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Moorthy V, Goh GS, Cheong Soh RC. What Preoperative Factors Are Associated With Achieving a Clinically Meaningful Improvement and Satisfaction After Single-Level Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis? Global Spine J 2024; 14:1287-1295. [PMID: 36366979 PMCID: PMC11289563 DOI: 10.1177/21925682221139816] [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: 11/13/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES The purpose of this study was to identify preoperative factors associated with clinically meaningful improvement, patient satisfaction and expectation fulfilment at 2 years follow-up in patients undergoing single-level TLIF for degenerative spondylolisthesis. METHODS Patients who underwent a primary, single-level TLIF for degenerative spondylolisthesis between 2006 and 2015 were identified from a prospectively maintained institutional spine registry. Baseline characteristics and PROMs including the Oswestry Disability Index (ODI), 36-Item Short-Form Physical Component Score (SF-36 PCS), Mental Component Score (SF-36 MCS), Visual Analogue Scale (VAS) back pain, and VAS leg pain were collected preoperatively, at 1 month, 3 months, 6 months, and 2 years. RESULTS A total of 997 patients were included. Multivariate analyses showed that increasing age (OR 1.039, P < .001) and better preoperative ODI (OR .984, P = .018) were associated with achieving minimal clinically important difference (MCID) for VAS Back. Increasing age (OR 1.032, P = .007) and better preoperative VAS Back (OR .783, P < .001) were associated with achieving MCID for VAS Leg. Lower BMI (OR .952, P = .024) and better preoperative ODI (OR .976, P < .001) were associated with achieving MCID for SF-36 PCS. Importantly, a better preoperative SF-36 MCS was associated with MCID attainment for ODI (OR 1.038, P < .001), satisfaction (OR 1.034, P < .001) and expectation fulfilment (OR 1.024, P < .001). CONCLUSION Patients who were older, have less preoperative disability and better preoperative mental health were significantly more likely to attain clinically meaningful improvement in PROMs and postoperative satisfaction after single-level TLIF. Identification of these factors would aid surgeons in patient selection and surgical counselling for single-level TLIF.
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Affiliation(s)
- Vikaesh Moorthy
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Graham S. Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Wang Y, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maitusong M, Chen Q, Rexiti P. Hybrid cortical bone trajectory and modified cortical bone trajectory techniques in transforaminal lumbar interbody fusion at L4-L5 segment: A finite element analysis. Heliyon 2024; 10:e26294. [PMID: 38434416 PMCID: PMC10906328 DOI: 10.1016/j.heliyon.2024.e26294] [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: 08/23/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Background The academia has increasingly acknowledged the superior biomechanical performance of the hybrid fixation technique in recent years. However, there is a lack of research on the hybrid fixation technique using BCS (Bilateral Cortical Screws) and BMCS (Bilateral Modified Cortical Screws). This study aims to investigate the biomechanical performance of the BCS and BMCS hybrid fixation technique in transforaminal lumbar interbody fusion (TLIF) at the L4-L5 segment in a complete lumbar-sacral finite element model. Methods Three cadaver specimens are used to construct three lumbar-sacral finite element models. The biomechanical properties of various fixation technologies (BCS-BCS, BMCS-BMCS, BMCS-BCS, and BCS-BMCS) are evaluated at the L4-5 segment with a TLIF procedure conducted, including the range of motion (ROM) of the L4-5 segment, as well as the stress experienced by the cage, screws, and rods. The testing is conducted under specific loading conditions, including a compressive load of 400 N and a torque of 7.5Nm, subjecting the model to simulate flexion, extension, lateral bending, and rotation. Results No significant variations are seen in the ROM at the L4-5 segment when comparing the four fixation procedures during flexion and extension. However, when it comes to lateral bending and rotation, the ROM is ordered in descending order as BCS-BCS, BCS-BMCS, BMCS-BMCS, and BMCS-BCS. The maximum stress experienced by the cage is observed to be highest within the BMCS-BCS technique during movements including flexion, extension, and lateral bending. Conversely, the BMCS-BMCS technique exhibits the highest cage stress levels during rotational movements. The stress applies to the screws and rods order the sequence of BCS-BCS, BCS-BMCS, BMCS-BCS, and BMCS-BMCS throughout all four working conditions. Conclusion The BMCS-BCS technique shows better biomechanical performance with less ROM and lower stress on the internal fixation system compared to other fixation techniques. BMCS-BMCS technology has similar mechanical performance to BMCS-BCS but has more contact area between screws and cortical bone, making it better for patients with severe osteoporosis.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Qihao Chen
