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Wolf JC, Anwar FN, Roca AM, Loya AC, Medakkar SS, Kaul A, Khosla I, Hartman TJ, Nie JW, MacGregor KR, Oyetayo OO, Zheng E, Federico VP, Sayari AJ, Lopez GD, Singh K. Impact of Early Depressive Burden on Patient-Reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. Clin Spine Surg 2024:01933606-990000000-00328. [PMID: 38934500 DOI: 10.1097/bsd.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/29/2024] [Indexed: 06/28/2024]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To evaluate mental health influence on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) patients. SUMMARY OF BACKGROUND DATA Poor mental health has been postulated to indicate inferior patient perceptions of surgical outcomes in spine literature. Few studies have assessed mental health as a dynamic metric throughout the perioperative period. METHODS A single-surgeon database was retrospectively searched for patients who underwent primary, elective MIS-TLIF for degenerative or isthmic spondylolisthesis. Summative depressive burden (SDB) was defined by the sum of preoperative and 6-week postoperative 9-item Patient Health Questionnaire (PHQ-9), with Lesser Burden (LB, SDB<10) and Greater Burden (GB, SDB≥10) cohorts. Patient-reported outcomes measures (PROMs) were compared preoperatively, at 6 weeks, and at final postoperative follow-up (11.4±10.9 mo), using Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Oswestry disability index (ODI), visual analog scale-back (VAS-B), VAS-leg (VAS-L), and PHQ-9. Improvements at 6-week (∆PROM-6W), final follow-up (∆PROM-FF), and minimum clinically important difference (MCID) achievement were compared. RESULTS The GB cohort consisted of 44 of 105 patients. Demographic variations included older age, higher Charlson comorbidity index, increased hypertension prevalence, and private insurance in the LB cohort (P≤0.018). The LB cohort demonstrated better baseline and 6-week PROMIS-PF/ODI/VAS-L (P≤0.032) and better final PROMIS-PF/ODI/VAS-L/PHQ-9 (P≤0.031). Both cohorts improved in all PROMs at 6 weeks and final follow-up (P≤0.029), except for PROMIS-PF at 6 weeks in the GB cohort. ∆PROM-6W, ∆PROM-FF, and MCID achievement rate for PHQ-9 were greater in the GB cohort (P≤0.001). CONCLUSION On average, patients undergoing MIS-TLIF for degenerative or isthmic spondylolisthesis improved in all PROMs by final follow-up. Patients with GB suffered inferior perceptions of physical function, disability, and leg pain. MCID rates in mental health were higher for GB cohort. Surgeons are encouraged to adopt a compassionate understanding of depressive burden and educate the patient on possible consequential postoperative outcomes.
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Affiliation(s)
- Jacob C Wolf
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago
| | - Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Aayush Kaul
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago
| | - Ishan Khosla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Gregory D Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Wu X, Liu W, Xiao X, Fan Y, Gu G, Yu S, Yan H, Wang X, Li X, Zhao Y, Ni H, He S. Comparison of the clinical outcomes of VBE-TLIF versus MIS-TLIF for single-level degenerative lumbar diseases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1120-1128. [PMID: 38347273 DOI: 10.1007/s00586-023-08096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVE This research aims to compare the clinical outcomes of VBE-TLIF and MIS-TLIF for the treatment of patients with single-level degenerative lumbar diseases. METHODS Ninety patients were enrolled in this study. The estimated blood loss, operation time, postoperative hospitalization days, time to functional exercise, amount of surgical drain and inflammatory index were recorded. The visual analog scale, Oswestry dysfunction index and modified MacNab criteria were used to assessed the patient's back and leg pain, functional status and clinical satisfaction rates. RESULTS The average operation time of the VBE-TLIF group was longer than that of the MIS-TLIF group. The time for functional exercise, length of hospital stay, estimated blood loss and amount of surgical drain in the VBE-TLIF group were relative shorter than those in the MIS-TLIF group. Additionally, the levels of CRP, neutrophil, IL-6 and CPK in the VBE-TLIF group were significantly lower than those in the MIS-TLIF group at postoperative days 1 and 3, respectively (P < 0.001). Patients undergoing VBE-TLIF had significantly lower back VAS scores than those in the MIS-TLIF group on postoperative days 1 and 3 (P < 0.001). No significant differences were found in the clinical satisfaction rates (95.83 vs. 95.24%, P = 0.458) or interbody fusion rate (97.92 vs. 95.24%, P = 0.730) between these two surgical procedures. CONCLUSIONS Both VBE-TLIF and MIS-TLIF are safe and effective surgical procedures for patients with lumbar diseases, but VBE-TLIF technique is a preferred surgical procedure with merits of reduced surgical trauma and quicker recovery.
