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Li S, Zhou Z, Meng F, Huang X, Cheng M, Shen Y, Zhang P, Lu Z, Zeng Q. Comparison of mMO-TLIF via Midline Incision Versus MIS-TLIF via Wiltse Approach in Lumbar Degenerative Disease. Indian J Orthop 2024; 58:1278-1287. [PMID: 39170666 PMCID: PMC11333641 DOI: 10.1007/s43465-024-01150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 08/23/2024]
Abstract
Background To compare the clinical and radiological outcomes of modified mini-open transforaminal lumbar interbody fusion (mMO-TLIF) via posterior midline incision for "targeted limited dissection" versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) via Wiltse approach in lumbar degenerative diseases. Methods A total of 60 consecutive patients in our center from January 2019 to March 2020 were enrolled, including 30 patients who were treated with mMO-TLIF via posterior midline incision and 30 treated with MIS-TLIF through the Wiltse approach. Perioperative parameters were recorded. The questionnaires of Oswestry Disability Index (ODI) and Visual Analogue Score (VAS) were conducted before the operation and after the operation (3 days, 1 week, and 2 years). CT and MRI radiological outcomes were evaluated before the operation and at a 2-year follow-up. Results There were no significant differences in the general data, gender, age, and BMI between the two groups. All patients were successfully operated without intraoperative complications. There were significant differences between the two groups in the operation time (p < 0.001) and intraoperative bleeding (p < 0.05). There was no difference in ODI and VAS scores between groups pre- and post-operatively, but they were both significantly improved compared to those before the operation (p < 0.01). At a 2-year follow-up, the paraspinal muscle atrophy and fat infiltration were increased comparing to pre-operation, but the difference was also not statistically significant (p > 0.05). In addition, both the two groups' fusion rates were more than 90% at a 2-year follow-up, however, no difference was detected between the two groups. Conclusion mMO-TLIF via midline incision for "targeted limited dissection" could achieve similar clinical and radiological outcomes as MIS-TLIF for lumbar degenerative disease.
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Affiliation(s)
- Shengwen Li
- Department of Orthopedics, Haining People’s Hospital, Jiaxing, 314400 China
| | - Zhiqiang Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Fanjian Meng
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, 215101 China
| | - Xinyu Huang
- Suzhou Medical College, Soochow University, Suzhou, 215004 China
| | - Maohua Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Yixin Shen
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Peng Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Zhengfeng Lu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Qianghua Zeng
- Department of Orthopedics, Haining People’s Hospital, Jiaxing, 314400 China
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Wang YL, Li XY, Liu L, Li SF, Han PF, Li XD. Oblique lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative disease of the lumbar spine: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:100. [PMID: 37119422 PMCID: PMC10148790 DOI: 10.1007/s10143-023-02009-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/20/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Abstract
This meta-analysis compared the efficacy of oblique lumbar interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative diseases. A computer search for the published literature on OLIF and MIS-TLIF for the treatment of lumbar degenerative diseases in the PubMed, Web of Science, Embase, CINAHL, MEDLINE, Cochrane Library, and other databases was performed, from which 522 related articles were retrieved and 13 were finally included. Two reviewers independently extracted data from the included studies and analyzed them using RevMan 5.4. The quality of the studies was assessed using the Cochrane systematic analysis and the Newcastle-Ottawa scale. Meta-analysis showed that the blood loss [95% confidence intervals (CI) (- 121.01, - 54.56), [Formula: see text]], hospital stay [95% CI (- 1.98, - 0.85), [Formula: see text]], postoperative fusion rate [95%CI (1.04, 3.60), [Formula: see text]], postoperative disc height [95% CI (0.50, 3.63), [Formula: see text]], and postoperative foraminal height [95% CI (0.96, 4.13), [Formula: see text]] were all better in the OLIF group; however, the complication rates were significantly lower in the MIS-TLIF group [95% CI (1.01, 2.06), [Formula: see text]]. However, there were no significant differences between the two in terms of surgery time, patient satisfaction, or postoperative functional scores. The OLIF group had the advantages of lower blood loss, a shorter hospital stay, a higher postoperative fusion rate, and better recovery of the disc and foraminal heights, whereas MIS-TLIF had a relatively lower complication rate.
