM in both flexion-extension and axial rotation versus all other treatments (P>0.05). CONCLUSIONS:: Stand-alone interbody cage placement results in a significant reduction in acute ROM at the operative segment in the absence of posterior supplemental fixation. If added fixation is desired, facet screw placement, including the Viper F2 facet screw system using an integrated compression washer and transfacet-pedicular trajectory, provides similar acute stability to the spinal segment compared with traditional bilateral pedicle screw fixation in the setting of lateral interbody cage deployment.

Kretzer RM; Molina C; Hu N; Umekoji H; Baaj AA; Serhan H; Cunningham BW

2013-02-01

 
 
 
 
281

Lumbar lordosis.  

UK PubMed Central (United Kingdom)

Lumbar lordosis is a key postural component that has interested both clinicians and researchers for many years. Despite its wide use in assessing postural abnormalities, there remain many unanswered questions regarding lumbar lordosis measurements. Therefore, in this article we reviewed different factors associated with the lordosis angle based on existing literature and determined normal values of lordosis. We reviewed more than 120 articles that measure and describe the different factors associated with the lumbar lordosis angle. Because of a variety of factors influencing the evaluation of lumbar lordosis such as how to position the patient and the number of vertebrae included in the calculation, we recommend establishing a uniform method of evaluating the lordosis angle. Based on our review, it seems that the optimal position for radiologic measurement of lordosis is standing with arms supported while shoulders are flexed at a 30° angle. There is evidence that many factors, such as age, gender, body mass index, ethnicity, and sport, may affect the lordosis angle, making it difficult to determine uniform normal values. Normal lordosis should be determined based on the specific characteristics of each individual; we therefore presented normal lordosis values for different groups/populations. There is also evidence that the lumbar lordosis angle is positively and significantly associated with spondylolysis and isthmic spondylolisthesis. However, no association has been found with other spinal degenerative features. Inconclusive evidence exists for association between lordosis and low back pain. Additional studies are needed to evaluate these associations. The optimal lordotic range remains unknown and may be related to a variety of individual factors such as weight, activity, muscular strength, and flexibility of the spine and lower extremities.

Been E; Kalichman L

2013-10-01

282

Stenosis of the lumbar spinal canal in vertebral ankylosing hyperostosis.  

Science.gov (United States)

Certain morphologic features frequently observed in radiography or computed tomography (CT) scan in patients with hyperostosis led us to study the association between a narrowed spinal canal and vertebral hyperostosis. Twenty-eight items were selected and studied by three different investigators (two rheumatologists and one radiologist) in radiographs and CT scans of 100 patients with acquired stenosis of the lumbar canal, with or without hyperostosis (46 and 54 cases, respectively). The most distinctive points that we suggest can be used as diagnostic criteria of the hyperostotic narrowed lumbar canal are anterior or posterior lateral marginal somatic osseous proliferations, proliferations of the nonarticular aspects of the posterior apophyses, and ossifications of the posterior articular capsule and of the ligaments (yellow ligament, posterior longitudinal ligament, and the supraspinal ligament). Four of these six criteria should be present to establish the diagnosis of hyperostotic lumbar stenosis. The appearance of lumbar hyperostosis on X-ray or CT scans differs from that of simple degenerative changes due to arthrosis, and the hyperostosis can be held responsible for dural compression. PMID:1440011

Leroux, J L; Legeron, P; Moulinier, L; Laroche, M; Mazieres, B; Blotman, F; Arlet, J

1992-10-01

283

Stenosis of the lumbar spinal canal in vertebral ankylosing hyperostosis.  

UK PubMed Central (United Kingdom)

Certain morphologic features frequently observed in radiography or computed tomography (CT) scan in patients with hyperostosis led us to study the association between a narrowed spinal canal and vertebral hyperostosis. Twenty-eight items were selected and studied by three different investigators (two rheumatologists and one radiologist) in radiographs and CT scans of 100 patients with acquired stenosis of the lumbar canal, with or without hyperostosis (46 and 54 cases, respectively). The most distinctive points that we suggest can be used as diagnostic criteria of the hyperostotic narrowed lumbar canal are anterior or posterior lateral marginal somatic osseous proliferations, proliferations of the nonarticular aspects of the posterior apophyses, and ossifications of the posterior articular capsule and of the ligaments (yellow ligament, posterior longitudinal ligament, and the supraspinal ligament). Four of these six criteria should be present to establish the diagnosis of hyperostotic lumbar stenosis. The appearance of lumbar hyperostosis on X-ray or CT scans differs from that of simple degenerative changes due to arthrosis, and the hyperostosis can be held responsible for dural compression.

Leroux JL; Legeron P; Moulinier L; Laroche M; Mazieres B; Blotman F; Arlet J

1992-10-01

284

[Research of single incision via MAST Quadrant retractor in management of lumbar spondylolisthesis].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate the effect of posterior lumbar interbody fusion (PLIF) using single incision via MAST Quadrant retractor in the management of lumbar spondylolisthesis. METHODS: From July 2008 to June 2009, 20 cases of lumbar spondylolisthesis were treated with posterior lumbar interbody fusion via MAST Quadrant retractor using single incision, including 2 cases of degenerative spondylolisthesis and 18 cases of isthmic spondylolisthesis. There were 8 males and 12 females aged from 34 to 62 years (average 45.5 years). The disease course was 1 to 6 years (mean 34.5 months). The spondylolisthesis locations were L4, 5 in 8 cases and L5, S1 in 12 cases. According to Meyerding classification, all cases were classified as degree I. The Visual Analogue Scale (VAS) score was (6.6 +/- 1.2) points. The operative time, the blood loss, and the therapeutic effects were recorded. RESULTS: The operative time was (155 +/- 23) minutes and the amount of blood loss was (360 +/- 102) mL. The hospitalization time were (12.0 +/- 3.4) days. All incisions healed by first intention. X-ray films showed spondylolisthesis reduction immediately after operation. All patients were followed up 14.3 months on average (from 9 to 20 months). The VAS score decreased to (1.6 +/- 2.3) points at the last follow-up, showing significant difference when compared with that of preoperation (P < 0.05). The X-ray films showed that lumbar interbody fusion was achieved in all the patients. No loosening, breakage, and displacement of pedicle screw fixation was observed. According to Nakai standard, the results were excellent in 18 cases and good in 2 cases at the last follow-up. CONCLUSION: As long as the indication is strictly chosen, PLIF via MAST Quadrant retractor is a safe, effective, and minimally invasive surgical technique in treating lumbar spondylolisthesis.

Teng H; Wang L; Guo Z; Fan L; Zhang D; Zhang W; Wang S

2010-05-01

285

Bone morphogenetic protein-induced inflammatory cyst formation after lumbar fusion causing nerve root compression.  

Science.gov (United States)

Bone morphogenetic protein (BMP) has been reported to cause early inflammatory changes, ectopic bony formation, adjacent level fusion, radiculitis, and osteolysis. The authors describe the case of a patient who developed inflammatory fibroblastic cyst formation around the BMP sponge after a lumbar fusion, resulting in compressive lumbar radiculopathy. A 70-year-old woman presented with left L-4 and L-5 radiculopathy caused by a Grade I spondylolisthesis with a left herniated disc at L4-5. She underwent a minimally invasive transforaminal lumbar interbody fusion with BMP packed into the interbody cage at L4-5. Her neurological symptoms resolved immediately postoperatively. Six weeks later, the patient developed recurrence of radiculopathy. Radiological imaging demonstrated an intraspinal cyst with a fluid-fluid level causing compression of the left L-4 and L-5 nerve roots. Reexpoloration of the fusion was performed, and a cyst arising from the posterior aspect of the cage was found to compress the axilla of the left L-4 nerve root and the shoulder of the L-5 nerve root. The cyst was decompressed, and the wall was partially excised. A collagen BMP sponge was found within the cyst and was removed. Postoperatively, the patient's radiculopathy resolved and she went on to achieve interbody fusion. Bone morphogenetic protein can be associated with inflammatory cyst formation resulting in neural compression. Spine surgeons should be aware of this complication in addition to the other reported BMP-related complications. PMID:22176433

Choudhry, Osamah J; Christiano, Lana D; Singh, Rahul; Golden, Barbara M; Liu, James K

2011-12-16

286

Pseudarthrosis after lumbar spine fusion: nonoperative salvage with pulsed electromagnetic fields.  

UK PubMed Central (United Kingdom)

We studied 100 patients in whom symptomatic pseudarthrosis had been established at more than 9 months after lumbar spine fusion. All patients were treated with a pulsed electromagnetic field device worn consistently 2 hours a day for at least 90 days. Solid fusion was achieved in 67% of patients. Effectiveness was not statistically significantly different for patients with risk factors such as smoking, use of allograft, absence of fixation, or multilevel fusions. Treatment was equally effective for posterolateral fusions (66%) as with interbody fusions (69%). For patients with symptomatic pseudarthrosis after lumbar spine fusion, pulsed electromagnetic field stimulation is an effective nonoperative salvage approach to achieving fusion.

Simmons JW Jr; Mooney V; Thacker I

2004-01-01

287

Single-level transforaminal interbody fusion for traumatic lumbosacral fracture-dislocation: a case report.  

UK PubMed Central (United Kingdom)

L5S1 fracture-dislocations are rare three-column injuries. The infrequency of this injury has led to a lack of a universally accepted treatment strategy. Transforaminal lumbar interbody fusion (TLIF) has been shown to be an effective approach for interbody fusion in degenerative indications, but has not been previously reported in the operative management of traumatic lumbosacral dislocation. The authors report a case of traumatic L5S1 fracture-dislocation in a 30-year-old male, presenting with a right-sided L5 neurologic deficit, following a street sweeper accident. Imaging revealed an L5S1 fracture-dislocation with fracture of the S1 body. Open reduction with TLIF and L5S1 posterolateral instrumented fusion was carried out within 24 hours of injury. Excellent reduction was obtained, and maintained at long-term follow-up, with complete resolution of pain and neurologic deficit. In this patient, L5S1 fracture-dislocation was treated successfully, with an excellent outcome, with a single level TLIF and instrumented posterolateral fusion at L5S1.

Herrera AJ; Berry CA; Rao RD

2013-02-01

288

Oral Extrusion of Screw after Anterior Cervical Interbody Fusion  

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We present a case of delayed oral extrusion of a screw after anterior cervical interbody fusion in a 68-year-old man with osteoporosis. Fifteen months earlier, he had undergone C5 corpectomy and anterior cervical interbody fusion at C4-6 for multiple spinal stenoses. The patient was nearly asymptoma...

Lee, Jin Soo; Kang, Dong-Ho; Hwang, Soo Hyun; Han, Jong Woo

289

Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis.  