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Affiliation(s)
- Xinbo Wu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Wei Liu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Xiao Xiao
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Yunshan Fan
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Guangfei Gu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Shunzhi Yu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Huang Yan
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Xiang Wang
- Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Xifan Li
- Department of Radiological, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Yingchuan Zhao
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Haijian Ni
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Shisheng He
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China.
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Zileli M, Karakoç HC, Bölük MS. Pros and Cons of Minimally Invasive Spine Surgery. Adv Tech Stand Neurosurg 2024; 50:277-293. [PMID: 38592534 DOI: 10.1007/978-3-031-53578-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
This paper reviews current knowledge on minimally invasive spine surgery (MISS). Although it has significant advantages, such as less postoperative pain, short hospital stay, quick return to work, better cosmetics, and less infection rate, there are also disadvantages. The long learning curve, the need for special instruments and types of equipment, high costs, lack of tactile sensation and biplanar imaging, some complications that are hard to treat, and more radiation to the surgeon and surgical team are the disadvantages.Most studies remark that the outcomes of MISS are similar to traditional surgery. Although patients demand it more than surgeons, we predict the broad applications of MISS will replace most of our classical surgical approaches.
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Affiliation(s)
- Mehmet Zileli
- Neurosurgery Department, Sanko University, Gaziantep, Turkey
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Guo W, Li T, Feng C, Yu Y, Hu Y, Fan X. Clinical comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis: a retrospective study with 24-month follow-up. J Orthop Surg Res 2023; 18:943. [PMID: 38066527 PMCID: PMC10709901 DOI: 10.1186/s13018-023-04401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To explore the safety and the mid-term efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and 3D microscope-assisted transforaminal lumbar interbody fusion (MMIS-TLIF) for treating single-segment lumbar spondylolisthesis with lumbar spinal stenosis (DLS-LSS). METHODS The clinical data of 49 patients who underwent UBE-TLIF or MMIS-TLIF in our hospital were retrospectively analyzed, including 26 patients who underwent the UBE-TLIF and 23 patients who underwent the MMIS-TLIF. The demographic and perioperative outcomes of patients before and after surgery were reviewed. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes of patients before surgery and at 1, 3, 6, 12 and 24 months after surgery. The lumbar lordosis angle (LL), disc height (DH) and lumbar intervertebral fusion rate were assessed before surgery and at the last follow-up. RESULTS The VAS and ODI scores of the two groups were improved compared with those before surgery. The ODI of UBE-TLIF group was lower than that of MMIS-TLIF group at 1, 3, 6, and 12 months after surgery, and there were no significant differences between the two groups at other time points (P > 0.05). There were no significant differences in VAS between the two groups at each time point (P > 0.05). However, the UBE-TLIF group had more advantages in blood loss and hospital stay. The complications between the UBE-TLIF group (11.54%) and the MMIS-TLIF group (17.39%) were comparable (P > 0.05). Radiographic outcomes showed that the LL and DH of the two groups were improved compared with those before surgery, and the difference before and after surgery was not significant (P > 0.05). The fusion rate was 96.2% in the UBE-TLIF group and 95.7% in the MMIS-TLIF group. There was no significant difference in the fusion rate between the two groups (P > 0.05). CONCLUSIONS Both UBE-TLIF and MMIS-TLIF have favorable outcomes for treating single-segment DLS-LSS. Both groups have the advantages of clear surgical vision, high surgical efficiency, and favorable mid-term efficacy. In addition, compared with MMIS-TLIF, UBE-TLIF causes less intraoperative bleeding and faster postoperative recovery.
