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Kang DH, Lee JH, Chang BS, Chang SY, Kim D, Park S, Kim H. Predicting adequate segmental lordosis correction in lumbar spinal stenosis patients undergoing oblique lumbar interbody fusion: a focus on the discontinuous segment. 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; 33:1957-1966. [PMID: 38421447 DOI: 10.1007/s00586-024-08146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To identify the factors associated with a correction of the segmental angle (SA) with a total change greater than 10° in each level following minimally invasive oblique lumbar interbody fusion (MIS-OLIF). METHODS Patients with lumbar spinal stenosis who underwent single- or two-level MIS-OLIF were reviewed. Segments with adequate correction of the SA >10° after MIS-OLIF in immediate postoperative radiograph were categorized as discontinuous segments (D segments), whereas those without such improvement were assigned as continuous segments (C segments). Clinical and radiological parameters were compared, and multivariate logistic regression analysis was performed to identify factors associated with SA correction >10° after MIS-OLIF. RESULTS Of 211 segments included, 38 segments (18.0%) were classified as D segments. Compared with C segments, D segments demonstrated a significantly smaller preoperative SA (mean ± standard deviation [SD], - 1.1° ± 6.7° vs. 6.6° ± 6.3°, p < 0.001), larger change of SA (mean ± SD, 13.5° ± 3.4° vs. 3.1° ± 3.9°, p < 0.001), and a higher rate of presence of facet effusion (76.3% vs. 48.6%, p = 0.002). Logistic regression revealed preoperative SA (odds ratio (OR) [95% confidence interval (CI)]:0.733 [0.639-0.840], p < 0.001) and facet effusion (OR [95% CI]:14.054 [1.758-112.377], p = 0.027) as significant predictors for >10° SA correction after MIS-OLIF. CONCLUSION Preoperative kyphotic SA and facet effusion can predict SA correction >10° following MIS-OLIF. For patients with lordotic SA and no preoperative facet effusion, supplemental procedures, such as anterior column release or posterior osteotomy, should be prepared for additional lumbar lordosis correction required for remnant global sagittal imbalance after MIS-OLIF.
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Affiliation(s)
- Dong-Ho Kang
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Ji Han Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Dongook Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Sanghyun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea.
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Changoor S, Faloon MJ, Dunn CJ, Sahai N, Issa K, Moore J, Sinha K, Hwang KS, Emami A. Long-term Outcomes of Minimally Invasive Lateral Lumbar Interbody Fusion in the Treatment of Adult Scoliosis. Orthopedics 2022; 45:e134-e139. [PMID: 35112966 DOI: 10.3928/01477447-20220128-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The literature has shown the importance of long-term follow-up for adults with scoliosis treated surgically because complication and revision rates are high. The goal of this study was to determine long-term outcomes and complications of lateral lumbar interbody fusion (LLIF) with posterior instrumentation for adult patients with scoliosis. A retrospective review of our institution's database was performed to identify adult patients with scoliosis treated with LLIF between 2008 and 2013 with a minimum follow-up of 4 years. Medical records were reviewed for complications and revisions. Pre- and postoperative deformity Cobb angle measurements were taken as well as pelvic incidence (PI) and lumbar lordosis (LL). Functional outcome scores, including Oswestry Disability Index and visual analog scale score for back and leg pain, were assessed preoperatively and at follow-up. Standard binomial and categorical comparative analysis was performed. The 26 patients included had a mean age of 62 years, mean follow-up of 89 months, and mean of 1.8 levels per operation. Four patients (15.4%) required revisions. Mean deformity Cobb angle was 26° preoperatively and 14° postoperatively. Mean PI-LL mismatch was 11.7° preoperatively and 5.9° postoperatively. Nineteen (73%) patients had a PI-LL mismatch greater than 10° preoperatively, whereas only 2 (7.7%) had a mismatch postoperatively. Improvement was seen in all functional outcome scores. Long-term clinical results of LLIF for adults with deformity showed a low proportion of revision in the treatment of a condition with an established high rate of revision. The ability to reduce pelvic mismatch may further reduce the rate of revision. In this study, LLIF resulted in improved functional outcomes and patient satisfaction. [Orthopedics. 2022;45(3):e134-e139.].
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Zileli M, Akıntürk N, Yaman O. Complications of adult spinal deformity surgery: A literature review. J Craniovertebr Junction Spine 2022; 13:17-26. [PMID: 35386240 PMCID: PMC8978850 DOI: 10.4103/jcvjs.jcvjs_159_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose: Adult spinal deformity incidence increases accordingly as the population ages. Even though surgery is the best option for the treatment, the complications due to surgery are pretty challenging. This study aims to review the complication rates of adult spinal deformity surgery. Methods: A literature review of the last decade was performed searching for the query “Adult spine deformity and complication.” This search yielded 2781 results, where 79 articles were chosen to investigate the complications of adult spinal deformity surgery. In addition, the demographic data, surgical interventions, and complications were extracted from the publications. Results: A total of 26,207 patients were analyzed, and 9138 complications were found (34.5%). Implant failure, including screw loosening, breakage, distal and proximal junctional kyphosis, were the most common complications. The neurologic complications were about 10.8%, and the infection rate was 3.6%. Cardiac and pulmonary complications were about 4.8%. Discussion: Age, body mass index, smoking, osteoporosis, and other comorbidities are the significant risk factors affecting adult spinal deformity surgery. Presurgical planning and preoperative risk factor assessment must be done to avoid complications. Furthermore, intra and postoperative complications affect the patients’ quality of life and length of stay, and hospital readmissions. Revision surgery also increases the risk of complications. Conclusion: Good patient evaluation before surgery and careful planning of the surgery are essential in avoiding complications of adult spinal deformity.
