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Ali EMS, El-Hewala TA, Eladawy AM, Sheta RA. Does minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) influence functional outcomes and spinopelvic parameters in isthmic spondylolisthesis? J Orthop Surg Res 2022; 17:272. [PMID: 35570302 PMCID: PMC9107691 DOI: 10.1186/s13018-022-03144-y] [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: 02/22/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We assessed the efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with low-grade isthmic spondylolisthesis. METHODS We included 24 symptomatic patients who underwent MIS-TLIF between December 2017 and December 2020. Patients were followed up clinically by the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and VAS for leg pain, as well as radiological radiographs after 6 weeks, 6 months, and at final follow-up (at least 12 months). Measured parameters included C7 sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), Meyerding slip grades, lumbar lordosis (LL), L1-L4 angle, L4-S1 angle, and segmental lordosis (SL) of the affected segment. The mismatch between the PI and LL was also measured. RESULTS VAS for back, VAS for leg pain, and ODI significantly improved postoperatively (all p < 0.001). We observed significantly decreased mean values of PT and slip percentage and increased mean values of SS and LL (all p < 0.05). We observed a significant reduction in L1-L4 lordosis and a significant increase in L4-S1 lordosis. The final PT, SS, and LL (total and L1-L4) were significantly higher in group III patients (n = 15) than the values of group II patients (n = 9). None of the patients became unbalanced postoperative, and all patients had a normal matching between the PI and the LL postoperatively. CONCLUSIONS MIS-TLIF is a safe procedure for managing low-grade isthmic spondylolisthesis with significant improvement in clinical and radiological outcomes. It can correct and maintain a proper spinopelvic alignment.
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Affiliation(s)
| | | | - Amr Mohamed Eladawy
- Orthopedic Department, Zagazig University Hospital, Qumia, Nour Hoda Street, Zagazig, Egypt
| | - Reda Ali Sheta
- Al-Ahrar Specialist Hospital, 1st Talaat Harb Street from El Salm Street, Beside Sednawey Hospital, Zagazig, Al-Sharkia, 44759 Egypt
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Porche K, Dru A, Moor R, Kubilis P, Vaziri S, Hoh DJ. Preoperative Radiographic Prediction Tool for Early Postoperative Segmental and Lumbar Lordosis Alignment After Transforaminal Lumbar Interbody Fusion. Cureus 2021; 13:e18175. [PMID: 34703700 PMCID: PMC8530555 DOI: 10.7759/cureus.18175] [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] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Transforaminal lumbar interbody fusion (TLIF) is a common approach and results in varying degrees of lordosis correction. The purpose of this study is to determine preoperative radiographic spinopelvic parameters that predict change in postoperative segmental and lumbar lordosis after TLIF. Materials & Methods This study is a single surgeon retrospective review of one-level and two-level TLIFs from L3-S1. All patients underwent bilateral facetectomies, 10 mm TLIF cage (non-lordotic) insertions, and bilateral pedicle screw-rod construct placements. Pre- and post-operative X-rays were assessed for preoperative segmental lordosis (SL), lumbar lordosis (LL), and pelvic incidence (PI). Univariate and multi-predictor linear regression analyses were performed to determine the relationships between preoperative radiographic findings and change in early postoperative segmental and lumbar lordosis. Results Ninety-seven patients contributing 128 intervertebral segments were examined. The mean change in SL after TLIF was 7.3 (range: 0.10-28.9°, SD 6.39°). The mean change in LL after TLIF was 5.5˚ (range: -14.8-39.2°, standard deviation (SD) 7.16°). Greater preoperative LL predicted less postoperative LL correction, while greater preoperative PI predicted more postoperative SL and LL correction. Greater anterior disk height was noted to be associated with a decreased change in SL (∆SL). An annular tear on preoperative magnetic resonance imaging (MRI) predicted a 2.7° decrease in ∆SL. A Schmorl's node on preoperative MRI predicted a 4.0° decrease in change in LL (∆LL). Conclusions A greater preoperative lordosis and a lower spinopelvic mismatch lessen the potential for an increase in the postoperative SL and LL after a TLIF, which is likely due to a ‘ceiling’ effect of an otherwise optimized spinal alignment. A greater anterior disk height and the presence of an annular tear are associated with decreased ∆SL.