UK PubMed Central (United Kingdom)

Extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USA) is a minimally invasive lateral transpsoas approach to the thoracolumbar spine. Though the procedure is rapidly increasing in popularity, limited data is available regarding its use in deformity surgery. We aimed to evaluate radiographic correction using XLIF in adults with degenerative lumbar scoliosis. Thirty consecutive patients were followed for an average of 14.3months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Plain radiographs were obtained on all patients preoperatively, postoperatively, and at most recent follow-up. Plain radiographic measurements of coronal Cobb angle, apical vertebral translation, segmental lordosis, global lordosis, disc height, neuroforaminal height and neuroforaminal width were made at each time point. CT scans were obtained for all patients 1year after surgery to evaluate for fusion. There was significant improvement in multiple radiographic parameters from preoperative to postoperative. Cobb angle corrected 72.3%, apical vertebral translation corrected 59.7%, neuroforaminal height increased 80.3%, neuroforaminal width increased 7.4%, and disc height increased 116.7%. Segmental lordosis at L4-L5 increased 14.1% and global lordosis increased 11.5%. There was no significant loss of correction from postoperative to most recent follow-up. There was an 11.8% pseudoarthrosis rate at levels treated with XLIF. Complications included lateral incisional hernia (n=1), rupture of anterior longitudinal ligament (n=2), wound breakdown (n=2), cardiac instability (n=1), pedicle fracture (n=1), and nonunion requiring revision (n=1). XLIF significantly improves coronal plane deformity in patients with adult degenerative scoliosis. XLIF has the ability to correct sagittal plane deformity, although it is most effective at lower lumbar levels.

Caputo AM; Michael KW; Chapman TM; Jennings JM; Hubbard EW; Isaacs RE; Brown CR

2013-07-01

290

Posterolateral versus posterior interbody fusion in isthmic spondylolisthesis.  

UK PubMed Central (United Kingdom)

Spondylolisthesis is a heterogeneous disorder characterized by subluxation of a vertebral body over another in the sagittal plane. Its most common form is isthmic spondylolisthesis (IS). This study aims to compare clinical outcomes of posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF) with posterior instrumentation in the treatment of IS. We performed a randomized prospective study in which 80 patients out of a total of 85 patients with IS were randomly allocated to one of two groups: PLF with posterior instrumentation (group I) or PLIF with posterior instrumentation (group II). Posterior decompression was performed in the patients. The Oswestry low back pain disability (OLBP) scale and Visual Analogue Scale (VAS) were used to evaluate the quality of life (QoL) and pain, respectively. Fisher's exact test was used to evaluate fusion rate and the Mann-Whitney U test was used to compare categorical data. Fusion in group II was significantly better than in group I (p=0.012). Improvement in low back pain was statistically more significant in group I (p=0.001). The incidence of neurogenic claudication was significantly lower in group I than in group II (p=0.004). In group I, there was no significant correlation between slip Meyerding grade and disc space height, radicular pain, and low back pain. There was no significant difference in post-operative complications at 1-year follow-up. Our data showed that PLF with posterior instrumentation provides better clinical outcomes and more improvement in low back pain compared to PLIF with posterior instrumentation despite the low fusion rate.

Farrokhi MR; Rahmanian A; Masoudi MS

2012-05-01

291

Posterolateral versus posterior interbody fusion in isthmic spondylolisthesis.  

Science.gov (United States)

Spondylolisthesis is a heterogeneous disorder characterized by subluxation of a vertebral body over another in the sagittal plane. Its most common form is isthmic spondylolisthesis (IS). This study aims to compare clinical outcomes of posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF) with posterior instrumentation in the treatment of IS. We performed a randomized prospective study in which 80 patients out of a total of 85 patients with IS were randomly allocated to one of two groups: PLF with posterior instrumentation (group I) or PLIF with posterior instrumentation (group II). Posterior decompression was performed in the patients. The Oswestry low back pain disability (OLBP) scale and Visual Analogue Scale (VAS) were used to evaluate the quality of life (QoL) and pain, respectively. Fisher's exact test was used to evaluate fusion rate and the Mann-Whitney U test was used to compare categorical data. Fusion in group II was significantly better than in group I (p=0.012). Improvement in low back pain was statistically more significant in group I (p=0.001). The incidence of neurogenic claudication was significantly lower in group I than in group II (p=0.004). In group I, there was no significant correlation between slip Meyerding grade and disc space height, radicular pain, and low back pain. There was no significant difference in post-operative complications at 1-year follow-up. Our data showed that PLF with posterior instrumentation provides better clinical outcomes and more improvement in low back pain compared to PLIF with posterior instrumentation despite the low fusion rate. PMID:22260338

Farrokhi, Majid Reza; Rahmanian, Abdolkarim; Masoudi, Mohammad Sadegh

2012-04-02

292

The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Comparatively little is known about the relation between the sagittal vertical axis and clinical outcome in cases of degenerative lumbar spondylolisthesis. The objective of this study was to determine whether lumbar sagittal balance affects clinical outcomes after posterior interbody fusion. This series suggests that consideration of sagittal balance during posterior interbody fusion for degenerative spondylolisthesis can yield high levels of patient satisfaction and restore spinal balance Methods A retrospective study of clinical outcomes and a radiological review was performed on 18 patients with one or two level degenerative spondylolisthesis. Patients were divided into two groups: the patients without improvement in pelvic tilt, postoperatively (Group A; n = 10) and the patients with improvement in pelvic tilt postoperatively (Group B; n = 8). Pre- and postoperative clinical outcome surveys were administered to determine Visual Analogue Pain Scores (VAS) and Oswestry disability index (ODI). In addition, we evaluated full spine radiographic films for pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), sacrofemoral distance (SFD), and sacro C7 plumb line distance (SC7D) Results All 18 patients underwent surgery principally for the relief of radicular leg pain and back pain. In groups A and B, mean preoperative VAS were 6.85 and 6.81, respectively, and these improved to 3.20 and 1.63 at last follow-up. Mean preoperative ODI were 43.2 and 50.4, respectively, and these improved to 23.6 and 18.9 at last follow-up. In spinopelvic parameters, no significant difference was found between preoperative and follow up variables except PT in Group A. However, significant difference was found between the preoperative and follows up values of PT, SS, TK, LL, and SFD/SC7D in Group B. Between parameters of group A and B, there is borderline significance on preoperative PT, preoperative LL and last follow up SS. Correlation analysis revealed the VAS improvements in Group A were significantly related to postoperative lumbar lordosis (Pearson's coefficient = -0.829; p = 0.003). Similarly, ODI improvements were also associated with postoperative lumbar lordosis (Pearson's coefficient = -0.700; p = 0.024). However, in Group B, VAS and ODI improvements were not found to be related to postoperative lumbar lordosis and to spinopelvic parameters. Conclusion In the current series, patients improving PT after fusion were found to achieve good clinical outcomes in degenerative spondylolisthesis. Overall, our findings show that it is important to quantify sagittal spinopelvic parameters and promote sagittal balance when performing lumbar fusion for degenerative spondylolisthesis.

Kim Mi; Lee Sun-Ho; Kim Eun-Sang; Eoh Whan; Chung Sung-Soo; Lee Chong-Suh

2011-01-01

293

Anterior to psoas fusion of the lumbar spine.  

Science.gov (United States)

Lateral interbody cages have proven useful in lumbar fusion surgery. Spanning both lateral cortical rims while sparing the anterior longitudinal ligament, they restore disc height, improve coronal balance and add stability. The standard approach to their insertion is 90 degrees lateral transpsoas which is bloodless compared to other techniques of interbody cage insertion but requires neuro-monitoring and at L4/5 can be difficult because of iliac crest obstruction or an anterior plexus position. The oblique muscle-splitting approach with the patient in a lateral position, remains retroperitoneal, and on the left side enters the disc space through a window between psoas and the common iliac vein. Reports of this approach are few and none previously have described how to use the large lateral-type cages so effective at restoring spinal alignment. In this video we demonstrate our technique of anterior to psoas fusion of the lumbar spine with a retroperitoneal approach and gentle retraction of the psoas muscle. The video can be found here: http://youtu.be/OS2vNcX9JMA. PMID:23829843

Gragnaniello, Cristian; Seex, Kevin A

2013-07-01

294

Anterior to psoas fusion of the lumbar spine.  

UK PubMed Central (United Kingdom)

Lateral interbody cages have proven useful in lumbar fusion surgery. Spanning both lateral cortical rims while sparing the anterior longitudinal ligament, they restore disc height, improve coronal balance and add stability. The standard approach to their insertion is 90 degrees lateral transpsoas which is bloodless compared to other techniques of interbody cage insertion but requires neuro-monitoring and at L4/5 can be difficult because of iliac crest obstruction or an anterior plexus position. The oblique muscle-splitting approach with the patient in a lateral position, remains retroperitoneal, and on the left side enters the disc space through a window between psoas and the common iliac vein. Reports of this approach are few and none previously have described how to use the large lateral-type cages so effective at restoring spinal alignment. In this video we demonstrate our technique of anterior to psoas fusion of the lumbar spine with a retroperitoneal approach and gentle retraction of the psoas muscle. The video can be found here: http://youtu.be/OS2vNcX9JMA.

Gragnaniello C; Seex KA

2013-07-01

295

Cervical Interbody fusion using calf bone.  

UK PubMed Central (United Kingdom)

Since 1972, Kiel Surgibone (calf bone) dowels have been inserted in the cervical intervertebral space of 221 patients. The anterior approach was used for cervical interbody fusion. Fusion occurred in every patient who survived long enough for it to occur. No complications occurred that specifically could be attributed to use of this type of grafting material. Kiel surgibone has the advantage of eliminating the need for osteotomy when autologous bone is used or for a bone bank when homologous bone is employed. Kiel Surgibone is supplied sterile and is precisely preshaped.

Siqueira EB; Kranzler LI

1982-07-01

296

Tricortical cervical inter-body screw fixation.  

Directory of Open Access Journals (Sweden)

Full Text Available A new tricortical method of screw implantation for anterior cervical interbody plate fixation is described. The screws are placed obliquely such that they engage the anterior cortex of the body and traverse through the cortices adjoining the disc space. By this method the screws not only hold the plate firmly with a tricortical purchase, but by virtue of their course stabilize the two adjoining vertebral bodies by themselves. Sixteen patients were treated by this method. In three of these cases only tricortical screws without the metal plate were used for fixation. The advantages of the technique are discussed.

Goel A

1997-01-01

297

Lumbar gossypiboma.  