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Key Laboratory of High Incidence Disease Research in Xinjiang (Xinjiang Medical University), Ministry of Education, Urumqi, China
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China
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Ai Y, Chen Q, Huang Y, Ding H, Wang J, Zhu C, Song Y, Feng G, Liu L. MRI-based vertebral bone quality score for predicting cage subsidence by assessing bone mineral density following transforaminal lumbar interbody fusion: a retrospective analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3167-3175. [PMID: 37479921 DOI: 10.1007/s00586-023-07854-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE This is the first study to evaluate the predictive value of the vertebral bone quality (VBQ) score on cage subsidence after transforaminal lumbar interbody fusion (TLIF) in a Chinese population using the spinal quantitative computed tomography (QCT) as the clinical standard. Meanwhile, the accuracy of the MRI-based VBQ score in bone mineral density (BMD) measurement was verified. METHODS We performed a retrospective study of patients who underwent single-level TLIF from 2015 to 2020 with at least 1 year of follow-up. Cage subsidence was measured using postoperative radiographic images based on cage protrusion through the endplates more than 2 mm. The VBQ score was measured on T1-weighted MRI. The results were subjected to statistical analysis. RESULTS A total of 283 patients (61.1% of female) were included in the study. The subsidence rate was with 14.1% (n = 40), and the average cage subsidence was 2.3 mm. There was a significant difference in age, sex, VBQ score and spinal QCT between the subsidence group and the no-subsidence group. The multivariable analysis demonstrated that only an increased VBQ score (OR = 2.690, 95% CI 1.312-5.515, p = 0.007) and decreased L1/2 QCT-vBMD (OR = 0.955, 95% CI 0.933-0.977, p < 0.001) were associated with an increased rate of cage subsidence. The VBQ score was found to be moderately correlated with the spinal QCT (r = -0.426, p < 0.001). The VBQ score was shown to significantly predict cage subsidence, with an accuracy of 82.5%. CONCLUSION Our findings indicate that the MRI-based VBQ score is a significant predictor of cage subsidence and could be used to assess BMD.
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Affiliation(s)
- Youwei Ai
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Orthopaedics and Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Juehan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Zhou T, Gu Y. Percutaneous transforaminal endoscopic surgery (PTES) and mini-incision L5/S1 OLIF with a self-lock cage for the surgical treatment of L5 spondylolisthesis. J Orthop Surg Res 2023; 18:527. [PMID: 37488544 PMCID: PMC10367385 DOI: 10.1186/s13018-023-04022-x] [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: 02/19/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES We reported thirteen cases of percutaneous transforaminal endoscopic surgery (PTES) under local anesthesia and mini-incision L5/S1 OLIF (OLIF51) with a self-lock cage for the treatment of L5 spondylolisthesis. METHODS From Jan 2019 to Feb 2020, the patients with L5 spondylolisthesis with nerve root symptoms undergoing PTES and OLIF51 were included in this study. PTES under local anesthesia was performed in a prone position, and OLIF51 with a self-lock cage and allograft was then undertaken through a left abdominal mini-incision and oblique retroperitoneal approach between bilateral iliac vessels with the external oblique, internal oblique and transverse abdominal muscles bluntly separated in turn for L5/S1 in a right oblique position under general anesthesia. Back and leg pain were preoperatively and postoperatively evaluated using the VAS, and the clinical outcomes were evaluated with the ODI before surgery and at the 2-year follow-up. The anterior and posterior intervertebral space height (AISH, PISH), lumbar lordotic, and surgical segmental lordotic angle (SLA) were measured on lumbar spine X-rays preoperatively and postoperatively. The fusion status was assessed according to Bridwell's fusion grades. RESULTS Thirteen cases of L5 spondylolisthesis were included. The operation duration was 49.1 ± 5.6 min for PTES and 73.6 ± 8.2 min for OLIF. There was blood loss of 25 (15-45) ml. The incision length was 7.5 ± 1.1 mm for PTES and 46.8 ± 3.8 mm for OLIF. The hospital stay was 5 (4-6) days, and the follow-up duration was 29 (24-37) months. For the clinical evaluation, the VAS of back and leg pain significantly dropped after surgery (p < 0.001), and the ODI significantly decreased from 64.7 ± 7.8% to 12.9 ± 4.3% 2 years after surgery (p < 0.001). AISH, PISH and SLA significantly improved after surgery (p < 0.05). Fusion grades based on the Bridwell grading system at the 2-year follow-up were grade I in 9 segments (69.2%) and grade II in 4 segments (30.8%). No patients had any form of permanent iatrogenic nerve damage or major complications. No failure of instruments was observed. CONCLUSIONS PTES and mini-incision OLIF51 with a self-lock cage is a viable option of minimally invasive surgery for L5 spondylolisthesis, which can achieve direct neurologic decompression, satisfactory fusion and hardly destroys the rectus abdominis and its sheath, paraspinal muscles and bone structures.
