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McDermott MR, Rogers M, Prior R, Mixa J, Garrett J, Michna R, Guiroy A, Asghar J, Paul R, Patel A. Analyzing the L4-5 Segmental Alignment Change of Two Minimally Invasive Prone-Based Interbody Fusions. Global Spine J 2024:21925682241266165. [PMID: 39030673 DOI: 10.1177/21925682241266165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE Restoration of lumbar lordosis (LL) is a principal objective during spinal fusion procedures, traditionally focusing on achieving an LL within 10° of the pelvic incidence (PI). Recent studies have demonstrated a relatively constant L4-S1 alignment of 35-40° at L4-S1 and at least 15° at L4-5, regardless of PI. Based on these results, this study was created to examine the success rate of achieving a minimum of 15° at L4-5 through two differing prone-based techniques: Prone Lateral (pLLIF) and Trans Foraminal Interbody Fusion (TLIF). METHODS One hundred patients with a primary single-level L4-5 interbody fusion (50 pLLIF and 50 TLIF) were retrospectively analyzed. Pre and post-operative radiographs were measured to examine the segmental change at each level in the lumbar spine and calculate the success rate for achieving a minimum L4-5 segmental lordosis of 15° at the final follow-up. RESULTS The overall success rate of achieving an L4-5 segmental alignment >15° at the final follow-up was 70%. Prone LLIF was significantly more likely than TLIF to achieve this goal, achieving L4-5 > 15° 84% of the time vs TLIFs 56% (P = 0.002). Prone LLIF demonstrated an average L4-5 increase of 5.6 ± 5.9° which was larger than the mean increase for TLIF 0.4 ± 3.8° (P < 0.001). In both techniques, there was an inverse correlation between pre-operative L4-5 angle and L4-5 angle change. CONCLUSION Prone lateral lumbar interbody fusion demonstrates a high success rate for achieving a post-operative L4-5 angle >15° and achieves this at a higher rate than TLIF.
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Affiliation(s)
| | | | - Robert Prior
- Department of Orthopedic Surgery, Franciscan Health Olympia Fields, Olympia Fields, IL USA
| | - Joseph Mixa
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA
| | - Jonathon Garrett
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA
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Kim M, Kumar R, Drolet CE, Bs MA, Hanks T, Yamaguchi K, Krause K, Nemani VM, Leveque JC, Louie PK. What is the early fate of adjacent segmental lordosis compensation at L3-4 and L5-S1 following a lateral versus transforaminal lumbar Interbody Fusion at L4-5? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08384-6. [PMID: 38965087 DOI: 10.1007/s00586-024-08384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 06/02/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Degenerative spondylolisthesis causes translational and angular malalignment, resulting in a loss of segmental lordosis. This leads to compensatory adjustments in adjacent levels to maintain balance. Lateral lumbar interbody fusion (LLIF) and transforaminal lumbar interbody fusion (TLIF) are common techniques at L4-5. This study compares compensatory changes at adjacent L3-4 and L5-S1 levels six months post LLIF versus TLIF for grade 1 degenerative spondylolisthesis at L4-5. METHODS A retrospective study included patients undergoing L4-5 LLIF or TLIF with posterior pedicle screw instrumentation (no posterior osteotomy) for grade 1 spondylolisthesis. Pre-op and 6-month post-op radiographs measured segmental lordosis (L3-L4, L4-L5, L5-S1), lumbar lordosis (LL), and pelvic incidence (PI), along with PI-LL mismatch. Multiple regressions were used for hypothesis testing. RESULTS 113 patients (61 LLIF, 52 TLIF) were studied. TLIF showed less change in L4-5 lordosis (mean = 1.04°, SD = 4.34) compared to LLIF (mean = 4.99°, SD = 5.53) (p = 0.003). L4-5 angle changes didn't correlate with L3-4 changes, and no disparity between LLIF and TLIF was found (all p > 0.16). In LLIF, greater L4-5 lordosis change predicted reduced compensatory L5-S1 lordosis (p = 0.04), while no significant relationship was observed in TLIF patients (p = 0.12). CONCLUSION LLIF at L4-5 increases lordosis at the operated level, with compensatory decrease at L5-S1 but not L3-4. This reciprocal loss at adjacent L5-S1 may explain inconsistent improvement in lumbar lordosis (PI-LL) post L4-5 fusion.
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Affiliation(s)
- Mary Kim
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Rakesh Kumar
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA
| | - Caroline E Drolet
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA
| | - Murad Alostaz Bs
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA
| | - Thomas Hanks
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Karissa Yamaguchi
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Katie Krause
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA
| | - Venu M Nemani
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA
| | - Jean-Christophe Leveque
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA
| | - Philip K Louie
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA.
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Van Pevenage PM, Tohmeh AG, Howell KM. Clinical and radiographic outcomes following 120 consecutive patients undergoing prone transpsoas lateral lumbar interbody fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08379-3. [PMID: 38937351 DOI: 10.1007/s00586-024-08379-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/14/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE The prone transpsoas approach is a single-position alternative to traditional lateral lumbar interbody fusion (LLIF). Earlier prone LLIF studies have focused on technique, feasibility, perioperative efficiencies, and immediate postoperative radiographic alignment. This study was undertaken to report longer-term clinical and radiographic outcomes, and to identify learnings from experiential evolution of the prone LLIF procedure. METHODS All consecutive patients undergoing prone LLIF for any indication at one institution were included (n = 120). Demographic, diagnostic, treatment, and outcomes data were captured via prospective institutional registry. Retrospective analysis identified 31 'pre-proceduralization' and 89 'post-proceduralization' prone LLIF approaches, enabling comparison across early and later cohorts. RESULTS 187 instrumented LLIF levels were performed. Operative time, retraction time, LLIF blood loss, and hospital stay averaged 150 min, 17 min, 50 ml, and 2.2 days, respectively. 79% of cases were without complication. Postoperative hip flexion weakness was identified in 14%, transient lower extremity weakness in 12%, and sensory deficits in 10%. At last follow-up, back pain, worst-leg pain, Oswestry, and EQ-5D health state improved by 55%, 46%, 48%, and 51%, respectively. 99% improved or maintained sagittal alignment with an average 6.5° segmental lordosis gain at LLIF levels. Only intra-psoas retraction time differed between pre- and post-proceduralization; proceduralization saved an average 3.4 min/level (p = 0.0371). CONCLUSIONS The largest single-center prone LLIF experience with the longest follow-up to-date shows that it results in few complications, quick recovery, improvements in pain and function, high patient satisfaction, and improved sagittal alignment at an average one year and up to four years postoperatively.
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Affiliation(s)
- Peyton M Van Pevenage
- MultiCare Neurosurgery and Spine, 605 E. Holland, Suite 202, Spokane, WA, 99218, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Antoine G Tohmeh
- MultiCare Neurosurgery and Spine, 605 E. Holland, Suite 202, Spokane, WA, 99218, USA.
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Capo G, Calvanese F, Vandenbulcke A, Zaed I, Di Carlo DT, Cao R, Barrey CY. Lateral-PLIF for spinal arthrodesis: concept, technique, results, complications, and outcomes. Acta Neurochir (Wien) 2024; 166:123. [PMID: 38451339 DOI: 10.1007/s00701-024-06024-y] [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: 11/12/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Posterior lumbar interbody fusion (PLIF) surgery represents an effective option to treat degenerative conditions in the lumbar spine. To reduce the drawbacks of the classical technique, we developed a variant, so-called Lateral-PLIF, which we then evaluated through a prospective consecutive series of patients. METHODS All adult patients treated at our institute with single or double level Lateral-PLIF for lumbar degenerative disease from January to December 2017 were prospectively collected. Exclusion criteria were patients < 18 years of age, traumatic patients, active infection, or malignancy, as well as unavailability of clinical and/or radiological follow-up data. The technique consists of insert the cages bilaterally through the transition zone between the central canal and the intervertebral foramen, just above the lateral recess. Pre- and postoperative (2 years) questionnaires and phone interviews (4 years) assessed pain and functional outcomes. Data related to the surgical procedure, postoperative complications, and radiological findings (1 year) were collected. RESULTS One hundred four patients were selected for the final analysis. The median age was 58 years and primary symptoms were mechanical back pain (100, 96.1%) and/or radicular pain (73, 70.2%). We found a high fusion rate (95%). A statistically significant improvement in functional outcome was also noted (ODI p < 0.001, Roland-Morris score p < 0.001). Walking distance increased from 812 m ± 543 m to 3443 m ± 712 m (p < 0.001). Complications included dural tear (6.7%), infection/wound dehiscence (4.8%), and instrument failure (1.9%) but no neurological deterioration. CONCLUSIONS Lateral-PLIF is a safe and effective technique for lumbar interbody fusion and may be considered for further comparative study validation with other techniques before extensive use to treat lumbar degenerative disease.
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Affiliation(s)
- Gabriele Capo
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Calvanese
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France.
