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Tabarestani TQ, Drossopoulos PN, Huang CC, Bartlett AM, Paturu MR, Shaffrey CI, Chi JH, Ray WZ, Goodwin CR, Amrhein TJ, Abd-El-Barr MM. The Importance of Planning Ahead: A Three-Dimensional Analysis of the Novel Trans-Facet Corridor for Posterior Lumbar Interbody Fusion Using Segmentation Technology. World Neurosurg 2024; 188:e247-e258. [PMID: 38777315 DOI: 10.1016/j.wneu.2024.05.091] [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: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The rise of minimally invasive lumbar fusions and advanced imaging technologies has facilitated the introduction of novel surgical techniques with the trans-facet approach being one of the newest additions. We aimed to quantify any pathology-driven anatomic changes to the trans-facet corridor, which could thereby alter the ideal laterality of approach to the disc space. METHODS In this retrospective cohort study, we measured the areas and maximum permissible cannula diameters of the trans-facet corridor using commercially available software (BrainLab, Munich, Germany). Exiting and traversing nerve roots, thecal sacs, and lumbar vertebrae were manually segmented on T2-SPACE magnetic resonance imaging. Spondylolisthesis, disc protrusions, and disc space heights were recorded. RESULTS A total of 118 trans-facet corridors were segmented bilaterally in 16 patients (65.6 ± 12.1 years, 43.8% female, body mass index 29.2 ± 5.1 kg/m2). The mean areas at L1-L2, L2-L3, L3-L4, and L4-L5 were 89.4 ± 24.9 mm2, 124 ± 39.4 mm2, 123 ± 26.6 mm2, and 159 ± 42.7 mm2, respectively. The mean permissible cannula diameter at the same levels were 7.85 ± 1.43 mm, 8.98 ± 1.72 mm, 8.93 ± 1.26 mm, and 10.2 ± 1.94 mm, respectively. Both parameters increased caudally. Higher degrees for spondylolisthesis were associated with larger areas and maximum cannula diameters on regression analysis (P < 0.001). CONCLUSIONS Our results illustrate that pathology, like spondylolisthesis, can increase the area of the trans-facet corridor. By understanding this effect, surgeons can better decide on the optimal approach to the disc while taking into consideration a patient's unique anatomy.
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Affiliation(s)
- Troy Q Tabarestani
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Peter N Drossopoulos
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chuan-Ching Huang
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Alyssa M Bartlett
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mounica R Paturu
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | | | - John H Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, North Carolina, USA
| | - Wilson Z Ray
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Timothy J Amrhein
- Department of Radiology, Duke University Hospital, Durham, North Carolina, USA
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Li H, Xiao C, Pan H, Yang H, Lei Y, Wang H, Li S. Surgical Strategy for Lumbar Disc Herniation based on the MSU Classification: Percutaneous Endoscopic Lumbar Discectomy versus Transforaminal Lumbar Interbody Fusion: A 5-year Retrospective Study. Orthop Surg 2024; 16:1963-1973. [PMID: 38961670 PMCID: PMC11293921 DOI: 10.1111/os.14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE Currently, there is no established guideline on whether to opt for percutaneous endoscopic lumbar discectomy (PELD) or traditional transforaminal lumbar interbody fusion (TLIF) surgery based on specific types of lumbar disc herniation (LDH). Based on the Michigan State University (MSU) classification system, this study conducted a medium- to long-term follow-up analysis of two surgical methods over 5 years for the first time, aiming to provide empirical evidence to assist in making more informed decisions before surgery for LDH treatment. METHODS This was a retrospective study that included 273 patients with single-level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1-day, 1-week, 1-year, and 5-year follow-ups. Complications, recurrences, and 5-year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample t-tests, repeated measures analysis of variance (ANOVA), and χ2 tests. RESULTS Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow-ups (p < 0.001). PELD showed better results than TLIF in reducing pain and improving the ODI scores in the classifications of 3B, 2B, and 2C (p < 0.05). TLIF demonstrated consistent superiority over PELD in 2A, 2AB, 3A, and 3AB classifications (p < 0.05). The total recurrence rate in the PELD group (11.05%) within 5 years after surgery was higher (p < 0.05) than that in the TLIF group (3.96%). These were mainly concentrated in the 2A, 2AB, 3A, and 3AB types. Moreover, the rate of excellent and good outcomes in the PELD was higher than in the TLIF but no significant difference (χ2 = 1.0568, p = 0.5895). CONCLUSION This study suggests that PELD and TLIF may relieve LDH, but have advantages under different MSU classifications. The MSU classification has specific guiding significance and could aid in the surgical selection of PELD or TLIF to achieve optimal treatment outcomes for patients with lumbar disc herniation.