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Affiliation(s)
- Tianyao Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
| | - Yutong Gu
- Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.
- Shanghai Southwest Spine Surgery Center, Shanghai, China.
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Yao YC, Chao H, Kao KY, Lin HH, Wang ST, Chang MC, Liu CL, Chou PH. CT Hounsfield unit is a reliable parameter for screws loosening or cages subsidence in minimally invasive transforaminal lumbar interbody fusion. Sci Rep 2023; 13:1620. [PMID: 36709341 PMCID: PMC9884280 DOI: 10.1038/s41598-023-28555-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/20/2023] [Indexed: 01/30/2023] Open
Abstract
Retrospective cohort study. To validate computed tomography (CT) radiodensity in Hounsfield units (HU) as a prognostic marker for pedicle screw loosening or cage subsidence in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). The retrospective study involved 198 patients treated with MI-TLIF. Screw loosening (SL), cage subsidence (CS), and fusion status were assessed by plain radiographs. The risk factors of SL and CS were identified using logistic regression. A total of 258 levels and 930 screws were analyzed. During a 2-year follow-up, 16.2% and 24.7% of patients had CS and SL respectively. The cut-off value of L1 HU for predicting SL or CS was 117. The L1 HU < 117 and BMI ≥ 25 were two independent risk factors. The risk of SL or CS was 4.1 fold in patients L1 HU < 117 and 2.6 fold in patients with BMI ≥ 25. For patients concurrently having BMI ≥ 25 and pre-op L1 HU < 117, the risk was 4.3 fold. Fusion rate and clinical outcome were comparable in patients with SL or CS. L1 HU < 117 and BMI > 25 were two independent risk factors that can be screened preoperatively for preventing SL or CS and lead to better management of patients undergoing MI-TLIF.
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Affiliation(s)
- Yu-Cheng Yao
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsien Chao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kun-Yu Kao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medical Education, Chi Mei Hospital, Tainan, Taiwan
| | - Hsi-Hsien Lin
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Tien Wang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan
| | - Ming-Chau Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Lin Liu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsin Chou
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Wang J, Liu J, Hai Y, Zhang Y, Zhou L. OLIF versus MI-TLIF for patients with degenerative lumbar disease: Is one procedure superior to the other? A systematic review and meta-analysis. Front Surg 2022; 9:1014314. [PMID: 36311941 PMCID: PMC9606620 DOI: 10.3389/fsurg.2022.1014314] [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: 08/08/2022] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To compare the effectiveness and safety of oblique lateral interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative lumbar disease. METHODS We searched relevant studies in Embase, PubMed, Cochrane, and Web of Science databases comprehensively from inception to March 2022. The data were extracted from included studies, including operation indications, radiographic parameters, and clinical outcomes. Random or fixed-effects models were used in all meta-analyses according to the between-study heterogeneity. RESULTS In total, 30 studies, including 2,125 patients, were included in this meta-analysis. Our study found similar disk height, length of hospital stay, visual analog scale (VAS), and Oswestry disability index(ODI) between the two groups. However, the OLIF showed an advantage in restoring lumbar lordotic angle compared with MI-TLIF, with the pooled mean change of 17.73° and 2.61°, respectively. Additionally, the operative time and blood loss in the OLIF group appeared to be less compared with the MI-TLIF group. Regarding complications, the rates of the two groups were similar (OLIF 14.0% vs. MI-TLIF 10.0%), but the major complications that occurred in these two procedures differed significantly. CONCLUSION The results of disk height, length of hospital stay, VAS, and ODI between the OLIF and MI-TLIF groups were similar. And the OLIF was superior in restoring lumbar lordotic angle, operative time, and blood loss. However, the OLIF group's complication rate was higher, although not significantly, than that in the MI-TLIF group.
