1
|
Li JR, Yan Y, Wu XG, He LM, Feng HY. Biomechanical evaluation of Percutaneous endoscopic posterior lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion: a biomechanical analysis. Comput Methods Biomech Biomed Engin 2024; 27:285-295. [PMID: 36847747 DOI: 10.1080/10255842.2023.2183348] [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: 11/14/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
In order to analyze and evaluate the stability of lumbar spine and the risk of cage subsidence after different minimally invasive fusion operations, two finite element models Percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and minimally invasive transforaminal lumbar interbody Fusion (MIS-TLIF) were established. The results showed that compared with MIS-TLIF, PE-PLIF had better segmental stability, lower pedicle screw rod system stress, and lower risk of cage subsidence. The results suggest that the cage with appropriate height should be selected to ensure the segmental stability and avoid the risk of the subsidence caused by the cage with large height.
Collapse
Affiliation(s)
- Jia-Rui Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Yang Yan
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Xiao-Gang Wu
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Li-Ming He
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Hao-Yu Feng
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| |
Collapse
|
2
|
Guo H, Song Y, Weng R, Tian H, Yuan J, Li Y. Comparison of Clinical Outcomes and Complications Between Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-analysis. Global Spine J 2023; 13:1394-1404. [PMID: 36447426 PMCID: PMC10416606 DOI: 10.1177/21925682221142545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a classic surgical procedure for the treatment of lumbar degenerative diseases (LDD). With the development of endoscopic technology, endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) can also achieve adequate decompression and interbody fusion. However, whether Endo-TLIF is superior to MIS-TLIF has not been adequately studied. In this systematic review and meta-analysis, we aimed to evaluate the treatment difference between Endo-TLIF vs MIS-TLIF. METHODS We conducted a systematic review and meta-analysis of the studies to compare the clinical outcomes and complications associated with Endo-TLIF vs. MIS-TLIF for the treatment of LDD. A literature search was conducted using the PubMed, Embase, Cochrane Library and Scopus databases for studies published up to April 1, 2022. Both retrospective and prospective studies that compared between Endo-TLIF and MIS-TLIF were included. RESULTS A total of 8 studies involving 581 patients were finally included in this meta-analysis. Endo-TLIF significantly prolonged the operation time, but reduced the blood loss amount and length of hospital stay. Moreover, Endo-TLIF was superior to MIS-TLIF on relief of back pain and functional recovery in the early postoperative period. However, there were no significantly differences in long-term clinical outcomes, fusion rate and incidence of complications between Endo-TLIF and MIS-TLIF. CONCLUSIONS Endo-TLIF was similar to MIS-TLIF in the long-term clinical outcomes, fusion and complication rates. Endo-TLIF prolongs the operation time, but shortens the length of hospital stay, and has the advantages of less surgical trauma, less blood loss, faster recovery, and early postoperative back pain relief.
Collapse
Affiliation(s)
- Haiwei Guo
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Yuke Song
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Rui Weng
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Han Tian
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiayao Yuan
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Li
- Department of Spine and Orthopedics, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
3
|
Chen H, Zheng G, Bian Z, Hou C, Li M, Zhang Z, Zhu L, Wang X. Comparison of minimally invasive transforaminal lumbar interbody fusion and endoscopic lumbar interbody fusion for lumbar degenerative diseases: a retrospective observational study. J Orthop Surg Res 2023; 18:389. [PMID: 37245051 DOI: 10.1186/s13018-023-03875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and endoscopic lumbar interbody fusion (Endo-LIF) are both minimally invasive interbody fusion procedures for lumbar degenerative diseases. In this study, we attempted to compare the clinical efficacy and postoperative outcomes of MIS-TLIF and Endo-LIF for lumbar degenerative diseases. METHODS The study cohort comprised 99 patients with lumbar degenerative diseases treated by MIS-TLIF or Endo-LIF from January 2019 to July 2021. The clinical outcomes (visual analogue scale (VAS), Oswestry disability index (ODI), and MacNab criteria) preoperatively, 1 month postoperatively, 3 months postoperatively, and 1 year postoperatively were compared between the two groups. RESULTS There were no significant differences between the two groups in sex, age, disease duration, affected spine segment, and complications (P > 0.05). The operation time was significantly longer in the Endo-LIF group than the MIS-TLIF group (155.25 ± 12.57 vs. 123.14 ± 14.50 min; P < 0.05). However, the Endo-LIF group had a significantly smaller blood loss volume (61.79 ± 10.09 vs. 259.97 ± 14.63 ml) and shorter hospital stay (5.46 ± 1.11 vs. 7.06 ± 1.42 days) than the MIS-TLIF group. In both groups, the ODI and VAS scores for lower back pain and leg pain were significantly lower at each postoperative timepoint than preoperatively (P < 0.05). Although there were no significant differences between the two groups in the ODI and VAS scores for lower back pain and leg pain (P > 0.05), the VAS for lower back pain was lower in the Endo-LIF group than the MIS-TLIF group at each postoperative timepoint. The MacNab criteria showed that the improvement rate was 92.2% in the MIS-TLIF group and 91.7% in the Endo-LIF group, with no significant difference between the two groups (P > 0.05). CONCLUSIONS There were no significant differences in short-term surgical outcomes between the MIS-TLIF and Endo-LIF groups. Compared with the MIS-TLIF group, the Endo-LIF group incurred less damage to surrounding tissues, experienced less intraoperative blood loss, and had less lower back pain, which is more conducive to recovery.
