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Sun W, Li D, Zhao S, Fu H, Tian J, Zhang F, Feng H, Wu D. The effect of large channel-based foraminoplasty on lumbar biomechanics in percutaneous endoscopic discectomy: a finite element analysis. J Orthop Surg Res 2024; 19:402. [PMID: 38997769 PMCID: PMC11241959 DOI: 10.1186/s13018-024-04870-1] [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: 04/01/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of foraminoplasty using large-channel endoscopy during TESSYS on the biomechanics of the lumbar spine. METHODS A complete lumbar spine model, M1, was built using 3D finite elements, and models M2 and M3 were constructed to simulate the intraoperative removal of the superior articular process of L5 using a trephine saw with diameters of 5 mm and 8.5 mm, respectively, and applying normal physiological loads on the different models to simulate six working conditions-anterior flexion, posterior extension, left-right lateral bending, and left-right rotation-to investigate the displacement and facet joint stress change of the surgical segment, and the disc stress change of the surgical and adjacent segments. RESULTS Compared with the M1 model, the M2 and M3 models showed decreased stress at the L4-5 left FJ and a significant increase in stress at the right FJ in forward flexion. In the M2 and M3 models, the L4-5 FJ stresses were significantly greater in left lateral bending or left rotation than in right lateral bending or right rotation. The right FJ stress in M3 was greater during left rotation than that in M2, and that in M2 was greater than that in M1. The L4-5disc stress in the M3 model was greater during posterior extension than that in the M1 and M2 models. The L4-5disc stress in the M3 model was greater in the right rotation than in the M2 model, and that in the M2 model was greater than that in the M1 model. CONCLUSION Foraminoplasty using large-channel endoscopy could increase the stress on the FJ and disc of the surgical segment, which suggested unnecessary and excessive resection should be avoided in PTED to minimize biomechanical disruption.
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Affiliation(s)
- Wei Sun
- Department of Spine Surgery, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, Jiangsu, 221006, China
| | - Duohua Li
- Graduate School of Xuzhou, Medical University, No. 209 Tongshan Road, Xuzhou, Jiangsu, 221004, China
| | - Sicong Zhao
- Graduate School of Xuzhou, Medical University, No. 209 Tongshan Road, Xuzhou, Jiangsu, 221004, China
| | - Hao Fu
- Graduate School of Xuzhou, Medical University, No. 209 Tongshan Road, Xuzhou, Jiangsu, 221004, China
| | - Jiayu Tian
- Graduate School of Xuzhou, Medical University, No. 209 Tongshan Road, Xuzhou, Jiangsu, 221004, China
| | - Feng Zhang
- Graduate School of Xuzhou, Medical University, No. 209 Tongshan Road, Xuzhou, Jiangsu, 221004, China
| | - Hu Feng
- Department of Spine Surgery, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, Jiangsu, 221006, China.
- Graduate School of Xuzhou, Medical University, No. 209 Tongshan Road, Xuzhou, Jiangsu, 221004, China.
| | - Dongying Wu
- Department of Spine Surgery, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, Jiangsu, 221006, China.
- Graduate School of Xuzhou, Medical University, No. 209 Tongshan Road, Xuzhou, Jiangsu, 221004, China.
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Lechtholz-Zey EA, Ayad M, Gettleman BS, Mills ES, Shelby H, Ton AT, Shah I, Wang JC, Hah RJ, Alluri RK. Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Reoperation Rates and Complications after Surgical Management of Lumbar Degenerative Disease. J Bone Metab 2024; 31:114-131. [PMID: 38886969 PMCID: PMC11184153 DOI: 10.11005/jbm.2024.31.2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND There is considerable heterogeneity in findings and a lack of consensus regarding the interplay between osteoporosis and outcomes in patients with lumbar degenerative spine disease. Therefore, the purpose of this systematic review and meta-analysis was to gather and analyze existing data on the effect of osteoporosis on radiographic, surgical, and clinical outcomes following surgery for lumbar degenerative spinal disease. METHODS A systematic review was performed to determine the effect of osteoporosis on the incidence of adverse outcomes after surgical intervention for lumbar degenerative spinal diseases. The approach focused on the radiographic outcomes, reoperation rates, and other medical and surgical complications. Subsequently, a meta-analysis was performed on the eligible studies. RESULTS The results of the meta-analysis suggested that osteoporotic patients experienced increased rates of adjacent segment disease (ASD; p=0.015) and cage subsidence (p=0.001) while demonstrating lower reoperation rates than non-osteoporotic patients (7.4% vs. 13.1%; p=0.038). The systematic review also indicated that the length of stay, overall costs, rates of screw loosening, and rates of wound and other medical complications may increase in patients with a lower bone mineral density. Fusion rates, as well as patient-reported and clinical outcomes, did not differ significantly between osteoporotic and non-osteoporotic patients. CONCLUSIONS Osteoporosis was associated with an increased risk of ASD, cage migration, and possibly postoperative screw loosening, as well as longer hospital stays, incurring higher costs and an increased likelihood of postoperative complications. However, a link was not established between osteoporosis and poor clinical outcomes.
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Affiliation(s)
- Elizabeth A. Lechtholz-Zey
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Mina Ayad
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Brandon S. Gettleman
- Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, SC,
USA
| | - Emily S. Mills
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Hannah Shelby
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Andy T. Ton
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Ishan Shah
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Raymond J. Hah
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
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Youn YH, Cho KJ, Kim JS, Baek H, Hong JH. Revision Extension of Fusion Surgery in Thoracolumbar Spine Using a Newly Designed Revision Rod - Comparative Matched Cohort Study Versus Implant-Replacement Surgery. Global Spine J 2024:21925682241248105. [PMID: 38624239 DOI: 10.1177/21925682241248105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare the results of revision extension of fusion surgery using the newly designed revision rod and implant-replacement surgery in thoracolumbar spine. METHODS Thirty-one patients who underwent extension of fusion surgery using the revision rod for adjacent segment disease were included in this study. Thirty-one patients who underwent implant-replacement revision surgery were selected as a control group by matching age, sex, preoperative diagnosis, and number of revision segments. RESULTS The mean age was 70.7 ± 8.0 years in the revision rod (RR) group and 69.0 ± 8.4 years in the control group. Preoperative diagnoses, underlying diseases, and mean number of revision segments (2.2 ± 1.1) were similar in both groups. The change of hemoglobin (1.0 ± 1.9 vs 2.5 ± 1.5 g/dl; P < .01), hematocrit (4.1 ± 4.9 vs 7.2 ± 4.4 % P < .01) and albumin (.8 ± .9 vs 1.3 ± .4 g/dl; P < .01) levels before and after surgery showed significant differences between the two groups. Hemovac drainage was significantly less in the RR group (P = .01). The mean operative time was shorter in the RR group (203.5 ± 9.5 min vs 233.5 ± 8.7 min; P = .12) with no statistical difference. Radiological results showed that the average lumbar lordosis 2 years after surgery was lower in the RR group compared to the control group (25.1 ± 9.9° vs 32.9 ± 9.8°; P = .02). Union rates and clinical outcomes were not different between the two groups. CONCLUSION Revision extension of fusion surgery using a newly designed revision rod had less hemovac drainage and superior laboratory findings compared to implant-replacement revision surgery.
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Affiliation(s)
- Yung-Hun Youn
- Department of Orthopedic Surgery, School of Medicine, Inha University, Incheon, Korea
| | - Kyu-Jung Cho
- Department of Orthopedic Surgery, School of Medicine, Inha University, Incheon, Korea
| | - Jeong-Seok Kim
- Department of Orthopedic Surgery, School of Medicine, Inha University, Incheon, Korea
| | - Hyeon Baek
- Department of Orthopedic Surgery, School of Medicine, Inha University, Incheon, Korea
| | - Jin-Hyun Hong
- Department of Orthopedic Surgery, School of Medicine, Inha University, Incheon, Korea
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Noriega DC, Eastlack RK, Hernández GL, Kafchitsas K, Ryang YM, Spitz SM, Lite IS. Does the interfacing angle between pedicle screws and support rods affect clinical outcomes after posterior thoracolumbar fusion? A retrospective clinical study. Spine J 2024; 24:125-131. [PMID: 37726089 DOI: 10.1016/j.spinee.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND CONTEXT Proper alignment and tightening of the pedicle screw/rod assembly after instrumented posterior fusion of the lower spine is known to be crucial in order to achieve satisfactory clinical results. Such interfacing angle mismatches indicate stress overloading of the implant system. PURPOSE The objective of this study is to investigate the incidence of postoperative screw/rod interfacing angle mismatch and to analyze the impact of mismatches on clinical outcome in terms of (1) revision surgery, (2) adjacent segment degeneration (ASD), and (3) pain. STUDY DESIGN This is a monocentric retrospective observational study. PATIENT SAMPLE Patients underwent fusion surgery with pedicle screw/rod systems for predominantly degenerative pathologies. OUTCOME MEASURES Pedicle screw/rod interfacing angle mismatch (mismatch is the angular deviation from 90° formed by the rod axis and the pedicle screw head axis as an indicator for missing form-fit) revision rate, ASD at the immediately adjacent cranial segment and VAS pain. METHODS Revision refers to subsequent procedures in which all or part of the original implant configuration is changed or removed. Radiographic parameters are evaluated using a/p and lateral radiographs at final follow-up. The interfacing angle mismatch between pedicle screw and rod is measured as the angle between two parallel lines on either side of each pedicle screw head and a line laterally along the associated rod. Multiple comparisons are counteracted by Bonferroni correction, adjusted significance level is at *p<.01. RESULTS Pedicle screw and rod interfacing angle mismatch was found in 171/406 (42.1%) of patients undergoing fusion surgery, affecting 613/3016 (20.3%) screws. The overall revision incidence was 11.8% (48/406), and a new ASD occurred in 12.1% of all patients (49/406) with an average follow-up of 5 years. Mean VAS pain score at final follow-up was 2.0. Comparison of the two groups with and without mismatches revealed statistically significantly higher (1) numbers of revision procedures performed (26.9% vs 0.9%), (2) numbers of new ASD developed (27.5% vs 3.8%), and (3) higher VAS pain scores (2.8/10 vs 1.4/10) for cases with mismatch. When comparing patients who underwent intraoperative correction and/or reduction with those who did not, statistically significant more screw mismatches (63.4% vs 39.7%) and revision surgeries (29.3% vs 9.9%) were noted in patients who had these forceful maneuvers. CONCLUSIONS Pedicle screw/rod interfacing angle mismatch is a frequent occurrence after fusion surgery. Mismatches indicate that the construct was assembled under mechanical stress. All preventable mechanical stresses, for example, unintentional uncontrolled forces on the instrumentation, should be avoided as much as possible, as they can negatively influence the clinical outcome.
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Affiliation(s)
- David C Noriega
- Department of Orthopaedics, University Hospital of Valladolid, Calle Ramon y Cajal, Valladolid, Spain.
| | - Robert K Eastlack
- Department of Orthopaedics, Scripps Clinic, N Torrey Pines Rd, La Jolla, CA, USA
| | | | | | - Yu-Mi Ryang
- Department of Neurosurgery and Center for Spine Therapy, Helios Clinic Berlin-Buch, Schwanebecker Chaussee, Berlin, Germany
| | - Steven M Spitz
- Department of Neurosurgery, Northside Hospital, Northside Cherokee Blvd, Canton, GA, USA
| | - Israel Sánchez Lite
- Department of Radiology, University Hospital of Valladolid, Calle Ramon y Cajal, Valladolid, Spain
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Toivonen LA, Häkkinen A, Pekkanen L, Kyrölä K, Kautiainen H, Neva MH. Benefits of lumbar spine fusion surgery reach 10 years with various surgical indications. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100276. [PMID: 37840551 PMCID: PMC10570578 DOI: 10.1016/j.xnsj.2023.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 10/17/2023]
Abstract
Background Context Lumbar spine fusion (LSF) surgery is a viable form of treatment for several spinal disorders. Treatment effects are preferably to be endorsed in real-life settings. Methods This prospective study evaluated the 10-year outcomes of LSF. A population-based series of elective LSFs performed at 2 spine centers between January 2008 and June 2012 were enrolled. Surgeries for tumor, acute fracture, or infection, neuromuscular scoliosis, or postoperative conditions were excluded. The following patient-reported outcome measures (PROMs) were collected at baseline, and 1, 2, 5, and 10 years postsurgery: VAS for back and leg pain, ODI, SF-36. Longitudinal measures of PROMs were analyzed using mixed-effects models. Results A total of 683 patients met the inclusion criteria, and 630 (92%) of them completed baseline and at least 1 follow-up PROMs, and they constituted the study population. Mean age was 61 (SD 12) years, 69% women. According to surgical indication, patients were stratified into degenerative spondylolisthesis (DS, n=332, 53%), spinal stenosis (SS, n=102, 16%), isthmic spondylolisthesis (IS, n=97, 15%), degenerative disc disease (DDD, n=52, 8%), and deformity (DF, n=47, 7%).All diagnostic cohorts demonstrated significant improvement at 1 year, followed by a partial loss of benefits by 10 years. ODI baselines and changes at 1 and 10 years were: (DS) 45, -21, and -14; (SS) 51, -24, and -13; (IS) 41, -24, and -20; (DDD) 50, -20, and -20; and (DF) 50, -21, and -16, respectively. Comparable patterns were seen in pain scores. Significant HRQoL achievements were recorded in all cohorts, greatest in physical domains, but also substantial in mental aspects of HRQoL. Conclusions Benefits of LSF were partially lost but still meaningful at 10 years of surgery. Long-term benefits seemed milder with degenerative conditions, reflecting the progress of the ongoing spinal degeneration. Benefits were most overt in pain and physical function measures.