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Alberto Vandenbulcke
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
| | - Ismail Zaed
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
| | - Davide Tiziano Di Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberta Cao
- Department of Neuroradiology, Pierre Wertheimer Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 696777, Lyon-Bron, France
| | - Cédric Y Barrey
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
- Laboratory of Biomechanics, ENSAM, Arts Et Metiers ParisTech, 153 Boulevard de L'Hôpital, 75013, Paris, France
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Buckland AJ, Proctor DJ, Thomas JA, Protopsaltis TS, Ashayeri K, Braly BA. Single-Position Prone Lateral Lumbar Interbody Fusion Increases Operative Efficiency and Maintains Safety in Revision Lumbar Spinal Fusion. Spine (Phila Pa 1976) 2024; 49:E19-E24. [PMID: 37134133 DOI: 10.1097/brs.0000000000004699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
STUDY DESIGN Multi-centre retrospective cohort study. OBJECTIVE To evaluate the feasibility and safety of the single-position prone lateral lumbar interbody fusion (LLIF) technique for revision lumbar fusion surgery. BACKGROUND CONTEXT Prone LLIF (P-LLIF) is a novel technique allowing for placement of a lateral interbody in the prone position and allowing posterior decompression and revision of posterior instrumentation without patient repositioning. This study examines perioperative outcomes and complications of single position P-LLIF against traditional Lateral LLIF (L-LLIF) technique with patient repositioning. METHOD A multi-centre retrospective cohort study involving patients undergoing 1 to 4 level LLIF surgery was performed at 4 institutions in the US and Australia. Patients were included if their surgery was performed via either: P-LLIF with revision posterior fusion; or L-LLIF with repositioning to prone. Demographics, perioperative outcomes, complications, and radiological outcomes were compared using independent samples t-tests and chi-squared analyses as appropriate with significance set at P <0.05. RESULTS 101 patients undergoing revision LLIF surgery were included, of which 43 had P-LLIF and 58 had L-LLIF. Age, BMI and CCI were similar between groups. The number of posterior levels fused (2.21 P-LLIF vs. 2.66 L-LLIF, P =0.469) and number of LLIF levels (1.35 vs. 1.39, P =0.668) was similar between groups.Operative time was significantly less in the P-LLIF group (151 vs. 206 min, P =0.004). EBL was similar between groups (150mL P-LLIF vs. 182mL L-LLIF, P =0.31) and there was a trend toward reduced length of stay in the P-LLIF group (2.7 vs. 3.3d, P =0.09). No significant difference was demonstrated in complications between groups. Radiographic analysis demonstrated no significant differences in preoperative or postoperative sagittal alignment measurements. CONCLUSION P-LLIF significantly improves operative efficiency when compared to L-LLIF for revision lumbar fusion. No increase in complications was demonstrated by P-LLIF or trade-offs in sagittal alignment restoration. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Aaron J Buckland
- Melbourne Orthopaedic Group, Melbourne, Vic Australia
- Spine and Scoliosis Research Associates Australia, Melbourne, Vic Australia
- NYU Langone Health, New York, NY
| | | | - J Alex Thomas
- Atlantic Neurosurgical and Spine Specialists, Wilmington, NC
| | | | | | - Brett A Braly
- The Spine Clinic of Oklahoma City, Oklahoma City, OK
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Levy AS, Maddy K, Murray A, John DL, Kumar V, Urakov T. Transforaminal lumbar interbody fusion with placement of steerable banana cage: A single-center retrospective analysis of radiographic parameters of success. Radiography (Lond) 2024; 30:163-167. [PMID: 38035428 DOI: 10.1016/j.radi.2023.10.016] [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: 07/29/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The transforaminal lumbar interbody fusion (TLIF) is among the most utilized methods for the surgical treatment of lumbar degenerative disc disease. The TLIF has advanced significantly with several iterative changes since its inception in the early 1980s, with the advent of several generations of interbody types, shapes, and materials. Steerable curvilinear interbodies are among the most recent innovations in this space and may offer biomechanical advantages, namely in preservation of lumbar and segmental lordosis. While radiographic parameters have been investigated for other cage shapes and lumbar interbody fusion techniques, no study has investigated postoperative radiographic outcomes specific to TLIFs done with curvilinear interbodies. METHODS This study is a retrospective review of TLIFs performed with curvilinear interbodies between 2019 and 2022 at a single institution. Upright radiographs were obtained preoperatively and at several timepoints postoperatively. Radiographic variables including interspace height and segmental lordosis were collected. RESULTS 26 surgeries with 32 curvilinear interbodies were performed across 3 years. There was significant increase in segmental lordosis at the L4-L5 (p = 0.0183) and L5-S1 levels (p = 0.004) as well as interspace height postoperatively at levels L3-L4 (p = 0.011) and L4-L5 (p = 0.002). Pain as measured with the numeric rating scale significantly improved in the overall cohort postoperatively (p<0.001). CONCLUSIONS TLIF with curvilinear interbody placement increases segmental lordosis and interspace height at the L4-L5 and L5-S1 levels, and increased interspace height at the L3-L4 and L4-L5 levels. Further investigation into additional radiographic parameters is warranted and expanded cohort size would benefit deeper analysis of other spinal levels. IMPLICATIONS FOR PRACTICE As an increasing number of cage designs and materials are brought to market, studies such as this allow for better understanding of cage specific outcomes allowing for better informed device selection.
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Affiliation(s)
- A S Levy
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - K Maddy
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - A Murray
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - D L John
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - V Kumar
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - T Urakov
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
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Heard JC, Lee Y, Lambrechts MJ, Ezeonu T, Dees AN, Wiafe BM, Wright J, Toci GR, Schwenk ES, Canseco JA, Kaye ID, Kurd MF, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. Risk Factors for Postoperative Urinary Retention After Lumbar Fusion Surgery: Anesthetics and Surgical Approach. J Am Acad Orthop Surg 2023; 31:1189-1196. [PMID: 37695724 DOI: 10.5435/jaaos-d-23-00172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/20/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Postoperative urinary retention (POUR) after lumbar fusion surgery can lead to longer hospital stays and thus increased risk of developing other postoperative complications. Therefore, we aimed to determine the relationship between POUR and (1) surgical approach and (2) anesthetic agents, including sugammadex and glycopyrrolate. METHODS After institutional review board approval, L4-S1 single-level lumbar fusion surgeries between 2018 and 2021 were identified. A 3:1 propensity match of patients with POUR to those without was conducted, controlling for patient age, sex, diabetes status, body mass index, smoking status, history of benign prostatic hyperplasia, and the number of levels decompressed. POUR was defined as documented straight catheterization yielding >400 mL. We compared patient demographic, surgical, anesthetic, and postoperative characteristics. A bivariant analysis and backward multivariable stepwise logistic regression analysis ( P -value < 0.200) were performed. Significance was set to P < 0.05. RESULTS Of the 899 patients identified, 51 met the criteria for POUR and were matched to 153 patients. No notable differences were observed between groups based on demographic or surgical characteristics. On bivariant analysis, patients who developed POUR were more likely to have been given succinylcholine (13.7% vs. 3.92%, P = 0.020) as an induction agent. The independent predictors of POUR identified by multivariable analysis included the use of succinylcholine {odds ratio (OR), 4.37 (confidence interval [CI], 1.26 to 16.46), P = 0.022} and reduced postoperative activity (OR, 0.99 [CI, 0.993 to 0.999], P = 0.049). Factors protective against POUR included using sugammadex as a reversal agent (OR, 0.38 [CI, 0.17 to 0.82], P = 0.017). The stepwise regression did not identify an anterior surgical approach as a notable predictor of POUR. CONCLUSION We demonstrate that sugammadex for anesthesia reversal was protective against POUR while succinylcholine and reduced postoperative activity were associated with the development of POUR. In addition, we found no difference between the anterior or posterior approach to spinal fusion in the development of POUR.
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Affiliation(s)
- Jeremy C Heard
- From the Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA (Heard, Lee, Ezeonu, Dees, Wiafe, Wright, Toci, Canseco, Kaye, Kurd, Hilibrand, Vaccaro, Schroeder, and Kepler), the Department of Orthopaedic Surgery, Washington University, St. Louis, MO (Lambrechts), and the Department Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA (Schwenk)
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Lee S, Kim JG, Kim HJ. Comparison of surgical outcomes between lumbar interbody fusions using expandable and static cages: a systematic review and meta-analysis. Spine J 2023; 23:1593-1601. [PMID: 37473812 DOI: 10.1016/j.spinee.2023.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The use of static cages for lumbar interbody fusion (LIF) can cause complications such as end plate violation, graft subsidence, and nerve injury. Therefore, expandable cages that allow for in-situ expansion have been developed to overcome these problems. However, it remains uncertain whether expandable cages have better surgical outcomes than static cages do. PURPOSE We aimed to determine the effectiveness of expandable cages by analyzing studies that compared the surgical outcomes between the use of expandable cages and static cages. STUDY DESIGN A systematic review and meta-analysis. METHODS The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to conduct this meta-analysis and systematic review. The primary outcomes of this study were anterior disc height, posterior disc height, segmental lordosis (SL), lumbar lordosis (LL), subsidence rate, numeric rating scale (NRS) scores for back and leg pain, and Oswestry Disability Index (ODI). RESULTS Thirteen studies with 1,700 patients were included in the meta-analysis. Compared with static cages for LIFs, expandable cages significantly increased the anterior disc height (standardized mean difference 0.478, 95% confidence interval [CI] 0.088-0.867, p=.0162) and segmental lordosis (sMD 0.307, 95% CI 0.159-0.454, p<.0001). There were no significant differences in the posterior disc height, lumbar lordosis, subsidence rate, back pain, leg pain, or ODI between the two groups. CONCLUSION Expandable cages show no clear clinical benefit over static cages.
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Affiliation(s)
- Sanghoon Lee
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea
| | - Jung Guel Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea.
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Hiyama A, Katoh H, Sakai D, Sato M, Watanabe M. Early Radiological Assessment of Static and Expandable Cages in Lateral Single Position for Indirect Decompression- Lateral Lumbar Interbody Fusion. World Neurosurg 2023; 178:e453-e464. [PMID: 37506844 DOI: 10.1016/j.wneu.2023.07.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE This study aimed to compare the postoperative alignment of static and expandable cages in lateral single-position (LSP) for indirect decompression in lateral lumbar interbody fusion (LLIF). METHODS We included sixty-seven patients who underwent LSP-LLIF for lumbar degenerative disease. We performed radiological assessments preoperatively and two weeks postoperatively using computed tomography and magnetic resonance imaging. We divided the patients into the expandable cage group (23 patients) and the static cage group (44 patients). We measured disc height (DH), segmental lordosis (SL), and foraminal area (FA) from computed tomography images and the area of the dural sac from magnetic resonance imaging. We recorded surgical outcomes and complications. RESULTS Both static and expandable cages demonstrated improvements in DH, SL, FA, and dural sac expansion. However, we found no statistically significant differences in the average change in DH (4.4 ± 2.1 mm vs. 4.2 ± 1.8 mm, P = 0.685), the average change in SL (1.0 ± 4.4° vs. 1.9 ± 3.6°, P = 0.310), or FA change (32.5 ± 31.7 mm2 vs. 34.9 ± 29.5 mm2, P = 0.966) between the expandable and static cage groups. We also found no statistically significant difference in dural sac enlargement between the two groups. We observed no significant differences in operation time, estimated blood loss, or length of hospital stay between the two groups. No severe adverse events or additional surgeries were reported. CONCLUSIONS In LSP-LLIF without facet joint resection or other posterior techniques, static and expandable cages showed comparable effectiveness in achieving increased DH, SL, FA, and indirect decompression.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Tanasansomboon T, Robinson JE, Anand N. Minimally Invasive Transforaminal Lumbar Interbody Fusion: Strategies for Creating Lordosis with a Posterior Approach. Neurosurg Clin N Am 2023; 34:643-651. [PMID: 37718110 DOI: 10.1016/j.nec.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
The purpose of this article is to review the outcomes concerning lumbar lordosis restoration after the MIS-TLIF and to present strategies to create lumbar lordosis by using this MIS posterior approach. MIS-TLIF is an effective MIS lumbar interbody fusion that can achieve lumbar lordosis restoration. Several crucial steps aid in this sagittal profile correction during the MIS-TLIF, including the appropraite prone positioning, optimizing disc space preparation, maximizing disc space height, anterior interbody cage placement, and reducing the spondylolisthesis.
