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Shen X, Gao YC, Zhang P, Song P, Jiang ZL, Wang F, Xuan WB, Gao ZX. Is unilateral-approach full-endoscopic lumbar fusion effective for single-level lumbar spondylolisthesis with bilateral symptoms? A preliminary report of 43 CT analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:409-416. [PMID: 37378709 DOI: 10.1007/s00586-023-07667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE To investigate the clinical results and radiological parameters changes after unilateral-approach endoscopic lumbar interbody fusion (Endo-LIF) for lumbar spondylolisthesis with bilateral symptoms. METHODS 43 single-level lumbar spondylolisthesis patients with bilateral lower limb symptoms were included from June 2020 to May 2022. All patients underwent unilateral-approach Endo-LIF and postoperative computed tomography. Radiological parameters including disk height (DH), degree of upper vertebral slip (DUVS), and foramen intervertebral parameters including bilateral foraminal height (FH), contralateral foraminal areas (FA) were evaluated. The clinical outcomes including low back pain and bilateral leg pain were evaluated using Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) before and after surgery. RESULTS All cases were successfully completed surgery and followed for average 15.16 ± 5.2 months. DH (44% ± 11%) and DUVS were significantly improvement postoperatively compared with preoperatively (p < 0.05). Statistically significant increases in bilateral FH (25% ± 11% on the surgical side, 17% ± 8% on the contralateral side) and contralateral FA (26% ± 6%) were observed (p < 0.05). The VAS and the ODI scores were significantly decreased in comparison with the preoperative scores (p < 0.05). CONCLUSION Unilateral-approach with contralateral indirect decompression in Endo-LIF can acquire satisfactory clinical outcomes. Therefore, unilateral-approach Endo-LIF may be a promising option for lumbar spondylolisthesis with bilateral symptoms.
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Affiliation(s)
- Xu Shen
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Yu-Cheng Gao
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Pei Zhang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Peng Song
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Zan-Li Jiang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Feng Wang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Wen-Bin Xuan
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Zeng-Xin Gao
- School of Medicine, Southeast University, Nanjing, 210009, China.
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
- Department of Orthopedics, Nanjing Lishui People's Hospital, Zhongda Lishui Brach, Nanjing, 210009, China.
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Pan W, Jiang J, Zhang W, Mei Z, Sun K, Zheng B, Meng Y, Bai Y, He Z, Shi J, Guo Y. Effects of "fixation-fusion" sequence of lumbar surgery on surgical outcomes for patients with lumbar spinal stenosis: study protocol for a multicenter randomized controlled trial. BMC Musculoskelet Disord 2023; 24:928. [PMID: 38041036 PMCID: PMC10691139 DOI: 10.1186/s12891-023-07052-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND New-onset neurological symptoms such as numbness and pain in lower extremities might appear immediately after conventional lumbar interbody fusion (LIF) surgery performed in patients with lumbar spinal stenosis. METHODS AND ANALYSIS This is a multicenter, randomized, open-label, parallel-group, active-controlled trial investigating the clinical outcomes of modified LIF sequence versus conventional LIF sequence in treating patients with lumbar spinal stenosis. A total of 254 eligible patients will be enrolled and randomized in a 1:1 ratio to either modified LIF sequence or conventional LIF sequence group. The primary outcome measure is the perioperative incidence of new-onset lower extremity neurological symptoms, including new adverse events of pain, numbness, and foot drop of any severity. Important secondary endpoints include visual analogue scale (VAS) pain score and lumbar Japanese Orthopaedic Association (JOA) recovery rate. Other safety endpoints will also be evaluated. The safety set used for safety data analysis by the actual surgical treatment received and the full analysis set for baseline and efficacy data analyses according to the intent-to-treat principle will be established as the two analysis populations in the study. CONCLUSION This study is designed to investigate the clinical outcomes of modified LIF sequences in patients with lumbar spinal stenosis. It aims to provide clinical evidence that the modified "fixation-fusion" sequence of LIF surgery is effective in treating lumbar spinal stenosis. TRIAL REGISTRATION http://www.chictr.org.cn/index.aspx ID: ChiCTR2100048507.