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Louie PK, Vaishnav AS, Gang CH, Urakawa H, Sato K, Chaudhary C, Lee R, Mok JK, Sheha E, Lafage V, Qureshi SA. Development and Initial Internal Validation of a Novel Classification System for Perioperative Expectations Following Minimally Invasive Degenerative Lumbar Spine Surgery. Clin Spine Surg 2021; 34:E537-E544. [PMID: 34459472 DOI: 10.1097/bsd.0000000000001246] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/23/2021] [Indexed: 12/17/2022]
Abstract
STUDY DESIGN This was a prospective consecutive clinical cohort study. OBJECTIVE The purpose of our study was to develop and provide an initial internal validation of a novel classification system that can help surgeons and patients better understand their postoperative course following the particular minimally invasive surgery (MIS) and approach that is utilized. SUMMARY OF BACKGROUND DATA Surgeons and patients are often attracted to the option of minimally invasive spine surgery because of the perceived improvement in recovery time and postsurgical pain. A classification system based on the impact of the surgery and surgical approach(es) on postoperative recovery can be particularly helpful. METHODS Six hundred thirty-one patients who underwent MIS lumbar/thoracolumbar surgery for degenerative conditions of the spine were included. Perioperative outcomes-operative time, estimated blood loss, postsurgical length of stay (LOS), 90-day complications, postoperative day zero narcotic requirement [in Morphine Milligram Equivalent (MME)], and need for intravenous patient-controlled analgesia (IV PCA). RESULTS Postoperative LOS and postoperative narcotic use were deemed most clinically relevant, thus selected as primary outcomes. Type of surgery was significantly associated with all outcomes (P<0.0001), except intraoperative complications. Number of levels for fusion was significantly associated with operative time, in-hospital complications, 24 hours oral MME, and the need for IV PCA and LOS (P<0.0001). Number of surgical approaches for lumbar fusion was significantly associated with operative time, 24 hours oral MME, need for IV PCA and LOS (P<0.001). Based on these parameters, the following classification system ("Qureshi-Louie classification" for MIS degenerative lumbar surgery) was devised: (1) Decompression-only; (2) Fusion-1 and 2 levels, 1 approach; (3) Fusion-1 level, 2 approaches; (4) Fusion-2 levels, 2 approaches; (5) Fusion-3+ levels, 2 approaches. CONCLUSIONS We present a novel classification system and initial internal validation to describe the perioperative expectations following various MIS surgeries in the degenerative lumbar spine. This initial description serves as the basis for ongoing external validation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Evan Sheha
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | | | - Sheeraz A Qureshi
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
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Massel DH, Mayo BC, Narain AS, Hijji FY, Louie PK, Jenkins NW, Parrish JM, Singh K. Improvements in Back and Leg Pain Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion. Int J Spine Surg 2020; 14:745-755. [PMID: 33184122 DOI: 10.14444/7107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Improvement in patient-reported outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is poorly defined. As such, the purpose of this study was to quantify improvements in Visual Analogue Scale back and leg pain, Oswestry Disability Index (ODI), and Short Form-12 (SF-12) Mental and Physical Composite scores following MIS-TLIF. METHODS A surgical registry of patients who underwent primary 1-level MIS-TLIF during 2014-2015 was reviewed. Comparisons of Visual Analogue Scale back and leg pain, ODI, and Short Form-12 Mental and Physical Composite scores were performed using paired t tests from preoperative to each postoperative time point. Analysis of variance was used to estimate the degree of improvement in back and leg pain over the first postoperative year. Subgroup analysis was performed for patients presenting with predominant back (pBP) or leg (pLP) pain. Multivariate linear regression was performed to compare patient-reported outcome scores by subgroup. RESULTS A total of 106 patients were identified. Visual Analogue Scale back and leg scores, and ODI improved from preoperative scores at all postoperative time points (P < .05 for each). Patients with pBP (n = 68) and patients with pLP (n = 38) reported reductions in both back and leg pain over the first postoperative year (P < .05 for each). In the pBP cohort, patients experienced significant reductions in ODI after the first 6 postoperative weeks (P < .05 for each). In the pLP cohort, patients experienced significant reductions in ODI throughout the first postoperative year (P < .05 for each). Patients with pLP and pBP experienced similar reductions in back pain, whereas patients with pLP experienced significantly greater reductions in leg pain at all postoperative time points (P < .05 for each). CONCLUSIONS The current study suggests patients experience significant improvements in back and leg pain following MIS-TLIF regardless of predominant symptom. CLINICAL RELEVANCE These results can assist surgeons when counseling their patients on the magnitude of symptom improvement they may experience following MIS-TLIF.
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Affiliation(s)
- Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Benjamin C Mayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Fady Y Hijji
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Si G, Li T, Wang Y, Liu X, Li C, Yu M. Minimally invasive surgery versus standard posterior approach for Lenke Type 1-4 adolescent idiopathic scoliosis: a multicenter, retrospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:706-713. [PMID: 32720126 DOI: 10.1007/s00586-020-06546-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/16/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the safety and efficacy of posterior minimally invasive surgery (MIS) to standard posterior spinal fusion (PSF) surgery for Lenke Type 1-4 adolescent idiopathic scoliosis (AIS). METHODS This multicenter retrospective study enrolled 112 patients with Lenke Type 1-4 AIS who treated with MIS (n = 64) or PSF (n = 48) between March 2007 and January 2015. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. Operative time, level of fusion, intraoperative blood loss, blood transfusion, and intraoperative radiation exposure were recorded. 22-item Scoliosis Research Society questionnaire (SRS-22) was applied for assessment of life quality. The accuracy of pedicle screw placement was assessed according to postoperative computed tomography images, and the complications were collected in follow-up period. RESULTS The baseline characteristics of 2 groups were matched. There was no significant difference between 2 groups in terms of radiographic parameters immediately after surgery and at the last follow-up. The MIS group had significantly longer operative time, more level of fusion, less intraoperative blood loss, and lower blood transfusion rate (p < 0.001). The evaluation of pain using SRS-22 showed significantly lower score in MIS group (p < 0.05). No significant difference was found between 2 groups in terms of accuracy of pedicle screw placement and complications. CONCLUSION Posterior MIS is a safe and effective alternative to standard open approach for Lenke Type 1-4 AIS patients with curves < 70° and reasonable flexibility. Mid-term results showed MIS had the advantages of less blood loss and pain with more fusion segments.
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Affiliation(s)
- Gao Si
- Department of Orthopaedic Surgery, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Tong Li
- Department of Orthopaedic Surgery, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Yu Wang
- Department of Orthopaedic Surgery, Peking University First Hospital, Beijing, People's Republic of China
| | - Xiaoguang Liu
- Department of Orthopaedic Surgery, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Chunde Li
- Department of Orthopaedic Surgery, Peking University First Hospital, Beijing, People's Republic of China
| | - Miao Yu
- Department of Orthopaedic Surgery, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China.
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Analysis of the Factors Affecting Lumbar Segmental Lordosis After Lateral Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2020; 45:E839-E846. [PMID: 32609468 DOI: 10.1097/brs.0000000000003432] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To elucidate factors that determine segmental lordosis after lateral retroperitoneal lumbar interbody fusion (LLIF) with percutaneous pedicle screw fixation. SUMMARY OF BACKGROUND DATA LLIF has been widely used in degenerative lumbar spine surgery. However, the detailed mechanisms that determine segmental lordosis are still unknown. METHODS A total of 69 patients who underwent LLIF with posterior pedicle screw fixation without posterior osteotomy were analyzed. Computed tomography was performed before and within 2 weeks after surgery, and segmental lordotic angle (SLA) after surgery (Post-SLA) was predicted using multiple regression analysis. Explanatory factors considered in this study included SLA before surgery (Pre-SLA), disc height before surgery (DiscH), cage position (CageP; distance between the center of the cage and the center of the disc, where a positive value indicates an anterior cage position), cage angle (CageA), cage height (CageH), CageH-DiscH (amount of lift up), previous decompression surgery, and level fused. RESULTS A total of 102 levels were analyzed. Multiple regression analysis revealed that the Post-SLA can be predicted with three independent variables, CageP, Pre-SLA, and CageH-DiscH and the adjusted R was 0.70. In cases when the cage was located anteriorly (CageP > 3 mm), Post-SLA was greater with larger CageH, larger CageA, and larger Pre-SLA. When the cage was located in the middle (3 mm ≤CageP ≤-1 mm), Post-SLA was greater with larger CageP, larger Pre-SLA, and without previous decompression surgery. If the cage was located posteriorly (CageP < -1 mm), Post-SLA was greater with smaller CageH-DiscH and greater Pre-SLA. CONCLUSION To gain maximum segmental lordosis in LLIF, the cage should be located anteriorly. Furthermore, if the cage can be located anteriorly, a thicker cage with proper angle cage will gain segmental lordosis. If the cage is located posteriorly, a thin cage should be selected. LEVEL OF EVIDENCE 3.