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Affiliation(s)
- Ken Porche
- Neurosurgery, University of Florida, Gainesville, USA
| | - Alexander Dru
- Neurosurgery, University of Florida, Gainesville, USA
| | - Rachel Moor
- Neurosurgery, University of Florida, Gainesville, USA
| | - Paul Kubilis
- Neurosurgery, University of Florida, Gainesville, USA
| | - Sasha Vaziri
- Neurosurgery, University of Florida, Gainesville, USA
| | - Daniel J Hoh
- Neurosurgery, University of Florida College of Medicine, Gainesville, USA
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Zhang GZ, Deng YJ, He XG, Ren EH, Wu ZL, Yang FG, Yang L, Ma ZJ, Gao YC, Guo XD, Wang YD, Liu MQ, Zhu DX, Kang XW. Different Types of Double-Level Degenerative Lumber Spondylolisthesis: What Is Different in the Sagittal Plane? World Neurosurg 2021; 150:e127-e134. [PMID: 33684582 DOI: 10.1016/j.wneu.2021.02.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Degenerative lumber spondylolisthesis (DLS) is a common orthopedic condition, described as a condition that compared with the lower vertebra, the superior vertebra slides forward or backward in the sagittal plane without accompanying isthmic spondylolisthesis. Information pertaining to different types of double-level DLS is scarce. This study aims to analyze parameters of patients with different types of double-level DLS to provide a reference for guiding surgical treatment and restoring sagittal balance of patients with DLS. METHODS From January 2014 to January 2020, records of patients with double-level DLS were retrospectively reviewed. Patients with double-level DLS were divided into 3 types: anterior, posterior, and combined; the anterior and combined types were studied. The sagittal spinopelvic parameters included C7 tilt, maximal thoracic kyphosis, maximal lumbar lordosis (LLmax), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). After descriptive analysis, demographic and radiographic data were compared. RESULTS Forty and 18 patients were included in the anterior and combined type groups, respectively. Both groups had different levels of chronic low back pain, but the incidence of radiating leg pain and neurogenic claudication was significantly higher in the anterior type. Oswestry Disability Index and visual analog scale low back scores were also higher in the anterior type. In the anterior type, C7 tilt (7.14 ± 2.15 vs. 5.41 ± 2.28, P = 0.007), LLmax (50.02 ± 14.76 vs. 36.96 ± 14.56, P = 0.003), PI (68.28 ± 9.16 vs. 55.53 ± 14.19, P < 0.001), PT (28.68 ± 7.31 vs. 19.38 ± 4.70, P < 0.001), and PT/PI (42.45 ± 11.22 vs. 36.04 ± 9.87, P = 0.041) were significantly higher. In the anterior type, PI correlated positively with LLmax (r = 0.59) and SS (r = 0.71). LLmax and SS (r = 0.65) had a positive correlation. PT/PI and SS (r = -0.77) had a negative correlation. In the combined type, PI correlated positively with LLmax (r = 0.61) and SS (r = 0.88), and PT/PI correlated negatively with SS (r = -0.81). CONCLUSIONS In patients with double-level DLS, the sagittal spinopelvic parameters differed between the anterior and combined types. Overall, spinal surgeons should focus on correcting sagittal deformities, relieving postoperative clinical symptoms, and improving quality of life during fusion surgery.
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Affiliation(s)
- Guang-Zhi Zhang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Ya-Jun Deng
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xue-Gang He
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - En-Hui Ren
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Zuo-Long Wu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Feng-Guang Yang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Liang Yang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Zhan-Jun Ma
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yi-Cheng Gao
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xu-Dong Guo
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yi-Dian Wang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Ming-Qiang Liu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Da-Xue Zhu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xue-Wen Kang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China; The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Lanzhou, Gansu, China.