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Affiliation(s)
- Hongtao Li
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Changming Xiao
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Hongyu Pan
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Haomiao Yang
- Department of Spine SurgeryThe Nanjing TCM Hospital Affiliated to Nanjing University of Traditional Chinese MedicineNanjingChina
| | - Yang Lei
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Haozhong Wang
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Sen Li
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
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Yang H, Wang H, Lu J, Hu L. A novel simplified sonographic approach with fluoroscopy-controlled L5 transforaminal epidural injections in patients with high iliac crest: a retrospective study. JA Clin Rep 2024; 10:43. [PMID: 39030365 PMCID: PMC11264496 DOI: 10.1186/s40981-024-00725-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND To explore a novel ultrasound (US) modality for lumbar transforaminal epidural injections (TFEIs) in patients with low back pain (LBP) and L5 radicular pain combined with high iliac crest (HIC). METHODS One-hundred and forty-one patients were retrospectively stratified into two groups based on the treatment they received: novel group, receiving US-guided and fluoroscopy (FL)-controlled TFEIs using a sagittal oblique approach between the superior articular process of L5 and S1, and control group, receiving US-guided TFEIs with conventional transverse approach combined with FL confirmation. Accuracy of contrast dispersing into lumbar epidural space was set as the primary endpoint. Radiation dosages, procedure time, numeric rating scale (NRS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, adverse events, and rescue analgesic requirement were also recorded. The generalized liner mixed model (GLMMs) was employed to compare the repeatedly measured variables between groups, taking individual confounding factors as covariance. RESULTS The accuracy of TFEIs was 92.8% and 65.2% in novel and control group, with a significant difference of 26.7% (95% CI: 15.4%, 39.8%) between two modalities (p < 0.001). Significant pain relief was observed in novel group as opposed to control group after one injection. Procedure time in novel group (8.4 ± 1.6 min) was shorter than control group (15.8 ± 3.5 min) (p < 0.001) with less radiation dosage (3047 ± 5670 vs. 8808 ± 1039 μGy/m2, p < 0.001). Significantly, lower incidence of L5 paresthesia occurred in novel group. Statistical differences of NRS scores between the novel and control group were reached at 1 week after procedure (1 (IQR: - 1-3) vs. 3 (IQR: - 1-7), p = 0.006), while not reached at both 1- (1 (IQR: 0-2) vs. 1 (IQR: - 1-3), p = 0.086) or 3-month follow-up (0 (IQR: - 1-1) vs. 1 (IQR: 0-2), p = 0.094). Both groups showed similar functional improvement (F = 0.103, p = 0.749) during follow-up. CONCLUSIONS The novel sonographic technique provided superior accuracy needle placement and better pain-relieving effect through one injection as compared to the routine transverse approach. Consequently, in situations where the HIC imposed limitations for TFEIs performance on L5, the novel technique should be recommended to consider increasing accurate puncture, minimizing radiation exposure, consuming procedure time, and reducing the risk of neuraxial injury.
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Affiliation(s)
- Haichang Yang
- Department of Pain Management, The Second Hospital of Tangshan, no. 21 Jianshe North Road, Lubei District, Tangshan City, 063015, Hebei Province, China
| | - Hongyan Wang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Jie Lu
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Ling Hu
- Department of Pain Management, Beijing Nuclear Industry Hospital, No. 2 Nan Fourth Lane, Sanlihe Street, Xicheng District, Beijing, 100045, China.