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Affiliation(s)
- Yun-Lu Wang
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Xi-Yong Li
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Lun Liu
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Song-Feng Li
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Peng-Fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China.
| | - Xiao-Dong Li
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, Changzhi, People's Republic of China.
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Morse KW, Alluri RK, Vaishnav AS, Urakawa H, Mok JK, Virk SS, Sheha ED, Qureshi SA. Do preoperative clinical and radiographic characteristics impact patient outcomes following one-level minimally invasive transforaminal lumbar interbody fusion based upon presenting symptoms? Spine J 2022; 22:570-577. [PMID: 34699995 PMCID: PMC9178522 DOI: 10.1016/j.spinee.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/13/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) frequently present with lower extremity neurologic symptoms with or without associated lower back pain. While symptomatic improvement of leg and back pain has been reported, the resolution of back pain when it is a predominant presenting symptom remains underreported following MI-TLIF. PURPOSE The purpose of this study was to compare clinical outcomes at 1 year of patients undergoing MI-TLIF with lower extremity neurologic symptoms with and without a significant component of back pain. STUDY DESIGN A retrospective review of prospectively collected data from a single surgeon surgical database from 2017 to 2019 was performed. PATIENT SAMPLE Fifty one patients undergoing MI-TLIF. OUTCOME MEASURES Self-reported measures included the Oswestry Disability Index (ODI), Visual analog scale back pain (VAS-back), and VAS leg pain (VAS-leg). METHODS Patients were divided into two groups: Leg Pain Predominant (patients reported greater than 50% leg pain upon presentation) and Back Pain Predominant (patients reported 50% or greater back pain). Multivariate analysis was performed to determine differences between groups based upon any significantly baseline characteristics. RESULTS Preoperative demographic and radiographic outcomes were similar between the two groups. Both groups demonstrated significant improvement in ODI, VAS-Back and VAS-leg at 1-year postoperatively. On multivariate analysis, there were differences in ODI at 1-year, 1-year back pain, and 1-year leg pain between groups with those who initially presented with leg pain having a lower ODI, VAS Back, and VAS leg. Patients who presented with predominantly leg pain were more likely to meet minimal clinically important difference (MCID) criteria for ODI and VAS-back compared to those with predominantly back pain. CONCLUSION Following MI-TLIF, patients with lower extremity neurologic symptoms with and without a significant component of back pain have improvements in back pain, leg pain, and ODI regardless of their primary presenting pain complaint; however, patients who presented with predominantly leg pain were more likely to meet MCID criteria for improvement in their back pain and ODI score.
