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Zhou C, Lou J, Fan Y, Guo Z, Shen H, Jin M, Wu J. How to Set Working Cannula in Endoscopic-Assisted Transforaminal Lumbar Interbody Fusion: A Morphometric Analysis Based on Computed Tomography. Orthop Surg 2024. [PMID: 39252538 DOI: 10.1111/os.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/13/2024] [Accepted: 08/22/2024] [Indexed: 09/11/2024] Open
Abstract
OBJECTIVES There is a high risk of nerve root injury during endoscopic-assisted transforaminal lumbar interbody fusion (Endo-TLIF). This study used computed tomography (CT) imaging to assess the relationship between the exiting nerve root and its surroundings, and the corresponding intervertebral disc. We also measured the approximate position and angle for the placement of the working cannula to reduce the risk of nerve root injury during Endo-TLIF procedures in the Chinese population. METHODS This retrospective study was conducted at our institution between December 2021 and December 2022. A total of 115 patients suffering from low back pain were recruited for the study. For each participant, three-dimensional (3D) vertebral models of the lumbar segments from L3 to S1 were constructed based on their CT images. The nerve root-disc distance, cannula insertion bypass distance and angle, foraminal height and width, exiting nerve root height, and nerve root-pedicle distance were measured. A paired t-test was used to compare measurements between the left and right sides, while inter- and intraobserver reproducibility was assessed using the intraclass correlation coefficient (ICC). RESULTS From L3/4 to L5/S1 segments, the ideal cannula insertion distance range was 37.51 ± 4.91-120.38 ± 37.71 mm at L3/4; 42.38 ± 5.29-116.25 ± 27.22 mm at L4/5; and 37.78 ± 4.86-69.26 ± 12.64 mm at L5/S1. The appropriate cannula insertion angle range was 30.86° ± 5.05°-62.59° ± 6.66° at L3/4; 34.30° ± 4.73°-60.88° ± 7.34° at L4/5; and 35.89° ± 4.18°-47.65° ± 7.38° at L5/S1. The height of the intervertebral foramen (IVF) gradually decreased, and the width steadily increased. The exiting nerve root height and the nerve root-pedicle distance slightly decreased caudally. CONCLUSION From L3/4 to L5/S1, the range of working cannula insertion distance and angle gradually decreased, and the exiting nerve root height occupying the IVF gradually increased. Our measurement can reduce the risk of nerve root injury caused by inserting the working cannula during Endo-TLIF.
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Affiliation(s)
- Conghui Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junsheng Lou
- Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunpeng Fan
- Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ziyi Guo
- Shenzhen Pingle Orthopedics Hospital, Shenzhen, China
| | - Honghao Shen
- Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengran Jin
- Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junsong Wu
- Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Ren BW, Zhao HM, Wu JH, An BC, Han ZC, Liu YH, Mao KY, Liu JH. Comparison of Fusion Rate and Clinical Outcomes in Minimally Invasive and Conventional Posterior Fusion for Lumbar Degenerative Disease: A Network Meta-Analysis. World Neurosurg 2024; 189:357-372.e8. [PMID: 38871284 DOI: 10.1016/j.wneu.2024.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The fusion rate, clinical efficacy, and complications of minimally invasive fusion surgery and open fusion surgery in the treatment of lumbar degenerative disease are still unclear. METHODS We conducted a literature search using PubMed, Embase, Cochrane Library, CNKI, and WANFANG databases. RESULTS This study included 38 retrospective studies involving 3097 patients. Five intervention modalities were considered: unilateral biportal endoscopic-lumbar interbody fusion (UBE-LIF), percutaneous endoscopic-lumbar interbody fusion (PE-LIF), minimally invasive-transforaminal lumbar interbody fusion (MIS-TLIF), transforaminal lumbar interbody fusion (TLIF), and posterior lumbar interbody fusion (PLIF). Quality assessment indicated that each study met acceptable quality standards. PE-LIF demonstrated reduced low back pain (Odds Ratio = 0.50, Confidence Interval: 0.38-0.65) and lower complication rate (Odds Ratio = 0.46, Confidence Interval: 0.25-0.87) compared to PLIF. However, in indirect comparisons, PE-LIF showed the lowest fusion rates, with the ranking as follows: UBE-LIF (83.2%) > MIS-TLIF (59.6%) > TLIF (44.3%) > PLIF (39.8%) > PE-LIF (23.1%). With respect to low back pain relief, PE-LIF yielded the best results, with the order of relief as follows: PE-LIF (96.4%) > MIS-TLIF (64.8%) > UBE-LIF (62.6%) > TLIF (23.0%) > PLIF (3.2%). Global and local consistency tests showed satisfactory results, and heterogeneity tests indicated good stability. CONCLUSIONS Compared to conventional open surgery, minimally invasive fusion surgery offered better scores for low back pain and Oswestry Disability Index, lower complication rates, reduced bleeding, and shorter hospital stays. However, minimally invasive fusion surgery did not show a significant advantage in terms of fusion rate and had a longer operative time.
