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Ricciardi L, Bongetta D, Piazza A, Norri N, Mangraviti A, Trungu S, Belli E, Zanin L, Lofrese G. Interscapular Pain after Anterior Cervical Discectomy and Fusion: Does Zygapophyseal Joints over Distraction Play a Role? J Clin Med 2024; 13:2976. [PMID: 38792516 PMCID: PMC11122480 DOI: 10.3390/jcm13102976] [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: 03/21/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) for cervical disc herniation (CDH) is commonly performed. Specific post-operative complications include dysphagia, dysphonia, cervicalgia, adjacent segment disorder, cage subsidence, and infections. However, interscapular pain is commonly reported by these patients after surgery, although its mechanisms have not been clarified yet. Methods: This retrospective series of 31 patients undergoing ACDF for CDH at a single Academic Hospital. Baseline and post-operative clinical, radiological, and surgical data were analyzed. The linear regression analysis was conducted to identify any factor independently influencing the incidence rate of post-operative interscapular pain. Results: The mean age was 57.6 ± 10.8 years, and the M:F ratio was 2.1. Pre-operative mean VAS-arm was 7.15 ± 0.81 among the 20 patients reporting brachialgia, and mean VAS-neck was 4.36 ± 1.43 among those 9 patients reporting cervicalgia. At 1 month, interscapular pain was still reported by 8 out of the 17 patients who experienced it post-operatively, and it was recovered in all patients after 2 months. The regression analysis showed that interscapular pain was not directly associated with age (p = 0.74), gender (p = 0.46), smoking status (p = 0.44), diabetes (0.42), pre-operative brachialgia (p = 0.21) or cervicalgia (p = 0.48), symptoms duration (p = 0.13), baseline VAS-arm (p = 0.11), VAS-neck (p = 0.93), or mJOA (p = 0.63) scores, or disc height modification (p = 0.90). However, the post-operative increase in the mean zygapophyseal joint rim distance was identified as an independent factor in determining interscapular pain (p = 0.02). Conclusions: Our study revealed that the onset of interscapular pain following ACDF may be determined by over distraction of the zygapophyseal joint rim. Then, proper sizing of prosthetic implants could reduce this painful complication.
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Affiliation(s)
- Luca Ricciardi
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Daniele Bongetta
- SC Neurochirurgia, Ospedale Fatebenefratelli e Oftalmico, 20121 Milan, Italy;
| | - Amedeo Piazza
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Nicolò Norri
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Antonella Mangraviti
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Sokol Trungu
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Evaristo Belli
- UO di Chirurgia Maxillo-Facciale, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy;
| | - Luca Zanin
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Giorgio Lofrese
- UOC di Neurochirurgia, Ospedale Bufalini di Cesena, 47521 Cesena, Italy;
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Agarwal T, Bhojraj SY, Nagad PB, Kashikar AD, Borde M, Powal G, Harikrishnan A. Spontaneous Lumbar Interbody Fusion Following Posterolateral Fusion Surgery: A Retrospective Analysis of 5-Year Data. Indian J Orthop 2024; 58:598-605. [PMID: 38694687 PMCID: PMC11058144 DOI: 10.1007/s43465-024-01148-w] [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] [Received: 10/16/2023] [Accepted: 03/31/2024] [Indexed: 05/04/2024]
Abstract
Background Posterolateral fusion (PLF) surgery is frequently performed for a range of spinal disorders. However, spontaneous lumbar interbody fusion (SLIF) following PLF surgery is yet to be reported. Thus, we evaluated the incidence and characteristics of SLIF among patients that underwent PLF surgery. Methods This retrospective study involved review of electronic medical records of 121 adult patients who underwent primary lumbar decompression with instrumented PLF between 2006 and 2011. The available radiographs of L2-S1 region were assessed for SLIF and PLF. At 1 year, modified Lee's and Lenke's criteria were used to assess SLIF and PLF, respectively. Differences between the patients in the fusion and non-fusion groups were evaluated. Results At 1-year follow-up, 28.93 and 87.61% patients had SLIF and PLF, respectively. Moreover, 27.27% patients had both SLIF and PLF. L4-L5 (n = 13) was the most common segment involved in SLIF. SLIF rate was significantly greater among young adults (p value = 0.001), and those with no pre-operative instability (p value = 0.003) as well as who underwent pedicular fixation instrumented PLF surgery (p value < 0.0001). While, PLF was significantly greater in patients who did not undergo discectomy (p value = 0.049). SLIF was not significantly associated with sex, age groups, discectomy status, and level of PLF surgery (all p values > 0.05). PLF was not significantly associated with sex, age groups, pre-operative instability, type of instrumentation, and level of PLF surgery (all p values > 0.05). There was no significant association between patients with SLIF and PLF (p value = 0.155). Conclusions More than a quarter of patients developed SLIF and majority of them had PLF. SLIF was significantly associated with younger age at surgery and use of pedicular fixation instruments.Level of Evidence III; retrospective cohort study.