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Shalita C, Wang T, Dibble CF, Adams SW, Nelli A, Sykes D, Tabarestani T, Bhowmik S, Liu B, Jung SH, Gulur P, Grossi P, Crutcher C, Abd-El-Barr MM. Percutaneous lumbar interbody fusion results in less perioperative opioid usage compared to minimally invasive transforaminal lumbar interbody fusion: a single institution, multi-surgeon retrospective study. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:190-203. [PMID: 38974490 PMCID: PMC11224795 DOI: 10.21037/jss-23-132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/23/2024] [Indexed: 07/09/2024]
Abstract
Background Ultra-minimally invasive percutaneous lumbar interbody fusion (percLIF) has been demonstrated to further minimize tissue trauma and has been associated with improved clinical outcomes including decreased blood loss, post-operative pain and length of stay when compared to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. A single-institution retrospective study was conducted to investigate whether 1-level percLIF is associated with decreased narcotic consumption compared to 1-level MIS-TLIF in the first 24-hour following surgery. Methods A retrospective study of patients undergoing either single-level percLIF or MIS-TLIF from January 2018 to December 2021. Opioid consumption in the 24-hour following surgery was converted into total morphine milligram equivalents (MME). The primary outcome used univariate and multivariate regression analysis to compare MME consumption between the MIS-TLIF and percLIF groups. Secondary outcome variables included, estimated blood loss, total intraoperative MME, MME at discharge, MME at 30 days post-op, exiting nerve root injury, post-anesthesia care unit (PACU) visual analogue scale (VAS) score at handoff, time to first ambulation, distance ambulated post-operative day one and hospital length of stay. Results A total of 51 patients (21 percLIF vs. 30 MIS-TLIF) were included in the study. Univariate regression analysis revealed that on average patients who underwent percLIF had a 24-hour postoperative MME -50.8 mg (95% CI: -91.6, -10) lower than those who had MIS-TLIF (P=0.02). On multivariable analysis, after adjusting for sex and age, 24-hour postoperative MME closely failed to meet statistical significance (P=0.06) with an average of -40.8 mg (95% CI: -83.2, 1.6) MME in percLIF patients compared to MIS-TLIF. There was no statistically significant difference in MME between MIS-TLIF and percLIF at the time of discharge and at 30 days post-op. Conclusions In the setting of the current opioid epidemic in the United States and increased numbers of patients undergoing lumbar interbody fusion, spine surgeons must continue to do their part helping reduce the need for opioid prescriptions for postoperative pain management. New "ultra-MIS" techniques such as percLIF allow surgeons to further decrease tissue trauma, which should lead to reduced need for post-operative narcotic requirements.