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Affiliation(s)
- Bo-Wen Ren
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA General Hospital, Beijing, China
| | - Hou-Ming Zhao
- Medical School of Chinese PLA General Hospital, Beijing, China
| | - Jian-Hui Wu
- Medical School of Chinese PLA General Hospital, Beijing, China
| | - Bo-Chen An
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA General Hospital, Beijing, China
| | - Zhen-Chuan Han
- Department of Orthopedics, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yi-Hao Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA General Hospital, Beijing, China
| | - Ke-Ya Mao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Jian-Heng Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China.
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Shalita C, Wang T, Dibble CF, Adams SW, Nelli A, Sykes D, Tabarestani T, Bhowmik S, Liu B, Jung SH, Gulur P, Grossi P, Crutcher C, Abd-El-Barr MM. Percutaneous lumbar interbody fusion results in less perioperative opioid usage compared to minimally invasive transforaminal lumbar interbody fusion: a single institution, multi-surgeon retrospective study. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:190-203. [PMID: 38974490 PMCID: PMC11224795 DOI: 10.21037/jss-23-132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/23/2024] [Indexed: 07/09/2024]
Abstract
Background Ultra-minimally invasive percutaneous lumbar interbody fusion (percLIF) has been demonstrated to further minimize tissue trauma and has been associated with improved clinical outcomes including decreased blood loss, post-operative pain and length of stay when compared to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. A single-institution retrospective study was conducted to investigate whether 1-level percLIF is associated with decreased narcotic consumption compared to 1-level MIS-TLIF in the first 24-hour following surgery. Methods A retrospective study of patients undergoing either single-level percLIF or MIS-TLIF from January 2018 to December 2021. Opioid consumption in the 24-hour following surgery was converted into total morphine milligram equivalents (MME). The primary outcome used univariate and multivariate regression analysis to compare MME consumption between the MIS-TLIF and percLIF groups. Secondary outcome variables included, estimated blood loss, total intraoperative MME, MME at discharge, MME at 30 days post-op, exiting nerve root injury, post-anesthesia care unit (PACU) visual analogue scale (VAS) score at handoff, time to first ambulation, distance ambulated post-operative day one and hospital length of stay. Results A total of 51 patients (21 percLIF vs. 30 MIS-TLIF) were included in the study. Univariate regression analysis revealed that on average patients who underwent percLIF had a 24-hour postoperative MME -50.8 mg (95% CI: -91.6, -10) lower than those who had MIS-TLIF (P=0.02). On multivariable analysis, after adjusting for sex and age, 24-hour postoperative MME closely failed to meet statistical significance (P=0.06) with an average of -40.8 mg (95% CI: -83.2, 1.6) MME in percLIF patients compared to MIS-TLIF. There was no statistically significant difference in MME between MIS-TLIF and percLIF at the time of discharge and at 30 days post-op. Conclusions In the setting of the current opioid epidemic in the United States and increased numbers of patients undergoing lumbar interbody fusion, spine surgeons must continue to do their part helping reduce the need for opioid prescriptions for postoperative pain management. New "ultra-MIS" techniques such as percLIF allow surgeons to further decrease tissue trauma, which should lead to reduced need for post-operative narcotic requirements.