Collapse
Affiliation(s)
- Hao Chen
- Department of Orthopedics Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Goudi Zheng
- Department of Orthopedics Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Zhenyu Bian
- Department of Orthopedics Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Changju Hou
- Department of Orthopedics Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Maoqiang Li
- Department of Orthopedics Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Zhen Zhang
- Department of Orthopedics Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Liulong Zhu
- Department of Orthopedics Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
| | - Xuepeng Wang
- Department of Orthopedics Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
| |
Collapse
|
4
|
Han Z, Ma C, Li B, Ren B, Liu J, Huang Y, Qiao L, Mao K. Biomechanical studies of different numbers and positions of cage implantation on minimally invasive transforaminal interbody fusion: A finite element analysis. Front Surg 2022; 9:1011808. [PMID: 36420402 PMCID: PMC9676234 DOI: 10.3389/fsurg.2022.1011808] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND The position and number of cages in minimally invasive transforaminal interbody fusion (MIS-TLIF) are mainly determined by surgeons based on their individual experience. Therefore, it is important to investigate the optimal number and position of cages in MIS-TLIF. METHODS The lumbar model was created based on a 24-year-old volunteer's computed tomography data and then tested using three different cage implantation methods: single transverse cage implantation (model A), single oblique 45° cage implantation (model B), and double vertical cage implantation (model C). A preload of 500 N and a moment of 10 Nm were applied to the models to simulate lumbar motion, and the models' range of motion (ROM), ROM ratio, peak stress of the internal fixation system, and cage were assessed. RESULTS The ROM ratios of models A, B, and C were significantly reduced by >71% compared with the intact model under all motions. Although there were subtle differences in the ROM ratio for models A, B, and C, the trends were similar. The peak stress of the internal fixation system appeared in model B of 136.05 MPa (right lateral bending), which was 2.07 times that of model A and 1.62 times that of model C under the same condition. Model C had the lowest cage stress, which was superior to that of the single-cage model. CONCLUSION In MIS-TLIF, single long-cage transversal implantation is a promising standard implantation method, and double short-cage implantation is recommended for patients with severe osteoporosis.
Collapse
Affiliation(s)
- Zhenchuan Han
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Chao Ma
- Key Laboratory of Modern Measurement and Control Technology, Ministry of Education, Beijing Information Science and Technology University, Beijing, China
| | - Bo Li
- Department of Orthopedics, Weihai Municipal Third Hospital, Weihai, China
| | - Bowen Ren
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Jianheng Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yifei Huang
- Department of Orthopedics, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lin Qiao
- Department of Orthopedics, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Keya Mao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
5
|
Finite Element Analysis of a Novel Fusion Strategy in Minimally Invasive Transforaminal Lumbar Interbody Fusion. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4266564. [PMID: 35601152 PMCID: PMC9117058 DOI: 10.1155/2022/4266564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/11/2022] [Indexed: 01/18/2023]
Abstract
Purpose To evaluate the biomechanics of a novel fusion strategy (hybrid internal fixation+horizontal cage position) in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods MIS-TLIF finite element models for three fusion strategies were created based on computed tomography images, namely, Model-A, hybrid internal fixation (ipsilateral pedicle screw and contralateral translaminar facet screw fixation)+horizontal cage position; Model-B, bilateral pedicle screw (BPS) fixation+horizontal cage position; and Model-C, BPS fixation+oblique 45° cage position. A preload of 500 N and a moment of 10 Nm were applied to the models to simulate lumbar motion, and the models' range of motion (ROM), peak stress of the internal fixation system, and cage were assessed. Results The ROM for Models A, B, and C were not different (P > 0.05) but were significantly lower than the ROM of Model-INT (P < 0.0001). Although there were subtle differences in the ROM ratio for Models A, B, and C, the trend was similar. The peak stress of the internal fixation system was significantly higher in Model-A than that of Models B and C, but only the difference between Models A and B was significant (P < 0.05). The peak stress of the cage in Model-A was significantly lower than that of Models B and C (P < 0.01). Conclusion Hybrid internal fixation with horizontal single cage implantation can provide the same biomechanical stability as traditional fixation while reducing peak stress on the cage and vertebral endplate.