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Affiliation(s)
- Wenlong Guo
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China.
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Tong Li
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Chaoqun Feng
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yang Yu
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Youpeng Hu
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Xiaohong Fan
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
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Essa A, Shehade M, Rabau O, Smorgick Y, Mirovsky Y, Anekstein Y. Fusion's Location and Quality within the Fixated Segment Following Transforaminal Interbody Fusion (TLIF). Healthcare (Basel) 2023; 11:2814. [PMID: 37957959 PMCID: PMC10648832 DOI: 10.3390/healthcare11212814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/14/2023] [Indexed: 11/15/2023] Open
Abstract
Transforaminal interbody fusion (TLIF) has gained increased popularity over recent decades and is being employed as an established surgical treatment for several lumbar spine pathologies, including degenerative spondylosis, spondylolisthesis, infection, tumor and some cases of recurrent disc herniation. Despite the seemingly acceptable fusion rates after TLIF (up to 94%), the literature is still limited regarding the specific location and quality of fusion inside the fixated segment. In this single-institution, retrospective population-based study, we evaluated all post-operative computed tomography (CT) of patients who underwent TLIF surgery at a medium-sized medical center between 2010 and 2020. All CT studies were performed at a minimum of 1 year following the surgery, with a median of 2 years. Each CT study was evaluated for post-operative fusion, specifically in the posterolateral and intervertebral body areas. The fusion's quality was determined and classified in each area according to Lee's criteria, as follows: (1) definitive fusion: definitive bony trabecular bridging across the graft host interface; (2) probable fusion: no definitive bony trabecular crossing but with no gap at the graft host interface; (3) possible arthrosis: no bony trabecular crossing with identifiable gap at the graft host interface; (4) definite pseudarthrosis: no traversing trabecular bone with definitive gap. A total of 48 patients were included in this study. The median age was 55.6 years (SD ± 15.4). The median time from surgery to post-operative CT was 2 years (range: 1-10). Full definitive fusion in both posterolateral and intervertebral areas was observed in 48% of patients, and 92% showed definitive fusion in at least one area (either posterolateral or intervertebral body area). When comparing the posterolateral and the intervertebral area fusion rates, a significantly higher definitive fusion rate was observed in the posterolateral area as compared to the intervertebral body area in the long term follow-up (92% vs. 52%, p < 0.001). In the multivariable analysis, accounting for several confounding factors, including the number of fixated segments and cage size, the results remained statistically significant (p = 0.048). In conclusion, a significantly higher definitive fusion rate at the posterolateral area compared to the intervertebral body area following TLIF surgery was found. Surgeons are encouraged to employ bone augmentation material in the posterolateral area (as the primary site of fusion) when performing TLIF surgery.