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Affiliation(s)
- Jianqiang Wang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jingwei Liu
- Department of Orthopedic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China,Correspondence: Yong Hai Lijin Zhou
| | - Yiqi Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lijin Zhou
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China,Correspondence: Yong Hai Lijin Zhou
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Comparing the medium-term outcomes of lumbar interbody fusion via transforaminal and oblique approach in treating lumbar degenerative disc diseases. Spine J 2022; 22:993-1001. [PMID: 34906739 DOI: 10.1016/j.spinee.2021.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Oblique lumbar interbody fusion (OLIF) has been proven to be effective in treating lumbar degenerative disorders (LDDs) via indirect decompression. However, its superiority over transforaminal lumbar interbody fusion (TLIF) remains questionable, especially in terms of medium-term follow-up. PURPOSE To compare the medium-term clinical and radiological outcomes of TLIF and OLIF in treating patients with LDDs. STUDY DESIGN Retrospective comparative study. PATIENT SAMPLE Fifty-two patients treated by TLIF and forty-six patients treated by OLIF. OUTCOME MEASURES Clinical records including the visual analog scale (VAS) score of the lower back and leg and the Oswestry Disability Index (ODI). Radiological records including disk height (DH), lumbar lordosis (LL), segmental lordosis (SL), the cross-sectional area (CSA) of the spinal canal, and fusion rate. Surgical-related information and complications were also recorded. METHODS A retrospective review was performed on patients who were surgically managed for LDDs at L4-5 between 2015 and 2017 and completed at least 4 years of follow-up. A total of 98 patients were analyzed, with 46 patients treated by OLIF combined with anterolateral single screw-rod fixation (OLIF-AF group), and 52 patients treated by TLIF (TLIF group). Parameters including postoperative outcomes and perioperative complications were compared with evaluate the efficacy of the two approaches. RESULTS There was significantly less bleeding, surgical duration, and hospitalization in the OLIF-AF group than in the TLIF group. Significant improvements in the clinical score were achieved in both groups. However, the VAS score of the lower back was significantly higher in the TLIF group than in the OLIF-AF group throughout the whole follow-up period. Significantly higher expansion of the CSA was found in the TLIF group than in the OLIF-AF group. However, the improvements in DH, LL, and SL were significantly lower in the TLIF group. The fusion rate was significantly higher in the OLIF-AF group than in the TLIF group within 6 months postoperatively, and there was no significant difference between the two groups at the final record. No significant difference was found in the rate of overall complications between the two groups (25.0% vs. 23.9%, p=.545). The intraoperative complication rate in the TLIF group (13.5%) was slightly higher than that in the OLIF-AF group (6.5%) (p=.257). There was no significant difference in the incidence of adjacent segment disorder (ASD) between the two groups (7.7% vs. 10.9%, p=.422). Cage subsidence was slightly lower in the TLIF group (5.8%) than in the OLIF-AF group (13.0%) (p=.298). CONCLUSIONS Both the TLIF and OLIF-AF approaches demonstrated good medium-term outcomes in treating LDDs. Compared with TLIF, OLIF-AF showed advantages in postoperative recovery, improvement of intervertebral space and lumbar sagittal balance, and early intervertebral fusion but was associated with inferior spinal canal decompression efficacy. The two approaches shared comparable overall complication rates. However, OLIF-AF tended to have fewer intraoperative complications, and a higher incidence of subsidence.
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Kamenova M, Li E, Soleman J, Fiebig O, Mehrkens A, Schaeren S. Posterior stabilization with polyetheretherketone (PEEK) rods and transforaminal lumbar interbody fusion (TLIF) with titanium rods for single-level lumbar spine degenerative disease in patients above 70 years of age. Arch Orthop Trauma Surg 2022; 143:2831-2843. [PMID: 35511354 DOI: 10.1007/s00402-022-04448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Given the lack of guidelines regarding the operative management of elderly patients needing lumbar spine fusion for degenerative disease, it is often difficult to balance between invasiveness respecting the fragile spine and geriatric comorbidities. AIM To compare reoperation rates and clinical outcome in patients above 70 years of age undergoing Transforaminal Lumbar Interbody Fusion (TLIF) with titanium rods or posterior stabilization with Polyetheretherketone (PEEK) rods for the treatment of one-level lumbar spine degenerative disease. METHODS Retrospective review of baseline characteristics, reoperation rates as well as the clinical and radiological outcomes of patients, older than 70 years, undergoing posterolateral fusion with PEEK rods (n = 76, PEEK group) or TLIF with titanium rods (n = 67, TLIF group) for a single-level lumbar degenerative disease from 2014 to 2020. Additional subanalysis on the patients above 80 years of age was performed. RESULTS Our results showed similar reoperation rates and outcomes in the TLIF and PEEK groups. However, intraoperative blood loss, administration of tranexamic acid, and operation time were significantly higher in the TLIF group. In patients older than 80 years, reoperation rates at first follow-up were significantly higher in the TLIF group, too. CONCLUSION According to our results, posterior stabilization with PEEK rods is less invasive and was associated with significantly lower blood loss, administration of blood products and shorter operation time. Moreover, in patients above 80 years of age reoperations rates were lower with PEEK rods, as well. Nevertheless, the benefits of PEEK rods for foraminal stenosis still have to be investigated.
