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Aspalter S, Stefanits H, Maier CJ, Radl C, Wagner H, Hermann P, Aichholzer M, Stroh N, Gruber A, Senker W. Reduction of spondylolisthesis and restoration of lumbar lordosis after anterior lumbar interbody fusion (ALIF). BMC Surg 2023; 23:66. [PMID: 36973719 PMCID: PMC10045589 DOI: 10.1186/s12893-023-01966-z] [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: 01/06/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Anterior lumbar interbody fusion (ALIF) is a well-established surgical treatment option for various diseases of the lumbar spine, including spondylolisthesis. This study aimed to evaluate the postoperative correction of spondylolisthesis and restoration of lumbar and segmental lordosis after ALIF. METHODS Patients with spondylolisthesis who underwent ALIF between 2013 and 2019 were retrospectively assessed. We assessed the following parameters pre-and postoperatively (6-months follow-up): Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), lumbar lordosis (LL), segmental lordosis (SL), L4/S1 lordosis, and degree of spondylolisthesis. RESULTS 96 patients were included. In 84 cases (87.50%), additional dorsal instrumentation was performed. The most frequent diagnosis was isthmic spondylolisthesis (73.96%). VAS was reduced postoperatively, from 70 to 40, as was ODI (50% to 32%). LL increased from 59.15° to 64.45°, as did SL (18.95° to 28.55°) and L4/S1 lordosis (37.90° to 44.00°). Preoperative spondylolisthesis was 8.90 mm and was reduced to 6.05 mm postoperatively. Relative spondylolisthesis was 21.63% preoperatively and 13.71% postoperatively. All clinical and radiological improvements were significant (all p < 0.001). No significant difference considering the lordosis values nor spondylolisthesis was found between patients who underwent ALIF surgery without dorsal instrumentation and patients who received additional dorsal instrumentation. Venous laceration was the most frequent complication (10.42%). CONCLUSIONS With ALIF, good clinical results and safe and effective reduction of spondylolisthesis and restoration of lordosis can be achieved. Additional dorsal instrumentation does not significantly affect postoperative lordosis or spondylolisthesis. Individual vascular anatomy must be reviewed preoperatively before considering ALIF.
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Affiliation(s)
- Stefan Aspalter
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Harald Stefanits
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria.
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg Weg 15, Linz, 4020, Austria.
| | - Christoph Johannes Maier
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Christian Radl
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Helga Wagner
- Center for Clinical Studies (CCS Linz), Johannes Kepler University, Linz, Austria
- Department of Medical Statistics and Biometry, Institute of Applied Statistics, Johannes Kepler University, Linz, Austria
| | - Philipp Hermann
- Center for Clinical Studies (CCS Linz), Johannes Kepler University, Linz, Austria
| | - Martin Aichholzer
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Nico Stroh
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Wolfgang Senker
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
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Kolz JM, Mitchell SA, Elder BD, Sebastian AS, Huddleston PM, Freedman BA. Sacral Insufficiency Fracture Following Short-Segment Lumbosacral Fusion: Case Series and Review of the Literature. Global Spine J 2022; 12:267-277. [PMID: 32865022 PMCID: PMC8907635 DOI: 10.1177/2192568220950332] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE Sacral insufficiency fracture is a rare and serious complication following lumbar spine instrumented fusion. The purpose of this study was to describe the patient characteristics, presentation, evaluation, treatment options, and outcomes for patients with sacral insufficiency fracture after short-segment lumbosacral fusion. METHODS Six patients from our institutional database and 16 patients from literature review were identified with a sacral insufficiency fracture after short-segment (L4-S1 or L5-S1) lumbar fusion within 1 year of surgery. RESULTS Patients were 55% female with a mean age of 58 years and body mass index of 30 kg/m2. Osteoporosis or osteopenia was the most common comorbidity (85%). Half of patients sustained a sacral fracture after surgery from a posterior approach, while the others had anterior or anterior-posterior surgery. Mean time to fracture was 42 days with patients clinically presenting with new sacral pain (86%), radiculopathy (60%), or neurologic deficit (5%). Ultimately, 73% of patients underwent operative fixation often involving extension of the construct (75%) and fusion to the pelvis (69%). Men (P = .02) and patients with new radicular pain or neurologic deficit (P = .01) were more likely to undergo revision surgical treatment while women over 50 years of age were more likely to be treated conservatively (P = .003). CONCLUSIONS Spine surgeons should monitor for sacral insufficiency fracture as a source of new-onset pain in the postoperative period in patients with a short segment fusion to the sacrum. The recognition of this complication should prompt an assessment of bone health and management of underlying bone fragility.
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Affiliation(s)
| | | | | | | | | | - Brett A. Freedman
- Mayo Clinic, Rochester, MN, USA,Brett A. Freedman, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
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Lin YT, Su KC, Chen KH, Pan CC, Shih CM, Lee CH. Biomechanical analysis of reduction technique for lumbar spondylolisthesis: anterior lever versus posterior lever reduction method. BMC Musculoskelet Disord 2021; 22:879. [PMID: 34649557 PMCID: PMC8518150 DOI: 10.1186/s12891-021-04758-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reduction of lumbar spondylolisthesis during spinal fusion surgery is important for improving the fusion rate and restoring the sagittal alignment. Despite the variety of reduction methods, the fundamental mechanics of lumbar spondylolisthesis reduction remain unclear. This study aimed to investigate the biomechanical behavior while performing spondylolisthesis reduction with the anterior and posterior lever reduction method. METHODS We developed an L4-L5 spondylolisthesis model using sawbones. Two spine surgeons performed the simulated reduction with a customized Cobb elevator. The following data were collected: the torque and angular motion of Cobb, displacement of vertebral bodies, change of lordotic angle between L4 and L5, total axial force and torque applied on the model, and force received by adjacent disc. RESULTS Less torque value (116 N-cm vs. 155 N-cm) and greater angular motion (53o vs. 38o) of Cobb elevator were observed in anterior lever reduction. Moreover, the total axial force received by the entire model was greater in the posterior lever method than that in the anterior lever method (40.8 N vs. 16.38 N). Besides, the displacement of both vertebral bodies was greater in the anterior lever method. CONCLUSIONS The anterior lever reduction is a more effort-saving method than the posterior lever reduction method. The existing evidence supports the biomechanical advantage of the anterior reduction method, which might be one of the contributing factors to successfully treating high-grade lumbar spondylolisthesis with short-segment instrumentation.
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Affiliation(s)
- Yu-Tsung Lin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
- Department of Chemical and Materials Engineering, Tunghai University, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan
- National Chung Hsing University, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing, and Management, Miaoli County, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- National Chung Hsing University, Taichung, Taiwan
- Department of Physical Therapy, Hungkuang University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.
- National Chung Hsing University, Taichung, Taiwan.
- Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan.