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Affiliation(s)
- Ahmad Essa
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Munder Shehade
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Oded Rabau
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Unit, Department of Orthopedic Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel
| | - Yossi Smorgick
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Unit, Department of Orthopedic Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel
| | - Yigal Mirovsky
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Unit, Department of Orthopedic Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel
| | - Yoram Anekstein
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Unit, Department of Orthopedic Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel
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Zhang S, Zhang Y, Huang L, Zhang S, Lu C, Liu Z, Kang C, Wang Z. Oblique lateral interbody fusion with internal fixations in the treatment for cross-segment degenerative lumbar spine disease (L2-3 and L4-5) finite element analysis. Sci Rep 2023; 13:17116. [PMID: 37816744 PMCID: PMC10564781 DOI: 10.1038/s41598-023-43399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 09/22/2023] [Indexed: 10/12/2023] Open
Abstract
Multi-segmental lumbar degenerative disease, including intersegmental disc degeneration, is found in clinical practice. Controversy still exists regarding the treatment for cross-segment degeneration. Oblique Lateral Interbody Fusion (OLIF) with several internal fixations was used to treat cross-segment lumbar degenerative disease. A whole lumbar spine model was extracted from CT images of the whole lumbar spine of patients with lumbar degeneration. The L2-3 and L4-5 intervertebral spaces were fused with OLIF using modeling software, the Pedicle screws were performed on L2-3 and L4-5, and different internal fixations were performed on L3-4 in Finite Element (FE) software. Among the six 10 Nm moments of different directions, the L3-4 no surgery (NS) group had the relatively largest Range of Motion (ROM) in the whole lumbar spine, while the L2-5 Long segmental fixation (LSF)group had the smallest ROM and the other groups had similar ROM. The ROM in the L1-2 and L5-S1 was relatively close in the six group models, and the articular cartilage stress and disc stress on the L1-2 and L5-S1 were relatively close. In contrast, the L3-4 ROM differed relatively greatly, with the LSF ROM the smallest and the NS ROM the largest, and the L3-4 Coflex (Coflex) group more active than the L3-4 Bacfuse (Bacfuse) group and the L3-4 translaminar facet screw fixation (TFSF) group. The stress on the articular cartilage and disc at L3-4 was relatively greater in the NS disc and articular cartilage, and greater in the Coflex group than in the Bacfuse and TFSF groups, with the greatest stress on the internal fixation in the TFSF group, followed by the Coflex group, and relatively similar stress in the Bacfuse, LSF, and NS groups. In the TFSF group, the stress on the internal fixation was greater than the yield strength among different directional moments of 10 Nm, which means it is unsuitable to be an internal fixation. The LSF group had the greatest overall ROM, which may lead to postoperative low back discomfort. The NS group has the greatest overall ROM, but its increased stress on the L3-4 disc and articular cartilage may lead to accelerated degeneration of the L3-4 disc and articular cartilage. The Coflex and Bacfuse groups had a reduced L3-4 ROM but a greater stress on disc compared to the LSF group, which may lead to disc degeneration in the long term. However, their stress on the articular cartilage was relatively low. Coflex and Bacfuse can still be considered better surgical options.
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Affiliation(s)
- Shuyi Zhang
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou, 350007, Fujian, China
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - Yilong Zhang
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - Licai Huang
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou, 350007, Fujian, China
| | - Shuao Zhang
- School of Civil Engineering, Lanzhou University of Technology, Lanzhou, 730000, Gansu, China
| | - Chenshui Lu
- Department of Foreign Languages, Fu Zhou University, Fuzhou, 350100, Fujian, China
| | - Zhengpeng Liu
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - Chan Kang
- Department of Orthopedics, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Zhao Wang
- Department of Orthopedics, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea.
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Tanasansomboon T, Robinson JE, Anand N. Minimally Invasive Transforaminal Lumbar Interbody Fusion: Strategies for Creating Lordosis with a Posterior Approach. Neurosurg Clin N Am 2023; 34:643-651. [PMID: 37718110 DOI: 10.1016/j.nec.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
The purpose of this article is to review the outcomes concerning lumbar lordosis restoration after the MIS-TLIF and to present strategies to create lumbar lordosis by using this MIS posterior approach. MIS-TLIF is an effective MIS lumbar interbody fusion that can achieve lumbar lordosis restoration. Several crucial steps aid in this sagittal profile correction during the MIS-TLIF, including the appropraite prone positioning, optimizing disc space preparation, maximizing disc space height, anterior interbody cage placement, and reducing the spondylolisthesis.
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Affiliation(s)
- Teerachat Tanasansomboon
- Department of Orthopedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Boulevard, Suite 901, Los Angeles, CA 90048, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Orthopedics, Center of Excellence in Biomechanics and Innovative Spine Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jerry E Robinson
- University of Pittsburg Medical Center (UPMC), Harrisburg, PA, USA
| | - Neel Anand
- Department of Orthopedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Boulevard, Suite 901, Los Angeles, CA 90048, USA.
