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Wu Y, Shen R, Li S, Luo T, Rong L, Zhang L. Fusion Surgery for Lumbar Spondylolisthesis: A Systematic Review with Network Meta-Analysis of Randomized Controlled Trials. World Neurosurg 2024; 185:327-337.e1. [PMID: 38369106 DOI: 10.1016/j.wneu.2024.02.051] [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: 01/28/2024] [Accepted: 02/09/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE This study aimed to systematically evaluate the optimal surgical fusion approach for lumbar spondylolisthesis, to provide the latest and most reliable evidence for future clinical practice. METHODS A comprehensive search of the PubMed, Ovid-Embase, Web of Science, Cochrane, and Scopus databases was conducted from inception to September 1, 2023, to identify relevant records. Two independent reviewers performed the literature screening, data extraction, and assessment of study quality. RESULTS Fifteen randomized controlled trials involving 892 patients met the inclusion criteria. The network evidence plot showed that posterolateral fusion and posterior lumbar interbody fusion (PLIF) were the most used fusion techniques. The network meta-analysis results revealed that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) had a significantly greater improvement in the Oswestry Disability Index (ODI) compared to endoscopic-TLIF, while PLIF had a significantly better fusion effect than posterolateral fusion. Furthermore, no statistically significant differences were observed between other fusion surgeries in terms of improving ODI, fusion rate, complications, or the improvement of visual analog scale-low back pain. The surface under the cumulative ranking curve results indicated that MIS-TLIF had the greatest potential for improving ODI, visual analog scale-low back pain, and complications, while PLIF had the greatest potential for increasing fusion rates. However, the existing selection bias, measurement bias, reporting bias, and publication bias may have reduced the reliability of the meta-analysis results. CONCLUSIONS Among the various fusion surgeries for lumbar spondylolisthesis, MIS-TLIF appears to provide the greatest benefit to patients. However, more high-quality, large-scale studies are needed to further investigate the treatment efficacy of different fusion surgeries for lumbar spondylolisthesis.
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Affiliation(s)
- Yingjie Wu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Ruoqi Shen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Shengke Li
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Ting Luo
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Liangming Zhang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.
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Lei Y, Chen J, Liu Z, Luo M, Yang Y, Liang C, Xiao Z. Effect of Lateral Surgery Compared with Posterior Surgery on Lumbar Degenerative Disease: A Meta-Analysis of 41 Cohort Studies. World Neurosurg 2024; 184:e417-e448. [PMID: 38309653 DOI: 10.1016/j.wneu.2024.01.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy of the lateral approach and posterior approach in the treatment of lumbar degenerative diseases. METHODS Through a systematic search of relevant articles published on or before July 20, 2023, in the Embase, PubMed, and Cochrane libraries, the 2 authors independently extracted data and used the Newcastle‒Ottawa scale to evaluate the quality of the included studies. Using Stata16 software, the continuous variables were presented as the standard mean deviation, and the bipartite variables were analyzed using the pooled odds ratio with 95% confidence interval. RESULTS A total of 13,892 articles were screened and 10,908 studies were identified after deleting duplicates, of which 41 met the criteria and were included in the meta-analysis. The meta-analysis showed that the lateral approach was superior to the posterior approach in reducing blood loss, operation time, and hospital stay. At the same time, compared with the posterior approach, the lateral approach has more advantages in the long-term Japanese Orthopaedic Association score and Oswestry Disability Index score, adjusting mid- and long-term LL and short- and long-term disc height. CONCLUSIONS Lateral and posterior surgery have similar clinical effects in the treatment of lumbar degenerative diseases and can significantly reduce pain and improve postoperative SL. At the same time, the lateral approach has more advantages in improving long-term quality of life, reducing the long-term disability index, adjusting mid- and long-term LL and short- and long-term disc height.
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Affiliation(s)
- Yuanhu Lei
- Department of Joint Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Juemiao Chen
- Department of Joint Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China; Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zhixuan Liu
- Department of Orthopedic Trauma, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Mingjiang Luo
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Yang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Can Liang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zhihong Xiao
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China.