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Affiliation(s)
- Kyle W. Morse
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Avani S. Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Hikari Urakawa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | - Sohrab S. Virk
- Department of Orthopaedic Surgery, North Shore Long Island Jewish Medical Center, New Hyde Park, NY
| | - Evan D. Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY
| | - Sheeraz A. Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY.,Corresponding author: Sheeraz A. Qureshi, MD MBA, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA, Phone: 212-606-1585, Fax: 917-260-3185,
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Buis N, Esfandiari H, Hoch A, Fürnstahl P. Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review. Front Surg 2022; 8:771275. [PMID: 35155547 PMCID: PMC8825480 DOI: 10.3389/fsurg.2021.771275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is a trend toward minimally invasive and more automated procedures in orthopedic surgery. An important aspect in the further development of these techniques is the quantitative assessment of the surgical approach. The aim of this scoping review is to deliver a structured overview on the currently used methods for quantitative analysis of a surgical approaches' invasiveness in orthopedic procedures. The compiled metrics presented in the herein study can serve as the basis for digitization of surgery and advanced computational methods that focus on optimizing surgical procedures. Methods We performed a blinded literature search in November 2020. In-vivo and ex-vivo studies that quantitatively assess the invasiveness of the surgical approach were included with a special focus on radiological methods. We excluded studies using exclusively one or multiple of the following parameters: risk of reoperation, risk of dislocation, risk of infection, risk of patient-reported nerve injury, rate of thromboembolic event, function, length of stay, blood loss, pain, operation time. Results The final selection included 51 articles. In the included papers, approaches to 8 different anatomical structures were investigated, the majority of which examined procedures of the hip (57%) and the spine (29%). The different modalities to measure the invasiveness were categorized into three major groups “biological” (23 papers), “radiological” (25), “measured in-situ” (14) and their use “in-vivo” or “ex-vivo” was analyzed. Additionally, we explain the basic principles of each modality and match it to the anatomical structures it has been used on. Discussion An ideal metric used to quantify the invasiveness of a surgical approach should be accurate, cost-effective, non-invasive, comprehensive and integratable into the clinical workflow. We find that the radiological methods best meet such criteria. However, radiological metrics can be more prone to confounders such as coexisting pathologies than in-situ measurements but are non-invasive and possible to perform in-vivo. Additionally, radiological metrics require substantial expertise and are not cost-effective. Owed to their high accuracy and low invasiveness, radiological methods are, in our opinion, the best suited for computational applications optimizing surgical procedures. The key to quantify a surgical approach's invasiveness lies in the integration of multiple metrics.
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Chen J, Li D, Wang R, Wang S, Shang Z, Wang M, Wang X. Benefits of the Enhanced Recovery After Surgery Program (ERAS) in Short-segment Posterior Lumbar Interbody Fusion Surgery. World Neurosurg 2021; 159:e303-e310. [PMID: 34929368 DOI: 10.1016/j.wneu.2021.12.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based approach to perioperative care that aims to reduce physiological and psychological stress, improve the quality of rehabilitation and speed up the recovery of patients. Our study aims to investigate the benefits of perioperative use of ERAS for short-segment posterior lumbar interbody fusion (PLIF). METHODS We selected two 1-year periods: the first from before the establishment of the multidisciplinary ERAS team in January 2017 (pre-ERAS year 2016) and the second period when ERAS was applied widely in our hospital (ERAS year 2019). Data were collected from the electronic medical records of patients who had undergone short-level PLIF during these 2 periods. The primary outcomes were postoperative complications, length of hospital stay (LOS) and off-bed time. RESULTS A total of 207 patients were included; 95 patients in the pre-ERAS group were compared with 112 patients in the ERAS group. There was no significant difference between the two groups in baseline demographic. Patients in the ERAS group had significantly shorter LOS, bed-off time and earlier drainage tube and catheter removal time. The rate of postoperative complications differed significantly between the pre-ERAS and ERAS groups. Patients in the ERAS group had significantly less intraoperative blood loss, financial cost and opioid consumption than patients in the pre-ERAS group. The VAS and ODI scores, similar at baseline, were significantly lower in the ERAS group at postoperative day 3 (POD 3). CONCLUSIONS The benefits of our ERAS protocol for patients undergoing short-level posterior lumbar fusion are evident in terms of reduced hospital stay and time to get out of bed, reduced incidence of postoperative complications, intraoperative blood loss, opioid use and hospital costs, and improved early postoperative pain and dysfunction.