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Zhang JK, Greenberg JK, Javeed S, Benedict B, Botterbush KS, Dibble CF, Khalifeh JM, Brehm S, Jain D, Dorward I, Santiago P, Molina C, Pennicooke BH, Ray WZ. Predictors of Postoperative Segmental and Overall Lumbar Lordosis in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Consecutive Case Series. Global Spine J 2023:21925682231193610. [PMID: 37522797 DOI: 10.1177/21925682231193610] [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: 08/01/2023] Open
Abstract
STUDY DESIGN Retrospective Case-Series. OBJECTIVES Due to heterogeneity in previous studies, the effect of MI-TLIF on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Therefore, we aim to identify radiographic factors associated with lordosis after surgery in a homogenous series of MI-TLIF patients. METHODS A single-center retrospective review identified consecutive patients who underwent single-level MI-TLIF for grade 1 degenerative spondylolisthesis from 2015-2020. All surgeries underwent unilateral facetectomies and a contralateral facet release with expandable interbody cages. PROs included the ODI and NRS-BP for low-back pain. Radiographic measures included SL, disc height, percent spondylolisthesis, cage positioning, LL, PI-LL mismatch, sacral-slope, and pelvic-tilt. Surgeries were considered "lordosing" if the change in postoperative SL was ≥ +4° and "kyphosing" if ≤ -4°. Predictors of change in SL/LL were evaluated using Pearson's correlation and multivariable regression. RESULTS A total of 73 patients with an average follow-up of 22.5 (range 12-61) months were included. Patients experienced significant improvements in ODI (29% ± 22% improvement, P < .001) and NRS-BP (3.3 ± 3 point improvement, P < .001). There was a significant increase in mean SL (Δ3.43° ± 4.37°, P < .001) while LL (Δ0.17° ± 6.98°, P > .05) remained stable. Thirty-eight (52%) patients experienced lordosing MI-TLIFs, compared to 4 (5%) kyphosing and 31 (43%) neutral MI-TLIFs. A lower preoperative SL and more anterior cage placement were associated with the greatest improvement in SL (β = -.45° P = .001, β = 15.06° P < .001, respectively). CONCLUSIONS In our series, the majority of patients experienced lordosing or neutral MI-TLIFs (n = 69, 95%). Preoperative radiographic alignment and anterior cage placement were significantly associated with target SL following MI-TLIF.
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Affiliation(s)
- Justin K Zhang
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Jacob K Greenberg
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Saad Javeed
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Braeden Benedict
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | | | | | - Jawad M Khalifeh
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, MD
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Deeptee Jain
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Ian Dorward
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Paul Santiago
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Camilo Molina
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | | | - Wilson Z Ray
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
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Yu B, Jiao J, Li C, Sun S, Wang J, Zhang C, Liu T. Effect of spinal fusion on degenerative scoliosis in elderly patients and analysis of influencing factors. Am J Transl Res 2023; 15:1168-1176. [PMID: 36915737 PMCID: PMC10006747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/10/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To analyze the factors influencing efficacy of spinal fusion for the improvement of degenerative scoliosis in elderly patients. METHODS Retrospective analysis of clinical data was conducted on 194 elderly patients with degenerative scoliosis treated with minimally invasive lumbar lateral fusion at Affiliated Hospital of Hebei University on February 2018 to February 2021. The patients were divided into a recovered group (n = 138) and an uncured group (n = 56) according to their recovery. The basic information of patients, preoperative complications, preoperative and postoperative imaging results, clinical function scores, postoperative complications, and other relevant information were collected. Logistic regression analysis was used to analyze the factors affecting outcome. Receiver operating characteristic curves were used to determine the predictive value of factors influencing prognosis. RESULTS Univariate analysis showed that, compared to the uncured group, the recovered group showed younger age, shorter duration of symptoms and length of hospital stay, less history of hypertension or diabetes, and lower Oswestry disability index (ODI), and Japanese Orthopedic Association scores (P<0.05). Multivariate retrospective analysis revealed that age, duration of symptoms, length of hospital stay, history of hypertension and pretreatment ODI score were independent risk factors affecting treatment efficacy (P<0.05). The area under the curve of the risk model for predicting efficacy was 0.951. CONCLUSION Age, duration of symptoms, length of hospital stay, history of hypertension, and pretreatment ODI score are risk factors affecting the treatment outcome of elderly patients with degenerative scoliosis, so these preoperative indications may be indicators to predict efficacy.