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Affiliation(s)
- Leevi A. Toivonen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PB 272, Tampere, 33101, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Seminaarinkatu 15, Jyväskylä, 40014, Finland
| | - Liisa Pekkanen
- Department of Surgery, Central Finland Healthcare District, Hoitajantie 3, Jyväskylä, 40620, Finland
| | - Kati Kyrölä
- Department of Surgery, Central Finland Healthcare District, Hoitajantie 3, Jyväskylä, 40620, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Yliopistonranta 8, Kuopio, 70210, Finland
- Folkhälsan Research Center, Topeliuksenkatu 20, Helsinki, 00250, Finland
| | - Marko H. Neva
- Department of Orthopedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PB 272, Tampere, 33101, Finland
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Yagi K, Kishima K, Tezuka F, Morimoto M, Yamashita K, Takata Y, Sakai T, Maeda T, Sairyo K. Advantages of Revision Transforaminal Full-Endoscopic Spine Surgery in Patients who have Previously Undergone Posterior Spine Surgery. J Neurol Surg A Cent Eur Neurosurg 2023; 84:528-535. [PMID: 35705180 DOI: 10.1055/a-1877-0594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Revision lumbar spine surgery via a posterior approach is more challenging than primary surgery because of epidural or perineural scar tissue. It demands more extensive removal of the posterior structures to confirm intact bony landmarks and could cause iatrogenic instability; therefore, fusion surgery is often added. However, adjacent segment disease after fusion surgery could be a problem, and further exposure of the posterior muscles could result in multiple operated back syndrome. To address these problems, we now perform transforaminal full-endoscopic spine surgery (TF-FES) as revision surgery in patients who have previously undergone posterior lumbar surgery. There have been several reports on the advantages of TF-FES, which include feasibility of local anesthesia, minimal invasiveness to posterior structures, and less scar tissue with fewer adhesions. In this study, we aim to assess the clinical outcomes of revision TF-FES and its advantages. METHODS We evaluated 48 consecutive patients with a history of posterior lumbar spine surgery who underwent revision TF-FES (at 60 levels) under local anesthesia. Intraoperative blood loss, operating time, and complication rate were evaluated. Postoperative outcomes were assessed using the modified Macnab criteria and visual analog scale (VAS) scores for leg pain, back pain, and leg numbness. We also compared the outcome of revision FES with that of primary FES. RESULTS Mean operating time was 70.5 ± 14.4 (52-106) minutes. Blood loss was unmeasurable. The clinical outcomes were rated as excellent at 16 levels (26.7%), good at 28 (46.7%), fair at 10 (16.7%), and poor at 6 (10.0%). The mean preoperative VAS score was 6.0 ± 2.6 for back pain, 6.8 ± 2.4 for leg pain, and 6.3 ± 2.8 for leg numbness. At the final follow-up, the mean postoperative VAS scores for leg pain, back pain, and leg numbness were 4.3 ± 2.5, 3.8 ± 2.6, and 4.6 ± 3.2, respectively. VAS scores for all three parameters were significantly improved (p < 0.05). There was no significant difference in operating time, intraoperative blood loss, or the complication rate between revision FES and primary FES. CONCLUSIONS Clinical outcomes of revision TF-FES in patients with a history of posterior lumbar spine surgery were acceptable (excellent and good in 73.4% of cases). TF-FES can preserve the posterior structures and avoid scar tissue and adhesions. Therefore, TF-FES could be an effective procedure for patients who have previously undergone posterior lumbar spine surgery.
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Affiliation(s)
- Kiyoshi Yagi
- Department of Orthopedics, Tokushima University, Tokushima, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Kazuya Kishima
- Department of Orthopedics, Tokushima University, Tokushima, Japan
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | | | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Anan Medical Center, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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Calek AK, Widmer J, Fasser MR, Farshad M. Lumbar vertebropexy after unilateral total facetectomy. Spine J 2023; 23:1730-1737. [PMID: 37451550 DOI: 10.1016/j.spinee.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 07/02/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND CONTEXT Posterior decompression with spinal instrumentation and fusion is associated with well-known complications. Alternatives that include decompression and restoration of native stability of the motion segment without fusion continue to be explored, however, an ideal solution has yet to be identified. PURPOSE The aim of this study was to test two different synthetic lumbar vertebral stabilization techniques that can be used after unilateral total facetectomy. STUDY DESIGN Biomechanical cadaveric study. METHODS Twelve spinal segments were biomechanically tested after unilateral total facetectomy and stabilized with a FiberTape cerclage. The cerclage was pulled through the superior and inferior spinous process (interspinous technique) or through the spinous process and around both laminae (spinolaminar technique). The specimens were tested after (1) unilateral total facetectomy, (2) interspinous vertebropexy and (3) spinolaminar vertebropexy. The segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR). RESULTS Unilateral facetectomy increased native ROM in FE by 10.6% (7.6%-12.6%), in LS by 25.8% (18.7%-28.4%), in LB 7.5% (4.6%-12.7%), in AS 39.4% (22.6%-49.2%), and in AR by 27.2% (15.8%-38.6%). Interspinous vertebropexy significantly reduced ROM after unilateral facetectomy: in FE by 73% (p=.001), in LS by 23% (p=.001), in LB by 13% (p=.003), in AS by 16% (p=.007), and in AR by 20% (p=.001). In FE and LS the ROM was lower than in the baseline/native condition. In AS and AR, the baseline ROM was not reached by 17% and 1%, respectively. Spinolaminar vertebropexy significantly reduced ROM after unilateral facetectomy: in FE by 74% (p=.001), in LS by 24% (p=.001), in LB by 13% (p=.003), in AS by 28% (p=.004), and in AR by 15 % (p=.001). Baseline ROM was not reached by 9% in AR. CONCLUSION Interspinous vertebropexy seems to sufficiently counteract destabilization after unilateral total facetectomy, and limits range of motion in flexion and extension while avoiding full segmental immobilization. Spinolaminar vertebropexy additionally restores native anteroposterior stability, allowing satisfactory control of shear forces after facetectomy. CLINICAL SIGNIFICANCE Lumbar vertebropexy seems promising to counteract the destabilizating effect of facetectomy by targeted stabilization.
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Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland; Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Lengghalde 5, CH-8008, Zurich, Switzerland.
| | - Jonas Widmer
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Lengghalde 5, CH-8008, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Lengghalde 5, CH-8008, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
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Antes S, Moringlane R, von Eckardstein KL. Augmented Reality-Supported Rod Bending in Multilevel Spinal Fusion Using the ADVISE Software. World Neurosurg 2023; 178:96-100. [PMID: 37454904 DOI: 10.1016/j.wneu.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND One of the most common reasons for poor patient outcomes and revision surgery in spinal fusion is hardware failure. Screw loosening or pullout occurs in up to one-quarter of all cases. It is known that even small screw-rod misalignments can cause significant mechanical overloads during rod fixation, which can result in hardware failure. To address this crucial surgical step, a novel augmented reality-assisted software was developed to generate custom rod templates that are precisely adapted to the individual patient. METHODS The novel software, which runs on a tablet, is used in spinal fusion surgery and is based on the use of a specific pedicle screw system, in which the polyaxial screw heads are connected to detachable guides. These guides can be recognized by the tablet camera and a light detection and ranging scanner. This image information is processed to determine the spatial positions of the screw heads and to calculate an ideally fitting rod template. RESULTS The calculated rod template is displayed in a 1-to-1 scale on the tablet screen. This template is used to cut and bend the rods of the pedicle screw system. Finally, the custom bent rod can be inserted into the screw heads without tension. CONCLUSIONS The augmented reality-assisted software is intended to give surgeons access to patient-specific intraoperative real-time data, helping them in bending rods that are more precisely adapted to the individual patient compared with the freehand technique.
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Affiliation(s)
- Sebastian Antes
- Department of Neurosurgery, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany.
| | - Rene Moringlane
- Department of Neurosurgery, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany
| | - Kajetan L von Eckardstein
- Department of Neurosurgery, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany; Department of Neurosurgery, Universitätsmedizin Mannheim, Mannheim, Germany
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Farshad M, Fasser MR, Widmer J, Unterfrauner I, Schader JF, Calek AK. Vertebropexy as a Ligamentous Stabilization for Degenerative Low-Grade Spondylolisthesis: A Report of 3 Cases. JBJS Case Connect 2023; 13:01709767-202312000-00023. [PMID: 37917724 DOI: 10.2106/jbjs.cc.23.00413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
CASE Three patients with low-grade spondylolisthesis were treated with vertebropexy, a new surgical technique that replaces rigid fusion with ligamentous stabilization. Clinical outcomes, functional radiographs, and magnetic resonance imaging were used to document the early clinical results of this biomechanically established and promising new surgical method. CONCLUSION Vertebropexy may be a valuable alternative to rigid fusion in the treatment of low-grade degenerative spondylolisthesis.
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Affiliation(s)
- Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ines Unterfrauner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jana Felicitas Schader
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Cao Z, Li Z, Zhao H, Wang J, Hou S. Revisional Endoscopic Foraminal Decompression via Modified Interlaminar Approach at L5-S1 after Failed Posterior Instrumented Lumbar Fusion in Elderly Patients. Bioengineering (Basel) 2023; 10:1097. [PMID: 37760199 PMCID: PMC10525451 DOI: 10.3390/bioengineering10091097] [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: 06/25/2023] [Revised: 08/27/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Elderly people usually have poorer surgical tolerance and a higher incidence of complications when undergoing revision surgery after posterior instrumented lumbar fusion (PILF). Full-endoscopic transforaminal surgery is a safe and effective option, but sometimes, it is difficult to revise L5-S1 foraminal stenosis (FS) after PILF. Therefore, we developed full-endoscopic lumbar decompression (FELD) at the arthrodesis level via a modified interlaminar approach under local anesthesia. This study aimed to describe the technical note and clinical efficacy of the technique. Eleven patients with unilateral lower limb radiculopathy after PILF underwent selective nerve root block and then underwent FELD. Magnetic resonance imaging (MRI) and computer tomography (CT) were performed on the second postoperative day. Their clinical outcomes were evaluated with a Visual analog scale (VAS) of low back pain and sciatica pain, Oswestry disability index (ODI), and the MacNab score. Complete decompression was achieved in every case with FELD without serious complications. Postoperative VAS of sciatica pain and ODI at each time point and VAS of low back pain and ODI after three months postoperatively were significantly improved compared with those preoperative (p < 0.05). According to the MacNab criteria, seven patients (63.6%) had excellent results at the two-year follow-up, and four patients (36.4%) had good results. No patients required further revision surgery. FELD, via a modified interlaminar approach, is effective for treating unilateral L5-S1 FS after PILF in elderly people.
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Affiliation(s)
| | - Zhenzhou Li
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing 100048, China; (Z.C.); (H.Z.); (J.W.); (S.H.)