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Affiliation(s)
- Weicheng Pan
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jialin Jiang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Weihang Zhang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Zijian Mei
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Bing Zheng
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yake Meng
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yushu Bai
- Departmentof Orthopedic Surgery, Spine Center, Changhai Hospital, Naval Medical University, No.168 Changhai Road, Shanghai, 200438, People's Republic of China
| | - Zhimin He
- Department of Orthopedic Surgery, Spine Center, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchang Middle Road, Shanghai, 200072, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Yongfei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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Liu L, Xue H, Han Z, Jiang L, Chen L, Wang D. Comparison between OLIF and MISTLIF in degenerative lumbar stenosis: an age-, sex-, and segment-matched cohort study. Sci Rep 2023; 13:13188. [PMID: 37580586 PMCID: PMC10425456 DOI: 10.1038/s41598-023-40533-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 08/11/2023] [Indexed: 08/16/2023] Open
Abstract
To compare outcomes after oblique lateral interbody fusion (OLIF) versus minimally invasive transforaminal lumbar interbody fusion (MISTLIF) with bilateral decompression via unilateral approach for treating mild to moderate symptomatic degenerative lumbar spinal stenosis (DLSS). We retrospectively compared patients who underwent single-level (L4/5) OLIF with an age-, sex-, and segment-matched MISTLIF with bilateral decompression via unilateral approach cohort. Perioperative data were collected for the operative time, intraoperative blood loss, drainage in the first postoperative day, postoperative hospital stay, cost, intraoperative fluoroscopy, and complications. Lumbar radiographs were measured for changes in posterior intervertebral space height (PISH), intervertebral space foramen height (IFH), intervertebral foramen area (IFA), and area of the spinal canal (ASC). Clinical and psychological outcomes included the visual analog scale (VAS), Oswestry Disability Index (ODI), and hospital anxiety and depression scale (HADS). 35 OLIF patients were compared with 35 MISTLIF patients in L4/5 DLSS. The OLIF group had shorter bedtime, postoperative hospital stays, less intraoperative and postoperative blood loss (all P < 0.05), but had more times of intraoperative fluoroscopy, longer operative time, and higher cost (all P < 0.05). The complication rates were equivalent (OLIF vs MISTLIF: 22.86% vs 17.14%). PISH (11.94 ± 1.78 mm vs 9.42 ± 1.94 mm, P < 0.05), IFH (23.87 ± 3.05 mm vs 21.41 ± 2.95 mm, P < 0.05), and IFA (212.14 ± 51.82 mm2 vs 177.07 ± 51.73 mm2, P < 0.05) after surgery were significantly increased in the OLIF group. The ASC was increased significantly after the operation in both groups, but the ASC in the MISTLIF group was increased significantly more than that in the OLIF group (450.04 ± 66.66 mm2 vs 171.41 ± 58.55 mm2, P < 0.05). The lumbar VAS scores at 1 month (1.89 ± 0.87 vs 2.34 ± 0.84, P = 0.028) and 6 months (1.23 ± 0.97 vs 1.80 ± 0.99, P = 0.018) after operation in the OLIF group were significantly lower. There were no significant differences in lower extremity VAS and ODI scores between the two groups. Compared with MISTLIF group, HADS scores on postoperative day 3 (2.91 ± 1.46 vs 4.89 ± 1.78, P < 0.05) and prior to hospital discharge (PTD) (2.54 ± 1.38 vs 3.80 ± 1.78, P = 0.002) in the OLIF group were decreased significantly. OLIF showed more advantages of less surgical invasion, lower incidence of postoperative low back pain, faster postoperative recovery, and less anxiety compared with MISTLIF. Regardless of cost, OLIF seems to be a better option to treat mild to moderate symptomatic DLSS.
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Affiliation(s)
- Lantao Liu
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China
| | - Hui Xue
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China
| | - Zhiyuan Han
- Graduate School of Dalian Medical University, No. 9 West Section of Lushun South Road, Dalian, 116044, Liaoning, People's Republic of China
| | - Lianghai Jiang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China
| | - Longwei Chen
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China
| | - Dechun Wang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China.
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Lu W, Zhang J, Deng Y, Wu L, Chen Y, Hu X, Ruan C, Wang Y, Ma W, Jiang W. Analysis of risk factors for contralateral symptomatic foraminal stenosis after unilateral transforaminal lumbar interbody fusion. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05826-6. [PMID: 37154958 DOI: 10.1007/s00264-023-05826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To analyze the risk factors of contralateral symptomatic foraminal stenosis (FS) after unilateral transforaminal lumbar interbody fusion (TLIF) and to guide and standardize the operation process of unilateral TLIF to reduce the occurrence of contralateral symptomatic FS. METHODS A retrospective study was undertaken on 487 patients with lumbar degeneration who underwent unilateral TLIF in the Department of Spinal Surgery of Ningbo Sixth Hospital between January 2017 and January 2021, comprising 269 males and 218 females, with a mean age of 57.1 years (range, 48-77 years). Cases of intraoperative improper operations, such as screw deviation, postoperative hematoma, and contralateral disc herniation, were excluded, and cases of nerve root symptoms caused by contralateral FS were analyzed. Post-surgery, 