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Affiliation(s)
| | - Timothy Wang
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | | | - Shawn W. Adams
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Amanda Nelli
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - David Sykes
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Troy Tabarestani
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Subasish Bhowmik
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Beiyu Liu
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Sin-Ho Jung
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Padma Gulur
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Peter Grossi
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Clifford Crutcher
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Relvas-Silva M, Pinto BS, Sousa A, Loureiro M, Pinho AR, Pereira P. Is endoscopic technique an effective and safe alternative for lumbar interbody fusion? A systematic review and meta-analysis. EFORT Open Rev 2024; 9:536-555. [PMID: 38828975 PMCID: PMC11195334 DOI: 10.1530/eor-23-0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Study design Systematic review; meta-analysis. Purpose Lumbar degenerative disease is frequent and has a tremendous impact on patients' disability and quality-of-life. Open and minimally invasive procedures have been used to achieve adequate decompression and fusion. Endoscopic lumbar interbody fusion (Endo-LIF) is emerging as an alternative, trying to reduce morbidity, while achieving comparable to superior clinical outcomes. The aim of this work is to perform a systematic review and meta-analysis to investigate how Endo-LIF compares to open or minimally invasive procedures. Methods Electronic databases (MEDLINE, Scopus, Web of Science, Cochrane) were systematically reviewed using the query: '(percutaneous OR endoscop*) AND (open OR minimal* invasive) AND lumbar AND fusion'. PRISMA guidelines were followed. Results Twenty-seven articles were included (25 cohort study, 1 quasi-experimental study, and 1 randomized control trial; for meta-analytical results, only observational studies were considered). Endo-LIF conditioned longer operative time, with significantly lower blood loss, bedtime, and hospital length of stay. Early post-operative back pain favored endoscopic techniques. Endo-LIF and non-Endo-LIF minimally invasive surgery displayed comparable results for most back and leg pain or disability outcomes, despite Endo-LIF having been associated with higher disability at late follow-up (versus Open-LIF). No differences were found regarding fusion rates, cage subsidence, or adverse events. Definitive conclusions regarding fusion rate cannot be drawn due to low number of studies and unstandardized fusion definition. Conclusion Endo-LIF is an effective and safe alternative to conventional lumbar interbody fusion procedures. Evidence shortcomings may be addressed, and future randomized control trials may be performed to compare techniques and to validate results.
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Affiliation(s)
- Miguel Relvas-Silva
- Department of Orthopaedics and Traumatology, São João Universitary Hospital Centre, Porto, Portugal
- NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, Porto, Portugal
| | - Bernardo Sousa Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - António Sousa
- Department of Orthopaedics and Traumatology, São João Universitary Hospital Centre, Porto, Portugal
| | - Miguel Loureiro
- Department of Orthopaedics and Traumatology, São João Universitary Hospital Centre, Porto, Portugal
- Hospital das Forças Armadas, Porto, Portugal
| | - André Rodrigues Pinho
- Department of Orthopaedics and Traumatology, São João Universitary Hospital Centre, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Pedro Pereira
- NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, Porto, Portugal
- CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
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Li Y, Ge M, Tian J, Zhou J, Kang Y, Xia C, Shao H, Wang Y, Huang Y, Zhao T. Effect of Tranexamic Acid on Hidden Blood Loss in Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: A Retrospective Study. Ther Clin Risk Manag 2024; 20:325-334. [PMID: 38827486 PMCID: PMC11144425 DOI: 10.2147/tcrm.s462784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/19/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) has become one of the most popular minimally invasive surgeries today. However, the issue of hidden blood loss (HBL) in this surgery has received little attention. This study aims to examine the HBL in PE-TLIF surgery and the effect of tranexamic acid (TXA) on blood loss. Methods In our research, We conducted a retrospective analysis of 300 patients who underwent PE-TLIF from September 2019 to August 2023. They were divided into 2 groups based on whether they received intravenous TXA injection before surgery. The variables compared included: demographic data, pre-and postoperative hemoglobin (HB), hematocrit (HCT), platelets (PLT), red blood cells (RBC), total blood loss (TBL), visible blood loss (VBL), HBL, operation time, postoperative hospital stay, inflammatory markers, coagulation parameters, and adverse events. Results Regarding demographic characteristics, besides the operation time, no significant differences were observed between the two groups. Compared with the control group, the TXA group showed a significant reduction trend in TBL, HBL, and VBL (P < 0.05). On the first day after surgery, there were significant differences in prothrombin (PT), activated partial thromboplastin time (APTT), and D-dimer (D-D) levels between the two groups. Similarly, HCT also found similar results on the third day after surgery. No adverse events occurred in either group. Conclusion Research has found that there is a significant amount of HBL in patients undergoing PE-TLIF. Intravenous injection of TXA can safely and effectively reduce perioperative HBL and VBL. Additionally, compared to the control group, the TXA group shows a significant reduction in operation time.