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Truckenmueller P, Czabanka M, Bayerl SH, Mertens R, Vajkoczy P. Oblique insertion of a straight cage during single level TLIF procedure proves to be non-inferior in terms of restoring segmental lordosis. BRAIN AND SPINE 2021; 1:100302. [PMID: 36247394 PMCID: PMC9562291 DOI: 10.1016/j.bas.2021.100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/02/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
Introduction With increasing relevance of the postoperative spinopelvic alignment, achieving optimal restoration of segmental lordosis (SL) during transforaminal lumbar interbody fusion (TLIF) has become increasingly important. However, despite the easier insertion of the straight cage, its potential to restore SL is still considered inferior to the preferred insert-and-rotate technique with a banana-shaped cage. Research question To determine, if simple oblique insertion of a straight cage allows for an equally effective restoration of SL, but reduces risk for intraoperative cage subsidence requiring revision surgery. Material and methods The authors retrospectively identified 81 patients who underwent single-level TLIF between 11/2017-03/2020. 40 patients were included in the straight cage group, 41 patients in the banana cage group. The authors determined pre- and postoperative SL from plain lateral radiographs. Bone density was analyzed on computed tomographs using Hounsfield unit (HU) values. Results Both cage types were equally effective in restoring SL. However, 7.3% in the banana cage group, but none in the straight cage group, had to undergo revision surgery due to intraoperative cage subsidence. This was related to reduced bone density with lower HU values. Discussion With an extended dorsal release, the straight cage may be equally effective in restoring SL. Since no repositioning is needed after oblique insertion, the straight cage might cause less intraoperative endplate violation. Conclusion Provided an adequate surgical technique, both cage types might be equally effective in restoring SL after one-level TLIF surgery. However, the straight cage might represent the safer alternative in patients with reduced bone quality. Straight cage in single-level TLIF equally effective in restoring segmental lordosis. Straight cage might cause less revisions due to intraoperative cage subsidence. Straight cage might be safer in patients with reduced bone quality.
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Chang CC, Chou D, Pennicooke B, Rivera J, Tan LA, Berven S, Mummaneni PV. Long-term radiographic outcomes of expandable versus static cages in transforaminal lumbar interbody fusion. J Neurosurg Spine 2020:1-10. [PMID: 33186902 DOI: 10.3171/2020.6.spine191378] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 06/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Potential advantages of using expandable versus static cages during transforaminal lumbar interbody fusion (TLIF) are not fully established. The authors aimed to compare the long-term radiographic outcomes of expandable versus static TLIF cages. METHODS A retrospective review of 1- and 2-level TLIFs over a 10-year period with expandable and static cages was performed at the University of California, San Francisco. Patients with posterior column osteotomy (PCO) were subdivided. Fusion assessment, cage subsidence, anterior and posterior disc height, foraminal dimensions, pelvic incidence (PI), segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence-lumbar lordosis mismatch (PI-LL), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA) were assessed. RESULTS A consecutive series of 178 patients (with a total of 210 levels) who underwent TLIF using either static (148 levels) or expandable cages (62 levels) was reviewed. The mean patient age was 60.3 ± 11.5 years and 62.8 ± 14.1 years for the static and expandable cage groups, respectively. The mean follow-up was 42.9 ± 29.4 months for the static cage group and 27.6 ± 14.1 months for the expandable cage group. Within the 1-level TLIF group, the SL and PI-LL improved with statistical significance regardless of whether PCO was performed; however, the static group with PCOs also had statistically significant improvement in LL and SVA. The expandable cage with PCO subgroup had significant improvement in SL only. All of the foraminal parameters improved with statistical significance, regardless of the type of cages used; however, the expandable cage group had greater improvement in disc height restoration. The incidence of cage subsidence was higher in the expandable group (19.7% vs 5.4%, p = 0.0017). Within the expandable group, the unilateral facetectomy-only subgroup had a 5.6 times higher subsidence rate than the PCO subgroup (26.8% vs 4.8%, p = 0.04). Four expandable cages collapsed over time. CONCLUSIONS Expandable TLIF cages may initially restore disc height better than static cages, but they also have higher rates of subsidence. Unilateral facetectomy alone may result in more subsidence with expandable cages than using bilateral PCO, potentially because of insufficient facet release. Although expandable cages may have more power to induce lordosis and restore disc height than static cages, subsidence and endplate violation may negate any significant gains compared to static cages.