23 patients with nerve root symptoms caused by contralateral FS were categorized as group A, and 60 patients without nerve root symptoms were randomly selected as group B during the same period. The general data (gender, age, body mass index (BMI), bone mineral density (BMD), and diagnosis) and imaging parameters before and after operation (including contralateral foramen area (CFA), lumbar lordosis angle (LL), segmental lordosis angle (SL), disc height (DH), foramen height (FH), foramen width (FW), fusion cage position, and the difference between postoperative and preoperative) were compared between the two groups. Univariate analysis was performed, and multivariate analysis was undertaken through logistics analysis to determine the independent risk factors. Additionally, the clinical outcomes of the two groups were compared immediately before surgery and one year after surgery, using the visual analogue scale (VAS) score and the Japanese Orthopaedic Association (JOA) score for evaluation. RESULTS The patients in this study were followed up for a period of 19-25 (22.8atien months. Among them, 23 cases (4.72% incidence) were diagnosed with contralaterally symptomatic FS after the surgery. Univariate analysis indicated significant differences between the two groups in CFA, SL, FW, and cage coronal position. Logistic regression analysis identified preoperative contralateral foramen area (OR = 1.176, 95% CI (1.012, 1.367)), small segmental lordosis angle (OR = 2.225, 95% CI (1.124, 4.406)), small intervertebral foramen width (OR = 2.706, 95% CI (1.028, 7.118)), and cage coronal position not crossing the midline (OR = 1.567, 95% CI (1.142, 2.149)) as independent risk factors for contralateral symptomatic FS after unilateral TLIF. However, there was no statistically significant difference in the pain VAS score between the two groups one year after the operation. In contrast, there was a significant difference in the JOA score between the two groups. CONCLUSION The identified risk factors for contralateral symptomatic FS after TLIF include preoperative contralateral intervertebral foramen stenosis, a small segmental lordosis angle, a small intervertebral foramen width, and the coronal position of the cage not crossing the midline. For patients with these risk factors, it is recommended to carefully lock the screw rod during the recovery of lumbar lordosis and ensure that the coronal position of the fusion cage is implanted beyond the midline. If necessary, preventive decompression should also be considered. However, this study did not quantify the imaging data for each risk factor, and further research is needed to improve our understanding of the topic.
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Affiliation(s)
- Wenjie Lu
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Jiaming Zhang
- Huai'an Hospital of Traditional Chinese Medicine, Huaian, 223001, Jiangsu, China
| | - Yuanguo Deng
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Lingqiao Wu
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Yunlin Chen
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Xudong Hu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Chaoyue Ruan
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Yang Wang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Weihu Ma
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Weiyu Jiang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China.
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Marie-Hardy L, Khalifé M, Upex P, Riouallon G, Wolff S. Pre- and postoperative MRI analysis of central decompression in MIS fusion with lumbar stenosis. Orthop Traumatol Surg Res 2023; 109:103222. [PMID: 35101598 DOI: 10.1016/j.otsr.2022.103222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Mini-invasive approaches have grown substantially these last decades in spinal surgery, notably for lumbar decompressions and fusion, with advantages over open approaches in terms of morbidity reduction. However, to our knowledge, no study has measured on MRI the amount of central decompression obtained by MIS approach. The goal of this study was to precisely measure the decompression of central stenosis by unilateral MIS approaches. METHODS The files of 42 patients that had a MIS lumbar fusion with central decompression for central stenosis were reviewed. All patients had a pre- and postoperative MRI that allowed on T2 axial images to classify the central stenosis, according to Schizas' classification, and measure the dural sac cross-sectional area (DSCA) and the anteroposterior diameter (DAP). The statistical analysis was made with paired t-test. RESULTS Fifty-six levels were analyzed, mostly L4L5 (58%). The mean preoperative DSCA was 70.53mm2 and the mean postoperative DSCA was 172.2mm2. The mean preoperative DAP was 6.15mm and postoperative was 10.68mm. Preoperatively, the levels analyzed were rated B, C or D according to Schizas for 53 out of 56 levels and A1-4 for 51 out of 56 levels in postoperative. All the results were statistically significant (p<0.001). CONCLUSION Decompression, assessed by MRI, seems to be equivalent by MIS approach to open laminarthrectomy. MIS approaches have been studied clinically in these indications with very satisfying results. As a conclusion, MIS approaches seems to be a relevant and efficient option in the treatment of lumbar degenerative stenosis. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Laura Marie-Hardy
- Service d'orthopédie et traumatologie, université Paris Sorbonne, hôpital de la Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - Marc Khalifé
- Service de chirurgie orthopédique, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Peter Upex