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Jeremy Goh KM, Liow MHL, Xu S, Yeo W, Ling ZM, Soh CCR, Tan SB, Guo CM. Reduction in foraminal height after lateral access surgery does not affect quality of life: A 2-year outcome study on lateral lumbar interbody fusion. J Orthop Surg (Hong Kong) 2020; 27:2309499019829336. [PMID: 30782071 DOI: 10.1177/2309499019829336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Reduction in neuroforaminal height (FH) may diminish the indirect decompression benefit that lateral access surgery (LAS) provides. However, the relationship between postoperative FH reduction in LAS and health-related quality-of-life (HRQoL) outcomes remains unclear. OBJECTIVES To determine whether FH reduction affects HRQoL outcomes at 2-year follow-up. METHODS A retrospective review of 45 patients who underwent LAS for degenerative lumbar spine conditions was performed. The cohort was divided into two groups: maintenance (A) and reduction (B) in FH. Outcome measures included numerical pain rating scale (NPRS back and leg pain), Oswestry Disability Index (ODI), Short Form 36 Health Survey (SF-36), North American Spine Society (NASS) score for neurogenic symptoms (NS), patient satisfaction, and expectation fulfilment for surgery. Mean disc height (DH), FH, and fusion were evaluated on plain radiographs. Radiological fusion was assessed with the Bridwell fusion classification. Unpaired student's t-test was used to compare between groups and one-way ANOVA with Bonferroni post hoc correction was used to determine differences between time intervals within each group. RESULTS The average pre-op mean FH was 16.9 ± 3.5 mm. Group A had 25 patients showing postoperative maintenance of FH (19.4 ± 3.3 mm to 20.2 ± 3.2 mm; 4% increase) at 2-year postsurgery while group B had 20 patients showing decrease in FH (21.1 ± 3.3 mm to 18.7 ± 3.5 mm; 11% decrease). Group A mean DH improved from 7.0 ± 2.0 mm to 10.3 ± 1.6 mm (47% increase). Group B mean DH improved from 6.8 ± 2.3 mm to 11.0 ± 3.0 mm (62% increase). There were no significant differences in NPRS, ODI, NASS, SF-36, and SF-36 MCS/PCS between groups at 2 years ( p > 0.05); 92% of group A and 85% of group B patients reported good satisfaction and fulfilment of expectations ( p > 0.05). CONCLUSION Despite an initial increase in FH after LAS surgery, 45% of patients had FH reduction at 2 years. However, FH reduction up to 11% did not affect short-term HRQoL outcomes.
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Affiliation(s)
| | | | - Sheng Xu
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | | | - Seang Beng Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Chang Ming Guo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Improvements in Back and Leg Pain After Minimally Invasive Lumbar Decompression. HSS J 2020; 16:62-71. [PMID: 32015742 PMCID: PMC6973967 DOI: 10.1007/s11420-018-09661-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few studies have quantified clinical improvement following minimally invasive lumbar decompression based on predominant back pain or leg pain. PURPOSE To quantify improvement in patient-reported outcomes following minimally invasive lumbar decompression and determine the degree of improvement in back pain, leg pain, and disability in patients who present with predominant back pain or predominant leg pain. METHODS Patients who underwent primary, one-level minimally invasive lumbar decompression for degenerative pathology were retrospectively reviewed. Comparisons of visual analog scale (VAS) back and leg pain scores, Oswestry Disability Index (ODI) scores, and Short Form-12 (SF-12) mental and physical component scores from pre-operative to 6-week, 12-week, 6-month, and 1-year follow-up. Subgroup analyses were performed for patients with predominant back pain or predominant leg pain. RESULTS A total of 102 patients were identified. Scores on VAS back and leg pain, ODI, and SF-12 physical component improved from pre-operative to all post-operative time points. After 1 year, patients reported a 2.8-point (47%) reduction in back pain and a 4-point (61.1%) reduction in leg pain scores; 52 patients with predominant back pain and 50 patients with predominant leg pain reported reductions in pain throughout the year following surgery. In both the back and leg pain cohorts, patients experienced reductions in ODI during the first 6 months and throughout 1-year follow-up, respectively. The majority of patients achieved minimum clinically important difference, regardless of predominant symptom. CONCLUSIONS Patients reported improvements in back and leg pain following minimally invasive lumbar decompression regardless of predominant presenting symptom; however, patients with predominant leg pain may experience greater improvement than those with predominant back pain.
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Sheng SR, Geng YB, Zhou KL, Wu AM, Wang XY, Ni WF. Minimally invasive surgery for degenerative spondylolisthesis: transforaminal or oblique lumbar interbody fusion. J Comp Eff Res 2019; 9:45-51. [PMID: 31838875 DOI: 10.2217/cer-2019-0055] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare the outcomes of minimally invasive surgery (MIS) for degenerative spondylolisthesis transforaminal lumbar interbody fusion (TLIF) and oblique lumbar interbody fusion (OLIF). Materials & methods: The clinical and surgical characteristics and outcomes of 38 patients with MIS-OLIF and 55 with MIS-TLIF were retrospectively evaluated. Results: Procedures and hospital stay were shorter and blood loss was less, with MIS-OLIF than with MIS-OLIF. The clinical and radiographic outcomes were similar. Postoperative changes in disk height and foraminal dimension were greater and patient satisfaction was better with MIS-OLIF than with MIS-TLIF. Conclusion: The clinical findings associated with the two procedures were similar; but patients preferred MIS-OLIF, which is less invasive, to MIS-TLIF. Clinical trial registration number: ChiCTR1800019443.