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11
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Ahn Y, Park HB. Transforaminal Endoscopic Lumbar Foraminotomy for Juxta-Fusional Foraminal Stenosis. J Clin Med 2023; 12:5745. [PMID: 37685812 PMCID: PMC10488747 DOI: 10.3390/jcm12175745] [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: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/10/2023] Open
Abstract
Adjacent segment foraminal stenosis is a significant adverse event of lumbar fusion. Conventional revision surgery with an extended fusion segment may result in considerable surgical morbidity owing to extensive tissue injury. Transforaminal endoscopic lumbar foraminotomy (TELF) is a minimally invasive surgical approach for symptomatic foraminal stenosis. This study aimed to demonstrate the surgical technique and clinical outcomes of TELF for the treatment of juxta-fusional foraminal stenosis. Full-scale foraminal decompression was performed via a transforaminal endoscopic approach under local anesthesia. A total of 22 consecutive patients who had undergone TELF were evaluated. The included patients had unilateral foraminal stenosis at the juxta-fusional level of the previous fusion surgery, intractable lumbar radicular pain despite at least six months of non-operative treatment, and verified pain focus by imaging and selective nerve root block. The visual analog scale and Oswestry Disability Index scores significantly improved after the two-year follow-up period. The modified MacNab criteria were excellent in six patients (27.27%), good in 12 (55.55%), fair in two (9.09%), and poor in two (9.09%), with a 90.91% symptomatic improvement rate. No significant surgical complications were observed. The minimally invasive TELF is effective for juxta-fusional foraminal stenosis.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea;
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12
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Calek AK, Altorfer F, Fasser MR, Widmer J, Farshad M. Interspinous and spinolaminar synthetic vertebropexy of the lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3183-3191. [PMID: 37284900 DOI: 10.1007/s00586-023-07798-y] [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: 12/14/2022] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE To develop and test synthetic vertebral stabilization techniques ("vertebropexy") that can be used after decompression surgery and furthermore to compare them with a standard dorsal fusion procedure. METHODS Twelve spinal segments (Th12/L1: 4, L2/3: 4, L4/5: 4) were tested in a stepwise surgical decompression and stabilization study. Stabilization was achieved with a FiberTape cerclage, which was pulled through the spinous process (interspinous technique) or through one spinous process and around both laminae (spinolaminar technique). The specimens were tested (1) in the native state, after (2) unilateral laminotomy, (3) interspinous vertebropexy and (4) spinolaminar vertebropexy. The segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR). RESULTS Interspinous fixation significantly reduced ROM in FE by 66% (p = 0.003), in LB by 7% (p = 0.006) and in AR by 9% (p = 0.02). Shear movements (LS and AS) were also reduced, although not significantly: in LS reduction by 24% (p = 0.07), in AS reduction by 3% (p = 0.21). Spinolaminar fixation significantly reduced ROM in FE by 68% (p = 0.003), in LS by 28% (p = 0.01), in LB by 10% (p = 0.003) and AR by 8% (p = 0.003). AS was also reduced, although not significantly: reduction by 18% (p = 0.06). Overall, the techniques were largely comparable. The spinolaminar technique differed from interspinous fixation only in that it had a greater effect on shear motion. CONCLUSION Synthetic vertebropexy is able to reduce lumbar segmental motion, especially in flexion-extension. The spinolaminar technique affects shear forces to a greater extent than the interspinous technique.
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Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Franziska Altorfer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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13
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Dantas FL, Dantas F, Caires AC, Cariri GA, Fonseca Filho GA, Botelho RV. Adjacent segment degeneration after posterolateral lumbar fusion: results and complications of posterior revision surgery. J Neurosurg Sci 2023; 67:446-453. [PMID: 34114431 DOI: 10.23736/s0390-5616.21.05315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lumbar fusion is an important technique for the treatment of degenerative pathologies. Adjacent segment degeneration is a known complication after lumbar fusion that causes significant morbidity. Our objective was to evaluate the demographics, risk factors, type of surgery, and surgical complications in patients who underwent reoperation through a posterior route due to adjacent segment degeneration. METHODS We performed a retrospective analysis of all patients who underwent instrumented posterolateral fusion in the lumbar spine for the treatment of degenerative diseases from January 2000 to December 2015 at a single institution. Patients who developed symptomatic adjacent segment degeneration requiring a second surgery were noted and compared with patients who did not develop adjacent segment degeneration. RESULTS A total of 750 patients with degenerative pathologies who underwent fusion with instrumentation were identified. Forty-five patients (6%) required a second surgery for symptomatic adjacent segment degeneration. The average onset of adjacent segment degeneration symptoms after fusion was 5.89 years. Adjacent segment degeneration occurred above the level of fusion in 40 cases and below in 5 cases. The risk factor identified in our series was L5-S1 fusion. The main complication seen after the second surgery was infection in 5 cases (11%). CONCLUSIONS This study identifies the L5-S1 fusion as a possible risk factor for adjacent segment degeneration. Reoperation through a posterior route is a therapeutic option but is associated with considerable morbidity. Further studies are necessary to elucidate this pathology and the best options for its management.
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Affiliation(s)
- Fernando L Dantas
- Department of Neurosurgery, Biocor Institute, Nova Lima, Brazil -
- Postgraduation in Health Sciences - IAMSPE, São Paulo, Brazil -
| | - François Dantas
- Department of Neurosurgery, Biocor Institute, Nova Lima, Brazil
- Feluma Postgraduation Program, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
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14
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Shih CM, Hsu CE, Chen KH, Pan CC, Lee CH. Surgical outcomes of anterior lumbar interbody fusion in revision lumbar interbody fusion surgery. J Orthop Surg Res 2023; 18:497. [PMID: 37443066 DOI: 10.1186/s13018-023-03972-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUNDS Anterior lumbar interbody fusion (ALIF) is an attractive option for revision lumbar interbody fusion as it provides wide access for implant removal and accommodation of large interbody grafts for fusion. However, revision lumbar interbody fusion surgery has not been found to result in significantly better functional outcomes compared with other approaches. To date, no prognostic factors of anterior lumbar interbody fusion in revision lumbar interbody fusion have been reported. In this study, we investigated the surgical results and possible prognostic factors of anterior lumbar interbody fusion in revision lumbar interbody fusion. METHODS Patients who received revision interbody fusion surgery between January 2010 and May 2018 in our hospital were reviewed. Clinical outcomes were determined according to whether the VAS score improvement in back pain and leg pain reached the minimum clinically important difference (MCID) and Macnab criteria. Radiographic outcomes were assessed with fusion rate, preoperative, and postoperative lumbar lordosis. Operative-relative factors that may affect clinical outcomes, such as BMI, existence of cage migration, cage subsidence, pseudarthrosis, previous procedure, and number of fusion segments, were collected and analyzed. RESULTS A total of 22 consecutive patients who received ALIF for revision interbody fusion surgery were included and analyzed. There were 9 men and 13 women with a mean age at operation of 56 years (26-78). The mean follow-up was 73 months (20-121). The minimal clinically important difference (MCID) was reached in 11 (50%) of the patients for back pain and 14 (64%) for leg pain. According to the modified Macnab criteria, 73% of the patients in this study had successful outcomes (excellent or good). The pain and lumbar lordosis had significant improvement (P < 0.05). Preoperative fusion segment ≥ 2 was shown to be a poor prognostic factor for back pain improvement reaching MCID (P = 0.043). CONCLUSIONS ALIF has proven effective for revision lumbar fusion surgery, yielding positive clinical and radiographic results. However, having two or more preoperative fusion segments can negatively impact back pain improvement. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cheng-Min Shih
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Physical Therapy, Hungkuang University, Taichung, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan.
| | - Kun-Hui Chen
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- College of Computing and Informatics, Providence University, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan
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15
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Farshad M, Tsagkaris C, Widmer J, Fasser MR, Cornaz F, Calek AK. Vertebropexy as a semi-rigid ligamentous alternative to lumbar spinal 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 2023; 32:1695-1703. [PMID: 36930387 DOI: 10.1007/s00586-023-07647-y] [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: 08/03/2022] [Revised: 01/26/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To develop ligamentous vertebral stabilization techniques ("vertebropexy") that can be used after microsurgical decompression (intact posterior structures) and midline decompression (removed posterior structures) and to elaborate their biomechanical characteristics. METHODS Fifteen spinal segments were biomechanically tested in a stepwise surgical decompression and ligamentous stabilization study. Stabilization was achieved with a gracilis or semitendinosus tendon allograft, which was attached to the spinous process (interspinous vertebropexy) or the laminae (interlaminar vertebropexy) in form of a loop. The specimens were tested (1) in the native state, after (2) microsurgical decompression, (3) interspinous vertebropexy, (4) midline decompression, and (5) interlaminar vertebropexy. In the intact state and after every surgical step, the segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR). RESULTS Interspinous vertebropexy significantly reduced the range of motion (ROM) in all loading scenarios compared to microsurgical decompression: in FE by 70% (p < 0.001), in LS by 22% (p < 0.001), in LB by 8% (p < 0.001) in AS by 12% (p < 0.01) and in AR by 9% (p < 0.001). Interlaminar vertebropexy decreased ROM compared to midline decompression by 70% (p < 0.001) in FE, 18% (p < 0.001) in LS, 11% (p < 0.01) in LB, 7% (p < 0.01) in AS, and 4% (p < 0.01) in AR. Vertebral segment ROM was significantly smaller with the interspinous vertebropexy compared to the interlaminar vertebropexy for all loading scenarios except FE. Both techniques were able to reduce vertebral body segment ROM in FE, LS and LB beyond the native state. CONCLUSION Vertebropexy is a new concept of semi-rigid spinal stabilization based on ligamentous reinforcement of the spinal segment. It is able to reduce motion, especially in flexion-extension. Studies are needed to evaluate its clinical application.
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Affiliation(s)
- Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christos Tsagkaris
- Institute of Biomechanics, ETH Zurich, Balgrist Campus, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Institute of Biomechanics, ETH Zurich, Balgrist Campus, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Institute of Biomechanics, ETH Zurich, Balgrist Campus, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Zhang B, Hu Y, Kong Q, Feng P, Liu J, Ma J. Comparison of Oblique Lumbar Interbody Fusion Combined with Posterior Decompression (OLIF-PD) and Posterior Lumbar Interbody Fusion (PLIF) in the Treatment of Adjacent Segmental Disease(ASD). J Pers Med 2023; 13:jpm13020368. [PMID: 36836602 PMCID: PMC9966658 DOI: 10.3390/jpm13020368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND An unintended consequence following lumbar fusion is the development of adjacent segment disease (ASD). Oblique lumbar interbody fusion combined with posterior decompression (OLIF-PD) is another feasible option for ASD, and there is no literature report on this combined surgical strategy. METHODS A retrospective analysis was performed on 18 ASD patients requiring direct decompression in our hospital between September 2017 and January 2022. Among them, eight patients underwent OLIF-PD revision and ten underwent PLIF revision. There were no significant differences in the baseline data between the two groups. The clinical outcomes and complications were compared between the two groups. RESULTS The operation time, operative blood loss and postoperative hospital stay in the OLIF-PD group were significantly lower than those in the PLIF group. The VAS of low back pain in the OLIF-PD group was significantly better than that in the PLIF group during the postoperative follow-up. The ODI at the last follow-up in the OLIF-PD group and the PLIF group were significantly relieved compared with those before operation. The excellent and good rate of the modified MacNab standard at the last follow-up was 87.5% in the OLIF-PD group and 70% in the PLIF group. There was a statistically significant difference in the incidence of complications between the two groups. CONCLUSION For ASD requiring direct decompression after posterior lumbar fusion, compared with traditional PLIF revision surgery, OLIF-PD has a similar clinical effect, but has a reduced operation time, blood loss, hospital stay and complications. OLIF-PD may be an alternative revision strategy for ASD.
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Affiliation(s)
- Bin Zhang
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Yuan Hu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Qingquan Kong
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence:
| | - Pin Feng
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Junlin Liu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Junsong Ma
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
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Buckland AJ, Braly BA, O'Malley NA, Ashayeri K, Protopsaltis TS, Kwon B, Cheng I, Thomas JA. Lateral decubitus single position anterior posterior surgery improves operative efficiency, improves perioperative outcomes, and maintains radiological outcomes comparable with traditional anterior posterior fusion at minimum 2-year follow-up. Spine J 2023; 23:685-694. [PMID: 36641035 DOI: 10.1016/j.spinee.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND CONTEXT The advantages of Lateral Single Position surgery (LSPS) in the perioperative period has previously been demonstrated, however 2-year postoperative outcomes of this novel technique have not yet been compared to circumferential anterior-posterior fusion (FLIP) at 2-years postoperatively. PURPOSE Evaluate the safety and efficacy of LSPS versus gold-standard FLIP STUDY DESIGN/SETTING: Multi-center retrospective cohort review. PATIENT SAMPLE Four hundred forty- two patients undergoing lumbar fusion via LSPS or FLIP OUTCOME MEASURES: Levels fused, operative time, estimated blood loss, perioperative complications, and reasons for reoperation at 30-days, 90-days, 1-year, and 2-years. Radiographic outcomes included lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), PI-LL mismatch, and segmental lumbar lordosis. METHODS Patients were grouped as LSPS if anterior and posterior portions of the procedure were performed in the lateral decubitus position, and FLIP if patients were repositioned from supine or lateral to prone position for the posterior portion of the procedure under the same anesthetic. Groups were compared in terms of demographics, intraoperative, perioperative and radiological outcomes, complications and reoperations up to 2-years follow-up. Measures were compared using independent samples or paired t-tests and chi-squared analyses with significance set at p<.05. RESULTS Four hundred forty- two pts met inclusion, including 352 LSPS and 90 FLIP pts. Significant differences were noted in age (62.4 vs 56.9; p≤.001) and smoking status (7% vs 16%; p=.023) between the LSPS and FLIP groups. LSPS demonstrated significantly lower Op time (97.7min vs 297.0 min; p<.001), fluoro dose (36.5mGy vs 78.8mGy; p<.001), EBL (88.8mL vs 270.0mL; p<.001), and LOS (1.91 days vs 3.61 days; p<.001) compared to FLIP. LSPS also demonstrated significantly fewer post-op complications than FLIP (21.9%vs 34.4%; p=.013), specifically regarding rates of ileus (0.0% vs 5.6%; p<.001). No differences in reoperation were noted at 30-day (1.7%LSPS vs 4.4%FLIP, p=.125), 90-day (5.1%LSPS vs 5.6%FLIP, p=.795) or 2-year follow-up (9.7%LSPS vs 12.2% FLIP; p=.441). LSPS group had a significantly lower preoperative PI-LL (4.1° LSPS vs 8.6°FLIP, p=.018), and a significantly greater postoperative LL (56.6° vs 51.8°, p = .006). No significant differences were noted in rates of fusion (94.3% LSPS vs 97.8% FLIP; p=.266) or subsidence (6.9% LSPS vs 12.2% FLIP; p=.260). CONCLUSIONS LSPS and circumferential fusions have similar outcomes at 2-years post-operatively, while reducing perioperative complications, improving perioperative efficiency and safety.