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Affiliation(s)
- Tejasvi Agarwal
- Department of Spine Surgery, Lilavati Hospital and Research Center, Bandra Reclamation Rd, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, Maharashtra 400050 India
| | - Shekhar Y. Bhojraj
- Department of Spine Surgery, Lilavati Hospital and Research Center, Bandra Reclamation Rd, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, Maharashtra 400050 India
| | - Premik B. Nagad
- Department of Spine Surgery, Lilavati Hospital and Research Center, Bandra Reclamation Rd, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, Maharashtra 400050 India
| | - Aaditya D. Kashikar
- Department of Spine Surgery, Lilavati Hospital and Research Center, Bandra Reclamation Rd, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, Maharashtra 400050 India
| | - Mandar Borde
- Department of Spine Surgery, Lilavati Hospital and Research Center, Bandra Reclamation Rd, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, Maharashtra 400050 India
| | - Gajendra Powal
- Department of Spine Surgery, Lilavati Hospital and Research Center, Bandra Reclamation Rd, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, Maharashtra 400050 India
| | - A. Harikrishnan
- Department of Spine Surgery, Lilavati Hospital and Research Center, Bandra Reclamation Rd, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, Maharashtra 400050 India
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Raitio A, Saarinen AJ, Sinikumpu JJ, Helenius I. Biodegradable biomaterials in orthopedic surgery: A narrative review of the current evidence. Scand J Surg 2024; 113:62-70. [PMID: 37817459 DOI: 10.1177/14574969231200650] [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: 10/12/2023]
Abstract
BACKGROUND Biomaterials are routinely used in orthopedic surgery to fill bone defects, improve bone healing, and as degradable fixation material. A wide range of materials are currently in use, and the materials are chosen according to their bioactive properties. Osteoinductive materials stimulate bone healing by promoting osteogenesis. Osteoconductive materials facilitate bone growth on the surface of the material. Despite the many materials in use and an increasing number of published studies, randomized controlled trials on the subject are scarce. METHODS This review aims to summarize the history of biodegradable biomaterials and also the published level I evidence currently available on orthopedic biomaterials. RESULTS Most of the studies have been superiority trials with non-significant differences compared to conventional treatment options, confirming that several biomaterials are suitable treatment options for multiple indications including bone and/or tendon fixation, filling bone defects, and spinal fusion. Biomaterials help to avoid donor site complications associated with autogenous bone grafts and often eliminate the need for implant removal. However, the surgical technique may in some cases be more demanding than with conventional methods. Careful consideration of the pros and cons is therefore recommended in clinical practice. CONCLUSION Biodegradable biomaterials complement the range of available treatment options in several fields of orthopedic surgery. However, some biomaterials performed worse than expected and were not recommended for clinical use, emphasizing the need for high-quality randomized trials. It is also noteworthy that several trials included only a limited number of patients, rendering the interpretation of the results of these underpowered studies challenging.