- Service de chirurgie orthopédique, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Guillaume Riouallon
- Service de chirurgie orthopédique, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Stéphane Wolff
- Service de chirurgie orthopédique, groupe hospitalier Paris Saint-Joseph, Paris, France
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Wu PH, Lau ETC, Kim HS, Grasso G, Jang IT. Spinal Canal Remodeling and Indirect Decompression of Contralateral Foraminal Stenosis After Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion. Neurospine 2023; 20:99-109. [PMID: 37016858 PMCID: PMC10080438 DOI: 10.14245/ns.2346132.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: There is a lack of literature on indirect decompression in uniportal endoscopic posterolateral transforaminal lumbar interbody fusion (EPTLIF). Our aim is to evaluate the dimensions of the spinal canal and contralateral foramen before and after EPTLIF.Methods: This is a retrospective study of patients who underwent EPTLIF in a tertiary spine centre over a 2-year period. The cross-sectional area of the spinal canal and the contralateral foramen at the level of fusion were measured on magnetic resonance imaging scan at 1-day postoperation and at the final follow-up. Patients were grouped according to the decompression performed as per the clinician’s judgement.Results: One hundred fifty-two levels of fusion were performed in 120 patients. There was a statistically significant clinical improvement in visual analogue scale and Oswestry Disability Index scores postoperation. The measurements of the spinal canal area were 106.0 mm<sup>2</sup>, 138.8 mm<sup>2</sup>, and 195.5 mm<sup>2</sup>; while contralateral foraminal area were 73.2 mm<sup>2</sup>, 104.4 mm<sup>2</sup>, and 120.7 mm<sup>2</sup> at preoperation, 1-day postoperation, and at the final follow-up, respectively (p < 0.001). For the subgroup analyses, spinal canal area measurements for the bilateral decompression cohort (n = 35) were 57.0 mm<sup>2</sup>, 123.9 mm<sup>2</sup>, and 191.8 mm<sup>2</sup>; for the ipsilateral decompression cohort (n = 42) were 89.3 mm<sup>2</sup>, 128.9 mm<sup>2</sup>, 183.3 mm<sup>2</sup>; and for the cohort without any decompression and only cage inserted (n = 75) were 138.3 mm<sup>2</sup>, 151.2 mm<sup>2</sup>, and 204.1 mm<sup>2</sup> (p < 0.001). Contralateral foraminal area measurements were 73.3 mm<sup>2</sup>, 106.4 mm<sup>2</sup> and 120.4 mm<sup>2</sup> in the bilateral decompression cohort; 69.5 mm<sup>2</sup>, 99.0 mm<sup>2</sup>, 116.9 mm<sup>2</sup> in the ipsilateral decompression cohort; and 75.1 mm<sup>2</sup>, 106.5 mm<sup>2</sup>, 122.9 mm<sup>2</sup> in the cohort without any decompression (p < 0.001).Conclusion: Indirect decompression of both the spinal canal and the contralateral foramen can be achieved via EPTLIF. Decompression on an asymptomatic contralateral side is not necessary.
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Affiliation(s)
- Pang Hung Wu
- National University Health System, Juronghealth Campus, Department of Orthopaedic Surgery, Singapore
| | - Eugene Tze-Chun Lau
- National University Health System, Juronghealth Campus, Department of Orthopaedic Surgery, Singapore
| | - Hyeun-Sung Kim
- Neurosurgical Clinic, Department of Biomedicine, Neurosciences and Advanced Diagnostics University for Palermo, Palermo, Italy
- Corresponding Author Hyeun-Sung Kim Department of Neurosurgery, Nanoori Hospital Gangnam, 731 Eonju-ro, Gangnam-gu, Seoul 06048, Korea ,
| | - Giovanni Grasso
- Neurosurgical Clinic, Department of Biomedicine, Neurosciences and Advanced Diagnostics University for Palermo, Palermo, Italy
| | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Korea
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External Review and Validation of a Spinal Epidural Abscess Predictive Score for Clinical Failure. World Neurosurg 2022; 163:e673-e677. [PMID: 35472643 DOI: 10.1016/j.wneu.2022.04.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spinal epidural abscess (SEA) is a rare but serious pathology that may result in delayed neurologic injury despite treatment with antibiotic therapy or surgery. Given this, the development of predictive scores for risk stratification has value in clinical decision making; however, external validation is necessary to understand their generalizability and reliability. METHODS A retrospective review was conducted of all patients presenting with SEA at a single institution. Patients were reviewed and graded according to the proposed SEA predictive score by Baum et al. Clinical failure was defined as documented laboratory or radiographic progression requiring surgical intervention, increased deformity requiring surgical intervention, or repeat surgical intervention if prior surgical intervention was undertaken as the initial treatment strategy. Brier score and receiver operating characteristic were used to calculate reliability. RESULTS There were 224 patients presenting with primary spinal infections with associated SEA. Of these, 209 patients had no history of intravenous drug abuse. Clinical failure was demonstrated in 52 of 209 patients (24.9%). Antibiotic treatment alone compared with antibiotic therapy and surgical treatment on initial presentation was found to have a significantly greater chance of clinical failure (odds ratio = 3.0930, P = 0.01). The proposed epidural abscess prediction score did not correlate with clinical outcomes with a Brier score of 0.229 and receiver operating characteristic area under the curve of 0.5944. CONCLUSIONS The proposed risk stratification scale for patients was not correlated with risk of clinical failure. Additionally, patients treated with antibiotics and surgical intervention on initial presentation had a significantly lower clinical failure rate.