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Affiliation(s)
- Yanlei Li
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Meng Ge
- Department of Orthopedics, Hospital of Traditional Chinese Medicine of Xiaoshan District, Hangzhou, Zhejiang, People’s Republic of China
| | - Jinlong Tian
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Jinlei Zhou
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yao Kang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Chen Xia
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Haiyu Shao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Yongguang Wang
- Department of Orthopedics, Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Yazeng Huang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Tingxiao Zhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
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Xu D, Liu M, Lou W, Li M, Xiao J, Wu H, Zhuang Y, Chen J. Hidden blood loss and the influential factors after minimally invasive treatment of posterior pelvic ring injury with sacroiliac screw. Trials 2024; 25:305. [PMID: 38711052 DOI: 10.1186/s13063-024-08147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND To analyze the perioperative bleeding and hidden blood loss (HBL) of sacroiliac screw minimally invasive treatment of pelvic posterior ring injury and explore the influential factors of HBL after operation for providing reference for clinical treatment. METHOD A retrospective analysis was conducted on data from 369 patients with posterior pelvic ring injuries treated with sacroiliac screws internal fixation at our hospital from January 2015 to January 2022. The research was registered in the Chinese Clinical Trial Registry in July 2022 (ChiCTR2200061866). The total blood loss (TBL) and HBL of patients were counted, and the factors such as gender, age, and surgical duration were statistically analyzed. The influential factors of HBL were analyzed by multiple linear regression. RESULTS The TBL was 417.96 ± 98.05 ml, of which the visible blood loss (VBL) was 37.00 ± 9.0 ml and the HBL was 380.96 ± 68.8 ml. The HBL accounted for 91.14 ± 7.36% of the TBL. Gender, surgical duration, fixed position, and fixed depth had significant effects on the HBL (P < 0.05). CONCLUSIONS The HBL was the main cause of anemia after minimally invasive treatment of posterior pelvic ring injury with a sacroiliac screw. Gender, surgical duration, fixed position, and fixed depth were closely related to the occurrence of HBL. In clinical treatment, we should consider these influential factors and take effective measures to reduce the impact of HBL on patients.
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Affiliation(s)
- Ding Xu
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China.
- Ningbo University Medical College, Ningbo, 315211, China.
| | - Min Liu
- Department of Orthopedics, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weigang Lou
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China
| | - Ming Li
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China
| | - Jingwei Xiao
- Ningbo University Medical College, Ningbo, 315211, China
| | - Hongbao Wu
- Ningbo University Medical College, Ningbo, 315211, China
| | - Yunqiang Zhuang
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China.
| | - Jianming Chen
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China.