UK PubMed Central (United Kingdom)

Gossypiboma is a mass formed by a retained surgical sponge and reactive tissue. The cases with gossypiboma are usually asymptomatic or with nonspecific symptoms, which delay diagnosis for months or years after surgery. We describe imaging findings in a 43-year-old woman with a symptomatic retained surgical sponge in a lumbar laminectomy site. Ultrasonography, computed tomography, magnetic resonance imaging (MRI), and diffusion-weighted MRI were performed. Gossypiboma should be considered in the differential diagnosis of a mass in a patient with a history of prior surgery. Diffusion-weighted MRI may provide important data for differential diagnosis of gossypiboma. With diffusion-weighted MRI, gossypiboma may be distinguished from an abscess by its low signal intensity and increased apparent diffusion coefficient (ADC) as compared to high signal intensity with low ADC in cases of abscess.

Erdem G; Ate? O; Koçak A; Alkan A

2010-03-01

298

Lumbar gossypiboma.  

Science.gov (United States)

Gossypiboma is a mass formed by a retained surgical sponge and reactive tissue. The cases with gossypiboma are usually asymptomatic or with nonspecific symptoms, which delay diagnosis for months or years after surgery. We describe imaging findings in a 43-year-old woman with a symptomatic retained surgical sponge in a lumbar laminectomy site. Ultrasonography, computed tomography, magnetic resonance imaging (MRI), and diffusion-weighted MRI were performed. Gossypiboma should be considered in the differential diagnosis of a mass in a patient with a history of prior surgery. Diffusion-weighted MRI may provide important data for differential diagnosis of gossypiboma. With diffusion-weighted MRI, gossypiboma may be distinguished from an abscess by its low signal intensity and increased apparent diffusion coefficient (ADC) as compared to high signal intensity with low ADC in cases of abscess. PMID:19813177

Erdem, Gülnur; Ate?, Ozkan; Koçak, Ayhan; Alkan, Alpay

2009-10-05

299

[The application of three lumbar fusion methods in the treatment of spondylolisthesis].  

UK PubMed Central (United Kingdom)

OBJECTIVE: to compare the therapeutic effect of posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF) and posterior circumferential fusion (PCF) for lumbar spondylolisthesis. METHODS: from January 2003 to December 2008, 232 patients with lumbar spondylolisthesis treated with pedicle screw fixation and followed for reviewed retrospectively. The patients were divided into three groups based on fusion method: group A (PLF, 66 case), group B (PLIF, 54 case)and group C (PCF, 112 case). The three groups were reviewed and compared for clinical outcome and fusion rate. RESULTS: the mean follow-up period was 21 months (range, 6-60 months). The fusion rate was 80.1% for PLF, 92.5% for PLIF and 93.7% for PCF group (P > 0.05). As to isthmic spondylolisthesis or Meyerding grade degenerative II and III spondylolisthesis, the fusion rate was 60.7% for PLF group, 90% for PLIF group and 93.3% for PCF group (P < 0.05). Compare the fusion rate for PLF group and PLIF+ PCF group (P < 0.05), fusion rate for PLIF group and PCF group (P > 0.05). The rate of excellent and good together was 84.8% in PLF group, 90.7% in PLIF group and 93.6% in PCF group (P > 0.05). CONCLUSIONS: posterior lumbar interbody fusion and posterior circumferential fusion are more consistent with bio-mechanics, have a higher fusion rate, for the treatment of spondylolisthesis they are the preferred surgical approaches.

Ma X; Qin YC; Huo JZ; Zhang HY

2010-11-01

300

Impact of total disc arthroplasty on the surgical management of lumbar degenerative disc disease: Analysis of the Nationwide Inpatient Sample from 2000 to 2008.  

UK PubMed Central (United Kingdom)

BACKGROUND: Spinal fusion is the most rapidly increasing type of lumbar spine surgery for various lumbar degenerative pathologies. The surgical treatment of lumbar spine degenerative disc disease may involve decompression, stabilization, or arthroplasty procedures. Lumbar disc athroplasty is a recent technological advance in the field of lumbar surgery. This study seeks to determine the clinical impact of anterior lumbar disc replacement on the surgical treatment of lumbar spine degenerative pathology. This is a retrospective assessment of the Nationwide Inpatient Sample (NIS). METHODS: The NIS was searched for ICD-9 codes for lumbar and lumbosacral fusion (81.06), anterior lumbar interbody fusion (81.07), and posterolateral lumbar fusion (81.08), as well as for procedure codes for revision fusion surgery in the lumbar and lumbosacral spine (81.36, 81.37, and 81.38). To assess lumbar arthroplasty, procedure codes for the insertion or replacement of lumbar artificial discs (84.60, 84.65, and 84.68) were queried. Results were assayed from 2000 through 2008, the last year with available data. Analysis was done using the lme4 package in the R programming language for statistical computing. RESULTS: A total of nearly 300,000 lumbar spine fusion procedures were reported in the NIS database from 2000 to 2008; assuming a representative cross-section of the US health care market, this models approximately 1.5 million procedures performed over this time period. In 2005, the first year of its widespread use, there were 911 lumbar arthroplasty procedures performed, representing 3% of posterolateral fusions performed in this year. Since introduction, the number of lumbar spine arthroplasty procedures has consistently declined, to 653 total procedures recorded in the NIS in 2008. From 2005 to 2008, lumbar arthroplasties comprised approximately 2% of lumbar posterolateral fusions. Arthroplasty patients were younger than posterior lumbar fusion patients (42.8 ± 11.5 vs. 55.9 ± 15.1 years, P < 0.0000001). The distribution of arthroplasty procedures was even between academic and private urban facilities (48.5% and 48.9%, respectively). While rates of posterolateral lumbar spine fusion steadily grew during the period (OR 1.06, 95% CI: 1.05-1.06, P < 0.0000001), rates of revision surgery and anterior spinal fusion remained static. CONCLUSIONS: The impact of lumbar arthroplasty procedures has been minimal. Measured as a percentage of more common lumbar posterior arthrodesis procedures, lumbar arthroplasty comprises only approximately 2% of lumbar spine surgeries performed in the United States. Over the first 4 years following the Food and Drug Administration (FDA) approval, the frequency of lumbar disc arthroplasty has decreased while the number of all lumbar spinal fusions has increased.

Awe OO; Maltenfort MG; Prasad S; Harrop JS; Ratliff JK

2011-01-01

 
 
 
 
301

Two-year follow-up results after treatment of lumbar instability with titanium-coated fusion system.  

UK PubMed Central (United Kingdom)

Objective:? The purpose of this prospective clinical trial, with a minimum two-year follow-up, was to evaluate the clinical effects of a titanium-coated lumbar interbody fusion system in the treatment of lumbar instability. Methods:? The study cohort consisted of 94 patients with lumbar instability who accepted posterior lumbar interbody fusion with a titanium-coated fusion system. The patients were examined at the sixth, 12th and 24th month postoperatively. The clinical outcomes of all patients were evaluated according to the Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI). Radiological studies, which included assessment of loss of disc space height, intervertebral angle and isodense bone bridging, were used to evaluate the fusion. Results:? The overall fusion rate was 95.75% at the 24th month after surgery. Ninety-two (97.87%) patients were able to work while 53 patients (56.38%) were capable of performing heavy manual labor. Neurological assessment showed 77 patients (81.92%) had no sensory or motor deficit. The mean JOA score had increased from 15.34 to 28.92 and ODI had decreased from 45 to 15 at the 24th month after surgery. No implant fracture or displacement was found. Conclusion:? The titanium-coated intervertebral fusion cage is effective and safe for treatment of lumbar instability.

Zhang YF; Yang HL; Wang JW; Tang TS

2009-05-01

302

Two-year follow-up results after treatment of lumbar instability with titanium-coated fusion system.  

Science.gov (United States)

Objective:? The purpose of this prospective clinical trial, with a minimum two-year follow-up, was to evaluate the clinical effects of a titanium-coated lumbar interbody fusion system in the treatment of lumbar instability. Methods:? The study cohort consisted of 94 patients with lumbar instability who accepted posterior lumbar interbody fusion with a titanium-coated fusion system. The patients were examined at the sixth, 12th and 24th month postoperatively. The clinical outcomes of all patients were evaluated according to the Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI). Radiological studies, which included assessment of loss of disc space height, intervertebral angle and isodense bone bridging, were used to evaluate the fusion. Results:? The overall fusion rate was 95.75% at the 24th month after surgery. Ninety-two (97.87%) patients were able to work while 53 patients (56.38%) were capable of performing heavy manual labor. Neurological assessment showed 77 patients (81.92%) had no sensory or motor deficit. The mean JOA score had increased from 15.34 to 28.92 and ODI had decreased from 45 to 15 at the 24th month after surgery. No implant fracture or displacement was found. Conclusion:? The titanium-coated intervertebral fusion cage is effective and safe for treatment of lumbar instability. PMID:22009824

Zhang, Ya-feng; Yang, Hui-lin; Wang, Jian-wei; Tang, Tian-si

2009-05-01

303

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... we’re going to be doing in a few minutes. Lumbar surgery, particularly from the micro-lumbar ... small approach, as you will see in a few minutes. We mobilize the nerve and remove the ...

304

Single-level lumbar spine fusion: a comparison of anterior and posterior approaches.  

UK PubMed Central (United Kingdom)

This study is a retrospective review of 122 patients who underwent single-level lumbar spine fusion. The objectives were to directly compare perioperative morbidity and early results of single-level anterior interbody posterolateral intertransverse process lumbar spine fusion and to provide objective findings that may be useful in selecting surgical method. Lumbar spinal fusion is a well-recognized surgical treatment of intractable low back pain resulting from DDD or spondylolisthesis. Assessments of techniques, results, and outcomes have been published, but detailed head-to-head comparisons of anterior posterior approaches with objective operative and postoperative data are not available in the literature. A retrospective review of 122 patients who underwent either an anterior interbody or posterolateral intertransverse process (average follow-up 22 and 26 months, respectively) single-level instrumented lumbar spinal fusion was performed. Surgical, perioperative, and follow-up data were obtained directly from medical records. The findings compared included estimated blood loss, need for blood transfusion, number of units transfused, operative time, number of days in hospital, need for transitional facility care, complications, need for further surgery, radiographic fusion, and clinical results. There was significantly less blood loss, need for transfusion, amount of blood transfused, operative time, and hospital stay for patients with anterior fusion procedures (p < 0.01). There was no significant difference in need for transitional facility care, complication rates, and given follow-up period in radiographic fusion rate and clinical outcome. Clinical results were significantly worse for those undergoing revision primary fusion (p < 0.01). The anterior approach to single-level lumbar fusion is associated with less morbidity than the posterolateral approach. This may in turn affect surgical outcome and hospital cost. However, both approaches to single-level lumbar fusion produce similar early fusion rates and clinical results. Revision fusions had poor early results regardless of approach.