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Novel bone grafting technique in stand-alone ALIF procedure combining allograft and autograft ('Northumbria Technique')-Fusion rate and functional outcomes in 100 consecutive patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1296-1302. [PMID: 33590282 DOI: 10.1007/s00586-021-06758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/03/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Successful ALIF surgery depends upon achieving solid fusion, whilst avoiding significant complications. Herein, we present the 'Northumbria Technique' of combining allograft with autograft in order to achieve solid interbody fusion. MATERIALS AND METHODS A single-surgeon series of 100 consecutive patients undergoing stand-alone ALIF from 2016 to 2019 was studied. All had percutaneously harvested iliac crest bone graft (ICBG) dowels inserted into blocks of fresh frozen femoral head (FFFH) allograft, which were then inserted into the ALIF cages. Patients had dynamic radiographs at 4 months, CT at 6 months, and patient reported outcome measure scores (PROMS) throughout. RESULTS One hundred patients (average age 44.8 years) were followed-up for an average of 29.1 months. Ninety-four (94%) patients were assessed as having fused on both CT and radiographs by an independent Radiologist. Three (3%) patients had abolition of movement on radiographs, but either lacked a CT scan or failed to meet Williams criteria for fusion. Two patients failed to attend for any imaging, so were considered not fused, and one patient had no evidence of fusion in either modality. There was a significant improvement in all PROMS. There were no intra-operative complications, and one patient had transient donor-site pain. CONCLUSIONS The newly described 'Northumbria Technique' utilises the osteoconductive characteristics of the FFFH allograft, as well as the osteoinductive and osteogenic properties of the ICBG autograft. It gives high fusion rates (94-97%) and statistically significant improvements in PROMS, whilst avoiding the complications of harvesting a large amount of autograft and the huge costs of using synthetic agents.
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Dias Pereira Filho AR. Technique for Exposing Lumbar Discs in Anterior Approach Using Steinmann Wires: Arthroplasties or Arthrodesis. World Neurosurg 2020; 148:189-195. [PMID: 33385594 DOI: 10.1016/j.wneu.2020.12.113] [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: 10/05/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to increasing longevity, the incidence of degenerative lumbar disc diseases has increased, and surgical treatment is often necessary. In this context, the anterior approach becomes an important technique. However, one of the main limitations of this method is the need for dedicated retractors, which requires larger incisions for its positioning and increases the cost of the procedure. The objective of the present study was to describe a technique for retracting abdominal structures by anterior approaches to the lumbar spine using Steinmann wires. METHODS This manuscript consists of a technique description of anterior approach for lumbar spine. RESULTS Surgical treatment of degenerative lumbar spine disease is often necessary when the patients have symptoms refractory to conservative treatments. Many of them will be candidates for surgical treatment with anterior approach, either for arthrodesis/anterior lumbar interbody fusion or arthroplasty. Small incisions are performed for positioning the modified Langenbeck retractors and the Steinmann wires. These retractors are easily positioned and provide good exposure of the lumbar discs making it possible to implant appropriate cages for restoring the necessary height, lordosis, and sagittal balance. CONCLUSIONS The technique described is safe, inexpensive, and reproducible. Simple and easily accessible instruments are required in most hospital complexes.
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Kalani MA, Kouloumberis P, Richards AE, Lyons MK, Davila VJ, Neal MT. Retrospective radiographic analysis of anterior lumbar fusion for high grade lumbar spondylolisthesis. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:650-658. [PMID: 33447667 PMCID: PMC7797809 DOI: 10.21037/jss-20-597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND High-grade spondylolisthesis (>50% slippage) is infrequently encountered in adults and frequently requires surgical treatment. The optimal surgical treatment is controversial with limited literature guidance as to optimal approach to treatment. An observational study to examine the technique and radiographic outcomes of adult patients treated with anterior lumbar interbody fusion (ALIF) and posterior percutaneous instrumentation for high-grade spondylolisthesis. METHODS ALIF was performed in 5 consecutive patients (3/5 female, 2/5 male) aged 29-67 years old who presented with low back pain and L5 radiculopathy. All patients failed conservative treatment and were treated with L4-5 and L5-S1 ALIF followed by posterior percutaneous L4-S1 pedicle screw and rod fixation. Pre- and postoperative clinical data was collected including L5-S1 posterior disk height in millimeters, millimeters of spondylolisthesis at L5-S1, degrees of segmental lordosis (L4-S1), lumbar lordosis (L1-S1), and lumbar lordosis pelvic incidence (LL-PI) mismatch. RESULTS Six weeks following surgery, no patient reported residual L5 radicular symptoms. At last follow up, patient satisfaction, according to Modified Macnab Criteria, was excellent in 4/5 patients and good in 1/5 patient. In the 4 patients with greater than 1 year radiographic follow up, fusion rate was 100% on computed tomography (CT). Mean increase in posterior disk height was 12.5 mm (range, 11.4-13.5 mm). Mean reduction in spondylolisthesis was 58.7% (range, 20.2-100%). Mean segmental (L4-S1) and overall (L1-S1) lumbar lordosis increased by 23.6% (range, 6.5-41.7%) and 16.6% (2.5-31.5%), respectively. Following surgery, LL-PI mismatch decreased from a mean of 16.4 to 10.2 degrees. CONCLUSIONS ALIF with posterior percutaneous instrumentation is a safe and effective treatment for high-grade lumbosacral spondylolisthesis in properly selected adults. This technique improves lumbar sagittal parameters and reduces spondylolisthesis. The indirect neural decompression from simultaneous disk height restoration and spondylolisthesis reduction may be associated with lower neurological injury rate compared to posterior-only. Future prospective study is needed to validate this hypothesis.
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Affiliation(s)
| | | | | | - Mark K Lyons
- Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, USA
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Iliocava junction to L4-L5 disc anatomical relationship in L5-S1 isthmic spondylolisthesis. Orthop Traumatol Surg Res 2020; 106:1195-1201. [PMID: 32331987 DOI: 10.1016/j.otsr.2020.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/22/2020] [Accepted: 02/28/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anterior lumbar interbody fusion finds a place in L5-S1 isthmic spondylolisthesis (ISPL) treatment. Extension of this arthrodesis at L4-L5 level is sometimes required. Anterior approach of the L4L5 disc is considered difficult due to the anatomical relationship between the iliocava junction (ICJ) and the spine. HYPOTHESIS Does the lumbosacral deformation induced by ISPL allows anterior approach of L4-L5 disc between the iliac? STUDY DESIGN Retrospective radiographic analysis of consecutive patients. METHODS This retrospective imaging study of a continuous series of 97 patients treated for an L5-S1 ISPL involved radiological parameters specific to ISPL and pelvic-sagittal balance. The distance between the ICJ and the L4 lower endplate was measured in millimeters. The factors influencing this distance were sought in order to identify a predictive model of high ICJ. RESULTS The ICJ took a cranial position with respect to the L4-L5 disc with an average distance of 1.8mm±16.4. This distance was statistically higher in the case of high-grade ISPL (p<0.01). The high ICJ position was correlated with a high Taillard index (r=0.39; CI95% [0.13; 0.61]; p<.001) and a low lumbar-sacral angle (LSA) (r=-0.33; CI95% [-0.56; -0.06]; p<0.01). Among the parameters specific to spino-pelvic statics, pelvic incidence, pelvic tilt and lumbar lordosis had similar correlations (r>0.30). CONCLUSION ISPL induces a geometric deformation of the lumbosacral hinge which modifies its anatomical relations with the ICJ. The anterior approach technique of L4-L5 disc in the presence of an L5-S1 ISPL is possible between the iliac veins for the large displacement and low LSA forms. LEVEL OF EVIDENCE IV, retrospective analysis.