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Affiliation(s)
| | - Timothy Wang
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | | | - Shawn W. Adams
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Amanda Nelli
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - David Sykes
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Troy Tabarestani
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Subasish Bhowmik
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Beiyu Liu
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Sin-Ho Jung
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Padma Gulur
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Peter Grossi
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Clifford Crutcher
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Karimi H, Patel J, Olmos M, Kanter M, Hernandez NS, Silver RE, Liu P, Riesenburger RI, Kryzanski J. Spinal Anesthesia Reduces Perioperative Polypharmacy and Opioid Burden in Patients Over 65 Who Undergo Transforaminal Lumbar Interbody Fusion. World Neurosurg 2024; 185:e758-e766. [PMID: 38432509 DOI: 10.1016/j.wneu.2024.02.127] [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: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Polypharmacy and opioid administration are thought to increase the risk of postoperative cognitive dysfunction and delirium in elderly patients. Spinal anesthesia (SA) holds potential to reduce perioperative polypharmacy in spine surgery. As more geriatric patients undergo spine surgery, understanding how SA can reduce polypharmacy and opioid administration is warranted. We aim to compare the perioperative polypharmacy and dose of administered opioids in patients ≥65 years who undergo transforaminal lumbar interbody fusion (TLIF) under SA versus general anesthesia (GA). METHODS A retrospective analysis of 200 patients receiving a single-surgeon TLIF procedure at a single academic center (2014-2021) was performed. Patients underwent the procedure with SA (n = 120) or GA (n = 80). Demographic, procedural, and medication data were extracted from the medical record. Opioid consumption was quantified as morphine milligram equivalents (MME). Statistical analyses included χ2 or Student's t-test. RESULTS Patients receiving SA were administered 7.45 medications on average versus 12.7 for GA patients (P < 0.001). Average perioperative opioid consumption was 5.17 MME and 20.2 MME in SA and GA patients, respectively (P < 0.001). The number of patients receiving antiemetics and opioids remained comparable postoperatively, with a mean of 32.2 MME in the GA group versus 27.5 MME in the SA group (P = 0.14). Antiemetics were administered less often as a prophylactic in the SA group (32%) versus 86% in the GA group (P < 0.001). CONCLUSIONS SA reduces perioperative polypharmacy in patients ≥65 years undergoing TLIF procedures. Further research is necessary to determine if this reduction correlates to a decrease the incidence of postoperative cognitive dysfunction and delirium.
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Affiliation(s)
- Helen Karimi
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
| | - Jainith Patel
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Michelle Olmos
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Matthew Kanter
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Nicholas S Hernandez
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Rachel E Silver
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA; Energy Metabolism Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Penny Liu
- Department of Anesthesiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Tsai PC, Liu YC, Chang TK, Chen LP, Huang YC, Lian YS, Chien KT. The novel Kambin Torpedo full-endoscopic lumbar interbody fusion technique: a case series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:417-428. [PMID: 37389696 DOI: 10.1007/s00586-023-07836-9] [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: 01/18/2023] [Revised: 05/10/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Full-endoscopic lumbar interbody fusion (FELIF) is a new-generation treatment for spondylolisthesis. However, owing to their unique characteristics, the two main endoscopic fusion trajectories, the trans-Kambin and posterolateral approaches, have important limitations. Herein, we aimed to introduce a new technique called Kambin Torpedo FELIF (KT-FELIF). METHODS The KT-FELIF technique is based on the trans-Kambin approach. It additionally completes ipsilateral total facetectomy and contralateral direct decompression. Thus, this novel technique combines the advantages of the trans-Kambin and posterolateral approaches. RESULTS We reported on the indications and technical steps of KT-FELIF and provided intraoperative and animated videos to clarify the procedure. Short-term follow-up based on 3-month postoperative computed tomography and plain films images taken at least 3 months after surgery showed adequate bony decompression, a large bone graft contact area, and good intervertebral trabecular bone growth without radiolucent lines between the graft, cage, and end plate. The clinical results, such as ipsilateral and contralateral visual analog scale and Oswestry disability index values, gradually improved at 1 and 3 months postoperatively. No complications were observed. CONCLUSIONS KT-FELIF is a promising FELIF technique for achieving bilateral direct decompression through a unilateral approach while accomplishing thorough discectomy and endplate preparation.
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Affiliation(s)
- Ping-Chi Tsai
- Department of Medical Education, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104217, Taiwan
| | - Yueh-Ching Liu
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Ting-Kuo Chang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Lei-Po Chen
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Yu-Ching Huang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Yan-Shiang Lian
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Kai-Ting Chien
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan.