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Affiliation(s)
- Arimatias Raitio
- Arimatias Raitio Department of Pediatric SurgeryUniversity of Turku and Turku University Hospital Turku Finland
- Turku University Hospital, Savitehtaankatu 5, 20520 Turku
| | - Antti J Saarinen
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha-Jaakko Sinikumpu
- Department of Pediatric Surgery and Orthopedics, Clinical Medicine Research Unit, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Ilkka Helenius
- Department of Pediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Yang J, Yang Y, Wang G, Xu S, Li G, Zhang S, Yang C, Wang S, Wang Q. Is local autogenous morselized bone harvested from decompression through a posterior-transforaminal approach sufficient for single-level interbody fusion in the lower lumbar spine? BMC Musculoskelet Disord 2023; 24:12. [PMID: 36609247 PMCID: PMC9817406 DOI: 10.1186/s12891-023-06131-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To determine the volume and applicability of local autogenous morselized bone (LAMB) harvested and used during posterior-transforaminal lumbar interbody fusion (P-TLIF) in the lower lumbar spine. METHODS Clinical and radiographic data of 147 patients (87 males) undergoing P-TLIF from January 2017 to December 2019 for lumbar degenerative diseases were retrospectively analyzed. Computed tomography was used to assess the fusion status (at 6 months, 1 year, and the last follow-up postoperatively), restored disc height, graft fusion area and volume, and the minimum required bone volume (MRBV). Clinical outcomes of P-TLIF were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for low back pain (LBP) and leg pain (LP). RESULTS The mean follow-up period was 28.4 ± 4.49 months. The patient's age and diagnosis were correlated to the volume and weight of LAMB (mean volume and weight: 3.50 ± 0.45 mL and 3.88 ± 0.47 g, respectively). The ratio of actual fusion area to the total disc endplate and the ratio of actual fusion volume to the total volume of the disc space were > 40%. MRBV ranged from 1.83 ± 0.48 cm3 to 2.97 ± 0.68 cm3. The proportion of grade 4 or 5 fusions increased from 60.6% at 6 months to 96.6% at the last follow-up. The ODI, VAS-LP, and VAS-LBP scores significantly improved after surgery and remained unchanged during the follow-up. CONCLUSION When combined with a cage, the volume of LAMB harvested from decompression through the unilateral approach at a single-level is sufficient to achieve a solid interbody fusion in the lower lumbar spine with excellent clinical and radiographic outcomes.
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Affiliation(s)
- Jin Yang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Yong Yang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China ,Department of Orthopedics Surgery, Chengdu Yumei Hospital, 269 Xiajiancao Road, Chengdu, 610051 Sichuan China
| | - Gaoju Wang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Shuang Xu
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Guangzhou Li
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Shuai Zhang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Chaohua Yang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Song Wang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Qing Wang
- grid.488387.8Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000 Sichuan China
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Vitamin D supplementation is a cost-effective intervention after posterolateral lumbar fusion: a systematic review. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Alejo AL, McDermott S, Khalil Y, Ball HC, Robinson GT, Solorzano E, Alejo AM, Douglas J, Samson TK, Young JW, Safadi FF. A Pre-clinical Standard Operating Procedure for Evaluating Orthobiologics in an In Vivo Rat Spinal Fusion Model. JOURNAL OF ORTHOPAEDICS AND SPORTS MEDICINE 2022; 4:224-240. [PMID: 36203492 PMCID: PMC9534599 DOI: 10.26502/josm.511500060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The rat animal model is a cost effective and reliable model used in spinal pre-clinical research. Complications from various surgical procedures in humans often arise that were based on these pre-clinical animal models. Therefore safe and efficacious pre-clinical animal models are needed to establish continuity into clinical trials. A Standard Operating Procedure (SOP) is a validated method that allows researchers to safely and carefully replicate previously successful surgical techniques. Thus, the aim of this study is to describe in detail the procedures involved in a common rat bilateral posterolateral intertransverse spinal fusion SOP used to test the efficacy and safety different orthobiologics using a collagen-soaked sponge as an orthobiologic carrier. Only two orthobiologics are currently FDA approved for spinal fusion surgery which include recombinant bone morphogenetic protein 2 (rhBMP-2), and I-FACTOR. While there are many additional orthobiologics currently being tested, one way to show their safety profile and gain FDA approval, is to use well established pre-clinical animal models. A preoperative, intraoperative, and postoperative surgical setup including specific anesthesia and euthanasia protocols are outlined. Furthermore, we describe different postoperative methods used to validate the spinal fusion SOP, which include μCT analysis, histopathology, biomechanical testing, and blood analysis. This SOP can help increase validity, transparency, efficacy, and reproducibly in future rat spinal fusion surgery procedures.