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Kunze KN, Lilly DT, Khan JM, Louie PK, Ferguson J, Basques BA, Nolte MT, Dewald CJ. High-Grade Spondylolisthesis in Adults: Current Concepts in Evaluation and Management. Int J Spine Surg 2020; 14:327-340. [PMID: 32699755 DOI: 10.14444/7044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Information regarding the treatment of high-grade spondylolisthesis (HGS) in adults has been previously described; however, previous descriptions of the evaluation and surgical management of HGS do not represent more recent and now established approaches. The purpose of the current review is to discuss current concepts in the evaluation and management of patients with HGS. Methods Literature review. Results HGS is diagnosed in up to 11.3% of adults with spondylolisthesis and typically presents as nonspecific lower back pain. Regarding evaluation, a thorough history and physical examination should be performed, which may help predict the presence of HGS. Diagnostic imaging, and specifically the use of spino-pelvic parameters, are now commonly implicated in guiding treatment course and prognosis. When surgical intervention is indicated, surgical approaches include in situ fusion variations, reduction and partial reduction with fusion, and vertebrectomy. Although the majority of studies suggest improvements with these approaches, the literature is limited by a low level of evidence with regards to the superiority of one technique when compared with others. Conclusions HGS is a unique cause of low back pain in adults that carries considerable morbidity, but rarely presents with neurologic symptoms. Although the definitions, classifications, and methods of diagnosis of this spinal deformity have been established and accepted, the ideal surgical management of this deformity remains highly debated. Fusion in situ techniques are often technically easier to perform and provide lower risk of neurologic complications, whereas reduction and fusion techniques offer greater restoration of global spino-pelvic balance. Preoperative spino-pelvic parameters may have utility in assisting in procedural selection; however, future, higher-quality and longer-term studies are warranted to determine the optimal surgical intervention among the widely available techniques currently used, and to better define the indications for these interventions.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Daniel T Lilly
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jannat M Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Philip K Louie
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Joseph Ferguson
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Christopher J Dewald
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Anterior lumbar fusion techniques: ALIF, OLIF, DLIF, LLIF, IXLIF. Orthop Traumatol Surg Res 2020; 106:S149-S157. [PMID: 31818690 DOI: 10.1016/j.otsr.2019.05.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023]
Abstract
An anterior approach to the lumbar spine is increasingly used in performing fusion. Depending on the level to be treated, several approaches have been developed to deal with the anatomic obstacles encountered: pure anterior, oblique anterior or lateral, and trans- or pre-psoas. Conventional techniques incur risk of muscle lesion and severe bleeding, and have been replaced by minimally invasive approaches, often with video assistance after rapid closure of laparoscopic approaches with gas insufflation. There has, in parallel, been great progress in anterior spinal instrumentation systems. Non-existent when these techniques were first developed, they have become increasingly sophisticated, and now employ a variety of stand-alone or not cages and anterior screwed plate that can be associated together or to posterior fixation. Each approach and type of fixation has its specific technical requirements that need to be fully mastered so as to minimize risk, especially regarding vessels, and to enable the patient to enjoy the benefit of their very low morbidity. We shall therefore detail here each step of the pure anterior approach, which is most often used for L5S1, the oblique and lateral approaches, mainly used for L2L5, and also the preparation of the lumbar spine for anterior interbody fusion, with the respective instrumentations. We shall then consider the pros, cons and risks, and also spinal or general contraindications that may sometimes preclude this option. From this, we shall derive the specific optimal and wrong indications for anterior lumbar surgery, to help decision-making when fusion is indicated.
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Rothrock RJ, McNeill IT, Yaeger K, Oermann EK, Cho SK, Caridi JM. Lumbar Lordosis Correction with Interbody Fusion: Systematic Literature Review and Analysis. World Neurosurg 2018; 118:21-31. [DOI: 10.1016/j.wneu.2018.06.216] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 01/04/2023]
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Kitchen D, Rao PJ, Zotti M, Woodman R, Sampson MJ, Allison D, Phan K, Selby M. Fusion Assessment by MRI in Comparison With CT in Anterior Lumbar Interbody Fusion: A Prospective Study. Global Spine J 2018; 8:586-592. [PMID: 30202712 PMCID: PMC6125925 DOI: 10.1177/2192568218757483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To evaluate the role of magnetic resonance imaging (MRI) in evaluation of fusion status following anterior lumbar interbody fusion (ALIF) and compare agreement and confidence in assessing fusion or its absence on MRI to the current standard computed tomography (CT). METHODS A prospective follow up of patients undergoing surgery by 2 spine surgeons between 2012 and 2015 at a single institution. Fusion was assessed at different time points in these patients by 2 independent musculoskeletal radiologists. Fusion was analyzed in coronal and sagittal planes using both imaging modalities, with confidence being attributed on a scale of 0 to 3. Assessors were blinded to patient data. RESULTS Fourteen patients (25 levels) with mean follow-up of 10.2 months (range 2.4-20.3 years) and age of 41 years (range 20.7-61.5 years) were assessed. MRI within the interbody cage in coronal (κ = .58) and sagittal (κ = .50) planes had the highest interobserver agreement. CT anterior to the cage in coronal (κ = .48) and sagittal (κ = .44) planes, as well as within the cage in coronal (κ = .50) and sagittal planes (κ = .44) showed moderate agreement. Confidence anterior to the interbody cage using MRI scan was reduced when compared with remaining angles and imaging modalities. CONCLUSIONS The study demonstrates that MRI may be a useful tool in the assessment of fusion following ALIF with results comparable to CT, and that it may have a useful role in select patients especially considering marked radiation exposure reduction.
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Affiliation(s)
- David Kitchen
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Prashanth J. Rao
- Neurospine Research Group, Adelaide, South Australia, Australia,Westmead Hospital, Westmead, Australia,University of Sydney, Sydney, Australia,Prashanth J. Rao, Royal Adelaide Hospital, Suite 3, Level 3, 20-22 Mons Road Westmead, Sydney, Australia, 2145.