Pradhan BB; Nassar JA; Delamarter RB; Wang JC

2002-10-01

305

Lateral transpsoas interbody fusion (LTIF) with plate fixation and unilateral pedicle screws: a preliminary report.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: We present the radiographic and clinical outcomes of 13 patients who underwent lateral transpsoas interbody fusion (LTIF) stabilized by unilateral pedicle screw instrumentation and anterior instrumentation. SUMMARY OF BACKGROUND DATA: LTIF is a surgical technique that permits anterior column lumbar interbody fusion via a direct lateral transpsoas approach. Because of the inherent stability of the implants used and the minimal disruption of stabilizing ligaments associated with LTIF, this technique may allow use of less invasive adjunctive fixation methods including unilateral pedicle screw fixation. METHODS: Information from medical records included patient demographics, medical comorbidities, clinical assessment, surgical time, blood loss, implant information, and complications. Oswestry Disability Index, Short Form-12, and visual analog pain scale scores were obtained. Postoperative imaging allowed assessment of fusion, subsidence, and alignment. RESULTS: Estimated blood loss averaged 225 mL and operative time averaged 261 minutes. No patients received a transfusion. Average length of hospital stay was 4.6 days. Oswestry Disability Index, Short Form-12, and visual analog pain scores demonstrated significant improvement. All patients with available 1 year postoperative imaging demonstrated solid fusion with average cranial and caudal subsidence of 1.8 and 0.8 mm, respectively. Two patients developed postoperative nondisplaced vertebral fractures through the anterior fixation screw tracts. Three patients developed transient postoperative hip flexion weakness and one also developed transient hypoesthesia in the anterior thigh, likely approach related. CONCLUSIONS: We report a series of patients treated with unilateral pedicle screw fixation with LTIF. Although the patient cohort is small, validated outcomes instruments were used and fusion was assessed by computed tomography scan in most cases. The data suggest that unilateral pedicle screw fixation may be adequate to achieve high fusion rates after LTIF surgery using anterior instrumentation. Applying this technique in patients with osteoporosis may lead to a significant risk of postoperative vertebral body fracture.

Kepler CK; Sharma AK; Huang RC

2011-08-01

306

Bellows-Like Expandable Interbody Fusion Cage  

UK PubMed Central (United Kingdom)

An interbody fusion device having an accordion-like structure, wherein the device in inserted into the disc space in its collapsed configuration and then expanded into its expanded configuration by compressing the accordion-like portion of the device. In some embodiments, a pre-formed tube with an accordion-like structure over a portion of its length is inserted in a relaxed (collapsed) configuration, giving the tube a minimum possible diameter. This tube has a cable running through it that is fixed to a distal end portion of the tube and extends past the proximal end portion of the tube to the outside of the patient. Once the tube is positioned on the rim of the endplate, the proximal end of the cable is pulled, thereby tensioning the cable and causing the accordion portion of the tube to become shorter in length but larger in diameter.

MARCHEK CONNIE; FRASIER WILLIAM

307

[Ventral intercorporal spondylodesis of the lumbar spine in segmental instability  

UK PubMed Central (United Kingdom)

Ventral intercorporal spondylodesis or anterior interbody fusion was applied via the extraperitoneal route to the lumbar spine of 25 adult patients. The approach had in all cases been indicated for segmental instability in spondylolisthesis or degeneration of vertebral discs with low-back pain in the wake of surgery. Described are the surgical technique used as well as intra-operative and postoperative complications. Solid union was recorded from 21 patients, while non-union occurred to four. Follow-up checks within six months to four and a half years from surgery (2.2 years on average) revealed good clinical success in 19 patients. Four of them were absolutely free of low-back pain, while the condition of 15 had changed to the better. Pain symptoms were not affected in six patients.

Mayer G; Albus H

1986-01-01

308

Oral extrusion of screw after anterior cervical interbody fusion.  

UK PubMed Central (United Kingdom)

We present a case of delayed oral extrusion of a screw after anterior cervical interbody fusion in a 68-year-old man with osteoporosis. Fifteen months earlier, he had undergone C5 corpectomy and anterior cervical interbody fusion at C4-6 for multiple spinal stenoses. The patient was nearly asymptomatic, except for a foreign body sensation in his throat. We conclude that the use of a mesh graft or other instrument in elderly patients and those with osteoporosis or problematic bone quality should be considered carefully and that if surgery were to be performed, periodic postoperative follow-up evaluations are mandatory.

Lee JS; Kang DH; Hwang SH; Han JW

2008-10-01

309

Oral extrusion of screw after anterior cervical interbody fusion.  

Science.gov (United States)

We present a case of delayed oral extrusion of a screw after anterior cervical interbody fusion in a 68-year-old man with osteoporosis. Fifteen months earlier, he had undergone C5 corpectomy and anterior cervical interbody fusion at C4-6 for multiple spinal stenoses. The patient was nearly asymptomatic, except for a foreign body sensation in his throat. We conclude that the use of a mesh graft or other instrument in elderly patients and those with osteoporosis or problematic bone quality should be considered carefully and that if surgery were to be performed, periodic postoperative follow-up evaluations are mandatory. PMID:19096688

Lee, Jin Soo; Kang, Dong-Ho; Hwang, Soo Hyun; Han, Jong Woo

2008-10-30

310

Plate fixation for anterior cervical interbody fusion.  

Science.gov (United States)

From April 1989 to April 1990, 13 patients with cervical spinal fracture/dislocation, spondylosis or metastasis were treated at the respective hospitals. There were 4 women and 9 men whose ages ranged from 25 to 70 years (mean 45 years). All of them were treated with neural decompression, bone grafting and anterior spinal interbody fusion. All iliac crest or fibular bone grafts were anchored to the vertebral bodies with plates and screws. The clinical outcomes were evaluated retrospectively. The results showed that all had improvement of neurological symptoms and signs. The radiographic evaluation revealed satisfactory alignment and sound union of the cervical spine in all 13 patients. No serious complications were found except screw loosening in two instances without impairment of clinical results. We concluded that anterior cervical plates provide effective stabilization which is essential for good results. Furthermore, from this study and a review of the literature, we advocated that it was not necessary for the tip of the screws to reach or even penetrate the posterior cortex of the vertebral body. PMID:1678412

Chen, I H; Yang, R S; Chen, P Q

1991-02-01

311

Plate fixation for anterior cervical interbody fusion.  

UK PubMed Central (United Kingdom)

From April 1989 to April 1990, 13 patients with cervical spinal fracture/dislocation, spondylosis or metastasis were treated at the respective hospitals. There were 4 women and 9 men whose ages ranged from 25 to 70 years (mean 45 years). All of them were treated with neural decompression, bone grafting and anterior spinal interbody fusion. All iliac crest or fibular bone grafts were anchored to the vertebral bodies with plates and screws. The clinical outcomes were evaluated retrospectively. The results showed that all had improvement of neurological symptoms and signs. The radiographic evaluation revealed satisfactory alignment and sound union of the cervical spine in all 13 patients. No serious complications were found except screw loosening in two instances without impairment of clinical results. We concluded that anterior cervical plates provide effective stabilization which is essential for good results. Furthermore, from this study and a review of the literature, we advocated that it was not necessary for the tip of the screws to reach or even penetrate the posterior cortex of the vertebral body.

Chen IH; Yang RS; Chen PQ

1991-02-01

312

Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4-5 spondylolisthesis: clinical outcomes.  

Science.gov (United States)

Object In this study the authors report on the clinical outcomes, safety, and efficacy of lateral retroperitoneal transpsoas minimally invasive surgery-lumbar interbody fusion (MIS-LIF) at the L4-5 disc space in patients with spondylolisthesis. This approach has become an increasingly popular means of fusion. Its most frequent complication is lumbar plexus injury. Reported complication rates at the L4-5 disc space vary widely in the literature, bringing into question the safety of MIS-LIF for the L4-5 region, especially in patients with spondylolisthesis. Methods The authors retrospectively reviewed prospectively acquired multicenter databases of patients with Grade I and II L4-5 spondylolisthesis who had undergone elective MIS-LIF between 2008 and 2011. Clinical follow-up had been scheduled for 1, 3, 6, 12, and 24 months postoperatively. Outcome measures included estimated blood loss, operative time, length of hospital stay, integrity of construct, complications, fusion rates, visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey (SF-36). Results Eighty-four patients with L4-5 MIS-LIF were identified, 31 of whom met the study inclusion criteria: 26 adults with Grade I and 5 adults with Grade II L4-5 spondylolisthesis who had undergone elective MIS-LIF and subsequent posterior percutaneous pedicle screw fixation without surgical manipulation of the posterior elements (laminectomy, foraminotomy, facetectomy). The study cohort consisted of 9 males (29%) and 22 females (71%) with an average age of 61.5 years. The mean total blood loss was 94 ml (range 20-250 ml). The mean hospital stay and follow-up were 3.5 days and 18.2 months, respectively. The average score on the ODI improved from 50.4 preoperatively to 30.9 at the last follow-up (p spondylolisthesis at the L4-5 vertebral segment. PMID:23889186

Ahmadian, Amir; Verma, Sean; Mundis, Gregory M; Oskouian, Rod J; Smith, Donald A; Uribe, Juan S

2013-07-26

313

[Comparison of three types of lumbar total disc arthroplasty. Four-year minimum follow-up].  

UK PubMed Central (United Kingdom)

BACKGROUND: Total lumbar disc replacement was developed to avoid the drawbacks of arthrodesis. This procedure should be done cautiously due to the various already known complications. The purpose of this study is to assess the clinical and radiographic results after single-level lumbar arthroplasty with the Prodisc-L, Maverick and Charité prostheses at our service. MATERIAL AND METHODS: A retrospective study was performed comparing the clinical and radiographic results of three groups of patients who underwent total lumbar disc arthroplasty from January 2000 to December 2007. RESULTS: Twenty-one lumbar prosthetic surgeries were performed. The Prodisc device was used in 13 patients, the Maverick in 4, and the Charité in 4. After the application of the Stauffer-Coventry scale, 16 patients reported excellent results and 5 good results. The mean preoperative interbody height was 7.9 mm and the mean postoperative height was 12.91 mm. The mean differential angle in the dynamic films was 5.47 degrees preoperatively and 4.61 postoperatively; the mean angle in neutral position was 13.38 preoperatively and 19.61 postoperatively. CONCLUSIONS: This study showed that the clinical result was good in all three groups. Mobility was better maintained with the Charité prosthesis compared to the Prodisc and Maverick devices. The three prostheses are appropriate for the treatment of lumbar degenerative disc disease.