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Affiliation(s)
- Aaron J Buckland
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia; Spine and Scoliosis Research Associates Australia, Melbourne, VIC, Australia; Spine Research Center, Departments of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
| | | | - Nicholas A O'Malley
- Spine Research Center, Departments of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kimberly Ashayeri
- Spine Research Center, Departments of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA; Department of Neurosurgery, NYU Langone Health, New York, NY, USA
| | | | - Brian Kwon
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
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New approaches to proven technology: force control posterior thoracolumbar fusion with an innovative pedicle screw system. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Zhang HQ, Wang YX, Guo CF, Tang MX, Liu SH, Deng A, Gao Q. Posterior-only debridement, bone fusion, single-segment versus short-segment instrumentation for mono-segmental lumbar or lumbosacral pyogenic vertebral osteomyelitis: minimum five year follow-up outcomes. J Orthop Surg Res 2022; 17:388. [PMID: 35962360 PMCID: PMC9373455 DOI: 10.1186/s13018-022-03269-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Pyogenic vertebral osteomyelitis (PVO), which is a potentially life-threatening condition and is associated with significant morbidity and mortality, is a cause of back pain that can lead to neurologic deficits if not diagnosed in time and effectively treated. The objective of this study is to compare the efficacy of posterior single-segment and short-segment fixation combined with one-stage posterior debridement and fusion for the treatment of mono-segmental lumbar or lumbosacral PVO.
Methods Charts of all patients with mono-segmental lumbar or lumbosacral PVO were treated by single-stage posterior debridement, bone graft fusion, and pedicle screw fixation from April 2012 to January 2016. All patients were divided into two groups: sinlge-segment fixation (Group A, n = 31) and short-segment fixation (Group B, n = 36). These patients were followed up for a minimum of five years. The clinical efficacy was evaluated and compared on average operation time, blood loss, visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), neurological function recovery and local lordotic angle. Results All 67 patients were completely cured during the follow-up. All patients had significant improvement of neurological condition and pain relief at the final follow-up. The VAS was 7.1 ± 0.7 in group A and 7.2 ± 0.6 in group B pre-operatively, which decreased to 2.1 ± 0.6 and 2.0 ± 0.7, respectively, at three months after surgery, then reduced to 0.4 ± 0.5 and 0.5 ± 0.5, respectively, at the final follow-up. ESR, CRP returned to normal limits in all patients 3 months after surgery. The mean blood loss and operation time in group A were less than that in group B (P < 0.05). The local lordotic angle in group A was increased from preoperative − 1.7 ± 7.9° to postoperative 5.8 ± 7.1°, with angle loss of 1.5 ± 0.8° at the final follow-up, respectively (P < 0.05). The local lordotic angle in group B was increased from preoperative − 1.6 ± 7.8° to postoperative 13.5 ± 6.2°, with angle loss of 1.3 ± 0.8° at the final follow-up, respectively (P < 0.05). In the mean postoperative local lordotic angle, there was significant difference between the two groups at the time of immediate postoperative period or the final follow-up (P < 0.05). Conclusion Posterior-only debridement, interbody graft using titanium mesh cage, posterior single-segment instrumentation and fusion represent a safe and effective treatment option for selected patients with mono-segmental lumbar and lumbosacral PVO. This approach may preserve more lumbar normal motor units with less blood loss and operation time when compared with that of short-segment fixation. But short-segment fixation was superior to the single-segment fixation in the correction of kyphosis.
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Affiliation(s)
- Hong-Qi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China.,National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China
| | - Yu-Xiang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China. .,National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China.
| | - Chao-Feng Guo
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China.,National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China
| | - Ming-Xing Tang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China.,National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China
| | - Shao-Hua Liu
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China.,National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China
| | - Ang Deng
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China.,National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China
| | - Qile Gao
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China.,National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China
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20
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Zhang D, Zeng T, Chen K, Jin S. Applications of the Crenel Lateral Interbody Fusion Procedure in Treatment for Adjacent Segments Degeneration of the Lumbar Spine. Orthop Surg 2022; 14:2150-2158. [PMID: 35929663 PMCID: PMC9483051 DOI: 10.1111/os.13420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/14/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To observe the clinical and radiological effect of crenel lateral interbody fusion (CLIF) procedure in the management of lumbar spine adjacent segment degenerative (ASD). METHODS Thirty-seven patients with lumbar spine ASD who underwent the CLIF procedure between June 2018 and December 2019 were included in the study. There were 13 males and 24 females, with a mean age of 64.30 ± 5.92 years. The VAS score of the back (VAS_Back) and legs (VAS_Leg), Oswestry Disability Index (ODI) score, the height of the intervertebral space (HIS), the height of the intervertebral foramen (HIF), the cross-sectional area (CSA) of the vertebral canal, segmental lordosis (SL), and lumbar lordosis (LL) were recorded before the operation, 2 weeks after the operation, 3 months after the operation, and at the last follow-up respectively. Clinical and radiological outcomes before and after the surgery were compared, and correlation and regression analyses were performed. RESULTS There were no vascular and nerve-related complications during the operation. The average follow-up time was 16.63 ± 4.24 months. The median of both VAS_Back and VAS_Leg was 7 before surgery and 1 at the last follow-up. Meanwhile, the average preoperative ODI score, HIS, HIF, CSA of the vertebral canal, LL, and SL was (67.48 ± 7.17) %, (4.80 ± 0.73) mm, (12.95 ± 2.07) mm, (59.52 ± 9.22) mm2 , (37.22 ± 5.92)° and (4.78 ± 1.99)°, respectively. At the final follow-up, ODI score, HIS, HIF, CSA of the vertebral canal, LL, and SL was (7.07 ± 2.66) %, (9.44 ± 0.61) mm, (17.30 ± 1.90) mm, (70.49 ± 8.95) mm2 , (44.67 ± 6.38)° and (13.44 ± 3.27)°, respectively. In the VAS_Back, VAS_Leg, ODI score, LL, SL, HIS, HIF, and CSA of the vertebral canal, the difference between preoperative and 2 weeks after the operation, 3 months after the operation, and the last follow-up were statistically significant (P < 0.05). However, the difference was not statistically significant between each time point after the operation in the CSA of the vertebral canal, LL, and SL (P > 0.05). Nonetheless, the difference was statistically significant in ODI between each time point after the operation (P < 0.05). VAS_Leg was associated with HIS, HIF, and CSA of the vertebral canal, while LL and SL were risk factors for low back pain. CONCLUSION Crenel lateral interbody fusion is an effective procedure in the management of lumbar ASD. Not only was the postoperative swift recovery due to minimal invasion, but also adequate LL and SL were achievable.
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Affiliation(s)
- Di Zhang
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Tong Zeng
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Keng Chen
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Song Jin
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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21
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Qu Z, Deng B, Gao X, Pan B, Sun W, Feng H. The association between Roussouly sagittal alignment type and risk for adjacent segment degeneration following short-segment lumbar interbody fusion: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:653. [PMID: 35804342 PMCID: PMC9264674 DOI: 10.1186/s12891-022-05617-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background To date, the influence of Roussouly type on development of adjacent segment degeneration (ASD) after lumber fusion is still not fully explored, and the current study is aimed to evaluate the effect of Roussouly type on development of radiological ASD after single-level lumber fusion, and to compare the Roussouly types and spinopelvic parameters among those with different degenerative patterns of ASDs on sagittal plane. Methods A retrospective review of 288 patients underwent L4/5 or L5/S1 single-level posterior interbody fusions between January 2016 and December 2018 with a minimum 2-year follow up was performed. Radiological ASDs were identified and divided into 3 groups according to different degenerative patterns of the cephalad adjacent level on sagittal plane, including the types of retrolisthesis (Group A), anterolisthesis (Group B), and axial disc space narrowing (Group C). Roussouly types and radiological measurements were compared among three groups and potential risk factors for ASD were evaluated. Results Radiological ASD was found in 59 (20.5%) cases, in which patients with Roussouly type-2 was the most common. While, on subgroup analysis among three ASD groups, Roussouly type-1 occupied the highest proportion in Group A, differ in Group B and Group C, both with Type-2 as the most common. Moreover, Group A had significantly lower pelvic tilt (PT), larger sacral slope (SS), and larger segmental angle (SA) than Group B and Group C, which showed a more anteverted pelvic in Group A. Multivariate regression analysis noted Roussouly type, preoperative PT, and ∆PI-LL as the independent risk factors for radiological ASD. Conclusion Roussouly type was significantly associated with the development of radiological ASD; however, the Roussouly types and spinal pelvic parameters were varied among different sagittal degenerative patterns of ASD, which was important in restoring optimal lumbar sagittal alignments in initial surgery.
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Affiliation(s)
- Zhe Qu
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Bin Deng
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Xiao Gao
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Bin Pan
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Wei Sun
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Hu Feng
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China. .,Xuzhou Medical University, Xuzhou, China.
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22
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MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure. J Clin Med 2022; 11:jcm11143952. [PMID: 35887716 PMCID: PMC9321056 DOI: 10.3390/jcm11143952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/25/2022] [Accepted: 07/04/2022] [Indexed: 01/25/2023] Open
Abstract
Background: Adjacent segment degeneration (ASD) has become a great concern as a late complication in patients following fusion spine surgery with a potential need for revision surgery. Segments above the fused spine have higher mobility and they are especially prone to accelerated disc degeneration. The purpose of our study is to investigate early disc degenerative changes two levels above a surgically fused lumbar spine segment and to compare MRI analyses after unilateral and bilateral TLIF procedures. Methods: A total of 117 patients were included in this cross-sectional retrospective single center study (after bilateral TLIF surgery: n = 91, and after unilateral TLIF: n = 26). In both groups, the average patient age was similar: 62.84 years (SD = 12.53) in the unilateral TLIF group and 60.67 years (SD = 11.89) in the bilateral TLIF group. On average, MRI was performed 2.5 years after surgery (SD = 2.09). The modified eight-level Pfirrmann grading system was used for the assessment of disc degeneration severity. Descriptive statistics and the Mann–Whitney test were used to show differences in the Pfirrmann grades regarding the after-surgery period and the patient age. The Wilcoxon signed-rank test results were used to display differences in the Pfirrmann grades before and after surgery. Results: The comparison of mean values, regardless of the type of surgery, shows that this mean value is on average higher in the first segment adjacent to the fused spine segment. The assessment of the intervertebral disc structure in BIL TLIF is higher in both the first and the second segment. Early disc degeneration progression is subtle yet detectable (UNI TLIF 9.28% vs. BIL TLIF 16.74%). The assessment of the intervertebral disc structure is on average lower in patients aged less than 50 years at time of surgery compared with patients aged more than 50 years in UNI TLIF, and higher in the BIL TLIF group, for both the first and the second segment. Conclusion: Patients who had undergone unilateral TLIF fusion surgery have a lower rate of early disc degenerative changes. Considering a significantly higher rate of progressive disc degenerative changes in the elderly with bilateral fusion surgery, extra caution is required in the selection of appropriate surgical technique.