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Affiliation(s)
- Teerachat Tanasansomboon
- Department of Orthopedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Boulevard, Suite 901, Los Angeles, CA 90048, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Orthopedics, Center of Excellence in Biomechanics and Innovative Spine Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jerry E Robinson
- University of Pittsburg Medical Center (UPMC), Harrisburg, PA, USA
| | - Neel Anand
- Department of Orthopedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Boulevard, Suite 901, Los Angeles, CA 90048, USA.
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Amaral R, Moriguchi R, Pokorny G, Arnoni D, Barreira I, Marcelino F, Pokorny J, Pimenta L. Comparison of segmental lordosis gain of prone transpsoas (PTP) vs. lateral lumbar interbody fusion. Arch Orthop Trauma Surg 2023; 143:5485-5490. [PMID: 36932208 DOI: 10.1007/s00402-023-04821-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Lumbar interbody fusion is a standard method to treat certain degenerative conditions that are refractory to conservative treatments. LLIF reduces posterior muscle damage, can relieve neurological symptoms through indirect decompression, provides increased stability with its wider cages, and promotes more significant segmental lordosis than standard posterior techniques. However, the technique possesses its issues, such as unusual positioning, possible plexus-related symptoms, and median segmental lordosis correction. Trying to ease those issues, the idea of a prone transpsoas technique occurred. METHODS Retrospective, single-centric, comparative, and non-randomized study. The authors paired patients receiving lateral lumbar interbody fusion (LLIF) or prone transpsoas (PTP) to evaluate the technique's impact on the segmental lordosis correction. A correlation test selected the covariates for the matching. p-Values inferior to 0.05 were deemed significant. RESULTS Seventy-one patients were included in the analysis, 53 in the LLIF group and 18 in the PTP group. The significant covariates to the segmental lordosis correction were technique, preoperative segmental lordosis, cage position, and preoperative pelvic tilt. After the paring model, PTP showed significant segmental lordosis correction potential regarding the LLIF. CONCLUSION The prone transpsoas approach can significantly enhance the correction of segmental lordosis proportionated to the traditional LLIF approach.
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Affiliation(s)
- Rodrigo Amaral
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | | | - Gabriel Pokorny
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil.
| | - Daniel Arnoni
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | - Igor Barreira
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | | | | | - Luiz Pimenta
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
- University of California, UCSD, San Diego, CA, USA
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Zhang JK, Greenberg JK, Javeed S, Benedict B, Botterbush KS, Dibble CF, Khalifeh JM, Brehm S, Jain D, Dorward I, Santiago P, Molina C, Pennicooke BH, Ray WZ. Predictors of Postoperative Segmental and Overall Lumbar Lordosis in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Consecutive Case Series. Global Spine J 2023:21925682231193610. [PMID: 37522797 DOI: 10.1177/21925682231193610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
STUDY DESIGN Retrospective Case-Series. OBJECTIVES Due to heterogeneity in previous studies, the effect of MI-TLIF on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Therefore, we aim to identify radiographic factors associated with lordosis after surgery in a homogenous series of MI-TLIF patients. METHODS A single-center retrospective review identified consecutive patients who underwent single-level MI-TLIF for grade 1 degenerative spondylolisthesis from 2015-2020. All surgeries underwent unilateral facetectomies and a contralateral facet release with expandable interbody cages. PROs included the ODI and NRS-BP for low-back pain. Radiographic measures included SL, disc height, percent spondylolisthesis, cage positioning, LL, PI-LL mismatch, sacral-slope, and pelvic-tilt. Surgeries were considered "lordosing" if the change in postoperative SL was ≥ +4° and "kyphosing" if ≤ -4°. Predictors of change in SL/LL were evaluated using Pearson's correlation and multivariable regression. RESULTS A total of 73 patients with an average follow-up of 22.5 (range 12-61) months were included. Patients experienced significant improvements in ODI (29% ± 22% improvement, P < .001) and NRS-BP (3.3 ± 3 point improvement, P < .001). There was a significant increase in mean SL (Δ3.43° ± 4.37°, P < .001) while LL (Δ0.17° ± 6.98°, P > .05) remained stable. Thirty-eight (52%) patients experienced lordosing MI-TLIFs, compared to 4 (5%) kyphosing and 31 (43%) neutral MI-TLIFs. A lower preoperative SL and more anterior cage placement were associated with the greatest improvement in SL (β = -.45° P = .001, β = 15.06° P < .001, respectively). CONCLUSIONS In our series, the majority of patients experienced lordosing or neutral MI-TLIFs (n = 69, 95%). Preoperative radiographic alignment and anterior cage placement were significantly associated with target SL following MI-TLIF.
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Affiliation(s)
- Justin K Zhang
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Jacob K Greenberg
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Saad Javeed
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Braeden Benedict
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | | | | | - Jawad M Khalifeh
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, MD
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Deeptee Jain
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Ian Dorward
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Paul Santiago
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Camilo Molina
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | | | - Wilson Z Ray
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
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13
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Hernandez NS, Diaz-Aguilar LD, Pham MH. Single position L5-S1 lateral ALIF with simultaneous robotic posterior fixation is safe and improves regional alignment and lordosis distribution index. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023:10.1007/s00586-023-07841-y. [PMID: 37452837 DOI: 10.1007/s00586-023-07841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/10/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Minimally invasive single position lateral ALIF at L5-S1 with simultaneous robot-assisted posterior fixation has technical and anatomic considerations that need further description. METHODS This is a retrospective case series of single position lateral ALIF at L5-S1 with robotic assisted fixation. End points included radiographic parameters, lordosis distribution index (LDI), complications, pedicle screw accuracy, and inpatient metrics. RESULTS There were 17 patients with mean age of 60.5 years. Eight patients underwent interbody fusion at L5-S1, five patients at L4-S1, two patients at L3-S1, and one patient at L2-S1 in single lateral position. Operative times for 1-level and 2-level cases were 193 min and 278 min, respectively. Mean EBL was 71 cc. Mean improvements in L5-S1 segmental lordosis were 11.7 ± 4.0°, L1-S1 lordosis of 4.8 ± 6.4°, sagittal vertical axis of - 0.1 ± 1.7 cm°, pelvic tilt of - 3.1 ± 5.9°, and pelvic incidence lumbar-lordosis mismatch of - 4.6 ± 6.4°. Six patients corrected into a normal LDI (50-80%) and no patients became imbalanced over a mean follow-up period of 14.4 months. Of 100 screws placed in lateral position with robotic assistance, there were three total breaches (two lateral grade 3, one medial grade 2) for a screw accuracy of 97.0%. There were no neurologic, vascular, bowel, or ureteral injuries, and no implant failure or reoperation. CONCLUSION Single position lateral ALIF at L5-S1 with simultaneous robotic placement of pedicle screws by a second surgeon is a safe and effective technique that improves global alignment and lordosis distribution index.
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Affiliation(s)
- Nicholas S Hernandez
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - L Daniel Diaz-Aguilar
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Martin H Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA.
- Department of Neurosurgery, UC San Diego Health, 9300 Campus Point Drive, MC7893, La Jolla, CA, 92037, USA.
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Lavantes P, Poignard A, Delambre J, Queinnec S, Dufour T, Arvieu R, Allain J. Influence of the preoperative L5S1 disc state on lateral L2 to L5 fusion's outcomes at an average follow-up of 3,5 years (minimum 2 years). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2344-2349. [PMID: 37209209 DOI: 10.1007/s00586-023-07771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION The impact of pre-existing degeneration of a disc underlying a lumbar arthrodesis via lateral approach on long-term clinical outcome has, to our knowledge, not been studied. When performing arthrodesis between L2 and L5, its extension to L5S1 is challenging because it imposes a different surgical approach. Therefore, surgeon's temptation is to not include L5S1 in the fusion even in case of discopathy. Our objective was to study the influence of the preoperative L5S1 status on the clinical outcome of lumbar lateral interbody fusion (LLIF) using a pre-psoatic approach between L2 and L5 with a minimum follow-up of 2 years. MATERIAL AND METHODS Patients who underwent LLIF from L2 to L5 between 2015 and 2020 were included in our study. We studied VAS, ODI, and global clinical outcome before surgery and at last follow-up. The L5-S1 disc was radiologically studied in preoperative imaging. Patients were included in two groups (A "with" and B :without" L5-S1 disc degeneration) to compare the clinical outcomes at last follow-up. Our primary objective was to evaluate the rate of L5-S1 disc revision surgery at last follow-up. RESULTS 102 patients were included. 2 required L5-S1 disc surgery following overlying arthrodesis. Our results showed a significant improvement in the patients' clinical outcomes at the last follow-up (p < 0.0001). We did not find any significant difference on clinical criteria between groups A & B. CONCLUSION A preop L5S1 disc degeneration does not seem to impact the final clinical outcomes after lumbar lateral interbody fusion at a minimal two years F.U. It should not be systematically involved in an overlying fusion.