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Ligamentum-preserved/Temporary Preserved Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis: Technical Note and 2-year Follow-up. Spine (Phila Pa 1976) 2022; 47:E328-E336. [PMID: 34075012 DOI: 10.1097/brs.0000000000004136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective study. OBJECTIVE The aim of this study was to prospectively assess the clinical outcomes of modified minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of singlesegment lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA MIS-TLIF is a safe and effective procedure in the treatment of lumbar degenerative disease. To avoid durotomy and nerve root injury, we modified the surgical order of MIS-TLIF such that the interbody fusion procedure was performed before the decompression procedure. METHODS One hundred thirty-nine patients with single-segment lumbar spondylolisthesis were separated into two groups. Sixty-seven patients underwent modified MIS-TLIF (group A). In group B, 72 patients underwent routine MIS-TLIF. The Japanese Orthopedic Association (JOA) score and the visual analogue scale (VAS) scores for lower back pain (LBP) and leg pain were assessed during the postoperative follow-up, and the lumbar interbody fusion rate was evaluated by CT scanning. RESULTS The mean operative time, incision length, average blood loss, and incision pain level were not significantly different (P > 0.05) between the two groups. No nerve root or dural injuries were observed in group A. In group B, there were two cases of dural injury and three cases of nerve root injury. One patient experienced temporary numbness and weakness on dorsiflexion of the foot, which recovered in 3 months. No differences were identified between the two groups when postoperative JOA scores, back pain, leg pain VAS scores, or the lumbar interbody fusion rate. CONCLUSION Both methods are effective in the treatment of lumbar degenerative disease. Modified MIS-TLIF is a safe and effective procedure that can significantly reduce the occurrence of injury to the dura and nerve root during decompression and the interbody fusion procedure.Level of Evidence: 3.
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Chen YL, Hu XD, Wang Y, Jiang WY, Ma WH. Contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion: causes and prevention. J Int Med Res 2021; 49:3000605211037475. [PMID: 34461766 PMCID: PMC8414939 DOI: 10.1177/03000605211037475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Unilateral transforminal lumbar interbody fusion (TLIF) with a single cage
can provide circumferential fusion and biomechanical stability. However, the
causes and prevention of contralateral radiculopathy following unilateral
TLIF remain unclear. Methods In total, 190 patients who underwent unilateral TLIF from January 2017 to
January 2019 were retrospectively reviewed. Radiological parameters
including lumbar lordosis, segmental angle, anterior disc height, posterior
disc height (PDH), foraminal height (FH), foraminal width, and foraminal
area (FA) were measured preoperatively and postoperatively. Preoperative and
postoperative visual analog scale scores were also recorded. Results The incidence of contralateral radiculopathy after unilateral TLIF was 5.3%
(10/190). The most common cause was contralateral foraminal stenosis.
Unilateral TLIF could increase the lumbar lordosis, segmental angle, and
anterior disc height but decrease the PDH, FA, and FH in patients with
symptomatic contralateral radiculopathy. The intervertebral cage should be
placed to cover the epiphyseal ring and cortical compact bone of the
midline, and the disc height can be increased to enlarge the contralateral
foramen. Conclusion The most common cause of contralateral radiculopathy is contralateral
foraminal stenosis. Careful preoperative planning is necessary to achieve
satisfactory outcomes. Improper unilateral TLIF will decrease the PDH, FA,
and FH, resulting in contralateral radiculopathy.
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Affiliation(s)
- Yun-Lin Chen
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Xu-Dong Hu
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Yang Wang
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Wei-Yu Jiang
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Wei-Hu Ma
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
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Singhatanadgige W, Promsuwan M, Tanasansomboon T, Yingsakmongkol W, Limthongkul W. Is Unilateral Minimally Invasive Transforaminal Lumbar Interbody Fusion Sufficient in Patients with Claudication? A Comparative Matched Cohort Study. World Neurosurg 2021; 150:e735-e740. [PMID: 33798783 DOI: 10.1016/j.wneu.2021.03.116] [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: 02/20/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate clinical and radiologic outcomes between bilateral decompression using the over-the-top technique (group 1) and unilateral decompression (group 2) in patients with claudication who underwent minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF). METHODS We enrolled patients with claudication who underwent MIS-TLIF from January 2017 to June 2019. Visual analog scale (VAS) scores and Oswestry Disability Index (ODI), walking distance, and perioperative outcomes were compared between groups. Preoperative and 3-month postoperative magnetic resonance imaging assessed changes in canal cross-sectional area, foraminal height, and lateral recess area. RESULTS Sixty-five consecutive patients with ≥1 year of follow-up were enrolled. VAS scores and ODI were not significantly different between groups (VAS and ODI, respectively, at 1 month follow-up, P = 0.62 and 0.88; 3 months follow-up, P = 0.96 and 0.53; 6 months follow-up, P = 0.10 and 0.85; and 12 months follow-up, P = 0.10 and 0.66). Operative time and blood loss between groups was not statistically significant (P = 0.43 and P = 0.55). There was also no difference in the length of hospital stay (P = 0.24). Canal dimensions increased in each group without significant differences between groups (cross-sectional area, P = 0.92; foraminal height [approach and contralateral side, respectively], P = 0.62 and 0.66; and lateral recess area [approach and contralateral side, respectively], P = 0.68 and 0.50). CONCLUSIONS A unilateral approach with ipsilateral side direct decompression and contralateral indirect decompression in MIS-TLIF is sufficient for early clinical improvement in patients with claudication.