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Haibier A, Yusufu A, Hang L, Abudurexiti T. Comparison of clinical outcomes and complications between endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:92. [PMID: 38281015 PMCID: PMC10821211 DOI: 10.1186/s13018-024-04549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/08/2024] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVE This study compares the efficacy and complications of endoscopic transforaminal lumbar fusion (Endo-TLIF) and minimally invasive transforaminal lumbar fusion (MIS-TLIF) in treating lumbar degenerative diseases. It aims to provide reference data for clinical decision-making. METHODS We identified randomized controlled studies and non-randomized controlled studies on Endo-TLIF and MIS-TLIF for treating lumbar degenerative diseases based on specific inclusion and exclusion criteria. Data were managed with Endnote X9 software and meta-analyzed using Revman 5.3 software. Extracted outcomes included lower back VAS score, lower extremity pain VAS score, low back pain ODI score, complication rate, fusion rate, time to surgery, blood loss, and length of hospital stay. RESULTS ① Thirteen high-quality studies were included in this meta-analysis, totaling 1015 patients-493 in the Endo-TLIF group and 522 in the MIS-TLIF group. ② Meta-analysis results revealed no significant differences in preoperative, postoperative 6-month, and final follow-up waist VAS scores, lower limb pain VAS score, ODI index, complications, and fusion rate between the two groups (P > 0.05). The MIS-TLIF group had a shorter operative time (MD = 29.13, 95% CI 10.86, 47.39, P = 0.002) than the Endo-TLIF group. However, the Endo-TLIF group had less blood loss (MD = - 76.75, 95% CI - 111.59, - 41.90, P < 0.0001), a shorter hospital stay (MD = - 2.15, 95% CI - 2.95, - 1.34, P < 0.00001), and lower lumbar VAS scores both immediately postoperative (≤ 2 week) (MD = - 1.12, 95% CI - 1.53, - 0.71, P < 0.00001) compared to the MIS-TLIF group. CONCLUSION Meta-analysis results indicated that Endo-TLIF is similar to MIS-TLIF in terms of long-term clinical outcomes, fusion rates, and complication rates. Although MIS-TLIF has a shorter operation time, Endo-TLIF can significantly reduce blood loss and hospital stay duration. Endo-TLIF offers the advantages of less surgical trauma, reduced blood loss, faster recovery, and early alleviation of postoperative back pain.
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Affiliation(s)
- Abuduwupuer Haibier
- XinJiang Medical University, Urumqi, 830054, Xinjiang Uygur Autonomous Region, People's Republic of China
- Department of Orthopedics of Trauma, The Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, 830002, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Alimujiang Yusufu
- XinJiang Medical University, Urumqi, 830054, Xinjiang Uygur Autonomous Region, People's Republic of China
- Department of Orthopedics of Trauma, The Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, 830002, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Lin Hang
- XinJiang Medical University, Urumqi, 830054, Xinjiang Uygur Autonomous Region, People's Republic of China
- Department of Orthopedics of Trauma, The Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, 830002, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Tuerhongjiang Abudurexiti
- XinJiang Medical University, Urumqi, 830054, Xinjiang Uygur Autonomous Region, People's Republic of China.
- Department of Orthopedics of Trauma, The Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, 830002, Xinjiang Uygur Autonomous Region, People's Republic of China.
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Hu X, Yan L, Jin X, Liu H, Chai J, Zhao B. Endoscopic Lumbar Interbody Fusion, Minimally Invasive Transforaminal Lumbar Interbody Fusion, and Open Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases: A Systematic Review and Network Meta-Analysis. Global Spine J 2024; 14:295-305. [PMID: 36999647 PMCID: PMC10676174 DOI: 10.1177/21925682231168577] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
STUDY DESIGN network meta-analysis. OBJECTIVE To compare the clinical efficacy and safety of endoscopic lumbar interbody fusion (Endo-LIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open transforaminal lumbar interbody fusion (OTLIF) in the treatment of lumbar degenerative diseases (LDDs). METHOD A literature search was conducted in the PubMed, Embase, and Cochrane Library databases. Studies comparing Endo-LIF, MIS-TLIF and OTLIF published from September 2017 to September 2022 for the treatment of LDD were retrieved. Data were extracted from preset clinical outcome measures, including operation time, estimated intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, Oswestry disability index (ODI) score, etc. RESULT Thirty-one studies with 3467 patients were included in this study. Network meta-analysis showed that in the comparison of the 3 procedures, Endo-LIF was superior to MIS-TLIF and OTLIF in terms of reducing EBL, LOS, time to ambulation, and VAS score of back pain. MIS-TLIF was superior to Endo-LIF in terms of ODI improvement, and OTLIF required the shortest intraoperative fluoroscopy time. There was no significant difference in operative time, complication rate, fusion rate, VAS score of leg pain, or JOA score among the 3 procedures. CONCLUSION Endo-LIF, MIS-TLIF and OTLIF each have their own advantages and disadvantages and show similar results in many respects, except for better early outcomes achieved with the more minimally invasive procedure.