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Affiliation(s)
- M Kamenova
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland. .,Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
| | - E Li
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland.,Department of Orthopedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - J Soleman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - O Fiebig
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland
| | - A Mehrkens
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland
| | - S Schaeren
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland
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9
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Chiang WC, Tu TH, Wu JC, Huang WC, Kuo CH. Traumatic Vertebral Fracture in a Patient With Transforaminal Lumbar Interbody Fusion: A Rare Complication. Cureus 2021; 13:e19004. [PMID: 34853743 PMCID: PMC8609958 DOI: 10.7759/cureus.19004] [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: 10/24/2021] [Indexed: 11/23/2022] Open
Abstract
Transforaminal lumbar interbody fusion (TLIF) offers the potential benefits of anterior and posterior column decompression and fusion. Pseudarthrosis and infection are among the most common perioperative complications. Vertebral fracture after TLIF is a rare and unusual complication. A 74-year-old female underwent L3-5 TLIF for lumbar spondylolisthesis that caused back pain and neurogenic claudication. She recovered well after surgery. However, she subsequently experienced progressive back pain and recurrent claudication after a fall. Elongated anterior-posterior length of the L5 body with progressive L5-S1 listhesis was observed in the serial radiographic follow-ups. The CT scan revealed complicated fracture lines crossing the L5 body. Further extended fixation was performed for decompression and reconstruction of the lumbosacral alignment. Although vertebral fracture after TLIF is a rare complication, a high index of suspicion is the key to early diagnosis, preferably with CT scans, for patients with traumatic accidents after TLIF surgery.
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Affiliation(s)
- Wan-Chi Chiang
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, TWN
| | - Jau-Ching Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, TWN.,Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN
| | - Wen-Cheng Huang
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, TWN
| | - Chao-Hung Kuo
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, TWN.,Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, TWN
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Comparison of Simultaneous Single-Position Oblique Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation with Posterior Lumbar Interbody Fusion Using O-arm Navigated Technique for Lumbar Degenerative Diseases. J Clin Med 2021; 10:jcm10214938. [PMID: 34768459 PMCID: PMC8584546 DOI: 10.3390/jcm10214938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 01/04/2023] Open
Abstract
Minimally invasive posterior or transforaminal lumbar interbody fusion (MI-PLIF/TLIF) are widely accepted procedures for lumbar instability due to degenerative or traumatic diseases. Oblique lateral interbody fusion (OLIF) is currently receiving considerable attention because of the reductions in damage to the back muscles and neural tissue. The aim of this study was to compare clinical and radiographic outcomes of simultaneous single-position OLIF and percutaneous pedicle screw (PPS) fixation with MI-PLIF/TLIF. This retrospective comparative study included 98 patients, comprising 63 patients with single-position OLIF (Group SO) and 35 patients with MI-PLIF/TLIF (Group P/T). Cases with more than 1 year of follow-up were included in this study. Mean follow-up was 32.9 ± 7.0 months for Group SO and 33.7 ± 7.5 months for Group P/T. Clinical and radiological evaluations were performed. Comparing Group SO to Group P/T, surgical time and blood loss were 118 versus 172 min (p < 0.01) and 139 versus 374 mL (p < 0.01), respectively. Cage height, change in disk height, and postoperative foraminal height were significantly higher in Group SO than in Group P/T. The fusion rate was 96.8% in Group SO, similar to the 94.2% in Group P/T (p = 0.985). The complication rate was 6.3% in Group SO and 14.1% in Group P/T (p = 0.191). Simultaneous single position O-arm-navigated OLIF reduces the surgical time, blood loss, and time to ambulation after surgery. Good indirect decompression can be achieved with this method.
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