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Affiliation(s)
- Jinlei Chen
- First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu, China
| | - Dongliang Li
- First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu, China
| | - Ruirui Wang
- First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu, China
| | - Shuang Wang
- School of Public Health, Lanzhou University, Lanzhou 730000, Gansu, China
| | - Zhizhong Shang
- First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu, China
| | - Mingchuan Wang
- First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu, China
| | - Xin Wang
- Department of Orthopedics, First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China
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Droeghaag R, Hermans SMM, Caelers IJMH, Evers SMAA, van Hemert WLW, van Santbrink H. Cost-effectiveness of open transforaminal lumbar interbody fusion (OTLIF) versus minimally invasive transforaminal lumbar interbody fusion (MITLIF): a systematic review and meta-analysis. Spine J 2021; 21:945-954. [PMID: 33493680 DOI: 10.1016/j.spinee.2021.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The number of performed instrumented lumbar spine surgeries and associated health-care-related costs has increased over the last decades, and will increase further in the future. With the consistent growth of health-care-related costs, cost-effectiveness of surgical techniques is of major relevance. Common indications for instrumented lumbar spine surgery are spondylolisthesis and degenerative disease. A commonly used technique is the open transforaminal lumbar interbody fusion (OTLIF). Nowadays, there is an increasing interest in the minimally invasive variation of this technique (minimally invasive transforaminal lumbar interbody fusion [MITLIF]). Currently available literature describes that MITLIF has comparable or even better clinical results compared to OTLIF. Cost-effectiveness of MITLIF and OTLIF is important considering the growing health-care related costs, although no consensus has been reached regarding the most cost-effective technique. In this systematic review, previous literature concerning costs and cost-effectiveness of OTLIF was compared with MITLIF in patients with lumbar spondylolisthesis or degenerative disease. Furthermore, methodological quality of included studies was assessed. PURPOSE This study aims to evaluate the current literature on cost-effectiveness of OTLIF compared MITLIF to in patients with lumbar spondylolisthesis or degenerative disease. STUDY DESIGN This study is a systematic literature review and meta-analysis. STUDY SAMPLE Clinical studies reporting costs or cost-effectiveness for either OTLIF or MITLIF in patients with spondylolisthesis, lumbar instability, or degenerative disease were included. OUTCOME MEASURES The following data items were evaluated: study design, study population, utility measurement tool, gained quality adjusted life years (QALYs), cost sources, health care and societal perspective costs, total costs, costs per QALY (cost-effectiveness) and incremental cost-effectiveness ratio (ICER). METHODS A systematic search was conducted using databases PubMed, CINAHL, EMBASE, Cochrane, Clinical Trials, Current Controlled Trials, ClinicalTrials.gov, NHS Centre for Review and Dissemination, Econlit and Web of Science on studies reporting OTLIF or MITLIF, spondylolisthesis or lumbar instability or degenerative disease, and costs. Relevant studies were selected and reviewed independently by two authors. For comparison, all costs were converted to American dollars with the reference year 2018. RESULTS After duplicate removal, a total of 892 studies were identified. Eventually, 32 studies were included. Nine studies compared OTLIF and MITLIF directly. All studies mentioned health care perspective costs. Seven studies mentioned societal perspective costs. Cost-effectiveness of OTLIF was mentioned in five studies, ranging from $47,303/QALY to $218,766/QALY. Cost-effectiveness of MITLIF was mentioned in one study, $121,105/QALY. Meta-analysis of hospital perspective costs showed a significant overall effect in favor of MITLIF, with a mean difference of $2,650. There was great heterogeneity in health care and societal perspective costs due to different in-, and exclusion factors, baseline characteristics, and calculation methods. Overall quality of studies was low. CONCLUSIONS OTLIF and MITLIF appear to be expensive interventions when using a threshold of $50,000/QALY. Results of this study and previous literature suggest that MITLIF is more cost-effective compared to OTLIF. Considering the increase in health care costs of instrumented spine surgery, cost-effectiveness could be one of the factors in surgical decision-making. Prospective randomized studies directly comparing cost-effectiveness of OTLIF and MITLIF from both hospital and societal perspectives are needed to obtain higher level of evidence.