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Affiliation(s)
- Xijian Hu
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lei Yan
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinjie Jin
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Haifeng Liu
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing Chai
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Zhao
- The Second Hospital of Shanxi Medical University, Taiyuan, China
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Pholprajug P, Kotheeranurak V, Liu Y, Kim JS. The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective. Neurospine 2023; 20:1224-1245. [PMID: 38171291 PMCID: PMC10762387 DOI: 10.14245/ns.2346888.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
Lumbar interbody fusion stands as a preferred surgical solution for degenerative lumbar spine diseases. The procedure primarily aims to establish lumbar segment stability, directly addressing patient symptoms associated with spinal complications. Traditional open surgery, though effective, is linked with notable morbidities and extended recovery time. To mitigate these concerns, minimally invasive surgery (MIS) has garnered significant popularity, presenting an appealing alternative with numerous benefits such as reduced soft tissue trauma, decreased blood loss, and expedited recovery. Among MIS procedures, full endoscopic spinal surgery, characterized by its minimal invasiveness, holds the potential to further minimize morbidities while enhancing surgical outcomes. Endoscopic lumbar interbody fusion, a novel procedure within this paradigm, has gained attention for offering advantages comparable to those of minimally invasive transforaminal lumbar interbody fusion. However, the safety, efficacy, and associated surgical techniques and instrument design of this method continue to be subjects of ongoing debate. This paper critically reviews current evidence on the safety, efficacy, and advantages of endoscopic lumbar spinal interbody fusion, examining whether it could indeed supersede existing mainstream techniques.
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Affiliation(s)
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Liang H, Zhao X, Wang L, Li J, Shen Y. Risk factors for perioperative hidden blood loss after one-segment posterior circumferential decompression surgery on thoracic ossification of the posterior longitudinal ligament: a finding of the double-layer sign on CT. BMC Musculoskelet Disord 2023; 24:223. [PMID: 36964520 PMCID: PMC10037783 DOI: 10.1186/s12891-023-06352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Hidden blood loss (HBL) is of increasing interest to spine surgeons. This retrospective study aimed to evaluate perioperative HBL and its risk factors in patients undergoing one-segment posterior circumferential decompression surgery on thoracic ossification of the posterior longitudinal ligament (T-OPLL). METHOD We retrospectively studied 112 patients diagnosed with T-OPLL following posterior circumferential decompression surgery from August 2015 to June 2020. Patient demographics, blood loss-related parameters, surgery-related data and imaging parameters were extracted. Postoperative complications were also recorded. Pearson or Spearman correlation analysis was used to investigate the correlation between patient demographics and HBL. Multivariate linear regression analysis was performed to determine the independent risk factors associated with HBL. RESULTS Forty-five men and 67 women were involved in this research, with an average age of 56.4 ± 10.2 years. The mean HBL was 459.6 ± 275.4 ml, accounting for 56.5% of the total blood loss. Multiple linear regression analysis showed that double-layer sign (P = 0.000), ossification occupancy ratio (OOR) > 60% (P = 0.030), age (P = 0.010), hematocrit (Hct) loss (P = 0.034), and postoperative Hct (P = 0.016) were independent risk factors for HBL. However, OPLL morphology (P = 0.319), operation time (P = 0.587), hemoglobin (Hb) loss (P = 0.644), and postoperative Hb (P = 0.952) were not significantly different from HBL. CONCLUSION A high proportion of HBL was found after posterior circumferential decompression surgery on T-OPLL during the perioperative period, which should not be overlooked. Double-layer sign, OOR > 60%, age, Hct loss and postoperative Hct are independent risk factors for HBL.