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Affiliation(s)
- Chih-Chang Chang
- Departments of1Neurosurgery and.,3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,5School of Medicine and.,6Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Joshua Rivera
- 4University of California, San Francisco, California; and
| | | | - Sigurd Berven
- 2Orthopaedic Surgery, University of California, San Francisco, California
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Oikonomidis S, Heck V, Bantle S, Scheyerer MJ, Hofstetter C, Budde S, Eysel P, Bredow J. Impact of lordotic cages in the restoration of spinopelvic parameters after dorsal lumbar interbody fusion: a retrospective case control study. INTERNATIONAL ORTHOPAEDICS 2020; 44:2665-2672. [PMID: 32661634 PMCID: PMC7679311 DOI: 10.1007/s00264-020-04719-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022]
Abstract
Purpose Aim of this study was to compare the reconstruction of radiological sagittal spinopelvic parameters between lordotic (10°) and normal cages (0°) after dorsal lumbar spondylodesis. Methods This retrospective monocentric study included patients who received dorsal lumbar spondylodesis between January 2014 and December 2018. Inclusion criteria were degenerative lumbar diseases and mono- or bi-segmental fusions in the middle and lower lumbar region. Exclusion criteria were long-distance fusions (3 segments and more) and infectious and tumour-related diseases. The sagittal spinopelvine parameters (lumbar lordosis, segmental lordosis, sacral slope, pelvic incidence, and pelvic tilt) were measured pre- and post-operatively by two examiners at two different times. The patients were divided into 2 groups (group 1: lordotic cage, group 2: normal cage). Results One hundred thirty-eight patients (77 female, 61 male) with an average age of 66.6 ± 11.2 years (min.: 26, max.: 90) were included in the study based on the inclusion criteria. Ninety-two patients (66.7%) received 0° cages and 46 (33.3%) lordotic cages (10°). Segmental lordosis was increased by 4.2° on average in group 1 and by 6.5° in group 2 (p = 0.074). Average lumbar lordosis was increased by 2.1° in group 1 and by 0.6° in group 2 (p = 0.378). There was no significant difference in the correction of sagittal spinopelvic parameters. Inter- and inter-class reliability was between 0.887 and 0.956. Conclusion According to the results of our study, no advantages regarding sagittal radiological parameters for the implantation of a lordotic cage could be demonstrated.
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Affiliation(s)
- Stavros Oikonomidis
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Vincent Heck
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sonja Bantle
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Max Joseph Scheyerer
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | | | - Stefan Budde
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hanover, Germany
| | - Peer Eysel
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan Bredow
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Zhao Y, Jia J, Liu W, Chen X, Mai R, Tian Y, Zhao J, Liu X. Influence of contoured versus straight rod on clinical outcomes and sagittal parameters in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) at L4/5 level-more than 5 years follow-up. J Orthop Sci 2020; 25:89-95. [PMID: 30929967 DOI: 10.1016/j.jos.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/16/2019] [Accepted: 03/10/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is among the most commonly performed surgical procedure to treat lumbar degenerative disorders. In open TLIF procedure, usually rods were contoured to restore normal lumbar sagittal alignment. However, in MIS-TLIF procedure, contoured rods sometimes were easier to rotate and harder to be locked at the satisfactory position due to instrumentation design and limited exposure. Thus, straight rods had been used in single-level MIS-TLIF in our institution. However, the effect of rod contouring on sagittal parameters and clinical outcomes remains unclear. In the present study, we aim to evaluate the effects of single-segment MIS-TLIF with contoured versus straight rods on sagittal parameters and clinical outcomes. METHODS A retrospective review of MIS-TLIF at L4/5 was performed between 2009 and 2013 in our hospital. Seventy-six cases were divided into contoured rod group (CR group, n = 35) and straight rod group (SR group, n = 41). Clinical outcomes and radiographic measurements at five years' follow-up were evaluated by visual analog score (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) score, spino-pelvic parameters, disc height and fused segment angle. Fusion rate and cage subsidence were also measured. RESULTS Preoperative VAS, JOA, ODI and radiographic parameters were comparable between two groups. The average follow-up was 63.72 ± 3.86 months. VAS, JOA and ODI were significantly improved at 5-year follow-up in both groups, and there were no significant differences between two groups(P > 0.05). Fused segment angle (FSA) was greater in CR group than SR group (P = 0.024), while the other radiographic parameters were not significantly different(P > 0.05). Rod process, fusion rate and cage subsidence were not risk factors of post-surgical malalignment, patients with pre-surgical sagittal imbalance was more prone to show post-surgical malalignment (P < 0.05). CONCLUSIONS Both CR and SR groups acquired satisfactory clinical results. Although contoured rods had better fused segment angle, contoured or straight rods at single L4/5 level had little effect on global spino-pelvic parameters and clinical outcomes in a 5-year follow-up.