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Dong W, Ren Z, Li S. Modified facet joint fusion for multilevel lumbar spinal stenosis: a retrospective study of 135 consecutive patients. Br J Neurosurg 2023; 37:1046-1051. [PMID: 33245247 DOI: 10.1080/02688697.2020.1850642] [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: 12/14/2019] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of modified facet joint fusion (MFF) for the treatment of multilevel (three-level or more) lumbar spinal stenosis (LSS). PATIENTS AND METHODS In this retrospective study, 135 consecutive patients who underwent initial MFF for multilevel LSS were included. Clinical outcomes included fusion rate, change of visual analogue scale pain scores for low back pain (VAS-LBP) and leg pain (VAS-LP), Japanese Orthopedic Association scores (JOA), Oswestry Disability Index (ODI) and MacNab classification before and after MFF. The complications were also analyzed. RESULTS The fusion rates were 46.7% (63/135) at 6-month and 89.6% (121/135) at 1-year. The mean VAS-LBP, VAS-LP, and ODI significantly decreased from 5.2 ± 0.6, 5.7 ± 0.8 and 65 ± 7.9 to 1.58 ± 0.4, 0.58 ± 0.3 and 20.8 ± 5.8, respectively (all p < 0.001). The mean JOA markedly improved from 10.0 ± 1.3 to 26.1 ± 1.5 (p < 0.001). Excellent/good results of MacNab classification were achieved in 88.9% (120/135) of the patients. The overall rate of complications after MFF was 5.9%, including poor wound healing (2.2%), calf muscular venous thrombosis (0.74%), deep venous thrombosis (0.74%), superficial wound infection (1.48%), transient foot drop (0.74%). All the complications were transient and improved without prolonged hospital stay and sequelae. CONCLUSION MFF may be safe and efficient for multilevel LSS with high fusion rate and significant symptom relief, which is worthy of further study.
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Affiliation(s)
- Wenfang Dong
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Zhinan Ren
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Shugang Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
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Toci GR, Lambrechts MJ, Heard JC, Karamian BA, Siegel NM, Carter MV, Curran JG, Canseco JA, Kaye ID, Woods BI, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Postoperative Opioid Use Following Single-Level Transforaminal Lumbar Interbody Fusion Compared with Posterolateral Lumbar Fusion. World Neurosurg 2022; 165:e546-e554. [PMID: 35760330 DOI: 10.1016/j.wneu.2022.06.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/19/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare postoperative opioid morphine milligram equivalents (MME) prescriptions for opioid-naïve patients undergoing single-level transforaminal lumbar interbody fusion (TLIF) versus posterolateral lumbar fusion (PLF) and total postoperative MME prescribed based on operative duration. METHODS Patients undergoing single-level TLIF or PLF from September 2017 to June 2020 were identified from a single institution. Patients were first grouped based on procedure type (TLIF or PLF) and subsequently regrouped based on median operative duration. Statistical tests compared patient demographics and opioid prescription data between groups. Multivariate regressions were performed to control for demographics, operative time, and procedure type. RESULTS Of 345 patients undergoing single-level PLF or TLIF, 174 (50.4%) were opioid-naïve; 101 opioid-naïve patients (58.0%) underwent PLF and 73 (42.0%) underwent TLIF. Patients undergoing TLIF received more opioid prescriptions (1.99 vs. 1.26, P < 0.001) and total MME (91.2 vs. 66.8, P = 0.002). After regrouping patients based on operative duration, independent of procedure type, there were no differences in postoperative opioid prescriptions, and Spearman rank correlation coefficient between total MME and operative duration was r = 0.014. Multivariate analysis identified TLIF as an independent predictor of increased postoperative opioid prescriptions (β = 0.64, P < 0.001), prescribers (β = 0.49, P = 0.003), and MME (β = 24.4, P = 0.030). CONCLUSIONS Opioid-naïve patients undergoing single-level TLIF receive a greater number of postoperative opioids than patients undergoing single-level PLF, and TLIF was an independent predictor of increased postoperative opioid prescribers, prescribers, and MME. There were no differences in postoperative opioid prescriptions when assessing patients based on operative duration.