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23
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5-Year Revision Rates After Elective Multilevel Lumbar/Thoracolumbar Instrumented Fusions in Older Patients: An Analysis of State Databases. J Am Acad Orthop Surg 2022; 30:476-483. [PMID: 35196291 DOI: 10.5435/jaaos-d-21-00643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/15/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The purpose of this study wasto evaluate cause-specific 5-year revision rates and risk factors for revision after elective multilevel lumbar instrumented fusion in older patients. METHODS Older patients (>60 years) who underwent elective multilevel (3+) lumbar instrumented fusions were identified in Healthcare Cost and Utilization Project state inpatient databases and followed for 5 years for revision operations because of mechanical failure, degenerative disease (DD), infection, postlaminectomy syndrome, and stenosis. Cox proportional hazards multivariate analyses were conducted to determine risk factors associated with revision for each diagnostic cause. RESULTS The cohort included 5,636 patients (female-3,285; average age-71.6 years). Most of the operations were 3 to 7 levels (97.4%), and the mean length of stay was 5.4 days. The overall 5-year revision rate was 16.5% with predominant etiologies of DD (50.7%), mechanical failure (32.2%), and stenosis (8.0%). The revision procedure at the index operation was associated with an increased revision risk for DD (hazards ratio [HR] = 1.59, 95% confidence interval [CI], 1.29 to 1.98, P < 0.001) and mechanical failure (HR = 1.56, 95% CI, 1.19 to 2.04, P = 0.020). Male sex was associated with a significantly reduced revision risk for DD (HR = 0.75, 95% CI, 0.62 to 0.91, P = 0.04). Age, race, and number of comorbidities had no notable effect on the overall or cause-specific risk of revision. DISCUSSION In this large database analysis, DD and mechanical failure were the most common etiologies comprising a 5-year revision rate of 16.5% after elective multilevel lumbar instrumented fusion in older patients. Revision operations and female patients carried the strongest risks for revision.
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24
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Hood C, Zamani R, Akrami M. Impact of heterotopic ossification following lumbar total disk replacement: a systematic review. BMC Musculoskelet Disord 2022; 23:382. [PMID: 35461244 PMCID: PMC9034498 DOI: 10.1186/s12891-022-05322-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND CONTEXT Lumbar total disc replacement (TDR) is an alternative to lumbar fusion in the treatment of lower back pain and reduces the risk of adjacent segment degeneration. Heterotopic ossification (HO) has been identified as a common complication following lumbar TDR. PURPOSE This systematic review aims to determine the prevalence, risk factors and clinical and radiological impact of HO following lumbar TDR. STUDY DESIGN Systematic Review. METHODS MEDLINE, Scopus, PubMed and Cochrane Central were searched for articles that referred to lumbar TDR and HO. The hits were assessed against inclusion and exclusion criteria. Data from each included study was extracted and analysed with respect to the study aims. RESULTS Twenty-six studies were included in this review and the pooled prevalence of HO was estimated to be between 13.2% (participants) and 15.3% (vertebral levels). TDR clinical outcomes were not found to be reduced by HO and there was insufficient data to identify a given impact upon radiological outcomes. Age and follow up time were identified as potential risk factors for HO. CONCLUSIONS This review was hampered by inconsistencies in the reporting of HO across the studies. We therefore recommend that a set of guidelines should be produced to aid future researchers and reduce the risk of bias.
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Affiliation(s)
- Colleen Hood
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Reza Zamani
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Mohammad Akrami
- Department of Engineering, University of Exeter, Exeter, UK.
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25
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Tan QC, Huang JF, Bai H, Liu ZX, Huang XY, Zhao X, Yang Z, Du CF, Lei W, Wu ZX. Effects of Revision Rod Position on Spinal Construct Stability in Lumbar Revision Surgery: A Finite Element Study. Front Bioeng Biotechnol 2022; 9:799727. [PMID: 35071208 PMCID: PMC8766337 DOI: 10.3389/fbioe.2021.799727] [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] [Received: 10/22/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
Revision surgery (RS) is a necessary surgical intervention in clinical practice to treat spinal instrumentation–related symptomatic complications. Three constructs with different configurations have been applied in RS. One distinguishing characteristic of these configurations is that the revision rods connecting previous segments and revision segments are placed alongside, outside, or inside the previous rods at the level of facetectomy. Whether the position of the revision rod could generate mechanical disparities in revision constructs is unknown. The objective of this study was to assess the influence of the revision rod position on the construct after RS. A validated spinal finite element (FE) model was developed to simulate RS after previous instrumented fusion using a modified dual-rod construct (DRCm), satellite-rod construct (SRC), and cortical bone trajectory construct (CBTC). Thereafter, maximum von Mises stress (VMS) on the annulus fibrosus and cages and the ligament force of the interspinous ligament, supraspinous ligament, and ligamentum flavum under a pure moment load and a follower load in six directions were applied to assess the influence of the revision rod position on the revision construct. An approximately identical overall reducing tendency of VMS was observed among the three constructs. The changing tendency of the maximum VMS on the cages placed at L4-L5 was nearly equal among the three constructs. However, the changing tendency of the maximum VMS on the cage placed at L2-L3 was notable, especially in the CBTC under right bending and left axial rotation. The overall changing tendency of the ligament force in the DRCm, SRC, and CBTC was also approximately equal, while the ligament force of the CBTC was found to be significantly greater than that of the DRCm and SRC at L1-L2. The results indicated that the stiffness associated with the CBTC might be lower than that associated with the DRCm and SRC in RS. The results of the present study indicated that the DRCm, SRC, and CBTC could provide sufficient stabilization in RS. The CBTC was a less rigid construct. Rather than the revision rod position, the method of constructing spinal instrumentation played a role in influencing the biomechanics of revision.
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Affiliation(s)
- Quan-Chang Tan
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China.,Department of Orthopaedics, Air Force Hospital of Eastern Theater Command, Nanjing, China
| | - Jin-Feng Huang
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Hao Bai
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Zi-Xuan Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Xin-Yi Huang
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Xiong Zhao
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Zhao Yang
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Cheng-Fei Du
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Wei Lei
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Zi-Xiang Wu
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
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26
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Pinto EM, Teixeira A, Frada R, Atilano P, Miranda A. Surgical risk factors associated with the development of adjacent segment pathology in the lumbar spine. EFORT Open Rev 2021; 6:966-972. [PMID: 34760295 PMCID: PMC8559561 DOI: 10.1302/2058-5241.6.210050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Adjacent segment pathology (ASP) is a major cause of disability, and the recognition of the surgical risk factors associated with the development of this condition is essential for its prevention. Different surgical approaches, from decompression without fusion to non-instrumented and instrumented fusion, have distinct contributions to the development of ASP. Although motion-preservation procedures could reduce the prevalence of ASP, these are also associated with a higher percentage of complications. Several risk factors associated with previous surgery, namely the chosen surgical approach and anatomical dissection, the choice of interbody fusion, the increment and length of the fusion, and the restoration of sagittal alignment, may influence the development of ASP.
Cite this article: EFORT Open Rev 2021;6:966-972. DOI: 10.1302/2058-5241.6.210050
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Affiliation(s)
- Eduardo Moreira Pinto
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Artur Teixeira
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Ricardo Frada
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Pedro Atilano
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - António Miranda
- Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal
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27
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Evaluation of the reduction, tightening and gripping performance of an innovative set screw technology for instrumented posterior lumbar fusion: A biomechanical study. Orthop Traumatol Surg Res 2021; 107:102918. [PMID: 33812093 DOI: 10.1016/j.otsr.2021.102918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Instrumented posterior lumbar fusion with top-loading pedicle screw systems (PSS) requires fully tightened set screws to achieve a secure fixation and symmetric load condition. This assumes a complete reduction of the rod by 90°, which is not always attainable in situ, especially under constraint. The objective of this work is to compare the mechanical performance of different innovative set screw technologies, which should improve the tightening process. HYPOTHESIS The hypotheses of the study are that modifications to the screw and screwdriver unit can (1) improve the quality of set screw tightening and (2) increase the axial gripping capacity of the construct. MATERIALS AND METHODS The four set screw technologies under investigation include a standard set screw with a flat surface (F-S; control group), a set screw with a convex surface (C-S) and a shaft tip method screwdriver used in combination with both flat (F-STM) and convex set screws (C-STM). The quality of set screw tightening is categorized as follows: failed=the rod is not completely reduced; reduced=the rod is successfully reduced but the set screw is not correctly fixed; good=remaining cases. An axial gripping capacity test is performed by a universal testing machine (Instron®) with a force capacity of 5kN. RESULTS Regarding the quality of set screw tightening, comparisons between F-S vs. F-STM, F-S vs. C-STM and between C-S vs. C-STM show statistically significant differences (p<0.001). The axial gripping capacity test shows mean gripping forces of 1223N (STD 331) in the F-STM group and of 1724N (STD 168) in the C-STM group with statistically significant differences between both groups (p=0.003). DISCUSSION Several biomechanical and clinical case studies have identified possible effects of misaligned rod-screw interfaces such as screw pull-out during rod reduction, screw loosening, screw or rod breakage, misalignment, adjacent segment degeneration and worsening of the clinical outcome. C-STM-technology thus supports controlled fixation in the sense of applying appropriate forces for correction or fixation during PSS assembly as well as friction-reduced final alignment and tightening with the aim to reduce implant loosening, hardware failure and reoperations, while respecting anatomical and biomechanical balance.
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28
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Maharjan S, Zeng Z, Yu Y, Cheng L. A Retrospective Analysis of Superior Facet Joint Violation Between Open and Minimally Invasive Transforaminal Lumbar Interbody Fusion and its Relation to Adjacent Segment Disease. Clin Spine Surg 2021; 34:E256-E263. [PMID: 38011510 DOI: 10.1097/bsd.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim was to analyze the superior facet joint violation (SFV) between open transforaminal lumbar interbody fusion (open-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and its effect on the superior and inferior adjacent segment disc height, segmental lordosis, lumbar lordosis, and facet joint degeneration. SUMMARY OF BACKGROUND DATA We compared SFV between open-TLIF and MIS-TLIF and its correlation with different factors as well as its effect on adjacent segment disease. MATERIALS AND METHODS We retrospectively studied data of patients undergoing single level TLIF surgery from January 2013 to February 2016 in single institutional hospital. Axial and coronal postoperative computed tomography scan images were used to analyze SFV. In secondary analysis patients were divided into nonfacet violation group (NSFVG) and facet violation group (SFVG) and compared the changes on the superior and inferior adjacent level disc height, segmental lordosis, lumbar lordosis, and facet joint degeneration. RESULTS Mean SFV grade was significantly greater in MIS-TLIF compared with open-TLIF (odds ratio: 0.638, confidence interval: 0.431-0.944; P=0.025). There was more grade 2 (10.71% vs. 5.60%) and grade 3 (4.46% vs. 1.29%) SFV in MIS-TLIF. Patient with age below 60 and body mass index (BMI) >30 kg/m2 in MIS-TLIF were more prone to high-grade SFV compared with open-TLIF. Further, logistic regression showed patients with BMI ≥30 kg/m2 has 7.137 increased odds of high-grade SFV (95% confidence interval: 3.261-15.618; P=0.000) compared with patients with BMI <30 kg/m2. Compared with NSFVG, SFVG has more SFV (0.096±0.244 vs. 0.177±0.317; P=0.012) and less improvement in lumbar visual analog scale scores -0.65±0.073 versus -0.67±0.074 (P=0.006). CONCLUSION MIS-TLIF has more high-grade SFV as well as overall mean SFV in comparison to open-TLIF with BMI >30 kg/m2 and location of pedicle screw as an independent risk factor for SFV and risk of adjacent segment disease increases with SFV. LEVEL OF STUDY Level III.