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Affiliation(s)
- P Lavantes
- Institut du Rachis Parisien, Clinique Geoffroy-Saint-Hilaire, 59, Rue Geoffroy-Saint-Hilaire, 75005, Paris, Ile-de-France, France.
| | - A Poignard
- Institut du Rachis Parisien, Clinique Geoffroy-Saint-Hilaire, 59, Rue Geoffroy-Saint-Hilaire, 75005, Paris, Ile-de-France, France
| | - J Delambre
- Institut du Rachis Parisien, Clinique Geoffroy-Saint-Hilaire, 59, Rue Geoffroy-Saint-Hilaire, 75005, Paris, Ile-de-France, France
| | - S Queinnec
- Institut du Rachis Parisien, Clinique Geoffroy-Saint-Hilaire, 59, Rue Geoffroy-Saint-Hilaire, 75005, Paris, Ile-de-France, France
| | - T Dufour
- Institut Parisien du Dos, Clinique Geoffroy-Saint-Hilaire, 59, Rue Geoffroy-Saint-Hilaire, 75005, Paris, Ile-de-France, France
| | - R Arvieu
- Institut du Rachis Parisien, Clinique Geoffroy-Saint-Hilaire, 59, Rue Geoffroy-Saint-Hilaire, 75005, Paris, Ile-de-France, France
| | - J Allain
- Institut du Rachis Parisien, Clinique Geoffroy-Saint-Hilaire, 59, Rue Geoffroy-Saint-Hilaire, 75005, Paris, Ile-de-France, France
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15
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Amaral R, Pokorny G, Marcelino F, Moriguchi R, Pokorny J, Barreira I, Mizael W, Yozo M, Fragoso S, Pimenta L. Lateral versus posterior approaches to treat degenerative lumbar pathologies-systematic review and meta-analysis of recent 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 2023; 32:1655-1677. [PMID: 36917302 DOI: 10.1007/s00586-023-07619-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/04/2023] [Accepted: 02/18/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION The lateral lumbar interbody fusion arose as a revolutionary approach to treating several spinal pathologies because the techniques were able to promote indirect decompression and lordosis restoration through a minimally invasive approach allowing for reduced blood loss and early recovery for patients. However, it is still not clear how the technique compares to other established approaches for treating spinal degenerative diseases, such as TLIF, PLIF, and PLF. MATERIAL AND METHODS This is a systematic review and meta-analysis of articles published in the last 10 years comparing lateral approaches to posterior techniques. The authors included articles that compared the LLIF technique to one or more posterior approaches, treating only degenerative pathologies, and containing at least one of the key outcomes of the study. Exclusion articles that were not original and the ones that the authors could not obtain the full text; also articles without the possibility to calculate the standard deviation or mean were excluded. For count variables, the odds ratio was used, and for continuous variables, the standard means difference (SMD) was used, and the choice between random or fixed-effects model was made depending on the presence or not of significant (p < 0.05) heterogeneity in the sample. RESULTS Twenty-four articles were included in the quantitative review. As for the intra-/perioperative variables, the lateral approaches showed a significant reduction in blood loss (SMD-1.56, p < 0.001) and similar operative time (SMD = - 0.33, p = 0.24). Moreover, the use of the lateral approaches showed a tendency to lead to reduced hospitalization days (SMD = - 0.15, p = 0.09), with significantly reduced odds ratios of complications (0.53, p = 0.01). As for the clinical outcomes, both approaches showed similar improvement both at improvement as for the last follow-up value, either in ODI or in VAS-BP. Finally, when analyzing the changes in segmental lordosis and lumbar lordosis, the lateral technique promoted significantly higher correction in both outcomes (p < 0.05). CONCLUSION Lateral approaches can promote significant radiological correction and similar clinical improvement while reducing surgical blood loss and postoperative complications.
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Affiliation(s)
| | | | | | | | | | - Igor Barreira
- Instituto de Patologia da Coluna, São Paulo, SP, Brazil
| | - Weby Mizael
- Instituto de Patologia da Coluna, São Paulo, SP, Brazil
| | - Marcelo Yozo
- Instituto de Patologia da Coluna, São Paulo, SP, Brazil
| | | | - Luiz Pimenta
- Instituto de Patologia da Coluna, São Paulo, SP, Brazil
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16
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Issa TZ, Lee Y, Lambrechts MJ, Tran KS, Trenchfield D, Baker S, Fras S, Yalla GR, Kurd MF, Woods BI, Rihn JA, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. The impact of cage positioning on lumbar lordosis and disc space restoration following minimally invasive lateral lumbar interbody fusion. Neurosurg Focus 2023; 54:E7. [PMID: 36587401 DOI: 10.3171/2022.10.focus22607] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/19/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate patient and surgical factors that predict increased overall lumbar lordosis (LL) and segmental lordosis correction following a minimally invasive lateral lumbar interbody fusion (LLIF) procedure. METHODS A retrospective review was conducted of all patients who underwent one- or two-level LLIF. Preoperative, initial postoperative, and 6-month postoperative measurements of LL, segmental lordosis, anterior disc height, and posterior disc height were collected from standing lateral radiographs for each patient. Cage placement was measured utilizing the center point ratio (CPR) on immediate postoperative radiographs. Spearman correlations were used to assess associations between cage lordosis and radiographic parameters. Multivariate linear regression was performed to assess independent predictors of outcomes. RESULTS A total of 106 levels in 78 unique patients were included. Most procedures involved fusion of one level (n = 50, 64.1%), most commonly L3-4 (46.2%). Despite no differences in baseline segmental lordosis, patients with anteriorly or centrally placed cages experienced the greatest segmental lordosis correction immediately (mean anterior 4.81° and central 4.46° vs posterior 2.47°, p = 0.0315) and at 6 months postoperatively, and patients with anteriorly placed cages had greater overall lordosis correction postoperatively (mean 6.30°, p = 0.0338). At the 6-month follow-up, patients with anteriorly placed cages experienced the greatest increase in anterior disc height (mean anterior 6.24 mm vs posterior 3.69 mm, p = 0.0122). Cages placed more posteriorly increased the change in posterior disc height postoperatively (mean posterior 4.91 mm vs anterior 1.80 mm, p = 0.0001) and at 6 months (mean posterior 4.18 mm vs anterior 2.06 mm, p = 0.0255). There were no correlations between cage lordotic angle and outcomes. On multivariate regression, anterior cage placement predicted greater 6-month improvement in segmental lordosis, while posterior placement predicted greater 6-month improvement in posterior disc height. Percutaneous screw placement, cage lordotic angle, and cage height did not independently predict any radiographic outcomes. CONCLUSIONS LLIF procedures reliably improve LL and increase intervertebral disc space. Anterior cage placement improves the lordosis angle greater than posterior placement, which better corrects sagittal alignment, but there is still a significant improvement in lordosis even with a posteriorly placed cage. Posterior cage placement provides greater restoration in posterior disc space height, maximizing indirect decompression, but even the anteriorly placed cages provided indirect decompression. Cage parameters including cage height, lordosis angle, and material do not impact radiographic improvement.
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Affiliation(s)
- Tariq Ziad Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Khoa S. Tran
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Delano Trenchfield
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sydney Baker
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sebastian Fras
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Goutham R. Yalla
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Barrett I. Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Wang H, Zhu J, Xia Y, Li Y, Fu C. Application of platelet-rich plasma in spinal surgery. Front Endocrinol (Lausanne) 2023; 14:1138255. [PMID: 37008931 PMCID: PMC10057539 DOI: 10.3389/fendo.2023.1138255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
With the aging of the population and changes in lifestyle, the incidence of spine-related diseases is increasing, which has become a major global public health problem; this results in a huge economic burden on the family and society. Spinal diseases and complications can lead to loss of motor, sensory, and autonomic functions. Therefore, it is necessary to identify effective treatment strategies. Currently, the treatment of spine-related diseases includes conservative, surgical, and minimally invasive interventional therapies. However, these treatment methods have several drawbacks such as drug tolerance and dependence, adjacent spondylosis, secondary surgery, infection, nerve injury, dural rupture, nonunion, and pseudoarthrosis. Further, it is more challenging to promote the regeneration of the interstitial disc and restore its biomechanical properties. Therefore, clinicians urgently need to identify methods that can limit disease progression or cure diseases at the etiological level. Platelet-rich plasma (PRP), a platelet-rich form of plasma extracted from venous blood, is a blood-derived product. Alpha granules contain a large number of cytokines, such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal growth factor, platelet factor 4 (PF-4), insulin-like growth factor-1 (IGF-1), and transforming growth factor-β (TGF-β). These growth factors allow stem cell proliferation and angiogenesis, promote bone regeneration, improve the local microenvironment, and enhance tissue regeneration capacity and functional recovery. This review describes the application of PRP in the treatment of spine-related diseases and discusses the clinical application of PRP in spinal surgery.
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Gobbi EA, De Zavalía M, Lanari Zubiaur F, Berjano R, Ortiz F, Zuliani P, Pons Belmonte R. Análisis radiográfico de los parámetros espinopélvicos obtenidos con el dispositivo de TLIF anterior. Estudio multicéntrico. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.6.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objetivo: Comunicar los resultados obtenidos según la posición del dispositivo de TLIF anterior.
Materiales y Métodos: Estudio multicéntrico, observacional, analítico, transversal, de recuperación retrospectiva. Se evaluaron los parámetros espinopélvicos prey posoperatorios de espinogramas de 20 pacientes que fueron operados entre septiembre de 2019 y agosto de 2021. Se incluyó a pacientes sometidos a artrodesis lumbar con implante de tipo TLIF anterior. Se excluyó a pacientes sin espinograma pre- oposquirúrgico y más de un dispositivo.
Resultados: La media de la lordosis monosegmentaria fue de 13,33° antes de la cirugía y de 18,81° después (p <0,001). La media de la lordosis monosegmentaria fue de 7,32°; 2,95° y 6,24° para las posiciones I, II y III, respectivamente. La media de la altura discal fue de 6,22 mm en el preoperatorio y 11,06 mm en el posoperatorio (p >0,001).
Conclusiones: Los resultados de la colocación de este tipo de dispositivos y su relación con la lordosis segmentaria fueron alentadores, se comprendió la importancia de la disposición de estos en el extremo anterior del espacio discal.