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Affiliation(s)
- Sun-Ren Sheng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, China
| | - Yi-Bo Geng
- Wenzhou Medical University, Wenzhou, China
| | - Kai-Liang Zhou
- Department of Orthopaedic Surgery, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, China
| | - Ai-Min Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, China
| | - Xiang-Yang Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, China
| | - Wen-Fei Ni
- Department of Orthopaedic Surgery, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, China
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Hu J, Ou Y, Zhu Y, Luo W, Zhao Z, Du X, Li J. [Effectiveness of nano-hydroxyapatite/polyamide-66 Cage in interbody fusion for degenerative lumbar scoliosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:287-295. [PMID: 30874383 DOI: 10.7507/1002-1892.201807060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) Cage in interbody fusion for degenerative lumbar scoliosis. Methods A retrospective analysis was designed and conducted for 43 patients, who underwent posterior decompression and n-HA/PA66 Cage interbody fusion with correction of deformity between January 2013 and June 2016. Eighteen cases were single-level fusion (single-level group) and 25 cases were double-level fusion (double-level group). There was no significant difference in gender, age, body mass index, direction of convex, degree of apical rotation, fusion level, the number of osteoporotic patients, pre-operative intervertebral height of fusion segments, coronal Cobb angle, visual analogue score (VAS), and modified Oswestry Disability Index (ODI) between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stay, and complications of the operation were recorded. Modified ODI, VAS score, and MacNab criteria were adopted to assess clinical outcomes. Radiographic indexes, including intervertebral height of fusion segments, coronal Cobb angle, disc insertion depth, and the bone graft fusion rate, were also evaluated. Results There was no significant difference in operation time, intraoperative blood loss, postoperative drainage, and hospital stay between 2 groups ( P>0.05). All patients were followed up 18-62 months (mean, 30.9 months). Wound complications, postoperative delirium, and Cage retropulsion occurred in 4 cases (2 cases in single-level group, 2 cases in double-level group), 1 case of single-level group, and 1 case of double-level group, respectively. The intervertebral height of fusion segments after operation significantly improved compared with preoperative ones in both groups ( P<0.05). At last follow-up, the intervertebral height in double-level group was superior to which in single-level group ( P<0.05). The coronal Cobb angles after operation significantly improved compared with preoperative ones ( P<0.05), and no significant difference was found between 2 groups at each time point ( P>0.05). The disc insertion depth showed no significant difference between different time points after operation in 2 groups ( P>0.05) and between 2 groups at each time point after operation ( P>0.05). Bony fusion was obtained in all patients at last follow-up. The VAS score and modified ODI after operation in both groups were superior to those before operation ( P<0.05). The VAS score in double-level group was higher than that in single-level group ( P<0.05) at last follow-up, and no significant difference was found in VAS score and modified ODI between 2 groups at other time points ( P>0.05). According to the MacNab criteria, the excellent and good rates at last follow-up were 94.4% and 84.0% in single-level group and double-level group, respectively. Conclusion The n-HA/PA66 Cage can effectively restore and maintain the disc height of fusion segment, normal sequence, and biomechanical stability of the spine, and gain favorable effectivenss for degenerative lumbar scoliosis. And double-level fusion is superior to single-level fusion in maintaining disc height of fusion segment.
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Affiliation(s)
- Jianyu Hu
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Yunsheng Ou
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016,
| | - Yong Zhu
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Wei Luo
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Zenghui Zhao
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Xing Du
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Jianxiao Li
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
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Walker CT, Farber SH, Cole TS, Xu DS, Godzik J, Whiting AC, Hartman C, Porter RW, Turner JD, Uribe J. Complications for minimally invasive lateral interbody arthrodesis: a systematic review and meta-analysis comparing prepsoas and transpsoas approaches. J Neurosurg Spine 2019; 30:446-460. [PMID: 30684932 DOI: 10.3171/2018.9.spine18800] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive anterolateral retroperitoneal approaches for lumbar interbody arthrodesis have distinct advantages attractive to spine surgeons. Prepsoas or transpsoas trajectories can be employed with differing complication profiles because of the inherent anatomical differences encountered in each approach. The evidence comparing them remains limited because of poor quality data. Here, the authors sought to systematically review the available literature and perform a meta-analysis comparing the two techniques. METHODS A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A database search was used to identify eligible studies. Prepsoas and transpsoas studies were compiled, and each study was assessed for inclusion criteria. Complication rates were recorded and compared between approach groups. Studies incorporating an analysis of postoperative subsidence and pseudarthrosis rates were also assessed and compared. RESULTS For the prepsoas studies, 20 studies for the complications analysis and 8 studies for the pseudarthrosis outcomes analysis were included. For the transpsoas studies, 39 studies for the complications analysis and 19 studies for the pseudarthrosis outcomes analysis were included. For the complications analysis, 1874 patients treated via the prepsoas approach and 4607 treated with the transpsoas approach were included. In the transpsoas group, there was a higher rate of transient sensory symptoms (21.7% vs 8.7%, p = 0.002), transient hip flexor weakness (19.7% vs 5.7%, p < 0.001), and permanent neurological weakness (2.8% vs 1.0%, p = 0.005). A higher rate of sympathetic nerve injury was seen in the prepsoas group (5.4% vs 0.0%, p = 0.03). Of the nonneurological complications, major vascular injury was significantly higher in the prepsoas approach (1.8% vs 0.4%, p = 0.01). There was no difference in urological or peritoneal/bowel injury, postoperative ileus, or hematomas (all p > 0.05). A higher infection rate was noted for the transpsoas group (3.1% vs 1.1%, p = 0.01). With regard to postoperative fusion outcomes, similar rates of subsidence (12.2% prepsoas vs 13.8% transpsoas, p = 0.78) and pseudarthrosis (9.9% vs 7.5%, respectively, p = 0.57) were seen between the groups at the last follow-up. CONCLUSIONS Complication rates vary for the prepsoas and transpsoas approaches owing to the variable retroperitoneal anatomy encountered during surgical dissection. While the risks of a lasting motor deficit and transient sensory disturbances are higher for the transpsoas approach, there is a reciprocal reduction in the risks of major vascular injury and sympathetic nerve injury. These results can facilitate informed decision-making and tailored surgical planning regarding the choice of minimally invasive anterolateral access to the spine.