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Affiliation(s)
- Weerasak Singhatanadgige
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Matus Promsuwan
- Department of Orthopedics, Sukhothai Hospital, Sukhothai, Thailand
| | | | - Wicharn Yingsakmongkol
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Worawat Limthongkul
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
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11
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Liu W, Zhao Y, Jia J, Chen X, Mai R, Yuan S, Tian Y, Liu X. Morphologic Changes of Intervertebral Foramen After Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Radiographic and Clinical Study. World Neurosurg 2020; 142:e151-e159. [PMID: 32599187 DOI: 10.1016/j.wneu.2020.06.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to investigate the morphologic changes in the intervertebral foramen after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and analyze the necessity of routinely performing contralateral intervertebral foraminal decompression in degenerative lumbar spondylolisthesis cases with bilateral symptoms. METHODS 72 single-level degenerative lumbar spndylolisthesis patients with bilateral symptoms were included, all of whom underwent unilateral approach MIS-TLIF. Preoperative and postoperative foraminal height (FH), foraminal width (FW), disc height (DH), distance from existing nerve root to upper edge of lower pedicle (RTP), and contralateral side spinal canal area (CSCA) were measured at surgical and contralateral side. Clinical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association score. RESULTS The preoperative values are comparable between operative and contralateral sides (P > .05). The postoperative values for FH on operative and contralateral sides were 16.23±2.48 mm and 16.10±2.42 mm, for FW were 11.36±2.58 mm and 11.31±2.71 mm, for IH were 8.18±1.58 mm and 8.42±1.54 mm, for RTP were 8.58±1.26 mm and 9.14±1.77 mm, and the CSCA of the spinal canal on the contralateral side were 211.59±48.12 mm², respectively. The difference between these was also not statistically significant (P > .05). The values increased significantly on the surgical and contralateral side (P < .05). The visual analog scale for low-back and leg pain, Japanese Orthopaedic Association, and Oswestry Disability Index improved significantly at 2-year follow-up. CONCLUSIONS Unilateral MIS-TLIF can effectively improve contralateral FH, DH, FW, RTP, and CSCA. It is not necessary to routinely perform contralateral intervertebral foramen decompression in degenerative lumbar spondylolisthesis with bilateral symptoms when symptoms are mild on one side.
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Affiliation(s)
- Wubo Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Yiwei Zhao
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Jun Jia
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Xi Chen
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Ruopeng Mai
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China.
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Gelfand Y, Benton J, De la Garza-Ramos R, Yanamadala V, Yassari R, Kinon MD. Effect of Cage Type on Short-Term Radiographic Outcomes in Transforaminal Lumbar Interbody Fusion. World Neurosurg 2020; 141:e953-e958. [PMID: 32565381 DOI: 10.1016/j.wneu.2020.06.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The effect of expandable versus static cage type on radiographic outcomes in transforaminal lumbar interbody fusion (TLIF) has not been well studied in the literature. We studied the effect of 3 cage types on change in foraminal height (FH), disk height (DH), subsidence, and segmental lordosis (SL). METHODS We conducted a retrospective review of patients who underwent TLIF in a single institution from 2014 to 2019. The following 3 cage types were identified: banana cage, bullet, and expandable cage. Computed tomography (CT) scans of the lumbar spine or lumbar radiographs (when CT scan was not available) with 6-week follow-up time were used for radiographic assessment. RESULTS One hundred patients with 133 fused segments were identified. The average age was 60.9 years, and 40% were men. A banana cage was used in 19 segments (14.3%), a bullet cage was used in 47 (35.4%), and an expandable cage was used in 67 segments (50.4%). There were no significant differences in FH (average increase, 0.7 mm; P = 0.771), subsidence (average, 2.3 mm; P = 0.554), DH (average decrease, 1.0 mm; P = 0.769), or clinically significant subsidence (>4 mm; P = 0.174). Expandable cages demonstrated a positive 1.2° gain in SL, whereas both other cages demonstrated a decrease in SL on average (P = 0.05). This result held up on multivariate analysis (P = 0.031). CONCLUSIONS The average increase in the foraminal height in TLIF is small (0.7 mm) and is not different between the cage types; therefore, direct decompression is crucially important in this procedure. Although TLIF is often considered to be a kyphotic procedure, an expandable cage demonstrated superiority in terms of segmental lordosis improvement.