Zárate-Kalfópulos B; Bran-García M; Rosales-Olivarez LM; Alpizar-Aguirre A; Sánchez-Bringas MG; Juárez-Jiménez HG; Santillán-Montelongo A; Reyes-Sánchez A

2012-03-01

314

Instrumentation in lumbar fusion improves back pain but not quality of life 2 years after surgery  

Science.gov (United States)

Background and purpose Instrumented and non-instrumented methods of fusion have been compared in several studies, but the results are often inconsistent and conflicting. We compared the 2-year results of 3 methods of lumbar fusion when used in degenerative disc disease (DDD), using the Swedish Spine Register (SWESPINE). Methods All patients registered in SWESPINE for surgical treatment of DDD between January 1, 2000 and October 1, 2007 were eligible for the study. Patients who had completed the 2-year follow-up were included in the analysis. The outcomes of 3 methods of surgical fusion were assessed. Results Of 1,310 patients enrolled, 115 had undergone uninstrumented fusion, 620 instrumented posterolateral fusion, and 575 instrumented interbody fusion. Irrespective of the surgical procedure, quality of life (QoL) improved and back pain diminished. Change in QoL and functional disability and return to work was similar in the 3 groups. Patients who had undergone uninstrumented fusion had more back pain than the patients with instrumented interbody fusion at the 2-year follow-up (p = 0.02), although the difference was only 7 visual analog scale (VAS) units (95% CI: 1–13) on a 100-point scale. Moreover, 83% of the patients with uninstrumented fusion used analgesics at the end of follow-up as compared to 68% of the patients who had undergone surgery with one of the 2 instrumented fusion techniques. Interpretation In comparison with instrumented interbody fusion, uninstrumented fusion was associated with higher levels of back pain 2 years after surgery. We found no evidence for differences in QoL between uninstrumented fusion and instrumented interbody fusion.

2013-01-01

315

Fusion rates of instrumented lumbar spinal arthrodesis according to surgical approach: a systematic review of randomized trials.  

UK PubMed Central (United Kingdom)

BACKGROUND: Lumbar spine fusion rates can vary according to the surgical technique. Although many studies on spinal fusion have been conducted and reported, the heterogeneity of the study designs and data handling make it difficult to identify which approach yields the highest fusion rate. This paper reviews studies that compared the lumbosacral fusion rates achieved with different surgical techniques. METHODS: Relevant randomized trials comparing the fusion rates of different surgical approaches for instrumented lumbosacral spinal fusion surgery were identified through highly sensitive and targeted keyword search strategies. A methodological quality assessment was performed according to the checklist suggested by the Cochrane Collaboration Back Review Group. Qualitative analysis was performed. RESULTS: A literature search identified six randomized controlled trials (RCTs) comparing the fusion rates of different surgical approaches. One trial compared anterior lumbar interbody fusion (ALIF) plus adjunctive posterior transpedicular instrumentation with circumferential fusion and posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF). Three studies compared PLF with circumferential fusion. One study compared three fusion approaches: PLF, PLIF and circumferential fusion. CONCLUSIONS: One low quality RCT reported no difference in fusion rate between ALIF with posterior transpedicular instrumentation and circumferential fusion, and PLIF and circumferential fusion. There is moderate evidence suggesting no difference in fusion rate between PLF and PLIF. The evidence on the fusion rate of circumferential fusion compared to PLF from qualitative analysis was conflicting. However, no general conclusion could be made due to the scarcity of data, heterogeneity of the trials included, and some methodological defects of the six studies reviewed.

Lee CS; Hwang CJ; Lee DH; Kim YT; Lee HS

2011-03-01

316

Ipsilateral pedicle screw placement with contralateral percutaneous facet screws: Early results with an alternative in lumbar arthrodesis  

Directory of Open Access Journals (Sweden)

Full Text Available Richard B Rhiew, Sunil Manjila, Andrew M Lozen, David Hong, Murali Guthikonda, S S RengacharyDepartment of Neurosurgery, Wayne State University, Detroit, MI, USAAbstract: Transforaminal lumbar interbody fusion (TLIF) is a widely used method of surgical treatment for a variety of lumbar spinal disorders. Bilateral transpedicular instrumentation is routinely used in conjunction with an interbody graft to provide additional stability. In this technical note, we describe our fusion construct using ipsilateral pedicle screw placement on the side of TLIF and contralateral facet screw placement. We performed this construct at six levels in four patients. Suggested advantages include: low morbidity, small incision and lower cost. Outcomes parameters included radiographic evidence of solid union at four months and improvement in Oswestry Disability Index. A mean improvement from a preoperative score of 73 to 26 after surgery was observed at one-year follow-up. There were no instrument-related complications. In conclusion, this hybrid screw system minimizes contralateral dissection and is an attractive alternative to standard bilateral pedicle screw fixation.Keywords: TLIF, facet screw, pedicle screw, lumbar spine fusion

Richard B Rhiew; Sunil Manjila; Andrew M Lozen; David Hong; et al.

2009-01-01

317

[Clinical analysis of interspinous dynamic internal fixation with the Coflex system in treating lumbar degenerative disease].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare the clinical effects between interspinous dynamic internal fixation with Coflex system and posterior lumbar interbody fusion in treating lumbar degenerative disease. METHODS: From Jan. 2007 to Jan. 2010, 42 patients with lumbar degenerative disease were treated with interspinous dynamic internal fixation with Coflex system (non-fusion group, 21 cases) and posterior lumbar interbody fusion (fusion group, 21 cases), including 19 males and 23 females with an average age of (46.5 +/- 8.5) years (range, 33 to 62 years). The range of course of disease was from 6 to 84 months with an average of 36 months. All pathological changes were single segment in L4.5 by X-ray films or CT scanning, among them, single lumbar disc herniation was in 14 cases,combined with lumbar spinal stenosis in 28 cases. The clinical effects of all patients were evaluated according to Japanese orthopaedic association (JOA, 29 points) and Oswestry disability index (ODI); range of motion (ROM) of lumbar segments were measured by X-ray films; operative time, intraoperative blood loss,hospital stay were compared between two groups. RESULTS: All patients were followed up for 10 months at least. In non-fusion group, JOA increased from 13.8 +/- 3.7 preoperatively to 24.6 +/- 4.6 at final follow-up (P < 0.01); ODI decreased from 65.8 +/- 7.5 to 25.6 +/- 5.1 (P < 0.01), ROM improved from 4.2 +/- 0.7 to 5.3 +/- 0.6 at L4,5 (P < 0.01 ). In fusion group,JOA increased from 13.2 +/- 3.2 preoperatively to 24.5 +/-4.3 at final follow-up (P < 0.01); ODI decreased from 65.5 +/- 8.2 to 26.5 +/- 6.1 (P < 0.01); all ROM at L.4,5 had lose (decreased from 4.2 +/- 3.2 to 0). There were significant differences in the operative time, intraoperative blood loss, hospital stay between two groups (P < 0.01), in non-fusion group was respectively (71.2 +/- 12.8) min, (56.6 +/- 25.5) ml, (4.4 +/- 1.3) d and in fusion group was respectively (121.0 +/- 23.2) min, (135.8 +/- 19.8) ml, (12.6 +/- 2.4) d. No complications were found with the Coflex system. CONCLUSION: Interspinous dynamic internal fixation with Coflex system in treating lumbar degenerative disease is better than that of posterior lumbar interbody fusion in some aspects. Coflex system have high safety, less trauma, and can reserve lumbar mobility, which is effective in preventing adjacent intervertebral disc degeneration.

Du FT

2011-04-01

318

Biomechanics of lumbar arthroplasty.  

UK PubMed Central (United Kingdom)

There are many issues to consider in evaluating the biomechanics of lumbar arthroplasty, which may consist of a nucleus replacement, a total disc replacement, or a mobile posterior device. The goal of spinal arthroplasty is to replicate or augment the function of the normal spinal elements, by taking into consideration both in the quantity and quality of motion that occurs across the replaced joint. This article describes the relevant parameters for studying the biomechanics of lumbar arthroplasty and briefly summarizes the current knowledge with regard to those parameters in some well-known lumbar nucleoplasty, facet replacement, and total disc arthroplasty devices.

Crawford NR

2005-10-01

319

Biomechanics of lumbar arthroplasty.  

Science.gov (United States)

There are many issues to consider in evaluating the biomechanics of lumbar arthroplasty, which may consist of a nucleus replacement, a total disc replacement, or a mobile posterior device. The goal of spinal arthroplasty is to replicate or augment the function of the normal spinal elements, by taking into consideration both in the quantity and quality of motion that occurs across the replaced joint. This article describes the relevant parameters for studying the biomechanics of lumbar arthroplasty and briefly summarizes the current knowledge with regard to those parameters in some well-known lumbar nucleoplasty, facet replacement, and total disc arthroplasty devices. PMID:16326282

Crawford, Neil R

2005-10-01

320

Biomechanical comparison of translaminar screw versus pedicle screw supplementation of anterior femoral ring allografts in one-level lumbar spine fusion.  

Science.gov (United States)

Pedicle screws (PS) can provide initial stabilization of anterior interbody femoral ring allograft (FRA) lumbar constructs. Translaminar screws (TLS) have also been advocated for this procedure. The objective of this study was to use an in vitro human cadaveric model to compare the stability of one-level anterior interbody lumbar constructs stabilized with PS and those stabilized with TLS. Five human cadaveric spinal motion segments (L4-S2) were biomechanically evaluated in the intact condition and using the follow- ing methods of stabilization: anterior interbody fusion with FRA, anterior FRA supplemented with PS, and anterior FRA supplemented with TLS. Stability was determined for each construct by measuring construct displacement as a function of applied load under the following conditions: compression, flexion, extension, lateral bending to each side, and axial torsion. There were no statistically significant differences in construct stability between FRA supplemented with PS and FRA supplemented with TLS under any of the loading conditions. In selected cases, supplementation of anterior femoral ring allograft with translaminar screws is a viable alternative to supplementation with pedicle screws. PMID:22196385

Razi, Afshin E; Spivak, Jeffrey M; Kummer, Frederick J; Hersh, David S; Goldstein, Jeffrey A

2011-01-01

 
 
 
 
321

Biomechanical comparison of translaminar screw versus pedicle screw supplementation of anterior femoral ring allografts in one-level lumbar spine fusion.  