Nivel de Evidencia: IV
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Mikula AL, Lakomkin N, Pennington Z, Nassr A, Freedman B, Sebastian AS, Bydon M, Elder BD, Fogelson JL. Lumbar Lordosis Correction With Transforaminal Lumbar Interbody Fusion in Adult Spinal Deformity Patients with Minimum 2-Year Follow-up. World Neurosurg 2022; 167:e295-e302. [PMID: 35953034 DOI: 10.1016/j.wneu.2022.08.003] [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: 05/08/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the degree of lumbar lordosis (LL) correction possible via transforaminal lumbar interbody fusion (TLIF) in adult spinal deformity patients. METHODS A retrospective chart review identified patients ≥18 years of age with severe positive sagittal balance defined by the SRS-Schwab classification: pelvic incidence to LL mismatch >20°, sagittal vertical axis >9.5cm, and/or pelvic tilt >30°. All patients had surgery between 2013 to 2018 with a TLIF at L4-L5 and/or L5-S1 by the senior author (J.L.F.) with ≥2-years follow-up. RESULTS Sixty-one patients (18 men, 43 women) with 85 TLIFs were included with an average age of 66 years and average follow-up of 50 months. Average lumbar lordosis (L1-S1) improved from 27° preoperative to 48° postoperative and 45° at 2-year follow-up (P < 0.001). Average segmental lordosis at L4-L5 TLIF sites improved from 3° preoperative to 13° postoperative and persisted at 2-year follow-up (P < 0.001). Segmental lordosis at L5-S1 TLIF sites improved from 7° preoperative to 21° postoperative and 20° at 2-year follow-up (P < 0.001). Seventeen of the TLIFs (20%) had >20° of segmental lordosis improvement at long-term follow-up. The rate of revision surgery for pseudoarthrosis at the TLIF level was 5%. CONCLUSIONS Significant lordosis correction can be achieved through an open TLIF in patients with severe positive sagittal balance when utilizing meticulous deformity correction techniques, avoiding the added morbidity of an anterior approach or a 3-column osteotomy.
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Affiliation(s)
- Anthony L Mikula
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Nikita Lakomkin
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zach Pennington
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arjun S Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy L Fogelson
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Crawford CH, Epperson TN, Gum JL, Owens RK, Djurasovic M, Glassman SD, Carreon LY. Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter? NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 11:100145. [PMID: 35990008 PMCID: PMC9386101 DOI: 10.1016/j.xnsj.2022.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022]
Abstract
Background Controversy exists regarding the ability of posterior (transforaminal) lumbar interbody fusion (PLIF/TLIF) to achieve lordosis. We hypothesized that an interbody device (IBD) designed for positioning in the anterior disc space produces greater lordosis than IBDs designed for straight-in positioning. The purpose of this study is to determine if using either an anterior-position or straight-in position IBD design were associated with successful achievement of postoperative lordosis. Methods A consecutive series of patients undergoing a undergoing a single-level, posterior open midline (transforaminal) lumbar interbody fusion procedure for degenerative spine conditions during a time period when the two types of interbody devices were being used at surgeon discretion were identified from a multi-surgeon academic training center. Patient demographics and radiographic measures including surgical level lordosis (SLL), anterior disc height, middle disc height, posterior disc height, IBD height, and IBD insertion depth were measured on preop, immediate postop, and one-year postop standing radiographs using PACS. Group comparison and regression analysis were performed using SPSS. Results Sixty-one patients were included (n=37 anterior, n=34 straight-in). Mean age was 59.8±8.7 years, 32 (52%) were female. There was no difference between IBD type (anterior vs. straight-in) for mean Pre-op SLL (19±7° vs. 20±6°, p=0.7), Post-op SLL (21±5° vs 21±6°, p=0.5), or Change in SLL (2±4° vs. 1±5°, p=0.2). Regression analysis showed that Pre-op SLL was the only variable associated with Change in SLL (Beta = negative 0.48, p=0.000). While the mean Change in SLL could be considered clinically insignificant, there was wide variability: from a loss of 9° to a gain of 13°. Gain of lordosis >5° only occurred when Pre-op SLL was <21°, and loss of lordosis >5° only occurred when Pre-op SLL was >21°. Conclusions While group averages showed an insignificant change in segmental lordosis following a posterior (transforaminal) interbody fusion regardless of interbody device type, pre-operative lordosis was correlated with a clinically significant change in segmental lordosis. Preoperative hypolordotic discs were more likely to gain significant lordosis, while preoperative hyperlordotic discs were more likely to lose significant lordosis. Surgeon awareness of this tendency can help guide surgical planning and technique.
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Affiliation(s)
- Charles H Crawford
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United States
| | - Thomas N Epperson
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United States
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United States
| | - R. Kirk Owens
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United States
| | - Mladen Djurasovic
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United States
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United States
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States
- Corresponding author at: Norton Leatherman Spine Center, 210 E Gray Street, Suite 900, Louisville, KY 40202, United States.
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Dibble CF, Zhang JK, Greenberg JK, Javeed S, Khalifeh JM, Jain D, Dorward I, Santiago P, Molina C, Pennicooke B, Ray WZ. Comparison of local and regional radiographic outcomes in minimally invasive and open TLIF: a propensity score-matched cohort. J Neurosurg Spine 2022; 37:384-394. [PMID: 35276656 DOI: 10.3171/2022.1.spine211254] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Local and regional radiographic outcomes following minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) versus open TLIF remain unclear. The purpose of this study was to provide a comprehensive assessment of local and regional radiographic parameters following MI-TLIF and open TLIF. The authors hypothesized that open TLIF provides greater segmental and global lordosis correction than MI-TLIF. METHODS A single-center retrospective cohort study of consecutive patients undergoing MI- or open TLIF for grade I degenerative spondylolisthesis was performed. One-to-one nearest-neighbor propensity score matching (PSM) was used to match patients who underwent open TLIF to those who underwent MI-TLIF. Sagittal segmental radiographic measures included segmental lordosis (SL), anterior disc height (ADH), posterior disc height (PDH), foraminal height (FH), percent spondylolisthesis, and cage position. Lumbopelvic radiographic parameters included overall lumbar lordosis (LL), pelvic incidence (PI)-lumbar lordosis (PI-LL) mismatch, sacral slope (SS), and pelvic tilt (PT). Change in segmental or overall lordosis after surgery was considered "lordosing" if the change was > 0° and "kyphosing" if it was ≤ 0°. Student t-tests or Wilcoxon rank-sum tests were used to compare outcomes between MI-TLIF and open-TLIF groups. RESULTS A total of 267 patients were included in the study, 114 (43%) who underwent MI-TLIF and 153 (57%) who underwent open TLIF, with an average follow-up of 56.6 weeks (SD 23.5 weeks). After PSM, there were 75 patients in each group. At the latest follow-up both MI- and open-TLIF patients experienced significant improvements in assessment scores obtained with the Oswestry Disability Index (ODI) and the numeric rating scale for low-back pain (NRS-BP), without significant differences between groups (p > 0.05). Both MI- and open-TLIF patients experienced significant improvements in SL, ADH, and percent corrected spondylolisthesis compared to baseline (p < 0.001). However, the MI-TLIF group experienced significantly larger magnitudes of correction with respect to these metrics (ΔSL 4.14° ± 4.35° vs 1.15° ± 3.88°, p < 0.001; ΔADH 4.25 ± 3.68 vs 1.41 ± 3.77 mm, p < 0.001; percent corrected spondylolisthesis: -10.82% ± 6.47% vs -5.87% ± 8.32%, p < 0.001). In the MI-TLIF group, LL improved in 44% (0.3° ± 8.5°) of the cases, compared to 48% (0.9° ± 6.4°) of the cases in the open-TLIF group (p > 0.05). Stratification by operative technique (unilateral vs bilateral facetectomy) and by interbody device (static vs expandable) did not yield statistically significant differences (p > 0.05). CONCLUSIONS Both MI- and open-TLIF patients experienced significant improvements in patient-reported outcome (PRO) measures and local radiographic parameters, with neutral effects on regional alignment. Surprisingly, in our cohort, change in SL was significantly greater in MI-TLIF patients, perhaps reflecting the effect of operative techniques, technological innovations, and the preservation of the posterior tension band. Taking these results together, no significant overall differences in LL between groups were demonstrated, which suggests that MI-TLIF is comparable to open approaches in providing radiographic correction after surgery. These findings suggest that alignment targets can be achieved by either MI- or open-TLIF approaches, highlighting the importance of surgeon attention to these variables.
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Affiliation(s)
| | | | | | | | - Jawad M Khalifeh
- 3Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Deeptee Jain
- 2Orthopedic Surgery, Washington University, St. Louis, Missouri; and
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22
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Arnoni D, Amaral R, Pokorny G, Moriguchi R, Pimenta L. Impacto dos parâmetros espinopélvicos pré-operatórios na correção de lordose segmentar após fusão intersomática lombar por via lateral de um nível. Rev Bras Ortop 2022; 57:828-835. [PMID: 36226210 PMCID: PMC9550377 DOI: 10.1055/s-0042-1750797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives
The present study aimed to assess whether preoperative spinopelvic parameters can influence the gain of segmental lordosis after one level of lateral lumbar interbody fusion.
Methods
The following radiological parameters were measured in the X-rays: pelvic incidence, lumbar lordosis, pelvic tilt, L4S1 lordosis, index level segmental lordosis, intraoperative index segmental lordosis, pelvic mismatch (IP-LL), distal lordosis proportion, delta segmental lordosis, Pelvic Titlt (PT) > 20, actual sacral slope, and ideal sacral slope, and the correlation of these variables with the gain of segmental lordosis was investigated. Afterwards, an exploratory cluster analysis was performed to identify common characteristics between patients and segmental lordosis gain.
Results
The sample of the present study comprised 104 patients, of which 76% presented segmental lordosis gain. The most correlated parameters with the segmental lordosis gain were preoperative segmental lordosis (−0.50) and delta intraoperative lordosis (0.51). Moreover, patients in the high PI groups had a trend to gain more segmental lordosis (
p
< 0.05) and a reduced risk of losing segmental lordosis (Odds 6.08).
Conclusion
Patients with low-medium PI profiles presented higher odds of loss of segmental lordosis. However, the preoperative spinopelvic parameters alone do not seem to play a significant role in the fate of segmental lordosis gain.