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Hu X, Yan L, Jin X, Liu H, Chai J, Zhao B. Endoscopic Lumbar Interbody Fusion, Minimally Invasive Transforaminal Lumbar Interbody Fusion, and Open Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases: A Systematic Review and Network Meta-Analysis. Global Spine J 2024; 14:295-305. [PMID: 36999647 PMCID: PMC10676174 DOI: 10.1177/21925682231168577] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
STUDY DESIGN network meta-analysis. OBJECTIVE To compare the clinical efficacy and safety of endoscopic lumbar interbody fusion (Endo-LIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open transforaminal lumbar interbody fusion (OTLIF) in the treatment of lumbar degenerative diseases (LDDs). METHOD A literature search was conducted in the PubMed, Embase, and Cochrane Library databases. Studies comparing Endo-LIF, MIS-TLIF and OTLIF published from September 2017 to September 2022 for the treatment of LDD were retrieved. Data were extracted from preset clinical outcome measures, including operation time, estimated intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, Oswestry disability index (ODI) score, etc. RESULT Thirty-one studies with 3467 patients were included in this study. Network meta-analysis showed that in the comparison of the 3 procedures, Endo-LIF was superior to MIS-TLIF and OTLIF in terms of reducing EBL, LOS, time to ambulation, and VAS score of back pain. MIS-TLIF was superior to Endo-LIF in terms of ODI improvement, and OTLIF required the shortest intraoperative fluoroscopy time. There was no significant difference in operative time, complication rate, fusion rate, VAS score of leg pain, or JOA score among the 3 procedures. CONCLUSION Endo-LIF, MIS-TLIF and OTLIF each have their own advantages and disadvantages and show similar results in many respects, except for better early outcomes achieved with the more minimally invasive procedure.
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Affiliation(s)
- Xijian Hu
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lei Yan
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinjie Jin
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Haifeng Liu
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing Chai
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Zhao
- The Second Hospital of Shanxi Medical University, Taiyuan, China
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Ferraro M, Puglia F, Della Valle A, Cerbone V, Cicatelli A, Peroni DR, Cecconi D, Misaggi B, La Maida GA. Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique. J Orthop Traumatol 2023; 24:62. [PMID: 38091159 PMCID: PMC10719190 DOI: 10.1186/s10195-023-00741-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for PLIF. Tantalum is a metal that is particularly used in orthopedic surgery. It has a modulus of elasticity similar to marrow and leads to high primary stability of the implant. MATERIALS AND METHODS Our study was a retrospective monocentric observational study evaluating clinical and radiological outcomes of tantalum cages in a modified TLIF technique with posterior instrumentation and autologous and/or homologous posterolateral bone grafting. The aim of the study was to evaluate clinical outcomes and the increase in or redistribution of lumbar lordosis. The intersomatic arthrodesis was always carried out with a single tantalum cage normally used for PLIF to reduce the neurological risk. We retrospectively studied 105 patients who were treated with a modified unilateral TLIF approach by two surgeons between 2013 and 2018. We evaluated the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back pain, global lumbar lordosis, lordosis of L4-sacrum, segmental lordosis of functional motion units that underwent arthrodesis, pelvic tilt, pelvic incidence, and the sacral slope in 77 patients. All patients were suffering from grade III or IV Pfirrmann, instability, or foraminal post-laminectomy stenosis and/or grade I-II degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. They had no significant sagittal imbalance, with a sagittal vertical axis (SVA) of < 5 mm. The average follow-up duration was 30 months. RESULTS We achieved excellent clinical results, with only four cases of failure (5.2%). Moreover, we noticed a statistically significant redistribution of lumbar lordosis, with an average percentage increase in L4-S1 lordosis equal to 19.9% (P < 0.001), an average increase in the L4-S1/Lumbar lordosis (LL) ratio from 0.53 to 0.63 (P < 0.001), and a mean percentage increase in sacral slope equal to 7.6% (P < 0.001). CONCLUSION Thanks to the properties of tantalum, our modified single-portal TLIF technique is a valid surgical solution to obtain a solid arthrodesis and restore the correct lumbar lordosis distribution while reducing neurological complications and the number of failures. LEVEL OF EVIDENCE 4 Trial registration statement: retrospective observational study, no trial registration.
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Affiliation(s)
- Marcello Ferraro
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
| | - Francesco Puglia
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy.