UK PubMed Central (United Kingdom)

Pedicle screws (PS) can provide initial stabilization of anterior interbody femoral ring allograft (FRA) lumbar constructs. Translaminar screws (TLS) have also been advocated for this procedure. The objective of this study was to use an in vitro human cadaveric model to compare the stability of one-level anterior interbody lumbar constructs stabilized with PS and those stabilized with TLS. Five human cadaveric spinal motion segments (L4-S2) were biomechanically evaluated in the intact condition and using the follow- ing methods of stabilization: anterior interbody fusion with FRA, anterior FRA supplemented with PS, and anterior FRA supplemented with TLS. Stability was determined for each construct by measuring construct displacement as a function of applied load under the following conditions: compression, flexion, extension, lateral bending to each side, and axial torsion. There were no statistically significant differences in construct stability between FRA supplemented with PS and FRA supplemented with TLS under any of the loading conditions. In selected cases, supplementation of anterior femoral ring allograft with translaminar screws is a viable alternative to supplementation with pedicle screws.

Razi AE; Spivak JM; Kummer FJ; Hersh DS; Goldstein JA

2011-01-01

322

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting.  

UK PubMed Central (United Kingdom)

PURPOSE: The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoraco-lumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation. METHODS: The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years. RESULTS: The mean kyphotic angle improved from 32.4° pre-operatively to 7.2° in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5° at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages. CONCLUSION: Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.

Kumar MN; Joseph B; Manur R

2013-03-01

323

Transforaminal lumbar interbody fusion using a modified distractor handle: a midterm clinicoradiological follow-up study.  

UK PubMed Central (United Kingdom)

In current TLIF practice, the choice of the cage size is empirical and primarily depends on the case volume and experience of the surgeon. We used a self-made modified distractor handle in TLIF procedure with the goal of standardizing the intervertebral space tension and determining the proper cage size.

Rewuti A; Chen Z; Feng Z; Cao Y; Jiang X; Jiang C

2013-01-01

324

[Factor analysis of muscular paralysis due to nerve root injury after posterior lumbar interbody fusion (PLIF)].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To analyze the reasons of muscular paralysis due to nerve root injury after PLIF. METHODS: From January 2001 to January 2012, 1 250 cases underwent PLIF in our hospital, after operation, 29 cases occurred muscular paralysis due to nerve root injury. There were 10 males and 19 females with an average age of 61 years, 12 cases with one-segment, 14 cases with two-segment, 3 cases with three-segment. The clinical data of 29 patients were retrospectively analyzed including PODx (preoperative diagnosis), surgery procedure, postoperative symptoms and so on. RESULTS: The follow-up time was more than 1 year and the longest was 2.5 years with an average of 1 year and 7 months. Twenty-three patients obtained satisfactory results and muscle strength recovered to 4-5 levels,3 patients was poor and final muscle strength recovered to 0-2 levels. Recovering time after operation was directly proportional to the degree of injury,those muscle strength level was more than 2, usually could have significant improvement within 2 weeks. CONCLUSION: More complicated factors result in the reasons of nerve root injury after PLIF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory effect.

Liu YZ; Zhang SM; Dong FH

2013-03-01

325

Alternative strategies for lumbar discectomy: intradiscal electrothermy and nucleoplasty.  

Science.gov (United States)

In recent years the general trend in spinal surgery has been one of reductionism and minimalization. A number of techniques have recently been developed that are applicable in the treatment of lumbar disc herniation and discogenic pain due to degenerative disc disease. The purpose of this manuscript is to examine two newer percutaneous disc treatment techniques, intradiscal electrothermal therapy (IDET) anuloplasty and nucleoplasty. The authors review the appropriate clinical treatment criteria, techniques, and lessons learned after performing these procedures in more than 100 patients. The IDET involves the percutaneous insertion of a specially designed thermal resistance probe followed by controlled heating of the intervertebral disc. This may result in disc shrinkage and reduction in pain. The nucleoplasty procedure involves the percutaneous removal of disc material by using a low-temperature resister probe to disintegrate and evacuate disc material, followed by thermal treatment of adjacent residual disc material. To date, no study has been published in which investigators examine the outcomes of this procedure for the treatment of radicular leg pain and low-back pain. Both IDET and nucleoplasty appear to be safe procedures. The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with discogenic low-back pain. Nucleoplasty may provide a percutaneous alternative to microdiscectomy in selected cases. PMID:15916404

Welch, William C; Gerszten, Peter C

2002-08-15

326

Alternative strategies for lumbar discectomy: intradiscal electrothermy and nucleoplasty.  

UK PubMed Central (United Kingdom)

In recent years the general trend in spinal surgery has been one of reductionism and minimalization. A number of techniques have recently been developed that are applicable in the treatment of lumbar disc herniation and discogenic pain due to degenerative disc disease. The purpose of this manuscript is to examine two newer percutaneous disc treatment techniques, intradiscal electrothermal therapy (IDET) anuloplasty and nucleoplasty. The authors review the appropriate clinical treatment criteria, techniques, and lessons learned after performing these procedures in more than 100 patients. The IDET involves the percutaneous insertion of a specially designed thermal resistance probe followed by controlled heating of the intervertebral disc. This may result in disc shrinkage and reduction in pain. The nucleoplasty procedure involves the percutaneous removal of disc material by using a low-temperature resister probe to disintegrate and evacuate disc material, followed by thermal treatment of adjacent residual disc material. To date, no study has been published in which investigators examine the outcomes of this procedure for the treatment of radicular leg pain and low-back pain. Both IDET and nucleoplasty appear to be safe procedures. The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with discogenic low-back pain. Nucleoplasty may provide a percutaneous alternative to microdiscectomy in selected cases.

Welch WC; Gerszten PC

2002-08-01

327

[Anterior lumbar intercorporal spondylodesis. Radiological and functional therapeutic results  

UK PubMed Central (United Kingdom)

The purpose of this investigation was to identify risk factors in relation to non-union following lumbar intercorporal spondylodesis and to correlate this result with the functional outcome as assessed by the Dallas Pain Questionnaire (DPQ). This comprises questions concerning daily activities, work-leisure activities, anxiety-depression and social interest, measured on visual analog scales. During the period 1979-87 a total of 132 patients were operated with spondylodesis, diagnosed as suffering from spondylolisthesis or disc degeneration. Minimal follow-up was one year. Radiological graft incorporation was complete in 52% of the cases, partial in 24% and lacking in 24%. The rate of functional outcome follow-up was 72%. Seventy percent claimed an improvement in three out of four categories. Thirty percent claimed no improvement or worsened condition. The DPQ showed signs of poor prognosis for age groups above 45 (p < 0.04) and those with former spine surgery (p < 0.02). The questionnaire showed significantly better results for the group with perfect or doubtful union compared to the group with non-union (p < 0.006). In conclusion this investigation demonstrates a success rate of 70% for anterior lumbar interbody fusion. There is a tendency to poorer prognosis for patients with previous spine surgery and age above 45 years. The Dallas Pain Questionnaire correlates significantly to X-ray analysis and seems to be a useful tool for the description of individual biopsychosocial changes following spine surgery.

Christensen FB; Nielsen BK; Hansen ES; Pilgaard S; Bünger CE

1994-09-01

328

Adjacent Segment Instability and Degeneration After Posterior Lumbar Stabilisation  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: In our study, we aimed to research the changes of adjacent segment degeneration in posterior lumbar spinal fusion patients.Material and Method: In this study, lumbar spondylolysthesis operation applied 36 patients were investigated. Posterior stahilisation and fusion were applied to the first group of 26 patients hy using transpedicular screw and to the second group of 10 patients hy using interbody cage. Patients' JOA scales, adjacents segment disc heihts, osteophyte formations, lomher lordosis angles, and lysthesis degrees were evaluated before and after operation.Results: In hoth groups, as bej'ore and and after operation, the clinical healing was detected statistically significant according to JOA scale measurement. Postoperative lomher lordosis angles were increased, upper and lower disc spaces heights nex to the fused segments were decreased, new instability nex to the segment has not heen found and thus these results were not statistically significant.Conclusion: We observed significant clinical improvement in posterior lumhar spinal fusion applied patients in early postoperative period and ur?significant degeneration in adjacent segments.

Engin Ozar; Özgür ?enol; Levent Uysal; Murat Ta?k?n

2006-01-01

329

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... we talking about the minority that actually require surgical procedure? Oh, the vast majority of patients that present ... cervical spine problems? Yeah. We perform micro-lumbar surgical procedures in the cervical spine routinely. These are procedures ...

330

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... a seeing a procedure called a “minimally invasive microscopic lumbar discectomy.” Now this is a patient who ... as we’re literally bringing this minimally invasive microscopic discectomy to a close, I just want to ...

331

Minimally invasive lumbar foraminotomy.  

Science.gov (United States)

Lumbar radiculopathy is a common problem. Nerve root compression can occur at different places along a nerve root's course including in the foramina. Minimal invasive approaches allow easier exposure of the lateral foramina and decompression of the nerve root in the foramina. This video demonstrates a minimally invasive approach to decompress the lumbar nerve root in the foramina with a lateral to medial decompression. The video can be found here: http://youtu.be/jqa61HSpzIA. PMID:23829856

Deutsch, Harel

2013-07-01

332

Lumbar spinal stenosis.  

UK PubMed Central (United Kingdom)

Lumbar spinal stenosis affects many patients and is one of the most common reasons for spinal surgery in the elderly population. New research and surgical innovations have resulted in a better understanding of the disease and its diagnosis and treatment. To select the optimal treatment approach for each patient, it is helpful to review patient presentations, diagnostic workups, surgical and nonsurgical treatment options, evidence-based outcomes, and the pathophysiology of lumbar spinal stenosis.

Lee JY; Whang PG; Lee JY; Phillips FM; Patel AA

2013-01-01

333

Minimally invasive lumbar foraminotomy.  

UK PubMed Central (United Kingdom)

Lumbar radiculopathy is a common problem. Nerve root compression can occur at different places along a nerve root's course including in the foramina. Minimal invasive approaches allow easier exposure of the lateral foramina and decompression of the nerve root in the foramina. This video demonstrates a minimally invasive approach to decompress the lumbar nerve root in the foramina with a lateral to medial decompression. The video can be found here: http://youtu.be/jqa61HSpzIA.