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Ahlquist S, Park HY, Gatto J, Shamie AN, Park DY. Does approach matter? A comparative radiographic analysis of spinopelvic parameters in single-level lumbar fusion. Spine J 2018; 18:1999-2008. [PMID: 29631061 DOI: 10.1016/j.spinee.2018.03.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar fusion is a popular and effective surgical option to provide stability and restore anatomy. Particular attention has recently been focused on sagittal alignment and radiographic spinopelvic parameters that apply to lumbar fusion as well as spinal deformity cases. Current literature has demonstrated the effectiveness of various techniques of lumbar fusion; however, comparative data of these techniques are limited. PURPOSE This study aimed to directly compare the impact of various lumbar fusion techniques (anterior lumbar interbody fusion [ALIF], lateral lumbar interbody fusion [LLIF], transforaminal lumbar interbody fusion [TLIF], and posterolateral fusion [PLF]) based on radiographic parameters. STUDY DESIGN/SETTING A single-center retrospective study examining preoperative and postoperative radiographs was carried out. PATIENT SAMPLE A consecutive list of lumbar fusion surgeries performed by multiple spine surgeons at a single institution from 2013 to 2016 was identified. OUTCOME MEASURES Radiographic measurements used included segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic incidence-lumbar lordosis (PI-LL) mismatch, anterior and posterior disc height (DH-A, DH-P, respectively), and foraminal height (FH). METHODS Radiographic measurements were performed on preoperative and postoperative lateral lumbar radiographs on all single-level lumbar fusion cases. Demographic data were collected including age, gender, approach, diagnosis, surgical level, and implant lordosis. Paired sample t test, one-way analysis of variance (ANOVA), McNemar test, and independent sample t test were used to establish significant differences in the outcome measures. Multiple linear regression was performed to determine a predictive model for lordosis from implant lordosis, fusion technique, and surgical level. RESULTS There were 164 patients (78 men, 86 women) with a mean age of 60.1 years and average radiographic follow-up time of 9.3 months. These included 34 ALIF, 23 LLIF, 63 TLIF, and 44 PLF surgeries. ALIF and LLIF significantly improved SL (7.9° and 4.4°), LL (5.5° and 7.7°), DH-A (8.8 mm and 5.8 mm), DH-P (3.4 mm and 2.3 mm), and FH (2.8 mm and 2.5 mm), respectively (p≤.003). TLIF significantly improved these parameters, albeit to a lesser extent: SL (1.7°), LL (2.7°), DH-A (1.1 mm), DH-P (0.8 mm), and FH (1.1 mm) (p≤.02). PLF did not significantly alter any of these parameters while significantly reducing FH (-1.3 mm, p=.01). One-way ANOVA showed no significant differences between ALIF and LLIF other than ALIF with greater ΔDH-A (3.0 mm, p=.02). Both ALIF and LLIF significantly outperformed PLF in preoperative to postoperative changes in all parameters p≤.001. Additionally, ALIF significantly outperformed TLIF in the change in SL (6.2°, p<.001), and LLIF significantly outperformed TLIF in the change in LL (5.0°, p=.02). Both outperformed TLIF in ΔDH-A (7.7 mm and 4.7 mm) and ΔDH-P (2.6 mm and 1.5 mm), respectively (p≤.02). ALIF was the only fusion technique that significantly improved the proportion of patients with a PI-LL<10° (0.410.66, p=.02). Lordotic cages had superior improvement of all parameters compared with non-lordotic cages (p<.001). Implant lordosis (m=1.1), fusion technique (m=6.8), and surgical level (m=6.9) significantly predicted postoperative SL (p<.001, R2=0.56). CONCLUSIONS This study demonstrated that these four lumbar fusion techniques yield divergent radiographic results. ALIF and LLIF produced greater improvements in radiographic measurements postoperatively compared with TLIF and PLF. ALIF was the most successful in improving PI-LL mismatch, an important parameter relating to sagittal alignment. Lordotic implants provided better sagittal correction and surgeons should be cognizant of the impact that these differing implants and techniques produce after surgery. Surgical technique is an important determinant of postoperative alignment and has ramifications upon sagittal alignment in lumbar fusion surgery.
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Affiliation(s)
- Seth Ahlquist
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St, Santa Monica, CA 90404, USA
| | - Howard Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St, Santa Monica, CA 90404, USA
| | - Jonathan Gatto
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St, Santa Monica, CA 90404, USA
| | - Ayra N Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St, Santa Monica, CA 90404, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St, Santa Monica, CA 90404, USA.
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Choi SW, Ames C, Berven S, Chou D, Tay B, Deviren V. Contribution of Lateral Interbody Fusion in Staged Correction of Adult Degenerative Scoliosis. J Korean Neurosurg Soc 2018; 61:716-722. [PMID: 30396244 PMCID: PMC6280057 DOI: 10.3340/jkns.2017.0275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/17/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical outcomes of LIF, and staged LIF and posterior spinal fusion (PSF) for the treatment of adult degenerative scoliosis patients, we analyzed radiographic and clinical outcomes of adult degenerative scoliosis patients who underwent LIF and posterior spinal fusion.
Methods Forty consecutive adult degenerative scoliosis patients who underwent LIF followed by staged PSF at a single institution were retrospectively reviewed. Long-standing 36” anterior-posterior and lateral radiographs were taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed. Outcomes were assessed through the visual analogue scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index (ODI).
Results Forty patients with a mean age of 66.3 (range, 49–79) met inclusion criteria. A mean of 3.8 levels (range, 2–5) were fused using LIF, while a mean of 9.0 levels (range, 3–16) were fused during the posterior approach. The mean time between stages was 1.4 days (range, 1–6). The mean follow-up was 19.6 months. Lumbar lordosis was significantly restored from 36.4º preoperatively up to 48.9º (71.4% of total correction) after LIF and 53.9º after PSF. Lumbar coronal Cobb was prominently improved from 38.6º preoperatively to 24.1º (55.8% of total correction) after LIF, 12.6º after PSF respectively. The mean pelvic incidence-lumbar lordosis mismatch was markedly improved from 22.2º preoperatively to 8.1º (86.5% of total correction) after LIF, 5.9º after PSF. Correction of coronal imbalance and sagittal vertebral axis did not reach significance. The rate of perioperative complication was 37.5%. Five patients underwent revision surgery due to wound infection. No major perioperative medical complications occurred. At last follow-up, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores.
Conclusion LIF provides significant corrections in the coronal and sagittal plane in the patients with adult degenerative scoliosis. However, LIF combined with staged PSF provides more excellent radiographic and clinical outcomes, with reduced perioperative risk in the treatment of adult degenerative scoliosis.
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Affiliation(s)
- Seung Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Sigurd Berven
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Dean Chou
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Bobby Tay
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
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Rothrock RJ, McNeill IT, Yaeger K, Oermann EK, Cho SK, Caridi JM. Lumbar Lordosis Correction with Interbody Fusion: Systematic Literature Review and Analysis. World Neurosurg 2018; 118:21-31. [DOI: 10.1016/j.wneu.2018.06.216] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 01/04/2023]
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Liu G, Liu S, Zuo YZ, Li QY, Wu ZH, Wu N, Yu KY, Qiu GX. Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis. Chin Med J (Engl) 2018; 130:2608-2615. [PMID: 28799527 PMCID: PMC5678262 DOI: 10.4103/0366-6999.212688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective: Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. Data Sources: We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: “minimally invasive,” “spine,” “surgery,” and “scoliosis.” Study Selection: The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. Results: The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3–7, operative time was 2.3–8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications. Conclusions: MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.