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Affiliation(s)
- Huiqiang Liang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Xuan Zhao
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Jia Li
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
| | - Yong Shen
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
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Which Is Better in Clinical and Radiological Outcomes for Lumbar Degenerative Disease of Two Segments: MIS-TLIF or OPEN-TLIF? J Pers Med 2022; 12:jpm12121977. [PMID: 36556198 PMCID: PMC9785381 DOI: 10.3390/jpm12121977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/13/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
Objective: To compare the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional open transforaminal lumbar interbody fusion (OPEN-TLIF) in the treatment of two-level lumbar degenerative diseases. Methods: The clinical data of 112 patients were retrospectively analyzed, and were divided into an MIS-TLIF group and OPEN-TLIF group. The operative time, intraoperative fluoroscopy, blood loss, postoperative drainage volume, bed rest time, the content of creatine kinase(CK) and complications, were recorded. VAS score and ODI index were used to evaluate clinical efficacy. Bridwell grading was used to evaluate postoperative interbody fusion. Screw position was evaluated by Rao grading. Results: Compared with the OPEN-TLIF group, the MIS-TLIF group had longer operation times, more intraoperative fluoroscopy times, but shorter postoperative bed times (p < 0.05). There were no significant differences in blood loss, postoperative drainage and postoperative CK content between the two groups (p > 0.05). There was no difference in VAS score and ODI index during the follow-up (p > 0.05). There was no significant difference in the interbody fusion rate between the two groups (p > 0.05). There was no significant difference in the distribution of type A screws, but the type B screw in the MIS-TLIF group was higher (p < 0.05). There was no difference in the incidence of complications between the two groups (p > 0.05). Conclusion: The postoperative quality of life score and radiological outcomes of the two types of surgery in two-level lumbar degenerative diseases was similar, and there was no significant difference in muscle injury and complications, but the operation time and intraoperative radiation exposurewere higher than in the OPEN-TLIF group, and the pedicle screws were more likely to deviate laterally out of the vertebral body. Therefore, OPEN-TLIF is recommended for patients with lumbar degenerative diseases of two segments.
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Shi L, Ding T, Shi Y, Wang F, Wu C. Comparison of the Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion and Endoscopic Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Retrospective Matched Case-Control Study. World Neurosurg 2022; 167:e1231-e1240. [PMID: 36096389 DOI: 10.1016/j.wneu.2022.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We compared the clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF). METHODS We retrospectively analyzed the clinical data of patients who underwent single-segment Mis-TLIF or Endo-TLIF between June 2016 and June 2019 at our hospital. The patients in each treatment group were matched 1:1 for sex, age, and type of lumbar degenerative disease, and their clinical outcomes were compared at discharge and at 1 and 2 years postoperatively. RESULTS Our study included 64 patients, with 32 patients in each treatment group. Operative time and fluoroscopy time were significantly higher in the Endo-TLIF versus Mis-TLIF groups, whereas estimated blood loss, postoperative drainage volume, and the low back pain visual analog scale score at discharge were significantly lower. Both treatments achieved exact interbody fusion at the final-follow up. There was no significant difference in the visual analog scale score or Oswestry Disability Index between the groups at 1 and 2 years postoperatively. Complication rates were higher in the Endo-TLIF group (21.9%) than in the Mis-TLIF group (6.2%), although the difference was not significant. CONCLUSIONS Although there was no difference in the long-term outcomes between the treatments, Endo-TLIF had less blood loss and a lower postoperative drainage volume and low back pain visual analog scale score at discharge than Mis-TLIF. However, the longer operative time and potentially higher complication rate of Endo-TLIF suggest that surgeons may need to overcome the steeper learning curve than the procedure of Mis-TLIF.
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Affiliation(s)
- Liang Shi
- Department of Orthopedics, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang City, Hubei Province, China
| | - Tao Ding
- Department of Spine Surgery, Sheng Li OilField Central Hospital, Dongying City, Shandong Province, China
| | - Yihua Shi
- Department of Orthopedics, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang City, Hubei Province, China
| | - Fang Wang
- Department of Pathology, Qujing Second People's Hospital of Yunnan Province, Qujing City, Yunnan Province, China
| | - Chengcong Wu
- Department of Orthopedics, Qujing First People's Hospital: Kunming Medical University Affiliated Qujing Hospital, Qujing City, Yunnan Province, China.
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