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Affiliation(s)
- Yaroslav Gelfand
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Joshua Benton
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rafael De la Garza-Ramos
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vijay Yanamadala
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Reza Yassari
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Merritt D Kinon
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
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Sun K, Sun X, Huan L, Xu X, Sun J, Duan L, Wang S, Zhang B, Zheng B, Guo Y, Shi J. A modified procedure of single-level transforaminal lumbar interbody fusion reduces immediate post-operative symptoms: a prospective case-controlled study based on two hundred and four cases. INTERNATIONAL ORTHOPAEDICS 2020; 44:935-945. [PMID: 32086554 DOI: 10.1007/s00264-020-04508-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN This is a prospective case-controlled study. PURPOSE The purpose of this study is to investigate the effect of a modified transforaminal lumbar interbody fusion (TLIF) on the immediate post-operative symptoms in patients with lumbar disc herniation (LDH) accompanied with stenosis. METHODS A total of 204 LDH patients with single-level TLIF were enrolled. According to the sequence of the placement of rods and cage, patients were divided into group R (rod-prior-to-cage) and group C (cage-prior-to-rod). Neurological function was evaluated by the Japanese Orthopedic Association (JOA) score. Radiological assessment includes height of intervertebral space (HIS), foraminal height (FH), foraminal area (FA), and segmental lordosis (SL). Change of original symptoms (pain/numb) and new-onset symptoms (pain/numb) after surgery were also recorded. RESULTS Patients in group R had less change of HIS at L3/4, L4/5, and L5/S1 levels compared with pre-operation (all p > 0.05), whereas group C had larger change (all p < 0.05). No statistical difference was found in FH between the two groups before and after surgery at L3/4, L4/5, and L5/S1, respectively (all p > 0.05). In terms of FA, patients in group R had better improvement after surgery than those in group C at L3/4 and L4/5 (both p < 0.05). Patients in both groups acquired good improvement of neurological function. However, there were fewer patients in group R who experienced post-operative leg pain or numb compared with those in group C (p < 0.05). CONCLUSION The modified open TLIF can significantly reduce the incidence of immediate post-operative symptoms for patients with single-level lumbar disc herniation via installation of rods prior to insertion of cage and the "neural standard" should serve as the goal of decompression for spine surgeons to restore disc/foraminal height and to minimize nerve distraction.
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Affiliation(s)
- Kaiqiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiaofei Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Le Huan
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Ximing Xu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Liwei Duan
- Department of Emergency and Critical Care, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Bin Zhang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Bing Zheng
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yongfei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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Zhong R, Wang R, Liu J, Han Z, Jiang W, Liu Q, Mao K. [Comparison of minimally invasive transforaminal lumbar interbody fusion between two approaches in treatment of single-segment lumbar spinal stenosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:807-813. [PMID: 31297996 DOI: 10.7507/1002-1892.201903096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches in the treatment of single-segment lumbar spinal stenosis. Methods Between February 2015 and January 2017, 70 cases of single-segment lumbar spinal stenosis were treated with MIS-TLIF. The bilateral decompression via unilateral approach (group U) was performed in 36 cases and bilateral decompression via bilateral approaches (group B) in 34 cases. There was no significant difference in age, gender, body mass index, disease duration, distribution of responsibility segments, preoperative visual analogue scale (VAS) score of low back pain and leg pain and Oswestry disability index (ODI) score ( P>0.05). The operation time, intraoperative blood loss, hospitalization stay after operation, complications related to operation, incidence of asymptomatic lateral root symptoms, VAS scores of low back pain and leg pain, and ODI score before and after operation were compared between the two groups. X-ray film and CT scan at 12 months after operation were used to assessted the intervertebral bony fusion. Results The operation time and intraoperative blood loss in group U were significantly less than those in group B ( P<0.05). There was no significant difference in hospitalization stay after operation between the two groups ( t=-0.311, P=0.757). During the operation, 1 case in group U and 2 cases in group B had dural tear. No screw placement related nerve injury or asymptomatic lateral root symptoms occurred after operation. The patients were followed up 24 to 38 months, with an average of 32.8 months in group U and 35.5 months in group B. The VAS scores of low back pain and leg pain at 2 days, 3, 6, and 12 months after operation were significantly lower than that before operation in the two groups ( P<0.05), and there was no significant difference between the two groups ( P>0.05). The ODI scores at 3, 6 and 12 months after operation were significantly lower than that before operation in the two groups ( P<0.05), and there was no significant difference between the two groups ( P>0.05). Radiographic examination showed interbody fusion at 12 months after operation in the two groups. Conclusion MIS-TLIF is safe and effective in the treatment of single-segment lumbar spinal stenosis with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches. Bilateral decompression via unilateral approach takes less operation time and has less intraoperative blood loss.