| | - Mario Zotti
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Matthew J. Sampson
- Flinders University, Adelaide, South Australia, Australia,Benson Radiology, Adelaide, South Australia, Australia
| | - Dale Allison
- Benson Radiology, Adelaide, South Australia, Australia,Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Kevin Phan
- Neurospine Research Group, Adelaide, South Australia, Australia
| | - Michael Selby
- Royal Adelaide Hospital, Adelaide, South Australia, Australia,Queen Elizabeth Hospital, Adelaide, South Australia, Australia,University of Adelaide, Adelaide, South Australia, Australia
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Cyriac M, Kyhos J, Iweala U, Lee D, Mantell M, Yu W, O'Brien JR. Anterior Lumbar Interbody Fusion With Cement Augmentation Without Posterior Fixation to Treat Isthmic Spondylolisthesis in an Osteopenic Patient-A Surgical Technique. Int J Spine Surg 2018; 12:322-327. [PMID: 30276088 DOI: 10.14444/5037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Anterior lumbar interbody fusion (ALIF) has been well established as an effective surgical intervention for chronic back pain due to osteoporotic vertebral collapse. Historically, ALIF has consisted of an anterior approach to disc height restoration with a subsequent posterior pedicle screw fixation. Although the applications of cement augmentation with posterior fixation have been previously reported, treatment of patients with both isthmic spondylolisthesis and decreased bone mineral density using a stand-alone ALIF is controversial because of concerns for decreased fusion rates and increased subsidence risk, respectively. We report a case of stand-alone ALIF used to treat a low-grade isthmic spondylolisthesis in the setting of idiopathic thoraco-lumbar scoliosis in a patient with secondary degenerative changes and discuss the benefits of this surgical technique in a patient with several comorbidities. Methods An osteopenic 66-year-old woman with multiple medical comorbidities and 2 years of left radicular leg pain was found to have a Myerding grade I isthmic spondylolisthesis in the setting of idiopathic thoraco-lumbar scoliosis with secondary changes. The patient underwent an L5-S1 stand-alone ALIF with anterior cement augmentation without posterior pedicle screw fixation. Results The patient experienced immediate relief of radicular leg pain postoperatively and had an uneventful course. At 2 years follow-up, she remained symptom free, and radiographs showed excellent fusion and maintenance of intervertebral disc height. Conclusions The use of stand-alone ALIF with anterior cement augmentation of the vertebral bodies is a surgical technique that could produce excellent improvement in patients with low-grade isthmic spondylolisthesis in the setting of osteopenia. The use of the all-anterior approach in similar patients with multiple medical comorbidities can also be a useful technique, as it decreases associated morbidity of surgery and complication risks associated with prolonged operative times.
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Affiliation(s)
| | | | | | - Danny Lee
- George Washington University, Washington DC
| | | | - Warren Yu
- George Washington University, Washington DC
| | - Joseph R O'Brien
- Washington Spine and Scoliosis Clinic, OrthoBethesda, Bethesda, Maryland
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Koenders N, Rushton A, Verra ML, Willems PC, Hoogeboom TJ, Staal JB. Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:696-709. [DOI: 10.1007/s00586-018-5680-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/21/2018] [Indexed: 01/29/2023]
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Different Fusion Approaches for Single-level Lumbar Spondylolysis Have Similar Perioperative Outcomes. Spine (Phila Pa 1976) 2018; 43:E111-E117. [PMID: 28591074 DOI: 10.1097/brs.0000000000002262] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study OBJECTIVE.: The aim of this study was to compare perioperative adverse events for patients with lumbar spondylolysis treated with transforaminal lumbar interbody fusion (TLIF), posterior spinal fusion (PSF), combined anterior and posterior fusion (AP fusion), or anterior lumbar interbody fusion (ALIF). SUMMARY OF BACKGROUND DATA Previous cohort studies have shown similar long-term outcomes for different surgical approaches for this indication, but potential differences in 30-day perioperative adverse events have not been well characterized. METHODS The present study uses data extracted from the American College of Surgeons National Surgical Quality Improvement Database. Patients undergoing fusion with different approaches for lumbar spondylolysis were identified. Propensity score matching was utilized to account for potential differences in demographic and comorbidity factors. Comparisons among perioperative outcomes were then made among the propensity score-matched study groups. RESULTS Of 1077 cases of spondylolysis identified, 556 underwent TLIF, 327 underwent PSF, 108 underwent AP fusion, and 86 underwent ALIF. After propensity score matching, there were no differences in the rates of any of the 30-day individual adverse events studied and no differences in the aggregated groupings of any adverse event, serious adverse event, or minor adverse event. There was a significantly increased operative time in the AP fusion group, but there were no differences in hospital length of stay or readmission rates. CONCLUSION Because perioperative adverse event rates were similar, even with a slightly longer operative time in the AP fusion group, these findings suggest that surgeon preference and long-term outcomes are better used to determine the recommendation of one surgical approach over another for single level fusions for lumbar spondylolysis. LEVEL OF EVIDENCE 3.
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Viglione LL, Chamoli U, Diwan AD. Is Stand-Alone Anterior Lumbar Interbody Fusion a Safe and Efficacious Treatment for Isthmic Spondylolisthesis of L5-S1? Global Spine J 2017; 7:587-595. [PMID: 28894689 PMCID: PMC5582709 DOI: 10.1177/2192568217699210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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 A systematic review. OBJECTIVE The objective of this study was to determine the safety and efficacy of stand-alone anterior lumbar interbody fusion (sa-ALIF) for the treatment of symptomatic isthmic spondylolisthesis of L5-S1 by assessing the level of available clinical and radiographic evidence. METHODS A systematic review utilizing Medline, Embase, and Scopus online databases was undertaken. Clinical, radiographic, and adverse outcome data were extracted for the relevant isthmic spondylolisthesis cases with the intention of undertaking a meta-analysis. RESULTS The database search between January 1980 and December 2015 yielded 23 articles that concerned sa-ALIF for isthmic spondylolisthesis of L5-S1. Only in 9 of the 23 articles data could be extracted specific to sa-ALIF for isthmic spondylolisthesis of L5-S1. There was considerable inconsistency in the standards for reporting outcomes of the surgery due to which meta-analysis could not be undertaken, and hence each article was reviewed. CONCLUSIONS There was insufficient evidence to support the safety and efficacy of sa-ALIF for the treatment of isthmic spondylolisthesis of L5-S1. Although sa-ALIF is widely documented in the literature, there was insufficient evidence to support its use in treating this specific pathology. The unique pathological and anatomical situation that isthmic spondylolisthesis of L5-S1 presents must be recognized and its treatment with sa-ALIF should be well thought out.
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Affiliation(s)
- Luke L. Viglione
- Spine Service, St. George & Sutherland Clinical School, The University of New South Wales, Kogarah, New South Wales, Australia
| | - Uphar Chamoli
- Spine Service, St. George & Sutherland Clinical School, The University of New South Wales, Kogarah, New South Wales, Australia,School of Mechanical & Manufacturing Engineering, Kensington campus, The University of New South Wales, Sydney, New South Wales, Australia,Uphar Chamoli, The Orthopaedic Research Institute, 4-10 South Street, Level 2—Research and Education Building, St. George Public Hospital, Sydney, New South Wales 2217, Australia.