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Affiliation(s)
- Bo Yu
- Surgical Operating Room, Affiliated Hospital of Hebei University No. 212, Yuhua East Road, Lianchi District, Baoding 071000, Hebei, China
| | - Jianbao Jiao
- Department of Orthopedics, Affiliated Hospital of Hebei University No. 212, Yuhua East Road, Lianchi District, Baoding 071000, Hebei, China
| | - Congjie Li
- Department of Orthopedics, Affiliated Hospital of Hebei University No. 212, Yuhua East Road, Lianchi District, Baoding 071000, Hebei, China
| | - Shaosong Sun
- Department of Orthopedics, Affiliated Hospital of Hebei University No. 212, Yuhua East Road, Lianchi District, Baoding 071000, Hebei, China
| | - Jing Wang
- Department of Orthopedics, Gaoyang Hospital No. 112, Hongrun Street, Gaoyang County, Baoding 071000, Hebei, China
| | - Chaohui Zhang
- Medical Department of Hebei University Baoding, Hebei, China
| | - Teng Liu
- Department of Orthopedics, Affiliated Hospital of Hebei University No. 212, Yuhua East Road, Lianchi District, Baoding 071000, Hebei, China
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10
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Na M, Zhan X. Comparison of oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of degenerative lumbar diseases: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32356. [PMID: 36595815 PMCID: PMC9794273 DOI: 10.1097/md.0000000000032356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Degenerative lumbar diseases are common in the aging population, and is one of the most frequent causes of disability. Lumbar fusion is an effective surgical procedure for alleviating pain and improving function. A variety of fusion techniques applied where necessary are available and the optimal method remains controversial. We performed a protocol for systematic review and meta-analysis to compare the clinical efficacy of oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar diseases. METHODS This systematic review protocol will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) 2015 Statement.Following databases will be searched: PubMed, web of science, MEDLINE, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Wanfang data, and Chinese BioMedicine Literature Database. Only randomized controlled trials comparing OLIF and TLIF for treating degenerative lumbar diseases will be included. The meta-analysis will be performed with Review Manager Version 5.4 software (The Cochrane Collaboration, Copenhagen, Denmark). RESULTS The results of this systematic review will be published in a peer-reviewed journal. CONCLUSION This study will elucidate the clinical outcomes of OLIF compared with TLIF in treating degenerative lumbar diseases.