- University of Milan, Milan, Italy.
| | - Andrea Della Valle
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
| | - Vincenzo Cerbone
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
- University of Milan, Milan, Italy
| | - Alfonso Cicatelli
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
- University of Milan, Milan, Italy
| | - Donata Rita Peroni
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
| | - Davide Cecconi
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
| | - Bernardo Misaggi
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
| | - Giovanni Andrea La Maida
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
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Pholprajug P, Kotheeranurak V, Liu Y, Kim JS. The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective. Neurospine 2023; 20:1224-1245. [PMID: 38171291 PMCID: PMC10762387 DOI: 10.14245/ns.2346888.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
Lumbar interbody fusion stands as a preferred surgical solution for degenerative lumbar spine diseases. The procedure primarily aims to establish lumbar segment stability, directly addressing patient symptoms associated with spinal complications. Traditional open surgery, though effective, is linked with notable morbidities and extended recovery time. To mitigate these concerns, minimally invasive surgery (MIS) has garnered significant popularity, presenting an appealing alternative with numerous benefits such as reduced soft tissue trauma, decreased blood loss, and expedited recovery. Among MIS procedures, full endoscopic spinal surgery, characterized by its minimal invasiveness, holds the potential to further minimize morbidities while enhancing surgical outcomes. Endoscopic lumbar interbody fusion, a novel procedure within this paradigm, has gained attention for offering advantages comparable to those of minimally invasive transforaminal lumbar interbody fusion. However, the safety, efficacy, and associated surgical techniques and instrument design of this method continue to be subjects of ongoing debate. This paper critically reviews current evidence on the safety, efficacy, and advantages of endoscopic lumbar spinal interbody fusion, examining whether it could indeed supersede existing mainstream techniques.
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Affiliation(s)
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Bayram Y, Pınar E. Assessment of the Quality and Reliability of YouTube as an Information Source for Transforaminal Interbody Fusion. Cureus 2023; 15:e50210. [PMID: 38192971 PMCID: PMC10772853 DOI: 10.7759/cureus.50210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND This study aims to assess the quality and reliability of the information for patients from YouTube videos on transforaminal interbody fusion (TLIF). MATERIAL AND METHODS One hundred videos were listed by inputting "TLIF," "TLIF surgery," and "transforaminal interbody fusion" in the YouTube search engine. The top 50 most popular videos based on video power index (VPI), view ratio, and exclusion criteria were selected for review. One orthopedic consultant surgeon and one neurosurgeon consultant analyzed the videos together. The modified DISCERN score, the Global Quality Score (GQS), the Journal of the American Medical Association (JAMA) score, and a novel interbody fusion score were used to evaluate videos. Data of video length, view count, number of likes and dislikes, like ratio (like x 100/(like+dislike)), video source, and comment rate were collected. RESULTS The quality of the videos could have been better according to all scoring systems, regardless of the video source. The scores of the videos published by patients and commercials were significantly lower than those of physicians and allied professionals (p <0.05). VPI and view ratios were similar in all sources. Conclusion: The study demonstrates that YouTube videos providing information related to TLIF surgery are available and accessed by the public. The results of this study would suggest that YouTube is not currently an appropriate source of information on TLIF surgery for patients. Most of the YouTube videos about TLIF surgery contain information about the surgical technique and have limited information about the post-operative condition of the patients.