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Affiliation(s)
- Sujan Maharjan
- Department of Orthopaedics and Spine Surgery, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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29
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Kapetanakis S, Gkantsinikoudis N, Gkasdaris G, Charitoudis G. Treatment of adjacent segment disease with percutaneous transforaminal endoscopic discectomy: Early experience and results. J Orthop Surg (Hong Kong) 2021; 28:2309499020960560. [PMID: 32990158 DOI: 10.1177/2309499020960560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Adjacent segment disease (ASD) constitutes a long-term complication of instrumented spinal fusion. Aim of this study is to analyze the utilization of percutaneous transforaminal endoscopic discectomy (PTED) for the treatment of symptomatic ASD, emphasizing basically in the postoperative course. METHODS A prospective study with 35 patients was designed. Patients enrolled in our study were distributed in two different groups. Group A constituted of 15 patients featuring ASD as a complication of a previously conducted lumbar spinal fusion. Group B was composed of 20 patients, presenting simple lumbar disc herniation (LDH). All patients were subjected to successful PTED for LDH. Patients were evaluated at regular intervals in 6-week and 3-, 6-, and 12-month postoperatively. Visual analog scale was utilized for leg (VAS-LP) and low back pain (VAS-BP) evaluation. Health-related quality of life was assessed with short-form 36 health survey questionnaire (SF-36). RESULTS VAS-BP scores were statistically significantly differentiated between the two groups in all intervals of follow-up. In contrast, VAS-LP scores demonstrated statistically significant differentiation in none of follow-up intervals, indicating similar results between the two groups. Maximal improvement was in both cases for all patients observed in 6-week postoperatively, with subsequent stabilization. SF-36 preoperative evaluation denoted a statistically significant differentiation in bodily pain and role emotional parameters, which was continually until the end of follow-up observed. The other SF-36 parameters featured similar values between the two groups preoperatively as well as during the follow-up intervals. CONCLUSION PTED is capable of successfully dealing with LDH and furthermore with complications of fusion as ASD.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, 69021Interbalkan European Medical Center, Thessaloniki, Greece
| | - Nikolaos Gkantsinikoudis
- Spine Department and Deformities, 69021Interbalkan European Medical Center, Thessaloniki, Greece
| | - Grigorios Gkasdaris
- Spine Department and Deformities, 69021Interbalkan European Medical Center, Thessaloniki, Greece
| | - Georgios Charitoudis
- Spine Department and Deformities, 69021Interbalkan European Medical Center, Thessaloniki, Greece
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Tan QC, Wang D, Yang Z, Zhao XL, Zhang Y, Yan YB, Feng YF, Lei W, Zhao X, Wu ZX. Implant Preservation versus Implant Replacement in Revision Surgery for Adjacent Segment Disease After Thoracolumbar Instrumentation: A Retrospective Study of 43 Patients. World Neurosurg 2021; 150:e511-e519. [PMID: 33744424 DOI: 10.1016/j.wneu.2021.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the mechanical properties of a new connector rod aiming to preserve implants in revision surgery (RS) for adjacent segment disease, a problematic complication of instrumented spinal fusion, and to assess its clinical applicability. METHODS The mechanical properties of the connector-rod construct (implant preservation) and traditional rod construct (implant replacement) were evaluated and compared. Forty-three patients underwent RS for adjacent segment disease in the thoracolumbar spine with implant preservation or replacement, and radiological and clinical outcomes were assessed. RESULTS Mechanical properties in group A were comparable to those in group B. Total mean time from prior surgery to RS was 6.86 ± 1.08 years. Surgical time and blood loss values of group A were 40.14% and 29.29% statistically significantly smaller than values of group B. In group B, 12% (3/25) of patients developed surgical site infections. In both groups, the visual analog scale leg score decreased significantly after RS. Early postoperative (at 1-month and 3-month follow-up) Oswestry Disability Index and visual analog scale back scores of group A were significantly lower than those of group B; the difference in the visual analog scale back score between groups was significant until the 6-month follow-up. No implant failures occurred, and spinal fusion was achieved in all cases. CONCLUSIONS The connector rod is considered safe and can reduce the surgical time, blood loss, risk of complications, and medical costs. Better early postoperative clinical outcomes can be achieved with the rod owing to less surgical trauma.
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Affiliation(s)
- Quan-Chang Tan
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China; Department of Orthopaedics, Air Force Hospital of Eastern Theater Command, Nanjing, China
| | - Di Wang
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Zhao Yang
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Xiao-Lei Zhao
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yang Zhang
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Ya-Bo Yan
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Ya-Fei Feng
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Wei Lei
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Xiong Zhao
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Zi-Xiang Wu
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China.
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Wu X, Ma Y, Ding R, Xiao X, Yang D. Should adjacent asymptomatic lumbar disc herniation be simultaneously rectified? A retrospective cohort study of 371 cases that received an open fusion or endoscopic discectomy only on symptomatic segments. Spine J 2021; 21:411-417. [PMID: 32947038 DOI: 10.1016/j.spinee.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In the treatment of multiple disc herniations, the decision of whether to include the presumed asymptomatic lumbar disc herniation (asLDH) at adjacent segments remains uncertain. On the one hand, the untouched asLDH might soon become symptomatic and require treatment. On the other hand, additional surgery involving more segments will introduce greater risk, complications, and cost. PURPOSE To investigate the prognosis of untreated asLDH after open fusion or percutaneous endoscopic lumbar discectomy (PELD) on symptomatic lumbar disc herniation (LDHs) in patients. STUDY DESIGN This is a retrospective cohort study. PATIENT SAMPLE A total of 371 patients with multiple disc herniations who underwent open discectomy and fusion or PELD only for symptomatic levels from January 2012 to July 2018 were included. OUTCOME MEASURES The primary outcome of interest was the development of symptomatic LDH at the previous asLDH of both groups that required reoperation. A second analysis was performed to compare the reoperation rate due to deterioration of asLDH among different severity grades of herniation. Reoperation rates of the original surgery at the symptomatic segment in both fusion and PELD groups were also reviewed. METHODS The patients were divided into two groups based on the surgical procedure, with 264 patients undergoing fusion surgery and 107 patients undergoing PELD. Clinical and imaging follow-ups were performed at routine intervals for more than 3 years. The reoperation rates due to deterioration of previously asLDH and failure of original surgery were investigated and compared between the two groups, as well as among the different severity grades of herniation. RESULTS The follow-up times were 48.2±24.2 and 41.1±17.5 months for the fusion and the PELD groups, respectively. The overall reoperation rate at the previous adjacent asLDH was 6.7% (25/317). According to the severity of the asLDH, a higher grade of asymptomatic herniation yielded a significantly higher rate of reoperation rate in both groups. If the nerve root was displaced by disc material prominently (nG2), the reoperation rate of asLDHs was 42.9% (3/7) in the fusion group and 20% (3/15) in the PELD group. Twenty out of 264 patients (7.6%) in the fusion group and 5 out of 107 patients (4.7%) in the PELD group required reoperation due to deterioration of asLDH. Reoperation rates due to failure of the original surgery were 7.6% (20/264) in the fusion group and 8.4% (9/107) in the PELD group. CONCLUSIONS With multilevel LDHs, if the asLDH is left untreated, the reoperation rate is closely related to the degree of herniation. When confronting an asLDH graded as G2, a high possibility of reoperation should be clearly discussed with the patient, regardless of open fusion or PELD techniques. Considering that fusion and minimally invasive nonfusion techniques did not yield significantly different overall reoperation rates, ongoing degeneration seemed to have a greater contribution in terms of the deterioration of asLDH.
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Affiliation(s)
- Xiaoliang Wu
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yangyang Ma
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruoting Ding
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao Xiao
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dehong Yang
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Yu T, Zheng L, Chen G, Wang N, Wang X, Song C, Yan J, Xi C. A Study to Compare the Efficacy of a Biodegradable Dynamic Fixation System With Titanium Devices in Posterior Spinal Fusion Between Articular Processes in a Canine Model. J Biomech Eng 2021; 143:031010. [PMID: 33210131 DOI: 10.1115/1.4049154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Indexed: 11/08/2022]
Abstract
The objective of this study was to apply a biodegradable dynamic fixation system (BDFS) for lumbar fusion between articular processes and compare the fusion results and biomechanical changes with those of conventional rigid fixation. Twenty-four mongrel dogs were randomly assigned to 2 groups and subjected to either posterior lumbar fusion surgery with a BDFS or titanium rods (TRs) at the L5-L6 segments. Six animals in each group were sacrificed at 8 or 16 weeks. Fusion conditions were evaluated by computed tomography (CT), manual palpation, biomechanical tests, and histological analysis. Biomechanical tests were performed at the L4-7 (for range of motion (ROM)) and L5-6 (for fusion stiffness) segments. Histological examination was performed on organs, surrounding tissues, and the fused area. The magnesium alloy components maintained their initial shape 8 weeks after the operation, but the meshing teeth were almost completely degraded at 16 weeks. The biomechanical analysis revealed an increased lateral bending ROM at 8 weeks and axial torsion ROM at 16 weeks. The L4-5 extension-flexion ROMs in the BDFS group were 2.29 ± 0.86 deg and 3.17 ± 1.08 deg at 16 weeks, respectively, compared with 3.22 ± 0.56 deg and 5.55 ± 1.84 deg in TR group. However, both groups showed similar fusion results. The BDFS design is suitable, and its degradation in vivo is safe. The BDFS can be applied for posterior lumbar fusion between articular processes to complete the fusion well. Additionally, the BDFS can reduce the decline in lateral motion and hypermotion of the cranial adjacent segment in flexion-extension motion.
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Affiliation(s)
- Tailong Yu
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Harbin, Heilongjiang 150001, China
| | - Leyu Zheng
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Harbin, Heilongjiang 150001, China
| | - Guanghua Chen
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Harbin, Heilongjiang 150001, China
| | - Nanxiang Wang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, Guangdong 510000, China
| | - Xiaoyan Wang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Harbin, Heilongjiang 150001, China
| | - Chengchao Song
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Harbin, Heilongjiang 150001, China
| | - Jinglong Yan
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Xuefu Road 246#, Harbin, Heilongjiang 150001, China
| | - Chunyang Xi
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Xuefu Road 246#, Harbin, Heilongjiang 150001, China
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Ahlquist S, Thommen R, Park HY, Sheppard W, James K, Lord E, Shamie AN, Park DY. Implications of sagittal alignment and complication profile with stand-alone anterior lumbar interbody fusion versus anterior posterior lumbar fusion. JOURNAL OF SPINE SURGERY 2020; 6:659-669. [PMID: 33447668 DOI: 10.21037/jss-20-595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Anterior lumbar interbody fusion (ALIF) is commonly utilized in lumbar degenerative pathologies. Standalone ALIF (ST-ALIF) systems were developed to avoid added morbidity, surgical time, and cost of anterior and posterior fusion (APF). Controversy exists in the literature about which of these two techniques yields superior clinical and radiographic outcomes, and few studies have directly compared them. This study seeks to compare ST-ALIF and APF in terms of sagittal correction and surgical complications. Methods Ninty-two consecutive ALIF cases performed from 2013-2018 were retrospectively reviewed and separated into 2 groups. Radiographic measurements were performed on pre- and post-operative radiographs, including segmental lordosis (SL), lumbar lordosis (LL), and pelvic incidence-lumbar lordosis mismatch (PI-LL). Surgical complications were determined. Statistical analysis was performed using chi-square test of homogeneity, Fisher's exact test, and independent sample t-test. Comparisons between groups were deemed statistically significant at the P<0.05 threshold. Results Fifty-seven ST-ALIF, 35 APF were identified. There were no differences in age, gender, BMI, Charlson Comorbidity Index (CCI), preoperative diagnosis, or surgical level between the 2 cohorts. Bone Morphogenetic Protein (BMP) was utilized in 24.6% of ST-ALIF versus none of APF (P=0.001). No differences were detected in SL, LL, and PI-LL mismatch. ST-ALIF cohort had significantly greater risk of subsidence and revision surgery versus APF (12.3% vs. 0%, RD 95% CI: 3.8-20.8%, P=0.042). Recurrent spondylolisthesis occurred in 5 ST-ALIF cases, 3 cases with implant failure, and 2 nonunions versus none in the APF group. Conclusions ST-ALIF was associated with significantly greater subsidence and revision surgery versus APF. Careful patient selection is paramount when considering ST-ALIF. The potential for revision surgery may offset the potential benefit in avoiding posterior fusion. Despite the greater risk of subsidence, sagittal alignment was not significantly affected.
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Affiliation(s)
- Seth Ahlquist
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Rachel Thommen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Howard Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - William Sheppard
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Kevin James
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Elizabeth Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Arya N Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
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Lumbar interbody fusion: recent advances in surgical techniques and bone healing strategies. 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; 30:22-33. [DOI: 10.1007/s00586-020-06596-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/26/2020] [Accepted: 09/05/2020] [Indexed: 12/31/2022]
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Investigation of Alterations in the Lumbar Disc Biomechanics at the Adjacent Segments After Spinal Fusion Using a Combined In Vivo and In Silico Approach. Ann Biomed Eng 2020; 49:601-616. [PMID: 32785861 DOI: 10.1007/s10439-020-02588-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
The development of adjacent segment degeneration (ASD) is a major concern after lumbar spinal fusion surgery, but the causative mechanisms remain unclear. This study used a combined in vivo and in silico method to investigate the changes of anatomical dimensions and biomechanical responses of the adjacent segment (L3-4) after spinal fusion (L4-S1) in five patients under weight-bearing upright standing conditions. The in vivo adjacent disc height changes before and after fusion were measured using a dual fluoroscopic imaging system (DFIS), and the measured in vivo intervertebral positions and orientations were used as displacement boundary conditions of the patient-specific three-dimensional (3D) finite element (FE) disc models to simulate the biomechanical responses of adjacent discs to fusion of the diseased segments. Our data (represented by medians and 95% confidence intervals) showed that a significant decrease by - 0.8 (- 1.2, - 0.4) mm (p < 0.05) in the adjacent disc heights occurred at the posterior region after fusion. The significant increases in disc tissue strains and stresses, 0.32 (0.21, 0.43) mm/mm (p < 0.05) and 1.70 (1.07, 3.60) MPa (p < 0.05), respectively, after fusion were found in the posterolateral portions of the outermost annular lamella. The intradiscal pressure of the adjacent disc was significantly increased by 0.29 (0.13, 0.47) MPa after fusion (p < 0.05). This study demonstrated that fusion could cause alterations in adjacent disc biomechanics, and the combined in vivo and in silico method could be a valuable tool for the quantitative assessment of ASD after fusion.