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Affiliation(s)
- Daniel Arnoni
- Instituto de Patologia da Coluna, São Paulo, SP, Brasil
| | | | | | | | - Luiz Pimenta
- Instituto de Patologia da Coluna, São Paulo, SP, Brasil
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Application of Offset Dingo Instruments in Anterior to Psoas (ATP)/Oblique Lumbar Interbody Fusion (OLIF) Procedure: A Retrospective Study of 80 Patients. Neurochirurgie 2022; 68:575-582. [PMID: 35667474 DOI: 10.1016/j.neuchi.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/06/2022] [Accepted: 05/29/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Oblique lumbar interbody fusion (OLIF) is a minimally invasive lumbar fusion procedure that has flourished in recent years. However, complications related to the anterior-to-psoas (ATP) approach have been reported. The purpose of this study was to assess the OLIF technique using offset design "Dingo" instruments for the treatment of degenerative lumbar disorders. METHODS A retrospective review was performed to identify patients between March 2018 and November 2020 who underwent OLIF with conventional or modified instruments with a minimum follow-up of 12 months. Demographic data were recorded. Operation time, intraoperative blood loss, and length of hospital stay were compared between cohorts. Imaging parameters were measured and compared between cohorts before and after surgery. Clinical outcomes were assessed at each follow-up visit. All complications were reviewed. RESULTS A total of 80 consecutive patients were included. The mean follow-up times for the conventional group and modified group were 14.5 months and 16.3 months, respectively. The incidence of hip flexion weakness was 27.5% and 7.5% for the conventional cohort and modified cohort, respectively. The modified group was associated with a shorter operation time, shorter length of hospital stay, higher postoperative disk height and better cage position. The symptoms of all patients improved after surgery. At 1-week follow-up, the modified group showed significantly better clinical scores. CONCLUSIONS OLIF with modified instruments and techniques shows promising outcomes in reducing approach-related complications. Additionally, the modified technique is associated with a better cage position, shorter length of hospital stay and less postoperative pain in the early period.
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24
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Postoperative spinal alignment comparison of lateral versus supine patient position L5-S1 anterior lumbar interbody fusion. 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 2022; 31:2248-2254. [PMID: 35610486 DOI: 10.1007/s00586-022-07252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Over the past decade, alternative patient positions for the treatment of the anterior lumbar spine have been explored in an effort to maximize the benefits of direct anterior column access while minimizing the inefficiencies of single or multiple intraoperative patient repositionings. The lateral technique allows for access from L1 to L5 through a retroperitoneal, muscle-splitting, transpsoas approach with placement of a large intervertebral spacer than can reliably improve segmental lordosis, though its inability to be used at L5-S1 limits its overall adoption, as L5-S1 is one of the most common levels treated and where high levels of lordosis are optimal. Recent developments in instrumentation and techniques for lateral-position treatment of the L5-S1 level with a modified anterior lumbar interbody fusion (ALIF) approach have expanded the lateral position to L5-S1, though the positional effect on L5-S1 lordosis is heretofore unreported. The purpose of this study was to compare local and regional alignment differences between ALIFs performed with the patient in the lateral (L-ALIF) versus supine position (S-ALIF). METHODS Retrospective, multi-center data and radiographs were collected from 476 consecutive patients who underwent L5-S1 L-ALIF (n = 316) or S-ALIF (n = 160) for degenerative lumbar conditions. Patients treated at L4-5 and above with other single-position interbody fusion and posterior fixation techniques were included in the analysis. Baseline patient characteristics were similar between the groups, though L-ALIF patients were slightly older (58 vs. 54 years), with a greater preoperative mean L5-S1 disk height (7.8 vs. 5.8 mm), and with less preoperative slip (6.6 vs. 8.5 mm), respectively. 262 patients were treated with only L-ALIF or S-ALIF at L5-S1 while the remaining 214 patients were treated with either L-ALIF or S-ALIF at L5-S1 along with fusions at other thoracolumbar levels. Lumbar lordosis (LL), L5-S1 segmental lordosis, L5-S1 disk space height, and slip reduction in L5-S1 spondylolisthesis were measured on preoperative and postoperative lateral X-ray images. LL was only compared between single-level ALIFs, given the variability of other procedures performed at the levels above L5-S1. RESULTS Mean pre- to postoperative L5-S1 segmental lordosis improved 39% (6.6°) and 31% (4.9°) in the L-ALIF and S-ALIF groups, respectively (p = 0.063). Mean L5-S1 disk height increased by 6.5 mm (89%) in the L-ALIF and 6.4 mm (110%) in the S-ALIF cohorts, (p = 0.650). Spondylolisthesis, in those patients with a preoperative slip, average reduction in the L-ALIF group was 1.5 mm and 2.2 mm in the S-ALIF group (p = 0.175). In patients treated only at L5-S1 with ALIF, mean segmental alignment improved significantly more in the L-ALIF compared to the S-ALIF cohort (7.8 vs. 5.4°, p = 0.035), while lumbar lordosis increased 4.1° and 3.6° in the respective groups (p = 0.648). CONCLUSION Use of the lateral patient position for L5-S1 ALIF, compared to traditional supine L5-S1 ALIF, resulted in at least equivalent alignment and radiographic outcomes, with significantly greater improvement in segmental lordosis in patients treated only at L5-S1. These data, from the largest lateral ALIF dataset reported to date, suggest that-radiographically-the lateral patient position can be considered as an alternative to traditional ALIF positional techniques.
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25
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Farber SH, Sagar S, Godzik J, Zhou JJ, Walker CT, Khajavi K, Turner JD, Uribe JS. Radiographic comparison of lordotic and hyperlordotic implants in L5-S1 anterior lumbar interbody fusion. J Neurosurg Spine 2022; 36:775-783. [PMID: 34798612 DOI: 10.3171/2021.7.spine202221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior lumbar interbody fusion (ALIF) used at the lumbosacral junction provides arthrodesis for several indications. The anterior approach allows restoration of lumbar lordosis, an important goal of surgery. With hyperlordotic ALIF implants, several options may be employed to obtain the desired amount of lordosis. In this study, the authors compared the degree of radiographic lordosis achieved with lordotic and hyperlordotic ALIF implants at the L5-S1 segment. METHODS All patients undergoing L5-S1 ALIF from 2 institutions over a 4-year interval were included. Patients < 18 years of age or those with any posterior decompression or osteotomy were excluded. ALIF implants in the lordotic group had 8° or 12° of inherent lordosis, whereas implants in the hyperlordotic group had 20° or 30° of lordosis. Upright standing radiographs were used to determine all radiographic parameters, including lumbar lordosis, segmental lordosis, disc space lordosis, and disc space height. Separate analyses were performed for patients who underwent single-segment fixation at L5-S1 and for the overall cohort. RESULTS A total of 204 patients were included (hyperlordotic group, 93 [45.6%]; lordotic group, 111 [54.4%]). Single-segment ALIF at L5-S1 was performed in 74 patients (hyperlordotic group, 27 [36.5%]; lordotic group, 47 [63.5%]). The overall mean ± SD age was 61.9 ± 12.3 years; 58.3% of patients (n = 119) were women. The mean number of total segments fused was 3.2 ± 2.6. Overall, 66.7% (n = 136) of patients had supine surgery and 33.3% (n = 68) had lateral surgery. Supine positioning was significantly more common in the hyperlordotic group than in the lordotic group (83.9% [78/93] vs 52.3% [58/111], p < 0.001). After adjusting for differences in surgical positioning, the change in lumbar lordosis was significantly greater for hyperlordotic versus lordotic implants (3.6° ± 7.5° vs 0.4° ± 7.5°, p = 0.048) in patients with single-level fusion. For patients receiving hyperlordotic versus lordotic implants, changes were also significantly greater for segmental lordosis (12.4° ± 7.5° vs 8.4° ± 4.9°, p = 0.03) and disc space lordosis (15.3° ± 5.4° vs 9.3° ± 5.8°, p < 0.001) after single-level fusion at L5-S1. The change in disc space height was similar for these 2 groups (p = 0.23). CONCLUSIONS Hyperlordotic implants provided a greater degree of overall lumbar lordosis restoration as well as L5-S1 segmental and disc space lordosis restoration than lordotic implants. The change in disc space height was similar. Differences in lateral and supine positioning did not affect these parameters.
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Affiliation(s)
- S Harrison Farber
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Soumya Sagar
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Jakub Godzik
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - James J Zhou
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Corey T Walker
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Kaveh Khajavi
- 2Southeastern Neurosurgical Specialists, Georgia Spine and Neurosurgery Center, Atlanta, Georgia
| | - Jay D Turner
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Juan S Uribe
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Deep Learning based Vertebral Body Segmentation with Extraction of Spinal Measurements and Disorder Disease Classification. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Mohsinaly Y, Boissiere L, Maillot C, Pesenti S, Le Huec JC. Treatment of lumbar canal stenosis in patients with compensated sagittal balance. Orthop Traumatol Surg Res 2021; 107:102861. [PMID: 33610854 DOI: 10.1016/j.otsr.2021.102861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The need to combine fusion with decompression in patients with lumbar canal stenosis is still controversial. The aim of this study was to show that isolated decompression leads to the same outcomes as decompression plus fusion in patients who have preserved global sagittal balance. MATERIALS AND METHODS A single-center retrospective cohort of 110 patients who were operated for a single-level lumbar stenosis was divided into two groups based on the treatment: isolated decompression or fusion-decompression. These patients had a normal odontoid-hip axis angle (ODHA) (-5° to +2°) and had no spondylolisthesis or frontal deformity. We compared the clinical outcome scores and spinal-pelvic parameters preoperatively and at 1 year of follow-up. We evaluated the minimal clinically important difference (MCID) corresponding to a 12.8-point difference in the Owestry Disability Index (ODI). The analysis in each group was based on the MCID. RESULTS The clinical outcome scores improved significantly in both groups. There was a 77% decrease in the ODI>12.8 points with no significant difference between groups. The analysis based on the MCID showed that patients with a poor clinical result at 1 year in the isolated decompression group were more likely to have lumbar pain, while the ones in the fusion-decompression group were more likely to have radicular pain. CONCLUSION The clinical and radiological results of fusion-decompression are not superior at 1 year relative to isolated decompression for treating single-level lumbar canal stenosis in patients with compensated sagittal balance. Full-spine weight bearing radiographs are key to determining the patient's sagittal balance and to ensuring there are no radiological instability factors that may require a stabilizing procedure. LEVEL OF EVIDENCE IV Retrospective study of data collected prospectively.