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Affiliation(s)
- Ruud Droeghaag
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands; Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
| | - Sem M M Hermans
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
| | - Inge J M H Caelers
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Silvia M A A Evers
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Centre for economic evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Wouter L W van Hemert
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
| | - Henk van Santbrink
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
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Lo WC, Tsai LW, Yang YS, Chan RWY. Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies. Int J Mol Sci 2021; 22:3638. [PMID: 33807361 PMCID: PMC8037583 DOI: 10.3390/ijms22073638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
Transforaminal lumber interbody fusion (TLIF) is the last resort to address the lumber degenerative disorders such as spondylolisthesis, causing lower back pain. The current surgical intervention for these abnormalities includes open TLIF. However, in recent years, minimally invasive TLIF (MIS-TLIF) has gained a high momentum, as it could minimize the risk of infection, blood loss, and post-operative complications pertaining to fusion surgery. Further advancement in visualizing and guiding techniques along with grafting cage and materials are continuously improving the safety and efficacy of MIS-TLIF. These assistive techniques are also playing a crucial role to increase and improve the learning curve of surgeons. However, achieving an appropriate output through TLIF still remains a challenge, which might be synergized through 3D-printing and tissue engineering-based regenerative therapy. Owing to their differentiation potential, biomaterials such as stem/progenitor cells may contribute to restructuring lost or damaged tissues during MIS-TLIF, and this therapeutic efficacy could be further supplemented by platelet-derived biomaterials, leading to improved clinical outcomes. Thus, based on the above-mentioned strategies, we have comprehensively summarized recent developments in MIS-TLIF and its possible combinatorial regenerative therapies for rapid and long-term relief.
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Affiliation(s)
- Wen-Cheng Lo
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Lung-Wen Tsai
- Department of Medical Education and Research, Taipei Medical University Hospital, Taipei 11031, Taiwan;
| | - Yi-Shan Yang
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Ryan Wing Yuk Chan
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
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Sheinis D, Sheinis V, Benharroch D, Ohana N. Incidental Durotomy Following Transforaminal Lumbar Interbody Fusion Performed with the Modified Wiltse Approach. J Neurol Surg A Cent Eur Neurosurg 2020; 81:399-403. [PMID: 32588413 DOI: 10.1055/s-0039-1698390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Incidental durotomy is an intraoperative complication that occurs in 3 to 27% of lumbar spine surgeries. It has been reported more commonly following revision spinal procedures. STUDY OBJECTIVES To investigate the frequency of incidental durotomy while performing transforaminal lumbar interbody fusion (TLIF) using the modified Wiltse approach. A secondary goal was to compare the incidence of durotomy in patients undergoing primary spine surgery with those undergoing revision surgery. METHODS A group of consecutive patients who had undergone (TLIF) in the last 10 years ending in 2015 were enrolled in the study. All patients underwent TLIF via the modified Wiltse approach that included a central midline skin incision, followed by a paravertebral blunt dissection of the paraspinal muscles to reach the transverse processes. The deep paravertebral dissection was done conservatively, one side at a time. Demographic and clinical data were collected when relevant to the comparison. RESULTS The study cohort encompassed 257 patients: 200 primary cases and 57 revisions. The frequency of incidental durotomy was equal in both groups: 3.5% each (7/200 and 2/57). All durotomies were repaired primarily. No other immediate or late complications were observed during follow-up. CONCLUSION The present study displays a limited incidence of durotomy in the primary interventions and to a lesser degree in the revisions, all of which had used a TLIF performed with the modified Wiltse approach. This procedure probably circumvented the need for further revisions.