| | - Ashish D. Diwan
- Spine Service, St. George & Sutherland Clinical School, The University of New South Wales, Kogarah, New South Wales, Australia
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[A continuous series of 27 adult patients treated for L5-S1 isthmic spondylolisthesis by combined approach: Clinical and radiological outcomes at 1 year follow-up]. Neurochirurgie 2017; 63:74-80. [PMID: 28511802 DOI: 10.1016/j.neuchi.2017.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 11/21/2022]
Abstract
Through this single-center consecutive prospective study, we evaluated the results of a combined approach for L5-S1 isthmic spondylolisthesis, using a polyetheretherketone (PEEK) interbody lordotic cage during anterior approach and pedicle screw-based posterior fixation. Between 2010 and 2014, 27 adult patients were treated for L5-S1 isthmic spondylolisthesis (high and low grades) by a combined approach with a minimum follow-up of one year. Clinical outcome was assessed before surgical treatment and at four months and one year after surgery by: VAS, Oswestry Index (ODI) and Rolland-Morris scores. Two observers evaluated the following radiological parameters: pelvic incidence, pelvic tilt, lumbar lordosis, segmental lordosis L5-S1, anterior and posterior disc height, spinal vertical axis (SVA), SVA/sacro-femoral distance (SFD) ratio. Fusion was evaluated on the CT scan at one-year follow-up. Blood loss, surgery time and complications were also collected. The mean age was 47.7 years (±16.9). The VAS, ODI and Rolland-Morris scores were significantly improved postoperatively, decreased from 7.5 (±1.45); 48 (±19.25); 15.3 (±4.67) before the surgery to 3.8 (±2.55); 28.7 (±19.58) and 7.76 (±7.21) respectively at one year after the surgery (P=0.05). The mean follow-up was 3.3 years. Mean surgery time was 193.7min (±37). Fusion was obtained in 100% of cases. Segmental lordosis L5-S1, pelvic tilt, slippage, anterior and posterior L5-S1 disc height were significantly improved postoperatively, they passed from 20.1; 22.6; 35.3%; 26.4%; 17.9% to 29.5; 20.6; 20.3%; 64.4%; 36.3% respectively. Combined surgical procedure meets the required goals of surgery in the treatment of adults L5-S1 isthmic spondylolisthesis.
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17
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A Multicenter Evaluation of Clinical and Radiographic Outcomes Following High-grade Spondylolisthesis Reduction and Fusion. Clin Spine Surg 2017; 30:E363-E369. [PMID: 28437339 DOI: 10.1097/bsd.0000000000000218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A retrospective review of the clinical and radiographic outcomes from a multicenter study of surgical treatment for high-grade spondylolisthesis (HGS) in adults. The objective was to assess the safety of surgical reduction, its ability to correct regional deformity, and its clinical effectiveness. METHODS Retrospective, multicenter review of adults (age above 18 y) with lumbosacral HGS (Meyerding grade 3-5) treated surgically with open decompression, attempted reduction, posterior instrumentation, and interbody fusion. Preoperative and postoperative assessment of the Meyerding grade, slip angle, and sacral inclination were performed based on standing radiographs. Preoperative visual analog scale scores were compared with those at the mean follow-up period. Prolo and Oswestry Disability Index scores at most recent follow-up were assessed. RESULTS A total of 25 patients, aged 19-72 years, met inclusion criteria. Seventeen interbody cages were placed, including 15 transforaminal lumbar interbody fusions, 1 posterior lumbar interbody fusion, and 1 anterior lumbar interbody fusion. Five patients required sacral dome osteotomies. The average follow-up was 21.3 months.At most recent follow-up there was a statistically significant improvement in both the Meyerding grade and the slip angle (P<0.05). There was 1 intraoperative complication resulting in a neurological deficit (4%) and 1 intraoperative vertebral body fracture (4%). No additional surgery was required for any of these patients. There were no cases of nonunion or device failure except for 1 patient who suffered an unrelated traumatic injury 1 year after surgery. The mean Oswestry Disability Index and Prolo scores at mean follow-up of 21.3 months were 20% (minimum disability) and 8.2 (grade 1), respectively. CONCLUSIONS The present study suggests that reduction, when accomplished in conjunction with wide neural element decompression and instrumented arthrodesis, is safe, effective, and durable with low rates of neurological injury, favorable clinical results, and high-fusion rates.
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18
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Kim C, Harris JA, Muzumdar A, Khalil S, Sclafani JA, Raiszadeh K, Bucklen BS. The effect of anterior longitudinal ligament resection on lordosis correction during minimally invasive lateral lumbar interbody fusion: Biomechanical and radiographic feasibility of an integrated spacer/plate interbody reconstruction device. Clin Biomech (Bristol, Avon) 2017; 43:102-108. [PMID: 28235698 DOI: 10.1016/j.clinbiomech.2017.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 01/13/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lateral lumbar interbody fusion is powerful for correcting degenerative conditions, yet sagittal correction remains limited by anterior longitudinal ligament tethering. Although lordosis has been restored via ligament release, biomechanical consequences remain unknown. Investigators examined radiographic and biomechanical of ligament release for restoration of lumbar lordosis. METHODS Six fresh-frozen human cadaveric spines (L3-S1) were tested: (Miller et al., 1988) intact; (Battie et al., 1995) 8mm spacer with intact anterior longitudinal ligament; (Cho et al., 2013) 8mm spacer without intact ligament following ligament resection; (Galbusera et al., 2013) 13mm lateral lumbar interbody fusion; (Goldstein et al., 2001) integrated 13mm spacer. Focal lordosis and range of motion were assessed by applying pure moments in flexion-extension, lateral bending, and axial rotation. FINDINGS Cadaveric radiographs showed significant improvement in lordosis correction following ligament resection (P<0.05). The 8mm spacer with ligament construct provided greatest stability relative to intact (P>0.05) but did little to restore lordosis. Ligament release significantly destabilized the spine relative to intact in all modes and 8mm with ligament in lateral bending and axial rotation (P<0.05). Integrated lateral lumbar interbody fusion following ligament resection did not significantly differ from intact or from 8mm with ligament in all testing modes (P>0.05). INTERPRETATION Lordosis corrected by lateral lumbar interbody fusion can be improved by anterior longitudinal ligament resection, but significant construct instability and potential implant migration/dislodgment may result. This study shows that an added integrated lateral fixation system can significantly improve construct stability. Long-term multicenter studies are needed.
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Affiliation(s)
- Choll Kim
- Spine Institute of San Diego, 6719 Alvarado Road, Suite 308, San Diego, CA 92120, USA.
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
| | - Aditya Muzumdar
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
| | - Saif Khalil
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
| | - Joseph A Sclafani
- Spine Institute of San Diego, 6719 Alvarado Road, Suite 308, San Diego, CA 92120, USA.
| | - Kamshad Raiszadeh
- Spine Institute of San Diego, 6719 Alvarado Road, Suite 308, San Diego, CA 92120, USA.