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Affiliation(s)
- Gang Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Sen Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing 100730, China
| | - Yu-Zhi Zuo
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qi-Yi Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zhi-Hong Wu
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity; Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Nan Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing 100730, China
| | - Ke-Yi Yu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Gui-Xing Qiu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing 100730, China
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Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2272-2284. [DOI: 10.1007/s00586-018-5535-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/16/2018] [Accepted: 02/24/2018] [Indexed: 10/17/2022]
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Navarro-Ramirez R, Berlin C, Lang G, Hussain I, Janssen I, Sloan S, Askin G, Avila MJ, Zubkov M, Härtl R. A New Volumetric Radiologic Method to Assess Indirect Decompression After Extreme Lateral Interbody Fusion Using High-Resolution Intraoperative Computed Tomography. World Neurosurg 2018; 109:59-67. [DOI: 10.1016/j.wneu.2017.07.155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 11/30/2022]
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Janssen I, Lang G, Navarro-Ramirez R, Jada A, Berlin C, Hilis A, Zubkov M, Gandevia L, Härtl R. Can Fan-Beam Interactive Computed Tomography Accurately Predict Indirect Decompression in Minimally Invasive Spine Surgery Fusion Procedures? World Neurosurg 2017; 107:322-333. [DOI: 10.1016/j.wneu.2017.07.167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/29/2022]
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Narain AS, Hijji FY, Markowitz JS, Kudaravalli KT, Yom KH, Singh K. Minimally invasive techniques for lumbar decompressions and fusions. Curr Rev Musculoskelet Med 2017; 10:559-566. [PMID: 29027622 DOI: 10.1007/s12178-017-9446-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to summarize the recent literature investigating the use of minimally invasive (MIS) techniques in the treatment of lumbar degenerative stenosis, spondylolisthesis, and scoliosis. RECENT FINDINGS MIS lumbar decompression and fusion techniques for degenerative pathology are associated with reduced operative morbidity, shortened length of hospital stay, and reduced postoperative pain and narcotics utilization. Recent studies with long-term clinical follow-up have demonstrated equivalence in clinical outcomes between open and MIS surgical procedures. Radiographically, MIS procedures provide adequate postoperative correction of coronal alignment. Correction of sagittal alignment, however, is more variable based on current reports. MIS techniques are both safe and effective in the treatment of lumbar degenerative pathologies. While some studies have reported on long-term outcomes and costs associated with MIS procedures, more investigation into these topics is still necessary. Additionally, further work is required to analyze the training requirements and learning curves of MIS procedures to better promote adoption amongst surgeons.
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Affiliation(s)
- Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Fady Y Hijji
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Jonathan S Markowitz
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Krishna T Kudaravalli
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kelly H Yom
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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Siu TL, Lin K. Lateral lumbar interbody fusion at the lumbosacral junction. J Clin Neurosci 2017; 43:178-184. [DOI: 10.1016/j.jocn.2017.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/22/2017] [Indexed: 11/24/2022]
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Leveque JC, Yanamadala V, Buchlak QD, Sethi RK. Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy. Neurosurg Focus 2017; 43:E15. [DOI: 10.3171/2017.5.focus17195] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPedicle subtraction osteotomy (PSO) provides extensive correction in patients with fixed sagittal plane imbalance but is associated with high estimated blood loss (EBL). Anterior column realignment (ACR) with lateral graft placement and sectioning of the anterior longitudinal ligament allows restoration of lumbar lordosis (LL). The authors compare peri- and postoperative measures in 2 groups of patients undergoing correction of a sagittal plane imbalance, either through PSO or the use of lateral lumbar fusion and ACR with hyperlordotic (20°–30°) interbody cages, with stabilization through standard posterior instrumentation in all cases.METHODSThe authors performed a retrospective chart review of cases involving a lumbar PSO or lateral lumbar interbody fusion and ACR (LLIF-ACR) between 2010 and 2015 at the authors’ institution. Patients who had a PSO in the setting of a preexisting fusion that spanned more than 4 levels were excluded. Demographic characteristics, spinopelvic parameters, EBL, operative time, and LOS were analyzed and compared between patients treated with PSO and those treated with LLIF-ACR.RESULTSThe PSO group included 14 patients and the LLIF-ACR group included 13 patients. The mean follow-up was 13 months in the LLIF-ACR group and 26 months in the PSO group. The mean EBL was significantly lower in the LLIF-ACR group, measuring approximately 50% of the mean EBL in the PSO group (1466 vs 2910 ml, p < 0.01). Total LL correction was equivalent between the 2 groups (35° in the PSO group, 31° in the LLIF-ACR group, p > 0.05), as was the preoperative PI-LL mismatch (33° in each group, p > 0.05) and the postoperative PI-LL mismatch (< 1° in each group, p = 0.05). The fusion rate as assessed by the need for reoperation due to pseudarthrosis was lower in the LLIF-ACR group but not significantly so (3 revisions in the PSO group due to pseudarthrosis vs 0 in the LLIF-ACR group, p > 0.5). The total operative time and LOS were not significantly different in the 2 groups.CONCLUSIONSThis is the first direct comparison of the LLIF-ACR technique with the PSO in adult spinal deformity correction. The study demonstrates that the LLIF-ACR provides equivalent deformity correction with significantly reduced blood loss in patients with a previously unfused spine compared with the PSO. This technique provides a powerful means to avoid PSO in selected patients who require spinal deformity correction.
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Affiliation(s)
| | | | | | - Rajiv K. Sethi
- 1Neuroscience Institute, Virginia Mason Medical Center; and
- 2Department of Health Services, University of Washington,Seattle, Washington
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Barone G, Scaramuzzo L, Zagra A, Giudici F, Perna A, Proietti L. Adult spinal deformity: effectiveness of interbody lordotic cages to restore disc angle and spino-pelvic parameters through completely mini-invasive trans-psoas and hybrid approach. 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; 26:457-463. [PMID: 28523382 DOI: 10.1007/s00586-017-5136-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the study is to assess and quantify the effectiveness of interbody lordotic cages applied by trans-psoas approach to improve radiographic parameters, showing the differences between completely mini-invasive and hybrid approach. METHODS We collected data of 65 patients affected by degenerative lumbar deformity/diseases and underwent mini-invasive lateral interbody fusion followed by percutaneous (group A, completely mini-invasive) or open (group B, hybrid) posterior instrumentation. A subgroup underwent anterior column realignment (ACR). We assessed statistical differences in preoperative and postoperative (at least 6-month) coronal and sagittal parameters, and disc angle (DA) at each level of cage application. RESULTS 107 lordotic cages were implanted. Group B had the most significant mean changes, especially in coronal Cobb angle, sagittal vertical axis, lumbar lordosis (LL), pelvic incidence-LL mismatch and DA. Concerning DA, at each level of lordotic cage application, in group A changed from -2.9° preop to -6.5° postop (p = 0.01); in group B, DA changed from -2.6° to -9.5° (p = 0.002) and from +1° to -13.2° in patients underwent ACR. CONCLUSIONS Minimally invasive lateral lumbar interbody fusion is an effective technique in improving sagittal parameters. When combined with posterior open approach and/or application of ACR procedure greater corrections are possible.