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Kim SK, Park SW, Lim BC, Lee SC. Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases. J Neurol Surg A Cent Eur Neurosurg 2020; 81:392-398. [PMID: 32361983 DOI: 10.1055/s-0040-1709164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND STUDY AIM Reoperation for lumbar spinal stenosis (LSS) is technically challenging. Studies comparing preoperative risk factors and reoperation outcomes between spinal fusion and spinal decompression are limited. Thus this study compared fusion and decompression with respect to reoperation rates, preoperative factors related to re-surgery, and clinical outcomes. PATIENTS AND METHODS This retrospective cohort study included prospectively collected data from patients who underwent revision surgeries for degenerative LSS between May 2001 and March 2015. The reoperation rate, risk factors (proportional hazards analysis of index surgery), surgery type, main reason for revision, and final clinical outcomes (pain, quality-of-life modification, patient satisfaction, and complication rate) were analyzed and compared between the fusion and decompression surgeries. RESULTS Among 987 cases during 13 years, 25 cases of reoperation after fusion and 23 cases of reoperation after decompression were identified, accounting for reoperation rates of 5.88% and 4.00%, respectively. Combined comorbidities (hazard ratio [HR]: 1.98 for fusion; multilevel involvement [with fusion, HR: 2.92; decompression, HR: 1.95]) were strongly correlated with preoperative demographic risk factor for each procedure. The main reason for reoperation in fusion cases was proximal junctional kyphosis (40%) and implant failure (20%), and in decompression cases, recurrent lesions (48.8%) and incomplete surgery (17.4%) An additional fusion after initial fusion and re-decompression without fusion after initial decompression were the most common surgical procedure. Back pain and patient satisfaction after fusion were better compared with those after decompression. CONCLUSION The reoperation rate, preoperative risk factors, reason for revision, reoperation type, clinical outcomes, patient satisfaction, and time interval between index and re-surgery were different between the primary fusion and primary decompression. A better understanding of disease pathophysiology and surgical procedure characteristics will facilitate improvement in disease management and the development of treatment strategies.
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Affiliation(s)
- Seung-Kook Kim
- Himchan UHS Spine and Joint Centre, University Hospital Sharjah, Sharjah, United Arab Emirates.,Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Incheon, Korea.,Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, Seoul, Korea
| | - Seoung-Woo Park
- Department of Neurosurgery, College of Medicine, Graduate School, Kangwon National University, Chuncheon, Korea
| | - Byun-Chul Lim
- Department of Neurosurgery, College of Medicine, Graduate School, Kangwon National University, Chuncheon, Korea
| | - Su-Chan Lee
- Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, Seoul, Korea
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Bae IS, Bak KH, Chun HJ. Interspinous Process Fixation Device Versus Extended Pedicle Screw Fixation for Symptomatic Adjacent Segment Disease: 3-Year Retrospective Study. World Neurosurg 2020; 139:e144-e150. [PMID: 32251823 DOI: 10.1016/j.wneu.2020.03.147] [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: 03/03/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In the present study, we compared the clinical and radiographic outcomes of an interspinous process fixation device (IFD) with those of extended pedicle screw fixation (PSF) for symptomatic adjacent segment disease (ASD) after lumbar fusion. METHODS The data from 109 patients with ASD treated with IFD (n = 48) or extended PSF (n = 61) from January 2009 to January 2016 were reviewed retrospectively. The clinical outcomes were measured using a visual analog scale (VAS) and the Oswestry disability index. The radiographic outcomes included the fusion rate, incidence of cage subsidence, and additional radiographic ASD. RESULTS The mean incision length, operative time, blood loss, and length of hospital stay were significantly lower in the IFD group (P < 0.001). Postoperative back and leg pain were relieved in both groups (P < 0.001). The mean preoperative VAS scores were 8.3 ± 1.3 and 8.5 ± 1.1 in the IFD and PSF groups and had improved to 2.8 ± 1.1 and 2.7 ± 1.2 after 36 months, respectively (P < 0.001). At 36 months postoperatively, 10 of the 56 patients (17.9%) in the PSF group had developed additional radiographic ASD compared with 2 of 44 patients (4.5%) in the IFD group. CONCLUSION Our results have demonstrated that in the treatment of symptomatic ASD, comparable clinical and radiologic outcomes can be achieved using IFD, which has a shorter skin incision, shorter operative time, less intraoperative blood loss, and shorter hospital stay than the extended PSF technique. Although not statistically significant, the IFD resulted in a lower ASD incidence compare with the PSF technique. Thus, IFD might be an alternative surgical method for symptomatic ASD after lumbar spine fusion.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Nowon Eulji Medical Center, Nowon-gu, Republic of Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea.
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea
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Burch MB, Wiegers NW, Patil S, Nourbakhsh A. Incidence and risk factors of reoperation in patients with adjacent segment disease: A meta-analysis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:9-16. [PMID: 32549706 PMCID: PMC7274364 DOI: 10.4103/jcvjs.jcvjs_10_20] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
Study Design: This was a systematic review of the literature and meta-analysis. Objective: The objective of this study was to evaluate the current literature regarding the risk factors contributing to reoperation due to adjacent segment disease (ASD). Summary of Background Data: ASD is a broad term referring to a variety of complications which might require reoperation. Revision spine surgery is known to be associated with poor clinical outcomes and high rate of complications. Unplanned reoperation has been suggested as a quality marker for the hospitals. Materials and Methods: An electronic search was conducted using PubMed. A total of 2467 articles were reviewed. Of these, 55 studies met our inclusion criteria and included an aggregate of 1940 patients. Data were collected pertaining to risk factors including age, sex, fusion length, lumbar lordosis, body mass index, pelvic incidence, sacral slope, pelvis tilt, initial pathology, type of fusion procedure, floating versus sacral or pelvic fusion, presence of preoperative facet or disc degeneration at the junctional segment, and sagittal orientation of the facets at the junctional segment. Analysis of the data was performed using Comprehensive Meta-Analysis software (Biostat, Inc.). Results: The overall pooled incidence rate of reoperation due to ASD from all included studies was 0.08 (confidence interval: 0.065–0.098). Meta-regression analysis demonstrated no significant interaction between age and reoperation rate (P = 0.48). A comparison of the event rates between males and females demonstrated no significant difference between male and female reoperation rates (P = 0.58). There was a significantly higher rate of ASD in patients with longer fusion constructs (P = 0.0001). Conclusions: We found that 8% of patients in our included studies required reoperation due to ASD. Our analysis also revealed that longer fusion constructs correlated with a higher rate of subsequent revision surgery. Therefore, the surgeon should limit the number of fusion levels if possible to reduce the risk of future reoperation due to ASD. Level of evidence: IV
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Affiliation(s)
- Major B Burch
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, MO, USA
| | - Nicholas W Wiegers
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, MO, USA
| | - Sonal Patil
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Ali Nourbakhsh
- Department of Orthopedic Surgery, Spine Surgery Division, Atlanta Medical Center, Atlanta, GA, USA
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Liu Z, Zhang P, Li W, Xu Z, Wang X. Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up. J Orthop Surg Res 2020; 15:99. [PMID: 32156304 PMCID: PMC7063822 DOI: 10.1186/s13018-020-01616-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no comparative study with long-term follow-up between posterior-only and combined posterior-anterior approaches in treating lumbar spinal tuberculosis (LSTB) and lumbosacral spinal tuberculosis (LSSTB). This retrospective study aimed to compare and evaluate the long-term outcomes of these two surgical approaches in LSTB and LSSTB. METHODS Thirty patients with LSTB and 12 patients with LSSTB underwent posterior-only approach (group A); 26 patients with LSTB and 14 patients with LSSTB were managed with combined posterior-anterior approaches (group B). Analysis and comparison in clinical and radiographic outcomes between the two groups were performed. RESULTS The intra-operative bleeding amount, surgery time, and hospitalization days in group A were less than that in group B (P < 0.05). These patients were followed for a minimum of 7 years. All patients achieved completely healing within 2-year follow-up. Bony fusion was obtained in all patients. The visual analog scale, Japanese Orthopedic Association score, Oswestry Disability index, and Kirkaldy-Willis functional evaluation at the final visit demonstrated that all patients in both groups achieved satisfactory results. There was no significant difference in angle correction or maintaining correction between combined posterior-anterior approaches and posterior-only approach (P > 0.05). Complications occurred in both groups. CONCLUSIONS Both combined posterior-anterior approaches and posterior-only approach can achieve satisfactory clinical and radiological outcomes of long-term in treating LSTB and LSSTB, while posterior-only approach can safely and effectively achieve lesion debridement, decompression, and stability reconstruction and maintenance with the advantages of less invasive surgery, less bleeding, shorter surgery time, and hospital stay, and fewer complications. So, posterior-only approach seemed to be superior to the combined posterior-anterior one.
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Affiliation(s)
- Zheng Liu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Penghui Zhang
- The Orthopedics Department, the Seventh Affiliated Hospital, Sun Yat-sen University, 628#Zhenyuan Road, Zhenmei Community, Guangming District, Shenzhen, 518107, Guangdong, People's Republic of China
| | - Weiwei Li
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Zhengchao Xu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Xiyang Wang
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China. .,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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Mendoza-Elias N, Dunbar M, Ghogawala Z, Whitmore RG. Opioid Use, Risk Factors, and Outcome in Lumbar Fusion Surgery. World Neurosurg 2020; 135:e580-e587. [DOI: 10.1016/j.wneu.2019.12.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
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Liu Z, Li W, Xu Z, Wang X, Zeng H. One-stage posterior debridement, bone grafting fusion, and mono-segment vs. short-segment fixation for single-segment lumbar spinal tuberculosis: minimum 5-year follow-up outcomes. BMC Musculoskelet Disord 2020; 21:86. [PMID: 32033563 PMCID: PMC7007649 DOI: 10.1186/s12891-020-3115-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the clinical and radiological outcomes between posterior mono-segment and short-segment fixation combined with one-stage posterior debridement and bone grafting fusion in treating single-segment lumbar spinal tuberculosis (LSTB). METHODS Sixty-two patients with single-segment LSTB treated by a posterior-only approach were divided into two groups: short-segment fixation (Group A, n = 32) and mono-segment fixation (Group B, n = 30). The clinical and radiographic outcomes were analyzed and compared between the two groups. RESULTS The intraoperative bleeding volume, operation time, and hospitalization duration were lower in Group B than in Group A. All patients achieved the bony fusion criteria. The visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were substantially improved 3 months postoperatively and at the last visit in both groups, with no significant difference between the two groups (P > 0.05). Kirkaldy-Willis functional evaluation at the final follow-up demonstrated that all patients in both groups achieved excellent or good results. The difference in the angle correction rate and correction loss between Groups A and B was not significant (P > 0.05). CONCLUSIONS One-stage posterior debridement, bone grafting fusion, and mono-segment or short-segment fixation can provide satisfactory clinical and radiological outcomes. Mono-segment fixation is more suitable for the treatment of single-segment LSTB because the lumbar segments with normal motion can be preserved with less trauma, a shorter operation time, shorter hospitalization, and lower costs.