Deutsch H

2013-07-01

334

Properties of an interspinous fixation device (ISD) in lumbar fusion constructs: a biomechanical study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Segmental fixation improves fusion rates and promotes patient mobility by controlling instability after lumbar surgery. Efforts to obtain stability using less invasive techniques have lead to the advent of new implants and constructs. A new interspinous fixation device (ISD) has been introduced as a minimally invasive method of stabilizing two adjacent interspinous processes by augmenting an interbody cage in transforaminal interbody fusion. The ISD is intended to replace the standard pedicle screw instrumentation used for posterior fixation. PURPOSE: The purpose of this study is to compare the rigidity of these implant systems when supplementing an interbody cage as used in transforaminal lumbar interbody fusion. STUDY DESIGN: An in vitro human cadaveric biomechanical study. METHODS: Seven human cadaver spines (T12 to the sacrum) were mounted in a custom-designed testing apparatus, for biomechanical testing using a multiaxial robotic system. A comparison of segmental stiffness was carried out among five conditions: intact spine control; interbody spacer (IBS), alone; interbody cage with ISD; IBS, ISD, and unilateral pedicle screws (unilat); and IBS, with bilateral pedicle screws (bilat). An industrial robot (KUKA, GmbH, Augsburg, Germany) applied a pure moment (±5 Nm) in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) through an anchor to the T12 vertebral body. The relative vertebral motion was captured using an optoelectronic camera system (Optotrak; Northern Digital, Inc., Waterloo, Ontario, Canada). The load sensor and the camera were synchronized. Maximum rotation was measured at each level and compared with the intact control. Implant constructs were compared with the control and with each other. A statistical analysis was performed using analysis of variance. RESULTS: A comparison between the intact spine and the IBS group showed no significant difference in the range of motion (ROM) in FE, LB, or AR for the operated level, L3-L4. After implantation of the ISD to augment the IBS, there was a significant decrease in the ROM of 74% in FE (p<.001) but no significant change in the ROM in LB and AR. The unilat construct significantly reduced the ROM by 77% compared with FE control (p<.001) and by 55% (p=.002) and 42% (p=.04) in LB and AR, respectively, compared with control. The bilat construct reduced the ROM in FE by 77% (p<.001), LB by 77% (p=.001), and AR by 65% (p=.001) when compared with the control spine. There was no statistically significant difference in the ROM in FE among the stand-alone ISD, unilat, and bilat constructs. However, in both LB and AR, the unilat and the bilat constructs were significantly stiffer (reduction in the ROM) than the ISD and the IBS combination. The ISD stability in LB and AR was not different from the intact control with no instrumentation at all. There was no statistical difference between the stability of the unilat and the bilat constructs in any direction. However, LB and AR in the unilat group produced a mean rotation of 3.83°±3.30° and 2.33°±1.33°, respectively, compared with the bilat construct that limited motion to 1.96°±1.46° and 1.39°±0.73°. There was a trend suggesting that the bilat construct was the most rigid construct. CONCLUSIONS: In FE, the ISD can provide lumbar stability comparable with Bilat instrumentation. It provides minimal rigidity in LB and AR when used alone to stabilize the segment after an IBS placement. The unilat and the more typical bilat screw constructs were shown to provide similar levels of stability in all directions after an IBS placement, though the bilat construct showed a trend toward improved stiffness overall.

Techy F; Mageswaran P; Colbrunn RW; Bonner TF; McLain RF

2013-05-01

335

Anterior cervical interbody fusion with threaded cylindrical bone.  

UK PubMed Central (United Kingdom)

The author describes some modifications of the original Cloward method of cervical intervertebral body fusion. These modifications include the intraoperative threading of the standard cylindrical graft dowel (either autologous or heterologous) and the development of two new instruments designed to insert the graft into the intervertebral space. This modified technique was tested in an experimental study using the cervical spine of cadavers, after which a series of 37 patients were operated on with this method. The results of both series are presented. The chief advantages of this type of interbody fusion over the standard technique are: 1) easier insertion of the graft into the intervertebral space; and 2) decrease in complications. Complications with cervical interbody fusion, both minor (such as partial displacement of the graft, vertebral angulation, and radicular injury) and major (such as spinal cord compression and/or contusion), are fortunately infrequent, but they are important because of their irreparable consequences.

Otero Vich JM

1985-11-01

336

Lymphocoele: a rare and little known complication of anterior lumbar surgery.  

Science.gov (United States)

Lymphocoele is a rare and little known complication with only a handful of reports available. We report two cases of lymphocoele after anterior lumbar surgery that have occurred in two different centres and discuss diagnosis and management options. The first case is that of a 53-year-old male patient undergoing two level anterior lumbar interbody fusion (ALIF) for disabling back pain due to disc degeneration in the context of an old spondylodiscitis. He developed a large fluid mass postoperatively. Fluid levels of creatinin were low and intravenous urography ruled out a urinoma suggesting the diagnosis of a lymphocoele. Following two unsuccessful drainage attempts he underwent a laparoscopic marsupialization. The second case was that of a 32-year-old female patient developing a large fluid mass following a L5 corpectomy for a burst fracture. She was treated successfully with insertion of a vacuum drain during 7 days. Lymphocoele is a rare complication but should be suspected if fluid collects postoperatively following anterior lumbar spine procedures. Chemical analysis of the fluid can help in diagnosis. Modern treatment consists of laparoscopic marsupialization. Lymph vessel anatomy should be borne in mind while exposing the anterior lumbar spine. PMID:19214598

Schizas, Constantin; Foko'o, Noël; Matter, Maurice; Romy, Sebastien; Munting, Everard

2009-02-13

337

Lymphocoele: a rare and little known complication of anterior lumbar surgery.  

UK PubMed Central (United Kingdom)

Lymphocoele is a rare and little known complication with only a handful of reports available. We report two cases of lymphocoele after anterior lumbar surgery that have occurred in two different centres and discuss diagnosis and management options. The first case is that of a 53-year-old male patient undergoing two level anterior lumbar interbody fusion (ALIF) for disabling back pain due to disc degeneration in the context of an old spondylodiscitis. He developed a large fluid mass postoperatively. Fluid levels of creatinin were low and intravenous urography ruled out a urinoma suggesting the diagnosis of a lymphocoele. Following two unsuccessful drainage attempts he underwent a laparoscopic marsupialization. The second case was that of a 32-year-old female patient developing a large fluid mass following a L5 corpectomy for a burst fracture. She was treated successfully with insertion of a vacuum drain during 7 days. Lymphocoele is a rare complication but should be suspected if fluid collects postoperatively following anterior lumbar spine procedures. Chemical analysis of the fluid can help in diagnosis. Modern treatment consists of laparoscopic marsupialization. Lymph vessel anatomy should be borne in mind while exposing the anterior lumbar spine.

Schizas C; Foko'o N; Matter M; Romy S; Munting E

2009-07-01

338

Cost-effectiveness of lumbar artificial intervertebral disc replacement: driven by the choice of comparator.  

UK PubMed Central (United Kingdom)

BACKGROUND: Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment. METHODS: A cost-effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re-operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality-adjusted life-years gained. RESULTS: AIDR was estimated to be cost-saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost-effectiveness depends on the outcome considered and the comparator. CONCLUSIONS: AIDR is potentially a cost-saving treatment for lumbar disc degeneration, although longer-term follow-up data are required to substantiate this claim. The incremental cost-effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn.

Parkinson B; Goodall S; Thavaneswaran P

2013-09-01

339

Supra-psoas shallow docking in lateral interbody fusion.  

UK PubMed Central (United Kingdom)

BACKGROUND: Lateral interbody fusion techniques have been linked with considerable postoperative morbidity, often the outcome of direct psoas trauma. The most common neurological postoperative complications are transient motor weakness/palsy and sensory dysesthesia, which can be permanent. It appears that these neural complications are a result of passing through the psoas muscle where the potential for nerve injury is significant. The supra-psoas shallow docking method may be a safer alternative and may help minimize morbidities by eliminating or reducing direct psoas injury. OBJECTIVE: To describe the operative technique of performing lateral interbody fusion using supra-psoas retractor docking. METHODS: The authors describe the surgical technique including side selection, positioning, and patient outcomes. RESULTS: Fifteen patients were treated with the supra-psoas shallow docking method. Specifically, no patient reported weakness, numbness, and/or pain on the side that underwent the surgery. In these cases, performing lateral transpsoas interbody fusion using supra-psoas shallow docking appeared to minimize the most common neurological postoperative complications of the surgery, motor weakness/palsy and sensory dysesthesia, which may be a result of dilation of the psoas muscle. CONCLUSION: The shallow docking technique may decrease postoperative morbidities by docking on top of psoas muscle instead of passing through it. An important potential benefit of this approach is direct visualization of the lumbosacral plexus, which may potentially minimize the postoperative neurological morbidity often encountered in patients after this surgery.

Acosta FL Jr; Drazin D; Liu JC

2013-09-01

340

Cage versus tricortical graft for cervical interbody fusion. A prospective randomised study.  

Science.gov (United States)

We conducted a prospective, randomised study of 42 cervical interbody fusions undertaken with either an autologous tricortical graft or a cage. The factors assessed in the two groups were: (1) time taken to achieve fusion; (2) neck disability index; (3) pain score; (4) interbody height ratio; (5) interbody angle and (6) the influence of smoking on fusion. No statistical difference was seen in the time taken to achieve fusion, neck disability index, interbody height ratio, or interbody angles. Smoking did not have any effect on the fusion process. The pain score was significantly lower in the tricortical graft group at six months. We conclude that both methods of fusion give similar results, although tricortical graft fusion is cheaper than cage fusion, and is more effective in reducing the pain score. PMID:14516039

Siddiqui, A A; Jackowski, A

2003-09-01

 
 
 
 
341

Cage versus tricortical graft for cervical interbody fusion. A prospective randomised study.  

UK PubMed Central (United Kingdom)

We conducted a prospective, randomised study of 42 cervical interbody fusions undertaken with either an autologous tricortical graft or a cage. The factors assessed in the two groups were: (1) time taken to achieve fusion; (2) neck disability index; (3) pain score; (4) interbody height ratio; (5) interbody angle and (6) the influence of smoking on fusion. No statistical difference was seen in the time taken to achieve fusion, neck disability index, interbody height ratio, or interbody angles. Smoking did not have any effect on the fusion process. The pain score was significantly lower in the tricortical graft group at six months. We conclude that both methods of fusion give similar results, although tricortical graft fusion is cheaper than cage fusion, and is more effective in reducing the pain score.

Siddiqui AA; Jackowski A

2003-09-01

342

Early postoperative dislocation of the anterior Maverick lumbar disc prosthesis.  