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Affiliation(s)
- Yusuf Bayram
- Orthopedics and Traumatology, Hisar Intercontinental Hospital, Istanbul, TUR
| | - Ertuğrul Pınar
- Neurological Surgery, Special Pendik Yuzyil Hospital, Istanbul, TUR
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Sousa JM, Silva JL, Gamelas J, Guimarães Consciência J. Transiliac Endoscopic-Assisted L5S1 Intraforaminal Lumbar Interbody Fusion: Technical Considerations and Potential Complications. World Neurosurg 2023; 178:e741-e749. [PMID: 37544596 DOI: 10.1016/j.wneu.2023.07.153] [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: 07/04/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE We sought to determine the clinical outcomes, complications, and fusion rates in transiliac endoscopic-assisted L5S1 intraforaminal lumbar interbody fusion (iLIF). METHODS Between September 2020 and September 2021, patients with L5S1 degenerative disk disease were enrolled in a prospective study on transiliac L5S1 iLIF and followed for a minimum of 12 months. Conflict of the preoperative planned approach with the ilium was mandatory. The primary outcome measures were the Oswestry Disability Index, the visual analog scale (VAS) score for low back pain (VAS back) and leg pain (VAS leg), and the modified MacNab criteria. The secondary outcomes were complications and fusion rates. RESULTS Five consecutive patients were enrolled: 2 males and 3 females with a mean age of 50 ± 12.9. All had 12 months' follow-up. The mean improvement in the Oswestry Disability Index, VAS back, and VAS leg (44 ± 11.75, 6.6 ± 1.7, and 4.7 ± 4.2, respectively) was more than 3 times the minimum clinically important difference. The modified MacNab criteria were good or excellent in 80% of cases at all endpoints. Three patients had ipsilateral lower limb dysesthesia. One patient had revision surgery for foraminal bone fragment removal. All patients achieved fusion. CONCLUSIONS The transiliac iLIF is a feasible but demanding surgical technique that allows overcoming cases in which the ilium prevents endoscopic transforaminal access to L5S1. Our preliminary results had good clinical outcomes and high fusion rates. The main complication was late-onset dysesthesia of the ipsilateral lower limb, 10 to 14 days after surgery. Special care must be taken to prevent L5 dorsal root ganglion injury.
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Affiliation(s)
- José Miguel Sousa
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal; Centro Hospitalar Lisboa Ocidental, Orthopaedics Department, Lisbon, Portugal.
| | - João Luís Silva
- Centro Hospitalar Lisboa Ocidental, Orthopaedics Department, Lisbon, Portugal
| | - João Gamelas
- Centro Hospitalar Lisboa Ocidental, Orthopaedics Department, Lisbon, Portugal
| | - José Guimarães Consciência
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal; Centro Hospitalar Lisboa Ocidental, Orthopaedics Department, Lisbon, Portugal
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Sousa JM, Serrano A, Nave A, Mascarenhas V, Nogueira P, Gamelas J, Guimarães Consciência J. Transforaminal Endoscopic Approach to L5S1: Imaging Characterization of the Lower Lumbar Spine and Pelvis for Surgical Planning. World Neurosurg 2023; 175:e809-e817. [PMID: 37068606 DOI: 10.1016/j.wneu.2023.04.026] [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: 02/14/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To determine and compare pelvic and lumbosacral reference parameters with computed tomography in patients with low back pain (LBP) and a control group of asymptomatic patients to provide quantification data and morphological correlations for L5S1 transforaminal endoscopic approach (L5S1TEA). METHODS We prospectively evaluated 100 patients with LBP and a control group of 100 individuals, with spinopelvic computed tomography. We measured lumbopelvic and L5S1 transforaminal approach parameters: maximum approach angle (maxAA) and minimum approach angle (minAA) and skin incision (maxSI and minSI), iliac crest (IC) projection at intersection point (ICPi), distance between the projected intersection of maxAA with the ilium (ICi) and the posterior limit of the IC (ΔICi-ICpost), and distance between ICi and spinous process (ΔICi-SP). RESULTS Females and ICPi were increased in the LBP group: maxAA: 48.38° ± 5.09°; minAA:32.5° ± 3.90°; maxSI: 11.39 ± 1.86 cm; and minSI: 8.30 ± 1.48 cm. Ilium intersection was increased in males; IC projection at the highest point (ICPh) was higher than ICPi; maxAA intersected the ilium in 28% and minAA in 1.5% of cases; ICi was positively correlated with facet angle, ICPh, and ICPi and negatively with ΔICi-SP. CONCLUSIONS Our results set preliminary reference values for L5S1TEA surgical planning. Besides higher ICPi, there were no differences between groups in measured parameters. Traditional IC height (ICPh) does not correspond to the point of intersection of the approach and is significantly higher than ICPi. ICi correlated to higher facet angle values, ICPh and ICPi grades, and lower ΔICi-SP. Potential conflict with the ilium is increased in the male population. IC is not impeditive of L5S1TEA in most cases.