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Affiliation(s)
- Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas M Siegel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael V Carter
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John G Curran
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - I David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Wasinpongwanich K, Nopsopon T, Pongpirul K. Surgical Treatments for Lumbar Spine Diseases (TLIF vs. Other Surgical Techniques): A Systematic Review and Meta-Analysis. Front Surg 2022; 9:829469. [PMID: 35360425 PMCID: PMC8964266 DOI: 10.3389/fsurg.2022.829469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/11/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The purpose of this study is to compare fusion rate, clinical outcomes, complications among transforaminal lumbar interbody fusion (TLIF), and other techniques for lumbar spine diseases. Design This is a systematic review and meta-analysis. Data Sources PubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases were searched from January 2013 through December 2019. Eligibility Criteria for Selecting Studies Randomized controlled trials (RCTs) that compare lumbar interbody fusion with posterolateral fusion (PLF) and/or other lumbar interbody fusion were included for the review. Data Extraction and Synthesis Two independent reviewers extracted relevant data and assessed the risk of bias. Meta-analysis was performed using a random-effects model. Pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval of fusion rate, clinical outcomes, and complications in TLIF and other techniques for lumbar spinal diseases. Results Of 3,682 potential studies, 15 RCTs (915 patients) were included in the meta-analysis. Compared to other surgical techniques, TLIF had slightly lower fusion rate [RR = 0.84 (95% CI = 0.72–0.97), p = 0.02, I2 = 0.0%] at 1-year follow-up whereas there was no difference on fusion rate at 2-year follow-up [RR = 1.06 (95% CI = 0.96–1.18), p = 0.27, I2 = 69.0%]. The estimated RR of total adverse events [RR = 0.90 (95% CI = 0.59–1.38), p = 0.63, I2 = 0.0%] was similar to no fusion, PLF, PLIF, and XLIF groups, and revision rate [RR = 0.78 (95% CI = 0.34–1.79), p = 0.56, I2 = 39.0%] was similar to PLF and XLIF groups. TLIF had approximately half an hour more operative time than other techniques (no fusion, ALIF, PLF, PLIF, XLIF) [MD = 31.88 (95% CI = 5.33–58.44), p = 0.02, I2 = 92.0%]. There was no significant difference between TLIF and other techniques in terms of blood loss (no fusion, PLIF, PLF) and clinical outcomes (PLF). Conclusions Besides fusion rate at 1-year follow-up and operative time, TLIF has a similar fusion rate, clinical outcomes, parameters concerning operation and complications to no fusion, PLF, and other interbody fusion (PLIF, ALIF, XLIF). Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42020186858.
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Affiliation(s)
- Kanthika Wasinpongwanich
- Department of Orthopedics, Faculty of Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand
- Bumrungrad International Hospital, Bangkok, Thailand
| | - Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Bumrungrad International Hospital, Bangkok, Thailand
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- *Correspondence: Krit Pongpirul
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Li Z, Li Z, Chen X, Han X, Li K, Li S. Comparison between modified facet joint fusion and posterolateral fusion for the treatment of lumbar degenerative diseases: a retrospective study. BMC Surg 2022; 22:29. [PMID: 35090435 PMCID: PMC8796487 DOI: 10.1186/s12893-022-01468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To investigate the safety and effectiveness of modified facet joint fusion in the treatment of lumbar degenerative diseases and compare them with those of posterolateral fusion. Methods A total of 77 adult patients with lumbar degenerative disease diagnosed from January 2017 to February 2019 were considered for the present retrospective, nonrandomized, and controlled study. The patients were divided into two groups according to the fusion technique used during the surgery: the posterolateral fusion (PLF) group (n = 42) and the modified facet joint fusion (MFF) group (n = 35). The fusion rate, Oswestry Disability Index (ODI) score, visual analog scale (VAS) score for back pain and leg pain, Japanese Orthopedic Association (JOA) score, European Quality of Life–5 Dimensions (EQ-5D) score, length of hospital stay, length of operation, intraoperative blood loss, cost of hospitalization, complications and reoperations were compared between the 2 groups. Results All patients underwent a successful surgery, and all were followed up. No significant differences were found in age, sex, BMI, length of hospital stay, length of operation or cost of hospitalization. There were no significant differences in the preoperative or postoperative ODI or in the VAS, JOA, and EQ-5D scores between the MFF and PLF groups. However, the fusion rate of MFF group was higher than that of the PLF group (P < 0.05). What’s more, the MFF group had less intraoperative blood loss than the PLF group (P < 0.05). Complications related to iatrogenic nerve injury, vascular injury, epidural hematoma, intravertebral infection, and internal fixation did not occur in either group. None of the patients required reoperation. Conclusions Modified facet joint fusion is safe and efficient in the treatment of lumbar degenerative disease. The fusion rate of MFF was higher than PLF. The intraoperative blood loss of MFF was less than that of PLF. In addition, the therapeutic effect of MFF was not worse than that of PLF. Therefore, the MFF technique can be promoted in clinical treatment.