Science.gov (United States)

The authors report on 2 cases of anterior dislocation of the Maverick lumbar disc prosthesis, both occurring in the early postoperative period. These cases developed after experience with more than 50 uneventful cases and were therefore thought to be unrelated to the surgeon's learning curve. No similar complications have been previously reported. The anterior Maverick device has a ball-and-socket design made of cobalt-chromium-molybdenum metal plates covered with hydroxyapatite. The superior and inferior endplates have keels to resist translation forces. The patient in Case 1 was a 52-year-old man with severe L4-5 discogenic pain; and in Case 2, a 42-year-old woman with disabling L4-5 and L5-S1 discogenic back pain. Both patients were without medical comorbidities and were nonsmokers with no risk factors for osteoporosis. Both had undergone uneventful retroperitoneal approaches performed by a vascular access surgeon. Computed tomography studies on postoperative Day 2 confirmed excellent prosthesis placement. Initial recoveries were uneventful. Two weeks postoperatively, after stretching (extension or hyperextension) in bed at home, each patient suffered the sudden onset of severe abdominal pain with anterior dislocation of the Maverick prosthesis. The patients were returned to the operating room and underwent surgery performed by the same spinal and vascular surgeons. Removal of the Maverick prosthesis and anterior interbody fusion with a separate cage and plate were performed. Both patients had recovered well with good clinical and radiological recovery at the 6- and 12-month follow-ups. Possible causes of the anterior dislocation of the Maverick prosthesis include the following: 1) surgeon error: In both cases the keel cuts were neat, and early postoperative CT confirmed good placement of the prosthesis; 2) equipment problem: The keel cuts may have been too large because the cutters were worn, which led to an inadequate press fit of the implants; 3) prosthesis fault: Both plates of the dislocated implants looked normal and manufacturer analysis reported no fault; 4) patient factors: Both dislocations happened early in the postoperative period, after hyperextension of the spine while the patient was supine in bed. Bracing would not have reduced hyperextension. Dislocation of a lumbar spinal implant represents a life-threatening complication and should therefore be considered and recognized early. Radiographic and CT studies of both the lumbar spine (for prosthesis) and the abdomen (for hematoma) should be performed, as should CT angiography (for vessel damage or occlusion). Any anterior lumbar revision surgery is hazardous, and it is strongly advisable to have a vascular surgeon scrubbed. In cases of dislocation or extrusion of a lumbar interbody prosthesis, the salvage revision strategy is fusing the segment via the same anterior approach. Surgeons should be aware of the risk of anterior dislocation of the Maverick prosthesis. Keel cutters should be regularly checked for sharpness, as they may be implicated in the loosening of implants. Patients and their physical therapists should also avoid lumbar hyperextension in the early postoperative period. PMID:23768025

Gragnaniello, Cristian; Seex, Kevin A; Eisermann, Lukas G; Claydon, Matthew H; Malham, Gregory M

2013-06-14

343

Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients.  

UK PubMed Central (United Kingdom)

PURPOSE: The main aim of this paper was to report reproducible method of lumbar spine access via a lateral retroperitoneal route. METHODS: The authors conducted a retrospective analysis of the technical aspects and clinical outcomes of six patients who underwent lateral multilevel retroperitoneal interbody fusion with psoas muscle retraction technique. The main goal was to develop a simple and reproducible technique to avoid injury to the lumbar plexus. RESULTS: Six patients were operated at 15 levels using psoas muscle retraction technique. All patients reported improvement in back pain and radiculopathy after the surgery. The only procedure-related transient complication was weakness and pain on hip flexion that resolved by the first follow-up visit. CONCLUSIONS: Psoas retraction technique is a reliable technique for lateral access to the lumbar spine and may avoid some of the complications related to traditional minimally invasive transpsoas approach.

Aghayev K; Vrionis FD

2013-09-01

344

Risk factors for adjacent segment degeneration after surgical correction of degenerative lumbar scoliosis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Degenerative lumbar scoliosis surgery can lead to development of adjacent segment degeneration (ASD) after lumbar or thoracolumbar fusion. Its incidence, risk factors, morbidity and correlation between radiological and clinical symptoms of ASD have no consensus. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and certain imperative parameters. MATERIALS AND METHODS: 98 patients who had undergone surgical correction and lumbar/thoracolumbar fusion with pedicle screw instrumentation for degenerative lumbar scoliosis with a minimum 5 year followup were included in the study. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and imperative patient parameters like age at operation, sex, body mass index (BMI), medical comorbidities and bone mineral density (BMD). The radiological parameters taken into consideration were Cobb's angle, angle type, lumbar lordosis, pelvic incidence, intercristal line, preoperative existence of an ASD on plain radiograph and magnetic resonance imaging (MRI) and surgical parameters were number of the fusion level, decompression level, floating OP (interlumbar fusion excluding L5-S1 level) and posterolateral lumbar interbody fusion (PLIF). Clinical outcomes were assessed with the Visual Analogue Score (VAS) and Oswestry Disability Index (ODI). RESULTS: ASD was present in 44 (44.9%) patients at an average period of 48.0 months (range 6-98 months). Factors related to occurrence of ASD were preoperative existence of disc degeneration (as revealed by MRI) and age at operation (P = 0.0001, 0.0364). There were no statistically significant differences between radiological adjacent segment degeneration and clinical results (VAS, P = 0.446; ODI, P = 0.531). CONCLUSIONS: Patients over the age of 65 years and with preoperative disc degeneration (as revealed by plain radiograph and MRI) were at a higher risk of developing ASD.

Ha KY; Son JM; Im JH; Oh IS

2013-07-01

345

Techniques of lumbar-sacral spine fusion in spondylosis: systematic literature review and meta-analysis of randomized clinical trials.  

UK PubMed Central (United Kingdom)

BACKGROUND CONTEXT: Spine fusions can be performed through different techniques and are used to treat a number of vertebral pathologies. However, there seems to be no consensus regarding which technique of fusion is best suited to treat each distinct spinal disease or group of diseases. PURPOSE: To study the effectiveness and complications of the different techniques used for spinal fusion in patients with lumbar spondylosis. STUDY DESIGN: Systematic literature review and meta-analysis. SAMPLE: Randomized clinical studies comparing the most commonly performed surgical techniques for spine fusion in lumbar-sacral spondylosis, as well as those reporting patient outcome were selected. OUTCOME MEASURES: Identify which technique, if any, presents the best clinical, functional, and radiographic outcome. METHODS: Systematic literature review and meta-analysis based on scientific articles published and indexed to the following databases: PubMed (1966-2009), Cochrane Collaboration-CENTRAL, EMBASE (1980-2009), and LILACS (1982-2009). The general search strategy focused on the surgical treatment of patients with lumbar-sacral spondylosis. RESULTS: Eight studies met the inclusion criteria and were selected with a total of 1,136 patients. Meta-analysis showed that patients who underwent interbody fusion presented a significantly smaller blood loss (p=.001) and a greater rate of bone fusion (p=.02). Patients submitted to fusion using the posterolateral approach had a significantly shorter operative time (p=.007) and less perioperative complications (p=.03). No statistically significant difference was found for the other studied variables (pain, functional impairment, and return to work). CONCLUSIONS: The most commonly used techniques for lumbar spine fusion in patients with spondylosis were interbody fusion and posterolateral approach. Both techniques were comparable in final outcome, but the former presented better rates of fusion and the latter the less complications.

Umeta RS; Avanzi O

2011-07-01

346

Epidurography in lumbar spondylolisthesis  

International Nuclear Information System (INIS)

Seventeen patients with lytic lumbar spondylolisthesis (Meyerding grade I-II) and radicular symptoms were examined by epidurography in addition to radiculomyelography before surgical treatment. Epidurography is considered more suitable than radiculomyelogrphy for assessing this condition because narrowing of the epidural space and compression of the nerve roots, due to osteofibrous changes at the lysis, are more consistently demonstrated. (orig.).

1982-01-01

347

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... minimally invasive approach in terms of, you know, effectiveness of treating lumbar herniations? 2 Well, the minimally invasive ... think it’s important to stress here that the effectiveness of this procedure is about the same as the ...

348

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... Another part that is a problem is the cervical spine, inside the neck because that’s also very mobile. ... these minimally invasive procedures also be used for cervical spine problems? Yeah. We perform micro-lumbar surgical procedures ...

349

Anterior cervical interbody fusion with hydroxyapatite graft and plate system.  

UK PubMed Central (United Kingdom)

OBJECT: In cases of spondylosis or spine trauma, cervical interbody grafts are sometimes required after anterior discectomy. To avoid morbidity related to the harvesting of iliac crest bone, numerous materials have been developed such as allografts, methylmethacrylate, biocompatible osteoconductive polymer, and coralline grafts or cages. Some of these materials, however, are inefficient for fusion or are associated with specific complications. Conversely, hydroxyapatite (HA) grafts have numerous advantages. For example, their mechanical properties provide adequate load resistance and their porosity allows infiltration by newly formed bone, leading to complete fusion. The authors studied the results of using HA grafts combined with plating in patients who underwent anterior cervical discectomy. METHODS: Fifty-four patients underwent 68 cervical interbody fusion procedures in which an HA graft and plating were used. Indications for surgery were radiculopathy (caused by soft-disc herniation or spondylosis) in 46 cases, spondylotic myelopathy in two cases, and spinal trauma in six cases. Postoperatively the patients were followed for a mean of 24.6 months. Patients underwent radiography to evaluate fusion, intervertebral disc height, and the degree of lordosis. Clinically, excellent or good results (based on the Odon classification) were demonstrated in 91% of patients who presented with radiculopathy. Complete interbody fusion was achieved in 99% of all cases. Preoperative kyphotic deformities were corrected in all cases after surgery. Intervertebral disc height was maintained throughout follow up. Surgery-related morbidity was low; only one patient suffered from a permanent dysphagia. Graft deterioration was observed in 13 cases and two graft fractures occurred but without adversely affecting fusion. There were no cases of graft extrusion. CONCLUSIONS: Hydroxyapatite grafts are very efficient in achieving cervical fusion, maintaining intervertebral disc height, and restoring lordosis. When combined with the placement of a cervical plate, immediate stability is achieved and graft displacement is prevented.

Bruneau M; Nisolle JF; Gilliard C; Gustin T

2001-01-01

350

Structural and mechanical evaluations of a topology optimized titanium interbody fusion cage fabricated by selective laser melting process.  

Science.gov (United States)

A topology optimized lumbar interbody fusion cage was made of Ti-Al6-V4 alloy by the rapid prototyping process of selective laser melting (SLM) to reproduce designed microstructure features. Radiographic characterizations and the mechanical properties were investigated to determine how the structural characteristics of the fabricated cage were reproduced from design characteristics using micro-computed tomography scanning. The mechanical modulus of the designed cage was also measured to compare with tantalum, a widely used porous metal. The designed microstructures can be clearly seen in the micrographs of the micro-CT and scanning electron microscopy examinations, showing the SLM process can reproduce intricate microscopic features from the original designs. No imaging artifacts from micro-CT were found. The average compressive modulus of the tested caged was 2.97+/-0.90 GPa, which is comparable with the reported porous tantalum modulus of 3 GPa and falls between that of cortical bone (15 GPa) and trabecular bone (0.1-0.5 GPa). The new porous Ti-6Al-4V optimal-structure cage fabricated by SLM process gave consistent mechanical pr