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
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19
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Kreiner DS, Baisden J, Mazanec DJ, Patel RD, Bess RS, Burton D, Chutkan NB, Cohen BA, Crawford CH, Ghiselli G, Hanna AS, Hwang SW, Kilincer C, Myers ME, Park P, Rosolowski KA, Sharma AK, Taleghani CK, Trammell TR, Vo AN, Williams KD. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of adult isthmic spondylolisthesis. Spine J 2016; 16:1478-1485. [PMID: 27592807 DOI: 10.1016/j.spinee.2016.08.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/13/2016] [Accepted: 08/29/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adult Isthmic Spondylolisthesis features evidence-based recommendations for diagnosing and treating adult patients with isthmic spondylolisthesis. The guideline is intended to reflect contemporary treatment concepts for symptomatic isthmic spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of June 2013. NASS' guideline on this topic is the only guideline on adult isthmic spondylolisthesis accepted in the Agency for Healthcare Research and Quality's National Guideline Clearinghouse. PURPOSE The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with isthmic spondylolisthesis. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. STUDY DESIGN This is a guideline summary review. METHODS This guideline is the product of the Adult Isthmic Spondylolisthesis Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questionsto address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guidelines were submitted to an internal peer review process and ultimately approved by the NASS Board of Directors. Upon publication, the Adult Isthmic Spondylolisthesis guideline was accepted into the National Guideline Clearinghouse and will be updated approximately every 5 years. RESULTS Thirty-one clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. CONCLUSIONS The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with isthmic spondylolisthesis. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx and will remain updated on a timely schedule.
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Affiliation(s)
- D Scott Kreiner
- Ahwatukee Sports & Spine, 4530 E. Muirwood Dr, Ste. 110, Phoenix, AZ 85048-7693, USA.
| | - Jamie Baisden
- Department of Neurosurgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Daniel J Mazanec
- Cleveland Clinic Center for Spine Health, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Rakesh D Patel
- University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Robert S Bess
- Department of Orthopedic Surgery, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA
| | - Douglas Burton
- University of Kansas Medical Center, 3901 Rainbow Blvd # 5013, Kansas City, KS 66103, USA
| | | | - Bernard A Cohen
- Neurological Monitoring Associates, LLC, 333 W Brown Deer Rd, Milwaukee, WI 53217, USA
| | - Charles H Crawford
- Norton Leatherman Spine Center, Department of Orthopaedic Surgery, University of Louisville, 210 E Gray St, Louisville, KY 40202, USA
| | - Gary Ghiselli
- Denver Spine, 7800 E. Orchard Road, Greenwood Village, CO 80111, USA
| | - Amgad S Hanna
- Department of Neurological Surgery, University of Wisconsin, 20 S Park St, Madison, WI 53715, USA
| | - Steven W Hwang
- Department of Neurosurgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Cumhur Kilincer
- Department of Neurosurgery, Trakya University Faculty of Medicine, Edirne, Turkey 22030
| | - Mark E Myers
- Center for Diagnostic Imaging, 5775 Wayzata Blvd, Saint Louis Park, MN 55416, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Karie A Rosolowski
- North American Spine Society, 7075 Veterans Blvd, Willowbrook, IL 60527, USA
| | - Anil K Sharma
- Spine and Pain Medicine, 655 Shrewsbury Ave, Shrewsbury, NJ 07702, USA
| | | | | | - Andrew N Vo
- Rockford Health Physicians, 2350 N Rockton Ave, Rockford, IL 61103, USA
| | - Keith D Williams
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, 1400 S Germantown Rd, Germantown, TN 38138, USA
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Bai X, Chen J, Liu L, Li X, Wu Y, Wang D, Ruan D. Is reduction better than arthrodesis in situ in surgical management of low-grade spondylolisthesis? A system review and meta analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:606-618. [PMID: 27832362 DOI: 10.1007/s00586-016-4810-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/21/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the clinical and radiographic outcomes of arthrodesis in situ with arthrodesis after reduction in low-grade spondylolisthesis. METHODS We performed a comprehensive search of both observational and randomized clinical trials published up to April 2016 in PubMed, MEDLINE, Cochrane Library, and Embase databases. The outcomes included age, sex, operative time, blood loss, and at least 2 years clinical results of Oswestry disability index (ODI), visual analogue scale (VAS), lumbar lordosis, slippage, fusion rate, the rate of good and excellent and the complication rate. Two authors independently extracted the articles and the predefined data. RESULTS Seven eligible studies, involving four RCTs and three cohort studies were included in this systematic review and meta-analysis. Patients who underwent reduction did achieved better slippage correction comparing with arthrodesis in situ (P < 0.00001). However, there was no significant difference in the case of operative time, blood loss, VAS (P = 0.36), ODI (P = 0.50), lumbar lordosis (P = 0.47), the rate of good and excellent (P = 0.84), fusion rate (P = 0.083) and complication rate (P = 0.33) between the arthrodesis in situ group and the reduction group. CONCLUSIONS On the basis on this review, arthrodesis after reduction of low-grade spondylolisthesis potentially reduced vertebral slippage. Reduction was neither associated with a longer operative time nor more blood loss. There was no significant difference in the outcomes between reduction and arthrodesis in situ group. Both procedures could be expected to achieve good clinical result. LEVEL OF EVIDENCE Therapeutic Level IIa.
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Affiliation(s)
- Xuedong Bai
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Jiahai Chen
- Department of Orthopedics Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Liyang Liu
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Xiaochuan Li
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Yaohong Wu
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Deli Wang
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Dike Ruan
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China.
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Moreau PE, Flouzat-Lachaniette CH, Lebhar J, Mirouse G, Poignard A, Allain J. Particularities of anterior fusion in L4-L5 isthmic spondylolisthesis. Orthop Traumatol Surg Res 2016; 102:755-8. [PMID: 27341743 DOI: 10.1016/j.otsr.2016.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 05/16/2016] [Accepted: 05/25/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE L4-L5 isthmic spondylolisthesis may be associated with lumbosacral transitional vertebrae (LSTV) and altered venous vascular anatomy. The objectives of this study were to describe the anatomical characteristics of L4-L5 ISPL and the intraoperative difficulties encountered during the approach for anterior lumbar interbody fusion (ALIF). METHODS This is a retrospective review of 20 ALIFs for L4-L5 ISPL. The anatomy of the common iliac veins confluence and the position of L4-L5 with respect to the projection of the iliac crest were analysed on CT-scan. Intraoperative difficulties were noted. RESULTS A LSTV was present in 60% of cases, associated with abnormally distal positioning of L4-L5 below the projection of the iliac crest. The common iliac veins confluence was abnormally proximal compared to L4-L5. No complication was noted, even if the approach was unusually difficult in 11 cases. DISCUSSION Anterior lumbotomies are difficult because the left common iliac vein courses transversely across the left anterolateral aspect of the L4-L5 disc and L5 vertebral body, increasing the risk of vascular injury. Those difficulties have led us to abandon lumbotomies to treat L4-L5 ISPL to favour a pure anterior approach (midline) or an exclusive posterior approach. LEVEL OF EVIDENCE IV (retrospective study).