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Affiliation(s)
- Zhimin Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Hutong, Dong Cheng District, Beijing, 100730, China.,Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Hutong, Dong Cheng District, Beijing, 100730, China
| | - Zheng Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Hutong, Dong Cheng District, Beijing, 100730, China.
| | - Xin Chen
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Hutong, Dong Cheng District, Beijing, 100730, China
| | - Xiao Han
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Hutong, Dong Cheng District, Beijing, 100730, China
| | - Kuan Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Hutong, Dong Cheng District, Beijing, 100730, China
| | - Shugang Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Hutong, Dong Cheng District, Beijing, 100730, China.
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Porche K, Dru A, Moor R, Kubilis P, Vaziri S, Hoh DJ. Preoperative Radiographic Prediction Tool for Early Postoperative Segmental and Lumbar Lordosis Alignment After Transforaminal Lumbar Interbody Fusion. Cureus 2021; 13:e18175. [PMID: 34703700 PMCID: PMC8530555 DOI: 10.7759/cureus.18175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Transforaminal lumbar interbody fusion (TLIF) is a common approach and results in varying degrees of lordosis correction. The purpose of this study is to determine preoperative radiographic spinopelvic parameters that predict change in postoperative segmental and lumbar lordosis after TLIF. Materials & Methods This study is a single surgeon retrospective review of one-level and two-level TLIFs from L3-S1. All patients underwent bilateral facetectomies, 10 mm TLIF cage (non-lordotic) insertions, and bilateral pedicle screw-rod construct placements. Pre- and post-operative X-rays were assessed for preoperative segmental lordosis (SL), lumbar lordosis (LL), and pelvic incidence (PI). Univariate and multi-predictor linear regression analyses were performed to determine the relationships between preoperative radiographic findings and change in early postoperative segmental and lumbar lordosis. Results Ninety-seven patients contributing 128 intervertebral segments were examined. The mean change in SL after TLIF was 7.3 (range: 0.10-28.9°, SD 6.39°). The mean change in LL after TLIF was 5.5˚ (range: -14.8-39.2°, standard deviation (SD) 7.16°). Greater preoperative LL predicted less postoperative LL correction, while greater preoperative PI predicted more postoperative SL and LL correction. Greater anterior disk height was noted to be associated with a decreased change in SL (∆SL). An annular tear on preoperative magnetic resonance imaging (MRI) predicted a 2.7° decrease in ∆SL. A Schmorl's node on preoperative MRI predicted a 4.0° decrease in change in LL (∆LL). Conclusions A greater preoperative lordosis and a lower spinopelvic mismatch lessen the potential for an increase in the postoperative SL and LL after a TLIF, which is likely due to a ‘ceiling’ effect of an otherwise optimized spinal alignment. A greater anterior disk height and the presence of an annular tear are associated with decreased ∆SL.