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Affiliation(s)
- Dimitri Sheinis
- Department of Orthopaedics, Soroka University, Beer Sheva, Southern, Israel
| | - Vadim Sheinis
- Department of Orthopaedics, Assaf Harofeh Medical Centre, Be'er Ya'akov, Israel
| | - Daniel Benharroch
- Department of Pathology, Soroka University, Beer Sheva, Southern, Israel.,Department of Pathology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Nissim Ohana
- Department of Orthopaedics, Meir Medical Center, Kfar Saba, Israel
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Li F, Li C, Xi X, Zeng Z, Ma B, Xie N, Wang H, Yu Y, Cheng L. Distinct fusion intersegmental parameters regarding local sagittal balance provide similar clinical outcomes: a comparative study of minimally invasive versus open transforaminal lumbar interbody fusion. BMC Surg 2020; 20:97. [PMID: 32398125 PMCID: PMC7216338 DOI: 10.1186/s12893-020-00765-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Most contemporary studies suggested that intersegmental parameters including disc height and local lordosis contribute to the sagittal balance of fused lumbar. Although similar clinical outcomes following MIS- and Open-TLIF were reported essentially at the early postoperative time, the comparison of local balance variables after these two different techniques was lack. The radiological differences maybe not relevant to the postoperative efficacy at an earlier post-operation stage. But during the long-term follow-up, the complications with regards to the sagittal imbalance might occur due to the distinct biomechanical properties of fusion level after MIS- and Open-TLIF. Methods The patients who underwent a single-level MIS- and Open-TLIF were reviewed retrospectively. The anterior disc height (ADH), posterior disc height (PDH), and segmental lordosis (SL) of the fusion segment were measured using recognition technical fluoroscopy. The mean disc height (MDH) was calculated by (ADH + PDH)/2. The relative DH was normalized by the anterior height of the upper vertebrae. The body mass index (BMI), the pain score of low back and leg visual analogue scale (VAS), Oswestry disability index (ODI), estimated blood loss, and hospital stay length was collected. Results A total of 88 patients undergoing a single-level TLIF (MIS and Open) were included. The pre- and post-operative ADH, PDH, MDH, and SL of MIS-TLIF group were 1.57 ± 0.33 cm, 0.79 ± 0.20 cm, 1.18 ± 0.21 cm, 7.36 ± 3.07 and 1.63 ± 0.30 cm, 1.02 ± 0.28 cm, 1.32 ± 0.24 cm, 10.24 ± 4.79 respectively. Whereas, the pre- and post-operative ADH, PDH, MDH, and SL of Open-TLIF group were 1.61 ± 0.40 cm, 0.77 ± 0.21 cm, 1.19 ± 0.24 cm, 9.05 ± 5.48 and 1.81 ± 0.33 cm, 0.98 ± 0.24 cm, 1.39 ± 0.24 cm, 12.34 ± 4,74 respectively. MIS- and Open-TLIF group showed no significant differences in low back VAS, leg VAS, and ODI both in pre-operation and post-operation (P > 0.05). The estimated blood loss and hospital stay length in the MIS-TLIF group were significantly lower than those in the Open-TLIF group (P < 0.05). Conclusion MIS- and Open-TLIF provided similar clinical outcomes as the respect of low back VAS, leg VAS, and ODI. MIS-TLIF significantly reduced the blood loss and length of hospital stay though. The intervertebral parameters of DH and SL were both increased significantly, Open-TLIF group presented better sagittal balance in term of ADH and SL variables. The contrast investigation of intersegmental parameters may help the surgeons to figure out the further advantages of MIS-TLIF technique, and then better manage the rehabilitation and prevent the reoperation.