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Affiliation(s)
- P-E Moreau
- Service de chirurgie orthopédique et traumatologique, Fondation hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - C-H Flouzat-Lachaniette
- Service de chirurgie orthopédique et traumatologique, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - J Lebhar
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - G Mirouse
- Hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - A Poignard
- Clinique Geoffroy Saint-Hilaire, 59, rue Geoffroy-Saint-Hilaire, 75005 Paris, France
| | - J Allain
- Clinique Geoffroy Saint-Hilaire, 59, rue Geoffroy-Saint-Hilaire, 75005 Paris, France
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22
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Topalidou A, Tzagarakis G, Balalis K, Papaioannou A. Posterior Decompression and Fusion: Whole-Spine Functional and Clinical Outcomes. PLoS One 2016; 11:e0160213. [PMID: 27513643 PMCID: PMC4981320 DOI: 10.1371/journal.pone.0160213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/17/2016] [Indexed: 11/19/2022] Open
Abstract
The mobility of the spine and the change in the angle of the curvatures are directly related to spinal pain and spinal stenosis. The aim of the study was the evaluation of morphology and mobility of the spine in patients who were subjected to decompression and posterior fusion with pedicle screws. The treatment group consisted of 20 patients who underwent posterior fixation of lumbar spine (one and two level fusion). The control group consisted of 39 healthy subjects. Mobility and curvatures of the spine were measured with a non-invasive device, the Spinal Mouse. Pain was evaluated with the Visual Analogue Scale (VAS). The Oswestry Disability Index (ODI) and the SF-36 were used to evaluate the degree of the functional disability and the quality of life, respectively. The measurements were recorded preoperatively and at 3, 6 and 12 months postoperatively. The mobility of the lumbar spine in the sagittal plane increased (p = 0.009) at 12 months compared to the measurements at 3 months. The mobility of the thoracic spine in the frontal plane increased (p = 0.009) at 12 months compared to the preoperative evaluation. The results of VAS, ODI and SF-36 PCS improved significantly (p<0.001). The levels of fusion exhibited a strong linear correlation (r = 0.651, p = 0.002) with the total trunk inclination in the upright position. Although pain, quality of life and spinal mobility in the sagittal and frontal planes significantly improved in the treatment group, these patients still had limited mobility and decreased curves/angles values compared to control group.
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Affiliation(s)
- Anastasia Topalidou
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Heraklion, Greece
- * E-mail:
| | - George Tzagarakis
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Konstantine Balalis
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Alexandra Papaioannou
- Department of Anaesthesiology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Heraklion, Greece
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23
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Fan G, Zhang H, Guan X, Gu G, Wu X, Hu A, Gu X, He S. Patient-reported and radiographic outcomes of minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis with or without reduction: A comparative study. J Clin Neurosci 2016; 33:111-118. [PMID: 27443498 DOI: 10.1016/j.jocn.2016.02.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/19/2015] [Accepted: 02/14/2016] [Indexed: 11/19/2022]
Abstract
This retrospective study aimed to compare the patient-reported outcomes and radiographic assessment of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative spondylolisthesis with reduction versus in situ fusion. Patients receiving MI-TLIF with reduction were assigned as Group A, and those without reduction were assigned as Group B. Radiographic fusion was assessed using Bridwell's grading criteria. Preoperative and postoperative patient-reported outcomes including visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) scale and improvement rate were analyzed. There were 41 patients in Group A and 37 patients in Group B. The mean follow-up was 30.78±14.15months in Group A and 28.95±10.75months in Group B (p=0.525). There were no significant differences in hospital stay (p=0.261), estimated blood loss (p=0.639), blood transfusion (p=0.336), operation time (p=0.762) and complications (p=1.00) between the two groups. Radiographic fusion rate was 92.68% (38/41) in Group A, and 81.08% (30/37) in Group B (p=0.110). Significant differences were observed in either 3-month or last follow-up JOA, VAS, and ODI compared with preoperative JOA, VAS, and ODI, respectively (p<0.05). However, there were no significant differences in JOA, VAS, and ODI between the two groups whenever preoperatively, or 3-month postoperatively, or at the last follow-up (p>0.05). According to MacNab criteria, the excellent and good rate was 85.37% in Group A and 86.49% in Group B (p=0.983). MI-TLIF is an effective and satisfactory surgical technique to manage degenerative spondylolisthesis regardless of reduction or not, so routine reduction may not be a requirement in MI-TLIF for degenerative spondylolisthesis.
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Affiliation(s)
- Guoxin Fan
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China
| | - Hailong Zhang
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China
| | - Xiaofei Guan
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China
| | - Guangfei Gu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China
| | - Xinbo Wu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China
| | - Annan Hu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China
| | - Xin Gu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China
| | - Shisheng He
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China.
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Abt NB, De la Garza-Ramos R, Olorundare IO, McCutcheon BA, Bydon A, Fogelson J, Nassr A, Bydon M. Thirty day postoperative outcomes following anterior lumbar interbody fusion using the national surgical quality improvement program database. Clin Neurol Neurosurg 2016; 143:126-31. [PMID: 26937864 DOI: 10.1016/j.clineuro.2016.02.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 11/25/2022]
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Tay KS, Bassi A, Yeo W, Yue WM. Intraoperative reduction does not result in better outcomes in low-grade lumbar spondylolisthesis with neurogenic symptoms after minimally invasive transforaminal lumbar interbody fusion-a 5-year follow-up study. Spine J 2016; 16:182-90. [PMID: 26515392 DOI: 10.1016/j.spinee.2015.10.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/12/2015] [Accepted: 10/19/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intraoperative reduction of low-grade lumbar spondylolisthesis (LGLS) remains disputed. There is currently no published data comparing midterm outcomes of reduction versus in situ fusion. PURPOSE This study aimed to compare mid-term clinical, radiological, and perioperative outcomes for reduction versus in situ fusion in LGLS with neurogenic symptoms. STUDY DESIGN/SETTING A retrospective review of prospectively collected spine registry data in a single institution was carried out. PATIENT SAMPLE All patients who underwent minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for LGLS with neurogenic symptoms with a minimum 5-year follow-up comprised the patient sample. OUTCOME MEASURES Self-reported measures were Oswestry Disability Index, North American Spine Society Neurogenic Symptom Score, Health Outcomes Survey Short Form-36 score, and Numerical Pain Rating Scale (back and leg pain). Radiological outcomes were fusion grading, adjacent segment degeneration (ASD), and implant failure or loosening. Perioperative outcomes were fluoroscopic time, operative time, intraoperative blood loss, opioid analgesia usage, time to ambulation, duration of hospitalization, and complication rate. Functional outcomes were patient satisfaction rate and rate of return to full function. METHODS A retrospective review was performed on prospectively collected registry data of patients undergoing MIS TLIF for LGLS with neurogenic symptoms, from 2004 to 2009. The operative technique and postoperative protocol were standardized. Two groups were formed based on complete reduction of the spondylolisthesis (reduction group [RG]) or the lack thereof (non-reduction group [NRG]) in the immediate postoperative radiograph. Outcomes at baseline, 6 months, 2 years, and 5 years postsurgery were compared. RESULTS There were 56 patients included (RG=30, NRG=26). The two groups had comparable baseline characteristics: demographics, body mass index, spondylolisthesis etiology, spinal level involved, bone graft and bone morphogenetic protein used, and all self-reported outcome measures. Perioperative outcomes were not significantly different. The early complication rate (RG=3.3%, NRG=19.2%, p=.086) and late complication rate (RG=10%, NRG=23.1%, p=.184) were similar. All patients achieved Bridwell grade 1 fusion from 2 years onward. Adjacent segment degeneration rate at 5 years was similar (RG=10%, NRG=0%, p=NS). Both groups showed significant postoperative improvement in all self-reported measures with no significant differences between the two groups at all follow-up points. Functional outcomes were equivalent. CONCLUSIONS Intraoperative reduction does not improve outcomes in LGLS with neurogenic symptoms after MIS TLIF. Adequate decompression and solid fusion are likely the keys to good mid-term outcomes.