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Affiliation(s)
- Ken Porche
- Neurosurgery, University of Florida, Gainesville, USA
| | - Alexander Dru
- Neurosurgery, University of Florida, Gainesville, USA
| | - Rachel Moor
- Neurosurgery, University of Florida, Gainesville, USA
| | - Paul Kubilis
- Neurosurgery, University of Florida, Gainesville, USA
| | - Sasha Vaziri
- Neurosurgery, University of Florida, Gainesville, USA
| | - Daniel J Hoh
- Neurosurgery, University of Florida College of Medicine, Gainesville, USA
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Ren Z, Li Z, Li S, Xu D, Chen X. Modified Facet Joint Fusion for Lumbar Degenerative Disease: Case Series of a Fusion Technique, Clinical Outcomes, and Fusion Rate in 491 Patients. Oper Neurosurg (Hagerstown) 2020; 19:255-263. [PMID: 32469075 DOI: 10.1093/ons/opaa147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Controversy still exists regarding the optimal fusion technique for the treatment of unstable lumbar spondylolisthesis. OBJECTIVE To evaluate the safety and efficacy of modified facet joint fusion (MFF). METHODS A total of 491 patients with unstable lumbar spondylolisthesis who underwent MFF were retrospectively reviewed. Computed tomography was used to evaluate the fusion rate of MFF at 6- and 12-mo follow-up postoperatively. Clinical outcomes included visual analog scale pain scores for low back pain (VAS-LBP) and leg pain (VAS-LP), Japanese Orthopedic Association scores (JOA), and Oswestry Disability Index (ODI), all of which were obtained preoperatively and postoperatively at 1-, 3-, 6-, and 12-mo follow-up times. The clinical outcomes were determined to be excellent, good, fair, or poor according to the MacNab classification at the last follow-up time. RESULTS Of the 491 patients, the fusion rates at the 6-mo and 1-yr follow-up were 56.8% and 96.1%, respectively. Between baseline and 1-yr follow-up time, VAS-LP and VAS-LBP improved from 5.6 ± 0.9 to 0.4 ± 0.5 and 5.1 ± 1.2 to 1.5 ± 0.9, respectively (P < .001). JOA improved from 9.0 ± 2.0 to 27.7 ± 1.0, and ODI decreased from 64.0 ± 2.0 to 19 ± 1.0 (P < .001). At the final evaluation, 93.6% patients showed excellent or good results, and 3.2% showed fair results. There were no MFF technique-related complications. CONCLUSION MFF technique achieved satisfactory clinical outcomes and fusion rate and appears to be a promising alternative fusion technique for the treatment of unstable lumbar spondylolisthesis.
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Affiliation(s)
- Zhinan Ren
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zheng Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugang Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Derong Xu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Chen
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cristante AF, Silva RTE, Costa GHRD, Marcon RM. Adult Degenerative Scoliosis. Rev Bras Ortop 2020; 56:1-8. [PMID: 33627892 PMCID: PMC7895612 DOI: 10.1055/s-0040-1709736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/10/2020] [Indexed: 11/04/2022] Open
Abstract
Populational aging increases the incidence of musculoskeletal degenerative processes, such as adult scoliosis (AS). Adult scoliosis is defined as a spinal deformity in the coronal plane with a Cobb angle > 10°. Adult scoliosis may be iatrogenic or result from a degenerative process (scoliosis
de novo
) or a pre-existing scoliosis.
Adult scoliosis is a potentially limiting condition that affects a heterogeneous group of patients. Clinical treatment proved to be ineffective and surgery is often indicated. The present paper reviews AS pathophysiology, clinical presentation and diagnosis, in addition to surgical indications and the main techniques currently used.
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Affiliation(s)
- Alexandre Fogaça Cristante
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Teixeira E Silva
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Raphael Martus Marcon
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Eun IS, Son SM, Goh TS, Lee JS. Sagittal spinopelvic alignment after spinal fusion in degenerative lumbar scoliosis: a meta-analysis. Br J Neurosurg 2020; 34:176-180. [DOI: 10.1080/02688697.2020.1725437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Il-Soo Eun
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Republic of Korea
| | - Seung Min Son
- Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Gudeok-Ro, Seo-Gu, Busan, Republic of Korea
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Kelly JP, Alcala-Marquez C, Dawson JM, Mehbod AA, Pinto MR. Treatment of degenerative spondylolisthesis by instrumented posterolateral versus instrumented posterolateral with transforaminal lumbar interbody single-level fusion. JOURNAL OF SPINE SURGERY 2019; 5:351-357. [PMID: 31663046 DOI: 10.21037/jss.2019.08.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to compare outcomes of patients with degenerative spondylolisthesis treated by posterolateral lumbar fusion (PLF) versus PLF with transforaminal lumbar interbody fusion (PLF + TLIF). Studies of PLF versus PLF + TLIF have shown either equivalence or support for PLF + TLIF in lumbar spine surgery. Many are heterogeneous in the conditions treated, with few considering only spondylolisthesis of degenerative origin. Radiographic outcomes tend to favor PLF + TLIF, but this has not translated into better clinical outcomes. Methods This was a retrospective cohort study. Forty-nine patients undergoing single-level PLF and seventy patients undergoing single-level PLF + TLIF with two-year follow-up were retrospectively reviewed. Demographics, Oswestry Disability Index (ODI), implant cost, surgical data, and complications were analyzed. Results There was no difference in ODI improvement at two-year follow-up between the cohorts (P=0.97). Dural tears were more common in the PLF cohort (P<0.01), but otherwise complication and reoperation rates were similar. Implant cost (P<0.01) and operative time (P=0.01) were higher in the PLF + TLIF cohort. Conclusions The addition of a TLIF to a PLF did not result in a functional improvement in the treatment of degenerative spondylolisthesis as measured by the ODI.