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Affiliation(s)
- Yiwei Zhao
- Shandong University Cheeloo College of Medicine, Wenhua West Road 44#, Jinan, Shandong Province, 250012, PR China
| | - Jun Jia
- Shandong University Cheeloo College of Medicine, Wenhua West Road 44#, Jinan, Shandong Province, 250012, PR China
| | - Wubo Liu
- Shandong University Cheeloo College of Medicine, Wenhua West Road 44#, Jinan, Shandong Province, 250012, PR China
| | - Xi Chen
- Shandong University Cheeloo College of Medicine, Wenhua West Road 44#, Jinan, Shandong Province, 250012, PR China
| | - Ruopeng Mai
- Shandong University Cheeloo College of Medicine, Wenhua West Road 44#, Jinan, Shandong Province, 250012, PR China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, Shandong Province, 250012, PR China
| | - Jiang Zhao
- Department of Spine Surgery of Traditional Chinese Hospital Affiliated with Xinjiang Medical University, Urumqi, Xinjiang, PR China
| | - Xinyu Liu
- Shandong University Cheeloo College of Medicine, Wenhua West Road 44#, Jinan, Shandong Province, 250012, PR China.
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Kuhta M, Bošnjak K, Vengust R. Failure to maintain segmental lordosis during TLIF for one-level degenerative spondylolisthesis negatively affects clinical outcome 5 years postoperatively: a prospective cohort of 57 patients. 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 2019; 28:745-750. [DOI: 10.1007/s00586-019-05890-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/28/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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[Safety and efficacy of an electron beam melting technique-manufactured titanium mesh cage for lumbar interbody fusion]. DER ORTHOPADE 2018; 48:150-156. [PMID: 30569206 DOI: 10.1007/s00132-018-03681-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Electron beam melting (EBM) technique enables cage design changes such as the integration of guide rails on the cage surface or a 3D matrix for osseointegration. A change in manufacturing technique or design can lead to a decreased fusion rate or impaired applicability. OBJECTIVE The aim of the present study was to evaluate cage handling, lordosis reconstruction capability, and fusion rate 1 year after surgery. MATERIALS AND METHODS In this study, 50 patients who had undergone minimally invasive transforaminal lumbar interbody fusion (TLIF) or open posterior lumbar interbody fusion (PLIF) using an EBM-manufactured cage were retrospectively included. Fusion evaluation was based on routinely performed CTs and flexion-extension radiographs 12 months postoperatively. Lumbar and segmental lordosis were compared between pre-, post, and 1‑year follow-up. Postoperative cage position was used for evaluation of cage handling. RESULTS The radiological fusion rate was 97% at the 1‑year follow-up. Two cages were placed into the endplates during surgery without an effect on fusion. In 31% of the cages, placement at the anterior third of the disk space was possible. Lumbar lordosis was improved by a mean of 5° and segmental lordosis by a mean of 4°. At final follow-up, 1° was lost in both parameters. No implant-associated complications were registered. CONCLUSION The implant is safe and leads to a very high fusion rate. A learning curve results from the fact that the cage follows a defined radius dictated by the guide rails. Addressing this, exact placement at the anterior endplate can be achieved.
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