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Affiliation(s)
- Fuping Li
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Chen Li
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Xin Xi
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Zhili Zeng
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Bin Ma
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Ning Xie
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Hang Wang
- Department of Orthopaedics, Jinghong People's Hospital, Jinghong City, 666100, Yunnan Province, China
| | - Yan Yu
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
| | - Liming Cheng
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
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张 宇, 李 富, 西 信, 曾 至, 麻 彬, 谢 宁, 于 研, 程 黎. [Comparison of intervertebral height and lordosis of fusion segment between open- and minimally invasive-transforaminal lumbar interbody fusions]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:422-427. [PMID: 32291975 PMCID: PMC8171520 DOI: 10.7507/1002-1892.201910060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/14/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyze the restoration of intervertebral height and lordosis of fusion segment after open-transforaminal lumbar interbody fusion (Open-TLIF) and minimally invasive-TLIF (MIS-TLIF). METHODS Between January 2013 and February 2016, patients who treated with TLIF due to lumbar degenerative diseases and met the selection criteria were selected as the study objects. Among them, 41 patients were treated with open-TLIF (Open-TLIF group), 34 patients were treated with MIS-TLIF (MIS-TLIF group). There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, disease type, disease duration, pathological segment, and other general data. The intraoperative bleeding volume, hospital stay, visual analogue scale (VAS) score of waist and leg, and Oswestry disability index (ODI) were recorded before and after operation. The anterior disc height (ADH), posterior disc height (ADH), and segmental lordosis (SL) of fusion segment were measured by X-ray film before and at 6 months after operation. The differences of ADH, PDH, and SL between pre- and post-operation were calculated. RESULTS The intraoperative bleeding volume and hospital stay in Open-TLIF group were significantly higher than those in MIS-TLIF group ( t=14.619, P=0.000; t=10.021, P=0.000). All incisions healed by first intention without early complications. All patients were followed up 6-24 months (mean, 12.6 months) in Open-TLIF group and 6-24 months (mean, 11.5 months) in MIS-TLIF group. The preoperative VAS scores of waist and leg and ODI of the two groups significantly improved ( P<0.05). There was no significant difference in VAS scores and ODI between the two groups before operation and at 2 weeks and 6 months after operation ( P>0.05). Imaging examination showed the good intervertebral fusion. There was no significant difference in ADH, PDH, and SL between the two groups before operation and at 6 months after operation ( P>0.05). The differences of ADH, PDH, and SL between the two groups were not significant ( P>0.05). The ADH, PDH, and SL after operation significantly increased in the two groups ( P<0.05). CONCLUSION Open-TLIF and MIS-TLIF show similar effectiveness and radiological change in the treatment of single lumbar degenerative diseases and the improved intervertebral height and lordosis, but MIS-TLIF can significantly reduce hospital stay and intraoperative blood loss.
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Affiliation(s)
- 宇雷 张
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 富平 李
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 信 西
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 至立 曾
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 彬 麻
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 宁 谢
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 研 于
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 黎明 程
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
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Lener S, Wipplinger C, Hernandez RN, Hussain I, Kirnaz S, Navarro-Ramirez R, Schmidt FA, Kim E, Härtl R. Defining the MIS-TLIF: A Systematic Review of Techniques and Technologies Used by Surgeons Worldwide. Global Spine J 2020; 10:151S-167S. [PMID: 32528800 PMCID: PMC7263344 DOI: 10.1177/2192568219882346] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To date there is no consensus among surgeons as to what defines an MIS-TLIF (transforaminal lumbar interbody fusion using minimally invasive spine surgery) compared to an open or mini-open TLIF. This systematic review aimed to examine the MIS-TLIF techniques reported in the recent body of literature to help provide a definition of what constitutes the MIS-TLIF, based on the consensus of the majority of surgeons. METHODS We created a database of articles published about MIS-TLIF between 2010 and 2018. We evaluated the technical components of the MIS-TLIF including instruments and incisions used as well the order in which key steps are performed. RESULTS We could identify several patterns for MIS-TLIF performance that seemed agreed upon by the majority of MIS surgeons: use of paramedian incisions; use of a tubular retractor to perform a total facetectomy, decompression, and interbody cage implantation; and percutaneous insertion of the pedicle-screw rod constructs with intraoperative imaging. CONCLUSION Based on this review of the literature, the key features used by surgeons performing MIS TLIF include the use of nonexpandable or expandable tubular retractors, a paramedian or lateral incision, and the use of a microscope or endoscope for visualization. Approaches using expandable nontubular retractors, those that require extensive subperiosteal dissection from the midline laterally, or specular-based retractors with wide pedicle to pedicle exposure are far less likely to be promoted as an MIS-based approach. A definition is necessary to improve the communication among spine surgeons in research as well as patient education.