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Affiliation(s)
- Andrew L Alejo
- College of Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
| | - Scott McDermott
- Roper St. Francis Physician Partners Orthopaedics, Summerville, SC, USA
| | - Yusuf Khalil
- College of Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
| | - Hope C Ball
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
| | - Gabrielle T Robinson
- College of Graduate Studies, NEOMED, Rootstown, OH, USA
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
| | - Ernesto Solorzano
- College of Graduate Studies, NEOMED, Rootstown, OH, USA
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
| | - Amanda M Alejo
- College of Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
| | - Jacob Douglas
- College of Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
| | - Trinity K Samson
- College of Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
- College of Graduate Studies, NEOMED, Rootstown, OH, USA
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
| | - Jesse W Young
- College of Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
- College of Graduate Studies, NEOMED, Rootstown, OH, USA
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
| | - Fayez F Safadi
- College of Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
- College of Graduate Studies, NEOMED, Rootstown, OH, USA
- Musculoskeletal Research Group, NEOMED, Rootstown, OH, USA
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
- GPN Therapeutics Inc., Redi Zone NEOMED, Rootstown, OH, USA
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Letter to the editor regarding, "The impact of interbody approach and lumbar level on segmental, adjacent, and sagittal alignment in degenerative lumbar pathology: a radiographic analysis 6 months following surgery" by O'Connor et al. Spine J 2022; 22:1585. [PMID: 35988949 DOI: 10.1016/j.spinee.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
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Khokhani P, Belluomo R, Croes M, Gawlitta D, Kruyt MC, Weinans H. An in-vitro model to test the influence of immune cell secretome on MSC osteogenic differentiation. Tissue Eng Part C Methods 2022; 28:420-430. [PMID: 35770885 DOI: 10.1089/ten.tec.2022.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Immune cells and their soluble factors have an important role in the bone healing process. Modulation of the immune response, therefore, offers a potential strategy to enhance bone formation. To investigate the influence of the immune system on osteogenesis, we developed and applied an in-vitro model that incorporates both innate and adaptive immune cells. Human peripheral blood mononuclear cells (PBMCs) were isolated and cultured for 24 hours and subsequently stimulated with immune-modulatory agents; C-class CpG oligodeoxynucleotide (CpG ODN C), Polyinosinic acid-polycytidylic acid Poly(I:C), and lipopolysaccharide (LPS); all pathogen recognition receptor agonists, and that target Toll-like receptors TLR9, -3, and -4, respectively. The conditioned medium obtained from PBMCs after 24 hours was used to investigate its effects on the metabolic activity and osteogenic differentiation capacity of human bone marrow-derived mesenchymal stromal cells (MSCs). Conditioned media from unstimulated PBMCs did not affect the metabolic activity and osteogenic differentiation capacity of MSCs. The conditioned medium from CpG ODN C and LPS stimulated PBMCs increased alkaline phosphatase activity of MSCs by approximately 3-fold as compared to the unstimulated control, whereas Poly(I:C) conditioned medium did not enhance ALP activity of MSCs. Moreover, direct stimulation of MSCs with the immune-modulatory stimuli did not result in increased alkaline phosphatase activity. These results demonstrate that soluble factors present in conditioned medium from PBMCs stimulated with immune-modulatory factors enhance osteogenesis of MSCs. This in-vitro model can serve as a tool in screening immune-modulatory stimulants from a broad variety of immune cells for (indirect) effects on osteogenesis and also to identify soluble factors from multiple immune cell types that may modulate bone healing.