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Affiliation(s)
- Rui Zhong
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China;Department of Spinal Surgery, Sport Hospital Affiliated to Chengdu Sport University, Chengdu Sichuan, 610041, P.R.China
| | - Runsheng Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Jianheng Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Zhenchuan Han
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Wei Jiang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Qingzu Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Keya Mao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853,
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Hu D, Fei J, Chen G, Yu Y, Lai Z. Treatment for lumbar spinal stenosis in elderly patients using percutaneous endoscopic lumbar discectomy combined with postoperative three-dimensional traction. Expert Rev Med Devices 2019; 16:317-323. [PMID: 30916589 DOI: 10.1080/17434440.2019.1599282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Dexin Hu
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Jun Fei
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Genjun Chen
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Yongjie Yu
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Zhen Lai
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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Zhu K, Yan S, Guo S, Tong J, Li C, Tan J, Wan W. Morphological changes of contralateral intervertebral foramen induced by cage insertion orientation after unilateral transforaminal lumbar interbody fusion. J Orthop Surg Res 2019; 14:79. [PMID: 30866988 PMCID: PMC6416875 DOI: 10.1186/s13018-019-1121-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background This study was performed to investigate the morphological changes of contralateral intervertebral foramen (IVF) based on computed tomography images of patients with lumbar spinal stenosis after unilateral transforaminal lumbar interbody fusion (TLIF) and to compare the influence of different orientation of cage insertion on these changes. Methods This is a retrospective cohort study. Sixty-nine patients with lumbar spinal stenosis who had undergone single-level unilateral TLIF were retrospectively analyzed. The patients were divided into two groups according to the cage insertion orientation: the oblique group (o-group, 39 cases) and the transverse group (t-group, 30 cases). The morphological parameters of contralateral IVF were measured before and 6 months after the operation. Changes in these parameters were compared and analyzed between the two groups. The 6-month clinical outcomes of the two groups were also collected and analyzed. Results There was a significant difference in the rate of increase in the segmental angle (p < 0.01) between the two groups, the mean value of segmental angle increased by an average of 29.08% ± 14.93% in the o-group and 48.63% ± 12.01% in the t-group. Overall, the posterior disc height had a significant positive correlation with the foraminal height and area. In the o-group, however, an increase in the segmental angle resulted in a decrease in the foraminal area. No significant difference in clinical outcomes was found between the two groups. Conclusions Compared with oblique cage insertion, transverse cage insertion could achieve greater restoration of segmental lumbar lordosis without decreasing contralateral foraminal dimensions.
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Affiliation(s)
- Kai Zhu
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Shuaifeng Yan
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Song Guo
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Jinyu Tong
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Cong Li
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Jun Tan
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China.
| | - Weiping Wan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, 200003, China.
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Yang Y, Liu ZY, Zhang LM, Dong JW, Xie PG, Chen RQ, Yang B, Liu C, Liu B, Rong LM. Risk factor of contralateral radiculopathy following microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1925-1932. [DOI: 10.1007/s00586-017-5417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/01/2017] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
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18
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Govindasamy R, Solomon P, Sugumar D, Gnanadoss JJ, Murugan Y, Najimudeen S. Is the Cage an Additional Hardware in Lumbar Interbody Fusion for Low Grade Spondylolisthesis? A Prospective Study. J Clin Diagn Res 2017; 11:RC05-RC08. [PMID: 28658859 DOI: 10.7860/jcdr/2017/23368.9845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/11/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lumbar interbody fusion has become the standard of care for the management of lumbar instability, where fusion is achieved using bone grafts, cages, etc. AIM The aim of the study was to compare the outcomes of the interbody fusion using interbody cage technique and stand alone local bone graft technique. MATERIALS AND METHODS A total of 30 patients, operated for single level instability with low grade lytic and degenerative spondylolisthesis of L4-5/L5-S1, were selected and grouped into two groups: Group I (stand alone grafts) and Group II (interbody cage and graft) based on computer generated random numbers. All patients who underwent interbody fusion through conventional open posterior approach were included in the study. Data regarding the time taken for interbody fusion, formaninal height maintenance, disc height restoration, translation, functional scores (VAS,ODI) and operative complications were analysed using in both the groups was collected and a student's-t test was performed to evaluate the difference. RESULTS The mean age of patients in Group I was 46.7 years whereas, the mean age of patients in Group II was 43.5 years with mean age of 46.7 years and 43.5 years respectively. Interbody fusion, was achieved in seven and eight months in Group I and II respectively (p>0.05). The clinical results of both groups were comparable and there was no significant difference between the two groups in VAS score (p-0.147) and ODI score (p-0.983). Radiological parameters were also comparable and there was no significant difference between the postoperative measurements of the two groups (p=0.348 for translation, p=0.310 for intervertebral disc height and p=0.135 for foraminal height). One patient in Group I had transient foot drop which recovered, while one in Group II had infection, wound was managed with wound wash and antibiotics and another patient in Group II had pseudoarthrosis. CONCLUSION Lumbar interbody fusion with standalone local bone grafts is sufficient in single level low grade spondylolisthesis treated by conventional open surgery.
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Affiliation(s)
| | - Prince Solomon
- Assistant Professor, Department of Orthopedics, PIMS Medical College, Pondicherry, India
| | - Deepak Sugumar
- Postgraduate Student, Department of Orthopedics, PIMS Medical College, Pondicherry, India
| | - James J Gnanadoss
- Professor, Department of Orthopedics, PIMS Medical College, Pondicherry, India
| | - Yuvaraja Murugan
- Assistant Professor, Department of Orthopedics, PIMS Medical College, Pondicherry, India
| | - Syed Najimudeen
- Professor, Department of Orthopedics, PIMS Medical College, Pondicherry, India
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Than KD, Mummaneni PV. Unilateral approach for bilateral decompression with MIS TLIF. World Neurosurg 2014; 82:646-7. [PMID: 25153294 DOI: 10.1016/j.wneu.2014.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Khoi D Than
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, USA.
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