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Affiliation(s)
- Zheng Liu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Weiwei Li
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Zhengchao Xu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Xiyang Wang
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
- Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
| | - Hao Zeng
- Department of Spinal Surgery, the First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Rd, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of Regenerative Medicine, Nanning, 530021, Guangxi, China
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Le Huec JC, Seresti S, Bourret S, Cloche T, Monteiro J, Cirullo A, Roussouly P. Revision after spinal stenosis surgery. 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; 29:22-38. [PMID: 31997016 DOI: 10.1007/s00586-020-06314-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: 11/08/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To make a literature review on spinal stenosis recurrence after a first surgery and edit rules to avoid this complication. METHODS We conducted two separate PUBMED searches to evaluate the revision post-stenosis and degenerative scoliosis surgery using the terms: lumbar vertebrae/surgery, spinal stenosis, spine, scoliosis and reoperation. The resulting papers were categorized into three groups: (1) those that evaluated reoperation post-simple decompression; (2) those that evaluated spinal decompression and fusion for short (3 levels or less) or long (more than 3 levels) segment spinal fusion; and (3) those diagnosing the stenosis during the surgery. RESULTS (1) We found 11 relevant papers that only looked at revision spine surgery post-laminectomy for spinal stenosis. (2) We found 20 papers looked at reoperation post-laminectomy and fusion amongst which there were two papers specifically comparing long-segment (> 3 level) and short-segment (3 or less levels) fusions. (3) In the unspecified group, we found only one article. Fifteen articles were excluded as they were not specifically looking at our objective criteria for revision surgery. In regard to revision post-adult deformity surgery, we found 18 relevant articles. CONCLUSIONS After this literature review and analysis of post-operative stenosis, it seems important to provide some advice to avoid revision surgeries more or less induced by the surgery. It looks interesting when performing simple decompression without fusion in the lumbar spine to analyse the risk of instability induced by the decompression and facet resection but also by a global balance analysis. Regarding pre-operative stenosis in a previously operated area, different causes may be evocated, like screw or cage malpositionning but also insufficient decompression which is a common cause. Intraoperatively, the use of neuromonitoring and intraoperative CT scan with navigation are useful tool in complex cases to avoid persisting stenosis. Pre-op analysis and planning are key parameters to decrease post-op problems. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- J C Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France.
| | - S Seresti
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - S Bourret
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - T Cloche
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - J Monteiro
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - A Cirullo
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - P Roussouly
- Centre Des Massues, Croix Rouge, 92 Rue Dr Ed Locard, 69005, Lyon, France
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Sutovsky J, Sutovska M, Kocmalova M, Kazimierova I, Pappova L, Benco M, Grendar M, Bredvold HH, Miklusica J, Franova S. Degenerative Lumbar Spondylolisthesis: Biochemical Aspects and Evaluation of Stabilization Surgery Extent in Terms of Adjacent Segment Disease Theory. World Neurosurg 2019; 121:e554-e565. [DOI: 10.1016/j.wneu.2018.09.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 01/11/2023]
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Selective Anterior Lumbar Interbody Fusion for Low Back Pain Associated With Degenerative Disc Disease Versus Nonsurgical Management. Spine (Phila Pa 1976) 2018. [PMID: 29529003 DOI: 10.1097/brs.0000000000002630] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE To evaluate the long-term outcomes of selective one- to two-level anterior lumbar interbody fusions (ALIFs) in the lower lumbar spine versus continued nonsurgical management. SUMMARY OF BACKGROUND DATA Low back pain associated with lumbar intervertebral disc degeneration is common with substantial economic impact, yet treatment remains controversial. Surgical fusion has previously provided mixed results with limited durable improvement of pain and function. METHODS Seventy-five patients with one or two levels of symptomatic Pfirrmann grades 3 to 5 disc degeneration from L3-S1 were identified. All patients had failed at least 6 months of nonsurgical treatment. Forty-two patients underwent one- or two-level ALIFs; 33 continued multimodal nonsurgical care. Patients were evaluated radiographically and the visual analog pain scale (VAS), Oswestry Disability Index (ODI), EuroQol five dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System scores for pain interference, pain intensity, and anxiety. As-treated analysis was performed to evaluate outcomes at a mean follow-up of 7.4 years (range: 2.5-12). RESULTS There were no differences in pretreatment demographics or nonsurgical therapy utilization between study arms. At final follow-up, the surgical arm demonstrated lower VAS, ODI, EQ-5D, and Patient-Reported Outcomes Measurement Information System pain intensity scores versus the nonsurgical arm. VAS and ODI scores improved 52.3% and 51.1% in the surgical arm, respectively, versus 15.8% and -0.8% in the nonsurgical arm. Single-level fusions demonstrated improved outcomes versus two-level fusions. The pseudarthrosis rate was 6.5%, with one patient undergoing reoperation. Asymptomatic adjacent segment degeneration was identified in 11.9% of patients. CONCLUSION Selective ALIF limited to one or two levels in the lower lumbar spine provided improved pain and function when compared with continued nonsurgical care. ALIF may be a safe and effective treatment for low back pain associated with disc degeneration in select patients who fail nonsurgical management. LEVEL OF EVIDENCE 3.
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Leveque JCA, Segebarth B, Schroerlucke SR, Khanna N, Pollina J, Youssef JA, Tohmeh AG, Uribe JS. A Multicenter Radiographic Evaluation of the Rates of Preoperative and Postoperative Malalignment in Degenerative Spinal Fusions. Spine (Phila Pa 1976) 2018; 43:E782-E789. [PMID: 29189645 DOI: 10.1097/brs.0000000000002500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter, retrospective, institutional-review-board -approved study at 18 institutions in the United States with 24 treating investigators. OBJECTIVE This study was designed to retrospectively assess the prevalence of spinopelvic malalignment in patients who underwent one- or two-level lumbar fusions for degenerative (nondeformity) indications and to assess the incidence of malalignment after fusion surgery as well as the rate of alignment preservation and/or correction in this population. SUMMARY OF BACKGROUND DATA Spinopelvic malalignment after lumbar fusion has been associated with lower postoperative health-related quality of life and elevated risk of adjacent segment failure. The prevalence of spinopelvic malalignment in short-segment degenerative lumbar fusion procedures from a large sample of patients is heretofore unreported and may lead to an under-appreciation of these factors in surgical planning and ultimate preservation or correction of alignment. METHODS Lateral preoperative and postoperative lumbar radiographs were retrospectively acquired from 578 one- or two-level lumbar fusion patients and newly measured for lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt. Patients were categorized at preop and postop time points as aligned if PI-LL < 10° or malaligned if PI-LL≥10°. Patients were grouped into categories based on their alignment progression from pre- to postoperative, with preserved (aligned to aligned), restored (malaligned to aligned), not corrected (malaligned to malaligned), and worsened (aligned to malaligned) designations. RESULTS Preoperatively, 173 (30%) patients exhibited malalignment. Postoperatively, 161 (28%) of patients were malaligned. Alignment was preserved in 63%, restored in 9%, not corrected in 21%, and worsened in 7% of patients. CONCLUSION This is the first multicenter study to evaluate the preoperative prevalence and postoperative incidence of spinopelvic malalignment in a large series of short-segment degenerative lumbar fusions, finding over 25% of patients out of alignment at both time points, suggesting that alignment preservation/restoration considerations should be incorporated into the decision-making of even degenerative lumbar spinal fusions. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | | | | | - Nitin Khanna
- Orthopaedic Specialists of Northwest Indiana, Munster, IN
| | | | | | | | - Juan S Uribe
- University of South Florida, Tampa, FL.,Barrow Neurologic Institute, Phoenix, AZ
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Reoperation of decompression alone or decompression plus fusion surgeries for degenerative lumbar diseases: a systematic review. 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; 28:1371-1385. [DOI: 10.1007/s00586-018-5681-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/23/2018] [Indexed: 10/28/2022]
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Lee GW, Shin JH. Comparative Study of Two Surgical Techniques for Proximal Adjacent Segment Pathology after Posterior Lumbar Interbody Fusion with Pedicle Screws: Fusion Extension using Conventional Pedicle Screw vs Cortical Bone Trajectory-Pedicle Screw (Cortical Screw). World Neurosurg 2018; 117:e154-e161. [PMID: 29883823 DOI: 10.1016/j.wneu.2018.05.218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To present a minimally invasive surgical technique using cortical bone trajectory pedicle screws (cortical screws [CS]) for adjacent segment pathology (ASP) after lumbar fusion surgery, and to thoroughly compare postoperative outcomes of surgical techniques with either a CS or conventional pedicle screws (PS) for ASP at a 1-year follow-up. METHODS Among 59 patients who underwent surgical treatment for proximal ASP after lumbar fusion surgery, 53 patients who met the study criteria (group A, 31 patients with conventional technique using PS; group B, 22 patients with minimally invasive technique using CS) were enrolled in the study. The primary outcome measure was the fusion rate at 1 year after surgery, and secondary outcome measures included patient satisfaction, clinical outcomes, radiologic outcomes, and surgical outcomes and complications. RESULTS Fusion at 1 year postsurgery was achieved by 90% of the patients in group A with PS and 91% of those in group B with CS (P > 0.99). Patient satisfaction at 1 month postsurgery (P = 0.03) and pain intensity within 1 month postsurgery (P = 0.04) were significantly better in group B compared with group A. Regarding surgical outcomes, blood loss was significantly less, operation time and length of hospital stay were significantly shorter, and the incision was significantly shorter n group B than in group A. Other clinical parameters and outcomes were similar in the 2 groups. CONCLUSIONS We suggest that a minimally invasive surgical technique using CS for ASP can be a viable alternative to a conventional surgical technique using PS.
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Affiliation(s)
- Gun Woo Lee
- Spine Center and Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea.
| | - Ji-Hoon Shin
- Spine Center and Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
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Tu Z, Li L, Wang B, Li Y, Lv G, Dai Y. Stand-Alone Anterolateral Interbody Fusion Versus Extended Posterior Fusion for Symptomatic Adjacent-Segment Degeneration: A Retrospective Study of 2 Years' Follow-up. World Neurosurg 2018; 115:e748-e755. [PMID: 29729460 DOI: 10.1016/j.wneu.2018.04.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/20/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the clinical and radiologic outcome of stand-alone anterolateral lumbar interbody fusion (ALLIF) using self-locked cages in comparison with extended posterior lumbar interbody fusion (PLIF) for symptomatic adjacent-segment degeneration (ASD) after posterior lumbar fusion. METHODS This retrospective study enrolled 40 symptomatic patients with ASD who were treated with ALLIF (n = 13) or extended PLIF (n = 27) between January 2011 and January 2015. Evaluations were performed preoperatively, at 3, 12, and 24 months postoperatively. Clinical outcome measurements included visual analog scale scores for low-back and leg pain, Oswestry Disability Index score for function assessment, Short-Form 36 Questionnaire for quality of life, and modified Macnab criteria for patient satisfaction. Radiologic outcome measurements included fusion rate, cage subsidence, disc height, and lumbar lordosis. RESULTS There were no significant differences in the baseline data for the ALLIF and PLIF groups (P > 0.05). Mean operative time, blood loss, and length of hospital stay were significantly decreased for the ALLIF group (P < 0.05). Postoperatively, low back and leg pain was relieved, function and quality of life were improved in both groups (P < 0.05), whereas disc height and lumbar lordosis were restored (P < 0.05). At 24-month follow-up, fusion was observed in 13 of 13 patients (100%), with 3 of 13 (23.1%) patients developing cage subsidence in the ALLIF group. CONCLUSIONS Stand-alone ALLIF could achieve satisfactory safety and efficacy for the treatment of symptomatic ASD with less trauma and faster recovery, and it may serve as an alternative surgical treatment for symptomatic ASD with appropriate indication.
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Affiliation(s)
- Zhiming Tu
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - Yawei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Guohua Lv
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuliang Dai
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
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Reoperation within 2 years after lumbar interbody fusion: a multicenter study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1972-1980. [DOI: 10.1007/s00586-018-5508-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/16/2018] [Accepted: 01/30/2018] [Indexed: 11/26/2022]
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Predictive Factors for Postoperative Follow-up: Which Patients are Prone to Loss to Follow-up After Spinal Surgery? Clin Spine Surg 2018; 31:E25-E29. [PMID: 27906738 DOI: 10.1097/bsd.0000000000000465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To find out the predictive factors for the failure to follow-up in patients who underwent spinal surgery. SUMMARY OF BACKGROUND DATA Causes for loss to follow-up range from geographical accessibility to dissatisfaction with surgeons. There were few reports that investigated loss to follow-up after spinal surgery. METHODS A total of 649 patients who underwent laminectomy and 193 patients who underwent L4-L5 fusion from August 2006 to August 2013 were enrolled in this retrospective study. In each surgical group, demographic data and comorbidities as assessed by the Charlson index were investigated and analyzed for correlation with follow-up. The between-group difference of failure to follow-up was also evaluated. RESULTS The fusion group (n=193) was more likely to follow-up and the between-group difference was statistically significant (P=0.047). In the laminectomy group (n=649), 271 patients (41.8%) made regular hospital visits. Those who were male, had a spouse, or had fewer comorbidities were less prone to loss to follow-up (P<0.001). Other parameters including age, number of spinal segments operated on during surgery, distance from home to hospital, income, education level, and whether or not patients exercised were also significantly correlated with follow-up compliance (P>0.05). In contrast, 51.8% (n=100) of patients who underwent fusion had regular follow-ups. The fusion group showed a statistical difference in follow-up rate based only on sex (P=0.002). CONCLUSIONS Our study shows that patients who underwent decompression alone were less likely to attend follow-up than were patients who underwent fusion surgery. Whereas the factors correlated with loss to follow-up after laminectomy alone were sex, marital status, and number of comorbidities, the only predictor after fusion was male sex. Sex was the only shared risk factor for loss to follow-up. LEVEL OF EVIDENCE Level III.
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