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Affiliation(s)
- Paree Khokhani
- University Medical Centre Utrecht, 8124, Orthopedics , UMC Utrecht, dept. Orthopedics, G5.203, Heidelberglaan 100, Utrecht, Utrecht, Drenthe, Netherlands, 3584CX.,University Medical Centre, Utrecht (UMCU), UMC Utrecht, dept. Orthopedics, G5.203, Heidelberglaan 100, Netherlands;
| | - Ruggero Belluomo
- University Medical Centre Utrecht, 8124, Orthopedics , Utrecht, Utrecht, Netherlands;
| | - Michiel Croes
- University Medical Centre Utrecht, 8124, Orthopedics , Utrecht, Utrecht, Netherlands;
| | - Debby Gawlitta
- University Medical Center Utrecht, Oral and Maxillofacial Surgery, Prosthodontics & Special Dental Care, Heidelberglaan 100, G05.129, PO Box 85500, Utrecht, Netherlands, 3508 GA;
| | - Moyo C Kruyt
- University medical center Utrecht, Orthopedics, HP G 05.228, PO Box 85500, Utrecht, Netherlands, 3508 GA;
| | - Harrie Weinans
- University Medical Centre Utrecht, 8124, Orthopedics, Utrecht, Utrecht, Netherlands;
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Menezes CM, Lacerda GC, do Valle GSO, de Oliveira Arruda A, Menezes EG. Ceramic bone graft substitute vs autograft in XLIF: a prospective randomized single-center evaluation of radiographic and clinical outcomes. 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; 31:2262-2269. [PMID: 35723748 PMCID: PMC9208346 DOI: 10.1007/s00586-022-07275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/08/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
Purpose of the Study The objective of this prospective, parallel, randomized, single-center study is to evaluate the clinical success of a commercial ceramic bone graft substitute (CBGS) for autograft in eXtreme Lateral Interbody Fusion (XLIF) procedures.
Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Cristiano Magalhães], Last name [Menezes]. Author 2 Given name: [Gabriel Carvalho], Last name [Lacerda]. Author 5 Given name: [Erica Godinho], Last name [Menezes]. Also, kindly confirm the details in the metadata are correct.yes Methods Forty-five adult subjects were consecutively enrolled and randomized into a single-level XLIF procedure using either CBGS or iliac crest bone graft autograft (30 and 15 subjects, respectively). The primary outcome was fusion rate at 12, 18, and 24 months. Secondary outcomes were pain and disability measured by HRQOL questionnaires.
Kindly check and confirm whether the corresponding author and his corresponding affiliations is correctly identified.yes Results The fusion rates for both CBGS and autograft groups at the 24-month follow-up were 96.4% and 100%, respectively. For the CBGS group, mean ODI, mean back pain, and mean worst leg pain significantly improved at the 24-month follow-up by 76.7% (39.9–9.3), 77.6% (7.3–1.6), and 81.3% (5.1–1.0), respectively. For the autograft group, mean ODI, mean back pain, and mean worst leg pain significantly improved during the same time period by 77.1% (35.9–8.2), 75.6% (6.1–1.5), and 86.0% (6.6–0.9), respectively (all time points between groups, p < 0.05). Conclusion The results of this prospective, randomized study support the use of CBGS as a standalone bone graft substitute for autograft in single-level XLIF surgery. The clinical performance and safety outcomes reported here are consistent with published evidence on CBGS. Improvements in patient-reported back pain, leg pain, and disability outcomes were comparable between the CBGS and autograft groups.
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Affiliation(s)
| | - Gabriel Carvalho Lacerda
- Columna Institute, Belo Horizonte, Brazil.,Vila da Serra/Ortopédico Hospital, Belo Horizonte, Brazil
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Bokov A, Kalinina S, Leontev A, Mlyavykh S. Circumferential Fusion Employing Transforaminal vs. Direct Lateral Lumbar Interbody Fusion—A Potential Impact on Implants Stability. Front Surg 2022; 9:827999. [PMID: 35651676 PMCID: PMC9150499 DOI: 10.3389/fsurg.2022.827999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDifferent fusion techniques were introduced in clinical practice in patients with lumbar degenerative disc disease, however, no evidence has been provided on the advantages of one technique over another.The Objective of This StudyIs to assess the potential impact of circumferential fusion employing transforaminal lumbar interbody fusion (TLIF) vs. direct lateral interbody fusion (DLIF) on pedicle screw stability.Materials and MethodsThis is a single-center prospective evaluation of consecutive 138 patients with degenerative instability of lumbar spinal segments. Either conventional transforaminal lumbar interbody fusion (TLIF) with posterior fusion or direct lateral interbody fusion (DLIF) using cages of standard dimensions, were applied. The conventional open technique was used to supplement TLIF with pedicle screws while percutaneous screw placement was used in patients treated with DLIF. The duration of the follow-up accounted for 24 months. Signs of pedicle screws loosening (PSL) and bone union after fusion were assessed by the results of CT imaging. Fisher‘s exact test was used to assess the differences in the rate of CT loosening and revision surgery because of implant instability. Logistic regression was used to assess the association between potential factors and complication rate.ResultsThe rate of PSL detected by CT and relevant revision surgery in groups treated with TLIF and DLIF accounted for 25 (32.9%) vs. 2 (3.2%), respectively, for the former and 9 (12.0%) vs. 0 (0%) for the latter (p < 0.0001 and p = 0.0043) respectively. According to the results of logistic regression, a decrease in radiodensity values and a greater number of levels fused were associated with a rise in PSL rate. DLIF application in patients with radiodensity below 140 HU was associated with a considerable decrease in complication rate. Unipolar or bipolar pseudoarthrosis in patients operated on with TLIF was associated with a rise in PSL rate while patients treated with DLIF tolerate delayed interbody fusion formation. In patients treated with TLIF supplementary total or partial posterior fusion resulted in a decline in PSL rate.ConclusionEven though the supplementary posterior fusion may considerably reduce the rate of PSL in patients treated with TLIF, the application of DLIF provide greater stability resulting in a substantial decline in PSL rate and relevant revision surgery.