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Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE To compare posterolateral versus transforaminal interbody fusion (PLF vs. PLF+TLIF) of the L4/5 segment regarding rates of subsequent surgery, clinical and radiographic parameters, and patient satisfaction. SUMMARY OF BACKGROUND DATA Surgical treatment of lumbar stenosis, decompression with or without fusion, is an efficacious treatment in select patients. Reoperation is thought to be a problem after lumbar fusion. Despite multiple studies, the fusion method that minimizes the need for subsequent surgery has yet to be determined. MATERIALS AND METHODS A retrospective cohort study was conducted on 89 patients who had an isolated L4/5 decompression and fusion, from January 2006 to 2012. All patients had stenosis and degenerative spondylolisthesis at the L4/5 level. All surgeries were performed at a single center, using either PLF (31 patients) or PLF+TLIF (58 patients) techniques. Preoperative and postoperative patient-reported outcome measures (Oswestry disability index, visual analog scale back pain, visual analog scale leg pain) and radiographic parameters (L4/5 lordosis and overall lumbar lordosis) were measured. Patient satisfaction was acquired via a questionnaire. Chart reviews and patient questionnaires were used to determine the incidence of subsequent lumbar surgery over a minimum follow-up of 5 years. RESULTS At an average of 8.7 years follow-up, 2 of 31 patients in the PLF group had subsequent lumbar surgery, compared with 16 of 58 patients in the PLF+TLIF group (6% vs. 28%; P=0.02). There were no significant differences between groups with respect to sex, age, body mass index, tobacco, perioperative measures, patient-reported outcomes, or radiographic parameters (P>0.05). CONCLUSIONS Both PLF and PLF+TLIF are effective fusion methods for L4/5 stenosis and spondylolisthesis. In this study, patients treated with PLF were less likely to undergo a subsequent lumbar surgery. More research is needed to determine which factors influence whether PLF or PLF+TLIF should be used in these patients. LEVEL OF EVIDENCE Level III.
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Heinz von der Hoeh N, Villa T, Galbusera F, Voelker A, Spiegl UA, Jarvers JS, Heyde CE. Analysis of a Unilateral Bridging Cage for Lumbar Interbody Fusion: 2-Year Clinical Results and Fusion Rate with a Focus on Subsidence. World Neurosurg 2018; 116:e308-e314. [DOI: 10.1016/j.wneu.2018.04.195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
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Bozkurt G, Isikay I, Hanalioglu S. Radiological and Clinical Comparison of Posterolateral Fusion and Transforaminal Interbody Fusion Techniques in Degenerative Lumbar Stenosis. World Neurosurg 2018; 116:e1060-e1065. [DOI: 10.1016/j.wneu.2018.05.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an updated review of adult degenerative scoliosis (ADS). Epidemiology, classification, pathophysiology, and natural history are discussed along with a summary of commonly used outcome measures. Operative vs non-operative outcomes and new surgical techniques are discussed. RECENT FINDINGS The SRS-Schwab classification (2012) combines clinical and radiographic evaluation including overall global alignment. Current evidence regarding risk factors and efficacy of non-surgical modalities are discussed. Recent studies have reported surgical management to provide superior outcomes to non-operative modalities. New surgical techniques provide promising early data in regard to decreasing perioperative morbidity. ADS is a potentially debilitating condition that occurs with asymmetric spinal degeneration. This can produce global sagittal malalignment and central and foraminal stenosis and can lead to significant impairment often necessitating surgery. The surgeon must be aware of the perioperative risks in this population and implement appropriate age-specific alignment goals to achieve the best outcome for patients.
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Affiliation(s)
- Philip J York
- Department of Orthopaedic Surgery, University of Colorado, Aurora, CO, USA
| | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, 10021, USA.
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