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Affiliation(s)
- Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, Academia, Level 4, Singapore 169865
| | - Anupreet Bassi
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, Academia, Level 4, Singapore 169865
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, Academia, Level 4, Singapore 169865
| | - Wai Mun Yue
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, Academia, Level 4, Singapore 169865.
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Adogwa O, Elsamadicy AA, Han J, Cheng J, Bagley C. WITHDRAWN: Outcomes After Anterior Lumbar Interbody Fusion Versus Transforaminal Lumbar Interbody Fusion for the Treatment of Symptomatic L5-S1 Spondylolisthesis: A Prospective, Multi-Institutional Comparative Effectiveness Study. World Neurosurg 2015:S1878-8750(15)01214-0. [PMID: 26409090 DOI: 10.1016/j.wneu.2015.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/07/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Owoicho Adogwa
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Aladine A Elsamadicy
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jing Han
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph Cheng
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos Bagley
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Rao PJ, Ghent F, Phan K, Lee K, Reddy R, Mobbs RJ. Stand-alone anterior lumbar interbody fusion for treatment of degenerative spondylolisthesis. J Clin Neurosci 2015; 22:1619-24. [PMID: 26149405 DOI: 10.1016/j.jocn.2015.03.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
We sought to evaluate the clinical and radiologic efficacy of stand-alone anterior lumbar interbody fusion (ALIF) for low grade degenerative spondylolisthesis, the favoured surgical management approach at our institution. The optimal approach for surgical management of spondylolisthesis remains contentious. We performed a prospective analysis of all consecutive patients with low grade lumbar spondylolisthesis who underwent ALIF between 2009 and 2013 by a single surgeon (n=27). The mean age was 64.9 years with a male to female ratio of 14:13. There were 32 levels operated and the average preoperative spondylolisthesis was 14.8%, which reduced to 6.4% postoperatively and 9.4% at the latest follow-up (p=0001). Postoperative disc height was increased to 175% of preoperative values and was statistically significant (p<0.001) and remained improved with an overall change of 139% at the latest follow-up. The radiological fusion rate was 91%. The 12-Item Short Form Health Survey (SF-12) mental and physical component summary improved from 31.7 to 43.0 (p=0.007) and from 35.4 to 51.7 (p=0.0026), respectively. The mean visual analogue scale pain score improved from 7.6 to 2.2 (p<0.001), and the mean Oswestry disability index improved from 56.9 to 17.8% (p<0.0001). The overall clinical success rate was 93%. The posterior disc height correlated with spondylolisthesis reduction (p=0.04) and the only clinical factor affecting reduction was body mass index (p=0.04). The present study provides encouraging short term results for stand-alone ALIF as a procedure for low grade lumbar degenerative spondylolisthesis. Future studies should include adequately powered, prospective, multicentre registry studies with long term follow-up to allow a better assessment of the relative benefits and risks.
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Affiliation(s)
- Prashanth J Rao
- Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia.
| | - Finn Ghent
- Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; The University of New South Wales, Sydney, NSW, Australia
| | - Kevin Phan
- Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; Westmead Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia
| | - Keegan Lee
- Westmead Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia
| | - Rajesh Reddy
- Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; The University of New South Wales, Sydney, NSW, Australia
| | - Ralph J Mobbs
- Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia
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28
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Phan K, Mobbs RJ. Sacrum fracture following L5-S1 stand-alone interbody fusion for isthmic spondylolisthesis. J Clin Neurosci 2015; 22:1837-9. [PMID: 26100158 DOI: 10.1016/j.jocn.2015.03.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 03/28/2015] [Indexed: 11/16/2022]
Abstract
We report a 72-year-old man with a rare sacral fracture following stand-alone L5-S1 anterior lumbar interbody fusion for isthmic spondylolisthesis. The man underwent a minimally invasive management strategy using posterior percutaneous pedicle fixation and partial reduction of the deformity. We also discuss the current literature on fusion procedures for isthmic spondylolisthesis.
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Affiliation(s)
- Kevin Phan
- Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; NeuroSpine Surgery Research Group, Sydney, NSW, Australia
| | - Ralph J Mobbs
- Neuro Spine Clinic, Prince of Wales Private Hospital, Suite 7a, Level 7, Barker Street, Randwick, NSW 2031, Australia; NeuroSpine Surgery Research Group, Sydney, NSW, Australia.
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Barbagallo GMV, Piccini M, Alobaid A, Al-Mutair A, Albanese V, Certo F. Bilateral tubular minimally invasive surgery for low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS): analysis of a series focusing on postoperative sagittal balance and review of the literature. 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 2014; 23 Suppl 6:705-13. [PMID: 25228107 DOI: 10.1007/s00586-014-3543-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To report our early experience with minimally invasive surgery (MIS) in low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS), and to analyze the impact of surgery on postoperative spino-pelvic and sacro-pelvic parameters. METHODS Eight patients (mean age 47.6 years) underwent MIS for LDLLS involving in all but one the L5-S1 level. VAS and ODI were used for clinical assessment. Imaging included pre-operative X-rays, CT and MRI scans. Post-operatively, all patients underwent X-rays and CT-scans. Pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) values as well as lumbar lordosis (LL) have been derived from pre- and post-operative standard X-rays. RESULTS Mean follow-up is 30.12 months (range 15-42). No complications related to the surgical procedure were observed. Patients reported a satisfactory clinical outcome, as demonstrated by variation in mean VAS (from 9.1 to 3.6) and ODI (from 70.50 to 28.25 %) scores. Comparison between pre- and post-operative sacro-pelvic parameters documented moderate changes, with reduction of PT and increase of SS in all but one patient. Overall sagittal balance of the spine has been evaluated using the sagittal vertical axis (SVA), obtained from post-operative X-rays. Mean value of SVA demonstrated a good sagittal balance of the spine. CONCLUSION This series demonstrates that MIS is feasible and effective for LDLLS, as witnesses by the satisfactory clinical results maintained at medium-term follow-up. We submit that TLIF is a valid option but an adequately sized and positioned interbody cage is a key factor to allow satisfactory restoration of segmental lordosis.
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Affiliation(s)
- Giuseppe M V Barbagallo
- Neurosurgery Department, Policlinico "G. Rodolico" University Hospital, Viale XX Settembre 45, 95129, Catania, Italy,
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Yoo JS, Min SH, Yoon SH. Fusion rate according to mixture ratio and volumes of bone graft in minimally invasive transforaminal lumbar interbody fusion: minimum 2-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25 Suppl 1:S183-9. [DOI: 10.1007/s00590-014-1529-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
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