Collapse
|
6
|
Meta-Analysis of the Clinical Effect of MIS-TLF Surgery in the Treatment of Minimally Invasive Surgery of the Orthopaedic Spine. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2315533. [PMID: 35341166 PMCID: PMC8942634 DOI: 10.1155/2022/2315533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022]
Abstract
Minimally invasive surgery (MIS) has already had a significant impact on surgical treatment (spine). Because they are less invasive, minimally invasive treatments are often preferred over open spine surgery. MIS and open spine surgery in terms of posterior lumbar fusion (PLF), lumbar disc herniation (LDH), and cervical disc herniation (CDH) were all observational studies based on randomized controlled trials. Seventeen RCTs and six observational studies were conducted. Chemotherapy had no effect on the long-term alleviation of the neck or arm pain in patients with CDH. In LDH, MIS was superior in terms of pain relief, rehospitalization rates, and improvement in quality of life. At the expense of increased perioperative endoscopic, readmission, and revision rates, MIS achieved a significant reduction in 2-year expenditures, fewer medical problems, and improved Oswestry score ratings. There is no evidence to support the use of MIS over open surgery for lumbar or cervical process disc herniation. In comparison, MIS-TLIF has several advantages, in addition to lower revision/readmission rates. However, MIS significantly increases the surgeon's radiation exposure, regardless of the patient's sign. However, the effect on patients is unknown. These findings could help patients make better decisions when comparing open spine surgery to minimally invasive spine surgery, especially given how much advertising is out there for MIS.
Collapse
|
7
|
Chen X, Lin GX, Rui G, Chen CM, Kotheeranurak V, Wu HJ, Zhang HL. Comparison of Perioperative and Postoperative Outcomes of Minimally Invasive and Open TLIF in Obese Patients: A Systematic Review and Meta‑Analysis. J Pain Res 2022; 15:41-52. [PMID: 35023969 PMCID: PMC8747800 DOI: 10.2147/jpr.s329162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Previous studies have demonstrated that minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) is comparable to the open approach in terms of efficacy and safety. However, few comparative studies of surgical procedures in patients with obesity show that they may react differently to open-TLIF (O-TLIF) and MI-LTIF approaches. PATIENTS AND METHODS The main indicators were complications, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) score, and secondary indicators were operative time, blood loss, and hospital stay. RESULTS No significant differences in the VAS and ODI scores for back pain at the last follow-up and wound infection rates were observed between the two groups. Dural tear incidence and complication rate were significantly lower in the MI-TLIF group than that in the O-TLIF group (P = 0.002 and 0.001, respectively). No significant difference in operative time was found between the two groups. There was less blood loss and shorter hospital stay (P = 0.001 and 0.002, respectively) in the MI-TLIF group than that in the O-TLIF group. CONCLUSION Compared with O-TLIF, MI-TLIF is an effective and safe surgical option for patients with obesity, which resulted in similar improvements in pain and functional disability, as well as a lower complication rate.
Collapse
Affiliation(s)
- Xin Chen
- Department of Fifth Surgical, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, People's Republic of China
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Vit Kotheeranurak
- Spine Unit, Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | - Hua-Jian Wu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Huang-Lin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| |
Collapse
|
8
|
Lo WC, Tsai LW, Yang YS, Chan RWY. Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies. Int J Mol Sci 2021; 22:3638. [PMID: 33807361 PMCID: PMC8037583 DOI: 10.3390/ijms22073638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
Transforaminal lumber interbody fusion (TLIF) is the last resort to address the lumber degenerative disorders such as spondylolisthesis, causing lower back pain. The current surgical intervention for these abnormalities includes open TLIF. However, in recent years, minimally invasive TLIF (MIS-TLIF) has gained a high momentum, as it could minimize the risk of infection, blood loss, and post-operative complications pertaining to fusion surgery. Further advancement in visualizing and guiding techniques along with grafting cage and materials are continuously improving the safety and efficacy of MIS-TLIF. These assistive techniques are also playing a crucial role to increase and improve the learning curve of surgeons. However, achieving an appropriate output through TLIF still remains a challenge, which might be synergized through 3D-printing and tissue engineering-based regenerative therapy. Owing to their differentiation potential, biomaterials such as stem/progenitor cells may contribute to restructuring lost or damaged tissues during MIS-TLIF, and this therapeutic efficacy could be further supplemented by platelet-derived biomaterials, leading to improved clinical outcomes. Thus, based on the above-mentioned strategies, we have comprehensively summarized recent developments in MIS-TLIF and its possible combinatorial regenerative therapies for rapid and long-term relief.