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Affiliation(s)
- Giuseppe Barone
- Division of Orthopedic and Traumatology, Hospital S. Maria della Misericordia, University of the Study of Perugia, via Guido Monaco, 21, 06132, Perugia, Italy.
| | - Laura Scaramuzzo
- Spine Surgery Division 1, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Antonino Zagra
- Spine Surgery Division 1, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Fabrizio Giudici
- Spine Surgery Division 1, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Andrea Perna
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Luca Proietti
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
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Lang G, Perrech M, Navarro-Ramirez R, Hussain I, Pennicooke B, Maryam F, Avila MJ, Härtl R. Potential and Limitations of Neural Decompression in Extreme Lateral Interbody Fusion—A Systematic Review. World Neurosurg 2017; 101:99-113. [DOI: 10.1016/j.wneu.2017.01.080] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 02/08/2023]
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Phan K, Huo YR, Hogan JA, Xu J, Dunn A, Cho SK, Mobbs RJ, McKenna P, Rajagopal T, Altaf F. Minimally invasive surgery in adult degenerative scoliosis: a systematic review and meta-analysis of decompression, anterior/lateral and posterior lumbar approaches. JOURNAL OF SPINE SURGERY 2016; 2:89-104. [PMID: 27683705 DOI: 10.21037/jss.2016.06.07] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Minimally invasive approaches for the treatment of adult degenerative scoliosis have been increasingly implemented. However, little data exists regarding the safety and complication profiles of minimally invasive lumbar interbody fusion (LIF) for adult degenerative scoliosis. This study aimed to greater understand different minimally invasive surgical approaches for adult degenerative scoliosis with respect to clinical outcomes, changes in radiographic measurements, and complication profiles via meta-analytical techniques. METHODS A systematic search of six databases from inception to September 2015 was performed by two independent reviewers. Relevant studies were those that described the safety and/or effectiveness of minimally invasive anterior or lateral LIF (LLIF), transforaminal LIF (TLIF), and decompression only. Meta-analytical techniques and meta-regression were used to pool overall rates, and compare the different techniques. There was no financial funding or conflict of interest. RESULTS A total of 29 studies (1,228 patients) were included in this meta-analysis. Total pooled fusion rate was 95.9% (95% CI: 92.7-98.2%) for the anterior/lateral approach. The pooled construct or hardware-related complications was 4.3%, and was similar among anterior/lateral (4.4%) and posterior (5.2%) techniques. The total pooled pseudoarthrosis rate was 4.3% for the lateral approach. The overall pooled rate of motor deficit was 2.7% (95% CI: 1.7-4.0%). Subgroup meta-regression demonstrated that the anterior/lateral approach had the highest rate of motor deficits (3.6% LLIF vs. 0.7% TLIF vs. 0.5% decompression, P=0.004). The overall pooled rate of sensory deficit was 2.4%, highest for the anterior/lateral technique (3.3%) compared to TLIF (0.7%) and decompression (0.5%). The infection rate, dural tears/CSF leak, cardiac and pulmonary events were similar among the techniques, with a pooled value of 2.6%, 3.9%, 1.7%, and 1.4%, respectively. Similarly satisfactory radiological outcomes were obtained amongst the different approaches. CONCLUSIONS Minimally invasive spine technologies may be used for the surgical treatment of lumbar degenerative scoliosis with acceptable complication rates, functional and radiological outcome. Future studies, specifically multi-centered longitudinal, examining the adequacy of minimally invasive spine surgery is warranted to compare long-term outcomes with the traditional procedure.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Ya Ruth Huo
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Jarred A Hogan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Joshua Xu
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Alexander Dunn
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia
| | - Samuel K Cho
- Leni & Peter W May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Patrick McKenna
- Department of Orthopaedic Surgery, Royal Berkshire Hospital, Reading, UK
| | - Trichy Rajagopal
- Department of Orthopaedic Surgery, Royal Berkshire Hospital, Reading, UK
| | - Farhaan Altaf
- Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney, Australia
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Strom RG, Bae J, Mizutani J, Valone F, Ames CP, Deviren V. Lateral interbody fusion combined with open posterior surgery for adult spinal deformity. J Neurosurg Spine 2016; 25:697-705. [PMID: 27341052 DOI: 10.3171/2016.4.spine16157] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with < 6 months follow-up, prior fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and pedicle subtraction osteotomy (29° ± 10°, p = 0.045). CONCLUSIONS LIF+OP is an effective strategy for ASD of moderate severity. Compared with the authors' OP-only operations, LIF+OP was associated with faster recovery, fewer complications, and greater relief of pain and disability.
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Affiliation(s)
| | - Junseok Bae
- Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, South Korea; and
| | - Jun Mizutani
- Neurological Surgery, University of California, San Francisco, California
| | - Frank Valone
- Department of Orthopaedic Surgery, Washington University in St. Louis, Missouri
| | - Christopher P Ames
- Neurological Surgery, University of California, San Francisco, California
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Scheer JK, Khanna R, Lopez AJ, Fessler RG, Koski TR, Smith ZA, Dahdaleh NS. The concave versus convex approach for minimally invasive lateral lumbar interbody fusion for thoracolumbar degenerative scoliosis. J Clin Neurosci 2015; 22:1588-93. [DOI: 10.1016/j.jocn.2015.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
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Gabel BC, Hoshide R, Taylor W. An Algorithm to Predict Success of Indirect Decompression Using the Extreme Lateral Lumbar Interbody Fusion Procedure. Cureus 2015; 7:e317. [PMID: 26487993 PMCID: PMC4601908 DOI: 10.7759/cureus.317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose: The purpose of this study is to define an algorithm that will predict the success of indirect decompression without the need for direct decompression in patients undergoing lateral lumbar interbody fusions. Methods and Materials: A prospective cohort study was undertaken for patients undergoing indirect decompression with lateral lumbar interbody fusion. Patients had to meet the following criteria prior to indirect fusion: lack of facet fusion on CT, absence of free disc fragment or compressive facet joint cyst on MRI, absence of frank osteoporosis, lack of congenital and/or severe spinal stenosis on MRI, and significant reduction (greater than 50%) in leg and back pain at rest. We then assessed which patients at follow-up required a second stage open decompression procedure because of continued back and/or leg pain. Results: Our series included 28 patients who underwent indirect decompression with extreme lateral lumbar interbody fusion. Of the 28 patients, one patient required a second stage open decompression at follow-up. The most common level operated on was the L4-L5 level. Twelve patients underwent more than a single level fusion. Average preoperative lumbar lordosis was 29 degrees and average postoperative lordosis was 45 degrees. The average patient age was 66.3 years and average follow-up was 1.21 years. Conclusions: Our algorithm can be used as an aid to assess which patients may benefit from indirect decompression alone, compared to indirect decompression combined with posterior decompression procedures.