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Affiliation(s)
- Sara Lener
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
- Medical University of Innsbruck, Innsbruck, Austria
- These authors contributed equally to this work
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
- Medical University of Innsbruck, Innsbruck, Austria
- These authors contributed equally to this work
| | - R Nick Hernandez
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
- These authors contributed equally to this work
| | - Ibrahim Hussain
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Eliana Kim
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
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12
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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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Bai J, Zhang W, Liu X, Cheng J, Wang X, Ding W, Shen Y. Percutaneous transforaminal endoscopic discectomy in the treatment of senior patients with lumbar degenerative disc disease. Exp Ther Med 2018; 17:874-882. [PMID: 30651875 DOI: 10.3892/etm.2018.6996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 10/29/2018] [Indexed: 11/05/2022] Open
Abstract
The aim of the current study was to analyze the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar degenerative disc disease for senior patients. The clinical and follow-up data of senior patients were retrospectively reviewed. Patients were divided into a PTED group and an open surgery group. Parameters were analyzed, including surgery time, intraoperative fluoroscopy time, intraoperative blood loss, postoperative complications, visual analog scale (VAS) and Japan Orthopedic Association (JOA) scores. Compared with the open surgery group, the surgery time and intraoperative blood loss were decreased, while the intraoperative fluoroscopy time was increased, in the PTED group (P<0.001). Significant improvements in VAS and JOA scores were identified within both groups from preoperative to 12 months following surgery (P<0.001). VAS and JOA scores were significantly improved in the PTEN group compared with the open surgery group at 1 week after surgery (P<0.001), but there was no significant difference between groups prior to and at 12 months following surgery. The incidence of venous thrombosis of the lower extremities in the PTED group was decreased compared with the open surgery group (P<0.05). In the open surgery group, patients suffered from multiple postoperative complications, including constipation, urinary system infection, wound infection, gastrointestinal hemorrhagic stress ulcer, pneumonia, pulmonary embolism, mortality following myocardial infarction, mortality following cerebral infarction, and hemiplegia following cerebral hemorrhage. By contrast, patients in the PTED group did not experience any of these complications. In conclusion, PTED resulted in reduced trauma and a lower incidence of severe complications compared with open surgery, which suggests that PTED is a safe and effective minimally invasive surgery for senior patients with lumbar degenerative disc disease.
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Affiliation(s)
- Jiayue Bai
- Department of Orthopedics, The Third Hospital of Shijiazhuang Hebei Province, Shijiazhuang, Hebei 050051, P.R. China
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Key Biomechanical Laboratory of Orthopedics, Shijiazhuang, Hebei 050051, P.R. China
| | - Xiangzhou Liu
- Department of Orthopedics, The 251st Hospital of PLA, Zhangjiakou, Hebei 075000, P.R. China
| | - Jinghang Cheng
- Department of Orthopedics, Gaocheng People's Hospital, Shijiazhuang, Hebei 050000, P.R. China
| | - Xianzheng Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Key Biomechanical Laboratory of Orthopedics, Shijiazhuang, Hebei 050051, P.R. China
| | - Wenyuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Key Biomechanical Laboratory of Orthopedics, Shijiazhuang, Hebei 050051, P.R. China
| | - Yong Shen
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Key Biomechanical Laboratory of Orthopedics, Shijiazhuang, Hebei 050051, P.R. China
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Spinal Biologics in Minimally Invasive Lumbar Surgery. Minim Invasive Surg 2018; 2018:5230350. [PMID: 29850240 PMCID: PMC5907390 DOI: 10.1155/2018/5230350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/25/2018] [Indexed: 12/28/2022] Open
Abstract
As the use of minimally invasive spine (MIS) fusion approaches continues to grow, increased scrutiny is being placed on its outcomes and efficacies against traditional open fusion surgeries. While there are many factors that contribute to the success of achieving spinal arthrodesis, selecting the optimal fusion biologic remains a top priority. With an ever-expanding market of bone graft substitutes, it is important to evaluate each of their use as it pertains to MIS techniques. This review will summarize the important characteristics and properties of various spinal biologics used in minimally invasive lumbar surgeries and compare their fusion rates via a systematic review of published literature.
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