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Affiliation(s)
- Andrey Bokov
- Department of Oncology and Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Svetlana Kalinina
- Department of Traumatology, Orthopedics and Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Andrei Leontev
- Department of Oncology and Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Sergey Mlyavykh
- Department of Traumatology, Orthopedics and Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- *Correspondence: Sergey Mlyavykh
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Samal F, Sterba A, Haninec P, Jurek P, Waldauf P, Filip M, Linzer P. Long-Term Outcome After Midline Lumbar Fusion for the Treatment of Lumbar Spine Instability Due to Degenerative Disease. World Neurosurg 2021; 154:e641-e648. [PMID: 34332153 DOI: 10.1016/j.wneu.2021.07.108] [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: 04/16/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Midline lumbar fusion (MIDLF) is one promising new surgical technique that has been developed to minimize perioperative damage to the paravertebral stabilizing musculotendinous system. The aim of this study was to assess long-term clinical and radiological effects of MIDLF. METHODS This prospective cohort study evaluated patients who underwent MIDLF for degenerative spinal instability. Clinical and radiological examinations were performed before and after surgery. Perioperative and postoperative complications were recorded. Follow-up was 2 years. P ≤ 0.05 was considered statistically significant. RESULTS The study included 64 patients (mean age 58.9 ± 10.7 years; 41 women [64.1%]). The most frequent indication for MIDLF was degenerative spondylolisthesis grade I (28 cases [43.8%]); the prevalent spinal segment to be fused was L4-L5 (35 cases [54.7%]). Mean duration of surgery was 148.2 ± 28.9 minutes. Relief of low back pain and leg pain was significant and stable in the postoperative period as assessed by visual analog scale (P < 0.001). Of patients, 86.9% reported fair, good, or excellent outcomes in terms of pain relief based on MacNab score 2 years after surgery. Patients' level of function in activities of daily living improved significantly based on Oswestry Disability Index score: from 66.8 ± 9.8 before surgery to 33.9 ± 16.5 2 years after surgery (P < 0.001). X-rays and computed tomography at 12 months showed interbody fusion in 46 cases (73.4%), inconclusive results in 13 cases (20.3%), and no fusion in 4 cases (6.3%). No damage to neural or vascular structures and no failure of hardware or screw loosening were recorded. CONCLUSIONS MIDLF is a safe, efficient method for surgical treatment of lumbar spine instability. Its limited invasiveness contributes to better preservation of paravertebral muscles and enhanced postoperative spinal stability.
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Affiliation(s)
- Filip Samal
- Neurosurgical Clinic, Kralovske Vinohrady University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Albert Sterba
- Neurosurgical Clinic, Kralovske Vinohrady University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Haninec
- Neurosurgical Clinic, Kralovske Vinohrady University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Patrik Jurek
- Department of Neurosurgery, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Petr Waldauf
- Third Faculty of Medicine, Charles University, Prague, Czech Republic; Clinic of Anesthesiology and Resuscitation, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michal Filip
- Department of Neurosurgery, Tomas Bata Regional Hospital, Zlin, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Petr Linzer
- Department of Neurosurgery, Tomas Bata Regional Hospital, Zlin, Czech Republic.
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