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Affiliation(s)
- José Miguel Sousa
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal; Centro Hospitalar Lisboa Ocidental, Orthopaedics Department, Lisbon, Portugal.
| | - António Serrano
- Centro Hospitalar Lisboa Ocidental, Orthopaedics Department, Lisbon, Portugal
| | - Afonso Nave
- Centro Hospitalar Lisboa Ocidental, Orthopaedics Department, Lisbon, Portugal
| | - Vasco Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Lisbon, Portugal
| | - Paulo Nogueira
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Lisbon, Portugal
| | - Joao Gamelas
- Centro Hospitalar Lisboa Ocidental, Orthopaedics Department, Lisbon, Portugal
| | - José Guimarães Consciência
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal; Centro Hospitalar Lisboa Ocidental, Pre and Pos Graduation Department, Lisbon, Portugal
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Nie JW, Hartman TJ, MacGregor KR, Oyetayo OO, Zheng E, Singh K. Minimum Clinically Important Difference in Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion. Neurosurgery 2023; 92:1199-1207. [PMID: 36625578 DOI: 10.1227/neu.0000000000002350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/07/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Few studies have established the minimum clinically important difference (MCID) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for physical function and pain. OBJECTIVE To establish MCID for physical function and pain patient-reported outcome measures (PROMs) for MIS-TLIF through anchor- and distribution-based methods using the Oswestry Disability Index (ODI) as the anchor. METHODS Ninety-eight patients undergoing primary MIS-TLIF with preoperative and 1-year postoperative ODI scores were identified. MCID was calculated using anchor- and distribution-based methods. ODI responders were classified as patients who decreased by 1 disability classification. PROMs of Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), Visual Analog Scale (VAS) back/leg, and ODI were collected preoperatively and 1-year postoperatively. Anchor-based methods were average change, minimum detectable change, change difference, receiver operating characteristic curve, and cross-sectional analysis. Distribution-based methods were standard error of measurement, receiver change index, effect size, and 0.5 ∗ ΔSD. RESULTS Anchor-based methods ranged from 4.2 to 11.9 for PROMIS-PF, 6.0 to 15.8 for SF-12 PCS, 1.8 to 4.6 for VAS back, and 2.1 to 4.0 for VAS leg. The area under the curve for receiver operating characteristic analysis ranged from 0.66 to 0.81. Distribution-based methods ranged from 1.1 to 3.9 for PROMIS-PF, 1.6 to 10.4 for SF-12 PCS, 0.5 to 1.6 for VAS back, and 0.6 to 1.8 for VAS leg. CONCLUSION Patients undergoing MIS-TLIF had a wide range of MCID values. The receiver operating characteristic curve was selected as the most clinically appropriate method. The corresponding MCID values were 4.2 for PROMIS-PF, 6.8 for SF-12 PCS, 1.8 for VAS back, and 2.4 for VAS leg.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Waguia R, Gupta N, Gamel KL, Ukachukwu A. Current and Future Applications of the Kambin’s Triangle in Lumbar Spine Surgery. Cureus 2022; 14:e25686. [PMID: 35812644 PMCID: PMC9259071 DOI: 10.7759/cureus.25686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Kambin’s triangle has become the anatomical location of choice when accessing the lumbar spine to treat degenerative spinal disorders. Currently, lumbar interbody fusion is the most common procedure utilizing this space; however, with the advent of the Kambin’s prism definition, advanced imaging modalities, and robotic-assisted techniques, lumbar spine surgery has become increasingly precise and less invasive. These technological and procedural advances have drastically reduced the rate of complications, improved patient outcomes, and expanded the use of the Kambin’s triangle to treat different pathologies utilizing cutting-edge techniques. In this review, the authors present the current uses of the Kambin’s triangle and the future application of this anatomical corridor in lumbar spine surgery.
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