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Phan K, Rao PJ, Scherman DB, Dandie G, Mobbs RJ. Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity. J Clin Neurosci 2015; 22:1714-21. [PMID: 26190218 DOI: 10.1016/j.jocn.2015.03.050] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/10/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
We conducted a systematic review to assess the safety and clinical and radiological outcomes of the recently introduced, direct or extreme lateral lumbar interbody fusion (XLIF) approach for degenerative spinal deformity disorders. Open fusion and instrumentation has traditionally been the mainstay treatment. However, in recent years, there has been an increasing emphasis on minimally invasive fusion and instrumentation techniques, with the aim of minimizing surgical trauma and blood loss and reducing hospitalization. From six electronic databases, 21 eligible studies were included for review. The pooled weighted average mean of preoperative visual analogue scale (VAS) pain scores was 6.8, compared to a postoperative VAS score of 2.9 (p<0.0001). The weighted average preoperative and postoperative coronal segmental Cobb angles were 3.6 and 1.1°, respectively. The weighted average preoperative and postoperative coronal regional Cobb angles were 19.1 and 10.0°, respectively. Regional lumbar lordosis also significantly improved from 35.8 to 43.3°. Sagittal alignment was comparable pre- and postoperatively (34 mm versus 35.1mm). The weighted average operative duration was 125.6 minutes, whilst the mean estimated blood loss was 155 mL. The weighted average hospitalization length was 3.6 days. Whilst the available data is limited, minimally invasive XLIF procedures appear to be a promising alternative for the treatment of scoliosis, with improved functional VAS and Oswestry disability index outcomes and restored coronal deformity. Future comparative studies are warranted to assess the long term benefits and risks of XLIF compared to anterior and posterior procedures.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Clinic, Prince of Wales Private Hospital, Level 7, Barker Street, Randwick, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia; Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Prashanth J Rao
- NeuroSpine Clinic, Prince of Wales Private Hospital, Level 7, Barker Street, Randwick, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia; Westmead Hospital, Westmead, Sydney, NSW, Australia
| | | | | | - Ralph J Mobbs
- NeuroSpine Clinic, Prince of Wales Private Hospital, Level 7, Barker Street, Randwick, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia.
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Alimi M, Hofstetter CP, Tsiouris AJ, Elowitz E, Härtl R. Extreme lateral interbody fusion for unilateral symptomatic vertical foraminal stenosis. 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 2015; 24 Suppl 3:346-52. [PMID: 25893336 DOI: 10.1007/s00586-015-3940-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Asymmetric loss of disc height in adult deformity patients may lead to unilateral vertical foraminal stenosis and radiculopathy. The current study aimed to investigate whether restoration of foraminal height on the symptomatic side using extreme lateral interbody fusion (XLIF) would alleviate unilateral radiculopathy. METHODS In a retrospective study, patients with single-level unilateral vertical foraminal stenosis and corresponding radicular pain undergoing XLIF were included. Functional data (visual analog scale (VAS) for buttock, leg and back, as well as Oswestry Disability Index (ODI)) and radiographic measurements (bilateral foraminal height, disc height, segmental coronal Cobb angle and regional lumbar lordosis) were collected preoperatively, postoperatively and at the last follow-up. RESULTS Twenty-three patients were included, among whom 61 % had degenerative scoliosis. History of previous surgery at the level of index was present in 43 % of patients. Additional instrumentation was performed in 91 %. The foraminal height on the stenotic side was significantly increased postoperatively (p < 0.001), and remained significantly increased at the last follow-up of 11 ± 3.7 months (p < 0.001). Additionally, VAS buttock and leg on the stenotic side, VAS back and ODI were significantly improved postoperatively and at the last follow-up (p ≤ 0.001 for all parameters). The foraminal height on the stenotic side showed correlation with the VAS leg on the stenotic side, both postoperatively and the last follow-up (r = -0.590; p = 0.013, and r = -0.537; p = 0.022, respectively). CONCLUSIONS Single-level XLIF is an effective procedure for treatment of symptomatic unilateral foraminal stenosis leading to radiculopathy. In deformity patients with radicular pain caused by nerve compression at a single level, when not associated with other symptoms attributable to general scoliosis, treatment with single-level XLIF can result in short- and mid-term satisfactory outcome.
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Affiliation(s)
- Marjan Alimi
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY, 10065, USA,
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MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics. 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 2015; 24 Suppl 3:287-313. [DOI: 10.1007/s00586-015-3886-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 12/14/2022]
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Koerner JD, Reitman CA, Arnold PM, Rihn J. Degenerative Lumbar Scoliosis. JBJS Rev 2015; 3:01874474-201504000-00001. [DOI: 10.2106/jbjs.rvw.n.00061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ng CLL, Pang BC, Medina PJA, Tan KA, Dahshaini S, Liu LZ. The learning curve of lateral access lumbar interbody fusion in an Asian population: a prospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 3:361-8. [DOI: 10.1007/s00586-015-3876-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 02/13/2015] [Accepted: 02/26/2015] [Indexed: 11/24/2022]
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Lateral access surgery: a decade of innovation. 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 2015; 24 Suppl 3:285-6. [PMID: 25808484 DOI: 10.1007/s00586-015-3895-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 03/19/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
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Clinical results and limitations of indirect decompression in spinal stenosis with laterally implanted interbody cages: results from a prospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 3:339-45. [DOI: 10.1007/s00586-015-3807-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/08/2015] [Accepted: 02/08/2015] [Indexed: 10/24/2022]
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Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique. 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 2015; 24:800-9. [DOI: 10.1007/s00586-015-3796-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 11/25/2022]
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The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity. 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 2014; 23 Suppl 6:699-704. [PMID: 25217242 DOI: 10.1007/s00586-014-3561-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The recent proliferation of minimally invasive lateral lumbar interbody fusion (LLIF) techniques has drawn attention to potential for these techniques to control or correct sagittal misalignment in adult spinal deformity. We systemically reviewed published studies related to LLIF use in adult spinal deformity treatment with emphasis on radiographic assessment of sagittal balance. METHODS A literature review was conducted to examine studies focusing on sagittal balance restoration in adult degenerative scoliosis with the LLIF approach. RESULTS Fourteen publications, 12 retrospective and 2 prospective, reported data regarding lumbar lordosis correction (1,266 levels in 476 patients) but only two measured global sagittal alignment. CONCLUSION LLIF appears to be especially effective when the lumbar lordosis and sagittal balance correction goals are less than 10° and 5 cm, respectively. However, the review demonstrated a lack of consistent reporting on sagittal balance restoration with the MIS LLIF techniques.
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