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Affiliation(s)
- Yann Mohsinaly
- PolyClinique Bordeaux Nord Aquitaine, Bordeaux Université, 33000 Bordeaux, France
| | - Louis Boissiere
- PolyClinique Bordeaux Nord Aquitaine, Bordeaux Université, 33000 Bordeaux, France; ELSAN Polyclinique Jean Villar, 33520 Bruges, France
| | - Cédric Maillot
- Service de chirurgie orthopédique, CHU Beaujon, 92110 Clichy, France
| | - Sébastien Pesenti
- Service de chirurgie orthopédique pédiatrique, CHU la Timone, 13000 Marseille, France
| | - Jean-Charles Le Huec
- PolyClinique Bordeaux Nord Aquitaine, Bordeaux Université, 33000 Bordeaux, France.
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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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Liu J, Duan P, Mummaneni PV, Xie R, Li B, Dong Y, Berven S, Chou D. Does transforaminal lumbar interbody fusion induce lordosis or kyphosis? Radiographic evaluation with a minimum 2-year follow-up. J Neurosurg Spine 2021; 35:419-426. [PMID: 34243159 DOI: 10.3171/2020.12.spine201665] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Conflicting reports exist about whether transforaminal lumbar interbody fusion (TLIF) induces lordosis or kyphosis, ranging from decreasing lordosis by 3.71° to increasing it by 18.8°. In this study, the authors' aim was to identify factors that result in kyphosis or lordosis after TLIF. METHODS A single-center, retrospective study of open TLIF without osteotomy for spondylolisthesis with a minimum 2-year follow-up was undertaken. Preoperative and postoperative clinical and radiographic parameters and cage specifics were collected. TLIFs were considered to be "lordosing" if postoperative induction of lordosis was > 0° and "kyphosing" if postoperative induction of lordosis was ≤ 0°. RESULTS A total of 137 patients with an average follow-up of 52.5 months (range 24-130 months) were included. The overall postoperative disc angle (DA) and segmental lordosis (SL) increased by 1.96° and 1.88° (p = 0.003 and p = 0.038), respectively, whereas overall lumbar lordosis remained unchanged (p = 0.133). Seventy-nine patients had lordosing TLIFs with a mean SL increase of 5.72° ± 3.97°, and 58 patients had kyphosing TLIFs with a mean decrease of 3.02° ± 2.98°. Multivariate analysis showed that a lower preoperative DA, lower preoperative SL, and anterior cage placement were correlated with the greatest increase in postoperative SL (p = 0.040, p < 0.001, and p = 0.035, respectively). There was no difference in demographics, cage type or height, or spinopelvic parameters between the groups (p > 0.05). Linear regression showed that the preoperative DA and SL correlated with SL after TLIF (R2 = 0.198, p < 0.001; and R2 = 0.2931, p < 0.001, respectively). CONCLUSIONS Whether a TLIF induces kyphosis or lordosis depends on the preoperative DA, preoperative SL, and cage position. Less-lordotic segments became more lordotic postoperatively, and highly lordotic segments may lose lordosis after TLIF. Cages placed more anteriorly were associated with more lordosis.
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Affiliation(s)
- Jinping Liu
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
- 2Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Pingguo Duan
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Rong Xie
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Bo Li
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Yinhui Dong
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Sigurd Berven
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
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Soliman MAR, Khan A, Pollina J. Comparison of Prone Transpsoas and Standard Lateral Lumbar Interbody Fusion Surgery for Degenerative Lumbar Spine Disease: A Retrospective Radiographic Propensity Score-Matched Analysis. World Neurosurg 2021; 157:e11-e21. [PMID: 34464774 DOI: 10.1016/j.wneu.2021.08.097] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prone transpsoas lateral lumbar interbody fusion (PTP-LLIF) is a recently introduced modification to standard LLIF. To date, no study has compared the radiographic outcomes of standard LLIF and PTP-LLIF. We performed a radiographic parameter-based propensity score-matched analysis to compare postoperative clinical and radiographic outcomes between PTP-LLIF and standard LLIF for degenerative lumbar spine disease. METHODS A total of 30 consecutive patients met the inclusion criteria. The preoperative standing scoliosis radiographs were retrospectively reviewed for global and segmental sagittal alignment. Propensity score matching was calculated using the baseline radiographic parameters. One-to-one matching of patients who had undergone PTP-LLIF with those who had a similar propensity score but had undergone standard LLIF was performed to compare the radiographic (primary) and clinical (secondary) outcomes. RESULTS Propensity score matching resulted in 10 pairs of PTP-LLIF and standard LLIF patients. The PTP-LLIF group had had significantly better improvement in lumbar lordosis (P = 0.047). The difference in the improvement in pelvic incidence minus lumbar lordosis mismatch approached statistical significance for the PTP-LLIF group (P = 0.05). This led to better improvement in the short-form 12-item physical score (P = 0.03) and Oswestry disability index (P = 0.1) in the PTP-LLIF group. No significant differences were found between the 2 groups in the other clinical and radiographic outcomes. The PTP-LLIF group had a shorter operative time (P = 0.4) and hospital stay (P = 0.1), without a statistically difference, and shorter radiation exposure time (P = 0.5). The standard LLIF group had experienced less intraoperative bleeding, without a statistically significant difference (P = 0.3). The mean follow-up time was 10.2 ± 5.2 months in the PTP-LLIF group and 30.9 ± 17.2 months in the standard LLIF group (P < 0.05). CONCLUSIONS The PTP-LLIF group showed significantly better improvement in lumbar lordosis and short-form 12-item physical score.
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Affiliation(s)
- Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
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Stone LE, Wali AR, Santiago-Dieppa DR, Taylor WR. Prone-transpsoas as single-position, circumferential access to the lumbar spine: A brief survey of index cases. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 6:100053. [PMID: 35141621 PMCID: PMC8820054 DOI: 10.1016/j.xnsj.2021.100053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 10/24/2022]
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Miscusi M, Trungu S, Ricciardi L, Forcato S, Ramieri A, Raco A. The anterior-to-psoas approach for interbody fusion at the L5-S1 segment: clinical and radiological outcomes. Neurosurg Focus 2020; 49:E14. [PMID: 32871565 DOI: 10.3171/2020.6.focus20335] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Over the last few decades, many surgical techniques for lumbar interbody fusion have been reported. The anterior-to-psoas (ATP) approach is theoretically supposed to benefit from the advantages of both anterior and lateral approaches with similar complication rates, even in L5-S1. At this segment, the anterior lumbar interbody fusion (ALIF) requires retroperitoneal dissection and retraction of major vessels, whereas the iliac crest does not allow the lateral transpsoas approach. This study aimed to investigate clinical-radiological outcomes and complications of the ATP approach at the L5-S1 segment in a single cohort of patients. METHODS This is a prospective single-center study, conducted from 2016 to 2019. Consecutive patients who underwent ATP at the L5-S1 segment for degenerative disc disease or revision surgery after previous posterior procedures were considered for eligibility. Complete clinical-radiological documentation and a minimum follow-up of 12 months were set as inclusion criteria. Clinical patient-reported outcomes, such as the visual analog scale for low-back pain, Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) scores, as well as spinopelvic parameters, were collected preoperatively, 6 weeks after surgery, and at the last follow-up visit. Intraoperative and perioperative complications were recorded. The fusion rate was evaluated on CT scans obtained at 12 months postoperatively. RESULTS Thirty-two patients met the inclusion criteria. The mean age at the time of surgery was 57.6 years (range 44-75 years). The mean follow-up was 33.1 months (range 13-48 months). The mean pre- and postoperative visual analog scale (7.9 ± 1.3 vs 2.4 ± 0.8, p < 0.05), Oswestry Disability Index (52.8 ± 14.4 vs 22.9 ± 6.0, p < 0.05), and SF-36 (37.3 ± 5.8 vs 69.8 ± 6.1, p < 0.05) scores significantly improved. The mean lumbar lordosis and L5-S1 segmental lordosis significantly increased after surgery. The mean pelvic incidence-lumbar lordosis mismatch and pelvic tilt significantly decreased. No intraoperative complications and a postoperative complication rate of 9.4% were recorded. The fusion rate was 96.9%. One patient needed a second posterior revision surgery for residual foraminal stenosis. CONCLUSIONS In the present case series, ATP fusion for the L5-S1 segment has resulted in valuable clinical-radiological outcomes and a relatively low complication rate. Properly designed clinical and comparative trials are needed to further investigate the role of ATP for different L5-S1 conditions.