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Affiliation(s)
- Mengqi Na
- Department of Spinal Surgery, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Xinli Zhan
- Department of Spinal Surgery, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
- *Correspondence: Xinli Zhan, Department of Spinal Surgery, the First Affiliated Hospital of Guangxi Medical University, Guangxi, 530021, China (e-mail: )
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11
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Li K, Yan TZ, Lu ZA, Wang LH, Hao YK, Lv CL. Utility of Large Diameter Visible Trephine in Percutaneous Endoscopic Lumbar Interbody Fusion: A Technical Report. World Neurosurg 2022; 167:e1253-e1260. [PMID: 36075355 DOI: 10.1016/j.wneu.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE In this study, a large diameter visible trephine was designed and used in percutaneous endoscopic lumbar interbody fusion to increase endoscopic bone decompression efficiency. Large diameter visible trephine-related technical notes and preliminary clinical experience are described. METHODS A large diameter visible trephine was designed with normal diameter visible trephine as template. A total of 38 patients with lumbar degenerative diseases who underwent single-level percutaneous endoscopic lumbar interbody fusion with large or normal diameter visible trephine were included into a retrospective study. Operation time, bone decompression time, blood loss, intraoperative fluoroscopy, bone decompression fluoroscopy, and dura or nerve injury cases were recorded and analyzed statistically. Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) were used to analyze the clinical outcomes of the 2 groups. RESULTS The baseline data of the 2 groups were statistically similar. There was no significant difference in postoperative VAS and ODI scores between the 2 groups. Operation time and bone decompression time of large diameter visible trephine group were significantly shorter than that of normal diameter visible trephine group (P < 0.05). Intraoperative fluoroscopy times and bone decompression fluoroscopy times of large diameter visible trephine group were significantly more than that of normal diameter visible trephine group (P < 0.05). Blood loss of the 2 groups were not statistically different. There were no dura or nerve injury cases in the 2 groups. CONCLUSIONS For percutaneous endoscopic lumbar interbody fusion, the large diameter visible trephine is a safe and efficient endoscopic bone decompression tool under fluoroscopic guidance.
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Affiliation(s)
- Kang Li
- Shandong University of Traditional Chinese Medicine Postdoctoral Research Station, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, P.R. China; Department of Spine Surgery, Jining No.1 People's Hospital, Jining, Shandong Province, P.R. China
| | - Ting-Zhen Yan
- Department of Spine Surgery, Jining No.1 People's Hospital, Jining, Shandong Province, P.R. China
| | - Zi-Ang Lu
- Department of Spine Surgery, Jining No.1 People's Hospital, Jining, Shandong Province, P.R. China
| | - Ling-Hao Wang
- Department of Spine Surgery, Jining No.1 People's Hospital, Jining, Shandong Province, P.R. China
| | - Yan-Ke Hao
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, P.R. China
| | - Chao-Liang Lv
- Department of Spine Surgery, Jining No.1 People's Hospital, Jining, Shandong Province, P.R. China.
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12
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Prabhu MC, Jacob KC, Patel MR, Pawlowski H, Vanjani NN, Singh K. History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion. Neurospine 2022; 19:479-491. [PMID: 36203277 PMCID: PMC9537838 DOI: 10.14245/ns.2244122.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022] Open
Abstract
The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular surgical technique for lumbar arthrodesis, widely considered to hold great efficacy while conferring an impressive safety profile through the minimization of soft tissue damage. This elegant approach to lumbar stabilization is the byproduct of several innovations throughout the past century. In 1934, Mixter and Barr's paper in the New England Journal of Medicine elucidated the role of disc herniation in spinal instability and radiculopathy, prompting surgeons to explore new approaches and instruments to access the disc space. In 1944, Briggs and Milligan published their novel technique, the posterior lumbar interbody fusion (PLIF), involving continuous removal of vertebral bone chips and replacement of the disc with a round bone peg. The following decades witnessed several PLIF modifications, including the addition of long pedicle screws. In 1982, Harms and Rolinger sought to redefine the posterior corridor by approaching the disc space through the intervertebral foramen, establishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine surgery experienced a paradigm shift, with surgeons placing increased emphasis on tissuesparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated comparable surgical outcomes to the TLIF, with an improved safety profile. Here, we present a view into the history of the posterior-approach treatment of the discogenic radiculopathy, culminating in the MIS-TLIF. Additionally, we evaluate the hallmark characteristics, technical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF.
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Affiliation(s)
- Michael C. Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C. Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R. Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nisheka N. Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA,Corresponding Author Kern Singh Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612, USA
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13
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Balain B. Increasing relevance of minimally invasive spinal surgery. J Clin Orthop Trauma 2021; 22:101606. [PMID: 34631413 PMCID: PMC8479478 DOI: 10.1016/j.jcot.2021.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Birender Balain
- Consultant Spine Surgeon, Centre for Spinal Disorders, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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