Collapse
Affiliation(s)
- Wen-Cheng Lo
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Lung-Wen Tsai
- Department of Medical Education and Research, Taipei Medical University Hospital, Taipei 11031, Taiwan;
| | - Yi-Shan Yang
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Ryan Wing Yuk Chan
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| |
Collapse
|
9
|
Stickley C, Philipp T, Wang E, Zhong J, Balouch E, O'Malley N, Leon C, Maglaras C, Manning J, Varlotta C, Buckland AJ. Expandable cages increase the risk of intraoperative subsidence but do not improve perioperative outcomes in single level transforaminal lumbar interbody fusion. Spine J 2021; 21:37-44. [PMID: 32890783 DOI: 10.1016/j.spinee.2020.08.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/17/2020] [Accepted: 08/29/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Expandable cages (EXP) are being more frequently utilized in transforaminal lumbar interbody fusions (TLIF). EXP were designed to reduce complications related to neurological retraction, enable better lordosis restoration, and improve ease of insertion, particularly in the advent of minimally invasive surgical (MIS) techniques, however they are exponentially more expensive than the nonexpandable (NE) alternative. PURPOSE To investigate the clinical results of expandable cages in single level TLIF. STUDY DESIGN/SETTING Retrospective review at a single institution. PATIENT SAMPLE Two hundred and fifty-two single level TLIFs from 2012 to 2018 were included. OUTCOME MEASURES Clinical characteristics, perioperative and neurologic complication rates, and radiographic measures. METHODS Patients ≥18 years of age who underwent single level TLIF with minimum 1 year follow-up were included. OUTCOME MEASURES clinical characteristics, perioperative and neurologic complications. Radiographic analysis included pelvic incidence-lumbar lordosis (PI-LL) mismatch, segmental lumbar lordosis (LL) mismatch, disc height restoration, and subsidence ≥2 mm. Statistical analysis included independent t tests and chi-square analysis. For nonparametric variables, Mann-Whitney U test and Spearman partial correlation were utilized. Multivariate regression was performed to assess relationships between surgical variables and recorded outcomes. For univariate analysis significance was set at p<.05. Due to the multiple comparisons being made, significance for regressions was set at p<.025 utilizing Bonferroni correction. RESULTS Two hundred and fifty-two TLIFs between 2012 and 2018 were included, with 152 NE (54.6% female, mean age 59.28±14.19, mean body mass index (BMI) 28.65±5.38, mean Charlson Comorbidity Index (CCI) 2.20±1.89) and 100 EXP (48% female, mean age 58.81±11.70, mean BMI 28.68±6.06, mean CCI 1.99±1.66) with no significant differences in demographics. Patients instrumented with EXP cages had a shorter length of stay (3.11±2.06 days EXP vs. 4.01±2.64 days NE; Z=-4.189, p<.001) and a lower estimated blood loss (201.31±189.41 mL EXP vs. 377.82±364.06 mL NE; Z=-6.449, p<.001). There were significantly more MIS-TLIF cases and bone morphogenic protein (BMP) use in the EXP group (88% MIS, p<.001 and 60% BMP, p<.001) as illustrated in Table 1. There were no significant differences between the EXP and NE groups in rates of radiculitis and neuropraxia. In multivariate regression analysis, EXP were not associated with a difference in perioperative outcomes or complications. Radiographic analyses demonstrated that the EXP group had a lower PI-LL mismatch than the NE cage group at baseline (3.75±13.81° EXP vs. 12.75±15.81° NE; p=.001) and at 1 year follow-up (3.81±12.84° EXP vs. 8.23±12.73° NE; p=.046), but change in regional and segmental alignment was not significantly different between groups. Multivariate regression demonstrated that EXP use was a risk factor for intraoperative subsidence (2.729[1.185-6.281]; p=.018). CONCLUSIONS Once technique was controlled for, TLIFs utilizing EXP do not have significantly improved neurologic or radiographic outcomes compared with NE. EXP increase risk of intraoperative subsidence. These results question the value of the EXP given the higher cost.
Collapse
Affiliation(s)
- Carolyn Stickley
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Travis Philipp
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Erik Wang
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Jack Zhong
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Eaman Balouch
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Nicholas O'Malley
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Carlos Leon
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Constance Maglaras
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Jordan Manning
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Aaron J Buckland
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
| |
Collapse
|