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Affiliation(s)
- Massimo Miscusi
- 1Department of Neuroscience, Mental Health, and Sense Organs, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome
| | - Sokol Trungu
- 1Department of Neuroscience, Mental Health, and Sense Organs, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome
- 2Neurosurgery Unit, Cardinal G. Panico Hospital, Tricase; and
| | - Luca Ricciardi
- 1Department of Neuroscience, Mental Health, and Sense Organs, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome
- 2Neurosurgery Unit, Cardinal G. Panico Hospital, Tricase; and
| | - Stefano Forcato
- 2Neurosurgery Unit, Cardinal G. Panico Hospital, Tricase; and
| | - Alessandro Ramieri
- 3Department of Orthopedics, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Italy
| | - Antonino Raco
- 1Department of Neuroscience, Mental Health, and Sense Organs, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome
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Gelfand Y, Benton J, De la Garza-Ramos R, Yanamadala V, Yassari R, Kinon MD. Effect of Cage Type on Short-Term Radiographic Outcomes in Transforaminal Lumbar Interbody Fusion. World Neurosurg 2020; 141:e953-e958. [PMID: 32565381 DOI: 10.1016/j.wneu.2020.06.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The effect of expandable versus static cage type on radiographic outcomes in transforaminal lumbar interbody fusion (TLIF) has not been well studied in the literature. We studied the effect of 3 cage types on change in foraminal height (FH), disk height (DH), subsidence, and segmental lordosis (SL). METHODS We conducted a retrospective review of patients who underwent TLIF in a single institution from 2014 to 2019. The following 3 cage types were identified: banana cage, bullet, and expandable cage. Computed tomography (CT) scans of the lumbar spine or lumbar radiographs (when CT scan was not available) with 6-week follow-up time were used for radiographic assessment. RESULTS One hundred patients with 133 fused segments were identified. The average age was 60.9 years, and 40% were men. A banana cage was used in 19 segments (14.3%), a bullet cage was used in 47 (35.4%), and an expandable cage was used in 67 segments (50.4%). There were no significant differences in FH (average increase, 0.7 mm; P = 0.771), subsidence (average, 2.3 mm; P = 0.554), DH (average decrease, 1.0 mm; P = 0.769), or clinically significant subsidence (>4 mm; P = 0.174). Expandable cages demonstrated a positive 1.2° gain in SL, whereas both other cages demonstrated a decrease in SL on average (P = 0.05). This result held up on multivariate analysis (P = 0.031). CONCLUSIONS The average increase in the foraminal height in TLIF is small (0.7 mm) and is not different between the cage types; therefore, direct decompression is crucially important in this procedure. Although TLIF is often considered to be a kyphotic procedure, an expandable cage demonstrated superiority in terms of segmental lordosis improvement.
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Affiliation(s)
- Yaroslav Gelfand
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Joshua Benton
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rafael De la Garza-Ramos
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vijay Yanamadala
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Reza Yassari
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Merritt D Kinon
- Spine Research Group, Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
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The prone transpsoas technique: preliminary radiographic results of a multicenter experience. 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 2020; 30:108-113. [DOI: 10.1007/s00586-020-06471-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022]
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Divi SN, Schroeder GD, Goyal DKC, Radcliff KE, Galetta MS, Hilibrand AS, Anderson DG, Kurd MF, Rihn JA, Kaye ID, Woods BR, Vaccaro AR, Kepler CK. Fusion technique does not affect short-term patient-reported outcomes for lumbar degenerative disease. Spine J 2019; 19:1960-1968. [PMID: 31356987 DOI: 10.1016/j.spinee.2019.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND/CONTEXT Degenerative lumbar disease can be addressed via an anterior or posterior approach, and with or without the use of an interbody cage. Although several studies have compared the type of approach and technique, there is a lack of literature assessing patient-reported outcome measures (PROMs) and radiographic parameters between different fusion techniques. PURPOSE To determine whether the surgical approach and fusion technique for lumbar degenerative disease had an effect on short-term PROMs and radiographic parameters. STUDY DESIGN/SETTING Retrospective Cohort Study. PATIENT SAMPLE Three hundred and ninety-one patients who underwent a 1-3 level lumbar spine fusion procedure at a high-volume academic center were retrospectively identified. Patients were divided into three groups based on the type of fusion they underwent: posterolateral fusion (PLF), anterior lumbar interbody fusion (ALIF), or transforaminal lumbar interbody fusion (TLIF). OUTCOME MEASURES PROMs: Short Form-12 (SF-12) Physical Component Score (PCS) and Mental Component Score (MCS), Oswestry Disability Index (ODI), Visual Analog Score (VAS) Back, VAS Leg. Spinopelvic measurements: Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), Segmental Lordosis (SL), PI-LL mismatch. METHODS Patients with less than 1-year follow-up were excluded from the cohort. Pre- and postoperative spinopelvic measurements were obtained for all patients. Univariate analysis (Chi-squared/Fisher's exact test or ANOVA test with post-hoc Bonferroni test) was used to compare among the three groups in the PROMs and radiographic spinopelvic parameters. Multiple linear regression was used to determine if fusion technique was an independent predictor of change in each patient outcome. RESULTS Two hundred and sixteen patients were included in the PLF group, 33 patients in the ALIF group, and 142 patients in the TLIF group. The PLF group was significantly older at baseline (p<.001) and had lower preoperative diagnosis rates of degenerative scoliosis and disc herniations (p<.001), whereas the ALIF group underwent a higher proportion of three-level fusions (p<.001). There was no significant difference in spinopelvic parameters preoperatively, however the ALIF group showed significantly more improvement in SL postoperatively (p=.004) than the PLF and TLIF groups. Within each group, SL improved for the PLF and ALIF groups (p=.002 for both), but not for the TLIF group (p=.238). Comparing patient outcomes, the ALIF group reported lower preoperative VAS Leg scores (p=.031), however, this difference resolved postoperatively. Stratifying for preoperative diagnosis, there were no significant differences in outcomes, except for a greater improvement in VAS Leg scores for degenerative scoliosis patients undergoing ALIF. Using multivariate analysis, fusion technique was not found to be a significant predictor of change in any patient outcome or in odds of revision. CONCLUSIONS Lumbar degenerative disease can be treated with several different fusion techniques, however, the relationship between type of fusion and PROMs is not established. Based on the findings in this study, the ALIF group showed greater improvement in SL compared with the PLF and TLIF groups, however, there was no difference noted in overall LL, PI-LL mismatch or other spinopelvic parameters. Despite these radiographic findings, patient outcome measures remained similar between all three fusion types.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Dhruv K C Goyal
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Kristen E Radcliff
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Matthew S Galetta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - D Greg Anderson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Barrett R Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
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Odeh K, Rosinski A, Nguyen J, Modak A, Leasure J, Siebert S, Kondrashov D. Anterior Lumbar Interbody Fusion May Provide Superior Decompression of the Foraminal Space Compared with Direct Foraminotomy: Biomechanical Cadaveric Study. World Neurosurg 2019; 135:e71-e76. [PMID: 31678445 DOI: 10.1016/j.wneu.2019.10.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this cadaveric biomechanical study was to compare the area of the foraminal space during motion in the intact condition, after direct decompression via foraminotomy, and after indirect decompression via anterior lumbar interbody spacer insertion. METHODS Eight (8) L5-S1 cadaver specimens were used for testing. Each specimen was tested in the intact state, after posterior foraminotomy, and after standalone anterior lumbar interbody fusion (ALIF). Each specimen was 3-dimensional imaged under neutral loading, flexion, and extension. The 3-dimensional images were analyzed for changes in the foraminal area under each loading scenario. A repeat-measures design was used. Outcome measures from testing included the frequency in which an increase in cross-sectional area was observed, as well as the percent increase of the foraminal area for each surgical group and loading direction. RESULTS Direct foraminotomy and ALIF maintained the foraminal space during initial distraction under no loading with areas 99.7% and 96.5% of the native foraminal area, respectively (P = 0.955 and P = 0.455). Direct foraminotomy increased the foraminal area significantly during flexion to 112.2% of the area before motion (P = 0.008) while ALIF did not. Direct foraminotomy significantly decreased the foraminal area during extension to 89.2% of the area before motion (P = 0.006). ALIF, however, maintained its initial distraction during extension with 98.2% of the area before motion (P = 0.808). CONCLUSIONS ALIF maintains the foraminal area in extension while direct posterior foraminotomy does not.
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Affiliation(s)
- Khalid Odeh
- San Francisco Orthopaedic Residency Program, San Francisco, California, USA
| | | | - Jacqueline Nguyen
- San Francisco Orthopaedic Residency Program, San Francisco, California, USA
| | - Ashin Modak
- The Taylor Collaboration, San Francisco, California, USA
| | - Jeremi Leasure
- The Taylor Collaboration, San Francisco, California, USA.
| | - Scott Siebert
- San Francisco Orthopaedic Residency Program, San Francisco, California, USA
| | - Dimitriy Kondrashov
- San Francisco Orthopaedic Residency Program, San Francisco, California, USA; St. Mary's Spine Center, San Francisco, California, USA
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Butler JS, Lui DF, Malhotra K, Suarez-Huerta ML, Yu H, Selvadurai S, Agu O, Molloy S. 360-Degree Complex Primary Reconstruction Using Porous Tantalum Cages for Adult Degenerative Spinal Deformity. Global Spine J 2019; 9:613-618. [PMID: 31448194 PMCID: PMC6693065 DOI: 10.1177/2192568218814531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess both implant performance and the amount of correction that can be achieved using multilevel anterior lumbar interbody fusion (ALIF). METHODS Retrospective cohort study (n = 178) performed over a 4-year period. Surgical variables examined included blood loss, operative time, perioperative complications, and secondary/revision procedures. Follow-up radiographic assessment was performed to record implant-related problems. Radiographic parameters were examined pre- and postoperatively. Health-related quality of life (HRQOL) outcome measures were collected preoperatively and at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Descriptive and comparative statistical analysis, using paired-sample t test and repeated-measures analysis of variance (rANOVA), was performed. RESULTS Lumbar lordosis increased from 42° ± 17° preoperatively to 55° ± 11° postoperatively (P < .001). The visual analog scale back pain mean score improved from 8.3 ± 1.5 preoperatively to 2.6 ± 2.4 at 2 years (P < .001). The mean Oswestry Disability Index improved from 69.5 ± 21.5 preoperatively to 19.9 ± 15.2 at 2 years (P < .001). The EQ-5D mean score improved from 0.2 ± 0.2 preoperatively to 0.8 ± 0.1 at 2 years (P = .02). There were no neurological, vascular, or visceral approach-related injuries reported. No rod breakages and no symptomatic nonunions occurred. There was one revision procedure performed for fracture. CONCLUSIONS The use of porous tantalum cages as part of a 360-degree fusion to treat adult degenerative spinal deformity has been demonstrated to be a safe and effective strategy, leading to good clinical, functional, and radiographic outcomes in the short term.
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Affiliation(s)
- Joseph S. Butler
- Mater Misericordiae University Hospital, Dublin, Ireland,Tallaght University Hospital, Dublin, Ireland,Joseph S. Butler, National Spinal Injuries Unit,
Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital,
Eccles Street, Dublin 7, Ireland.
| | | | | | | | - Haiming Yu
- Royal National Orthopaedic Hospital, Stanmore, UK
| | | | | | - Sean Molloy
- Royal National Orthopaedic Hospital, Stanmore, UK
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