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Shen Z, Wang W, Ni L, Zhao H, Yang L, Yang H, Zhang L. Lumbar lordosis and sacral slope do not differ in two types of postoperative lumbar disc re-herniation: a cross-sectional observational study. BMC Musculoskelet Disord 2024; 25:267. [PMID: 38582848 PMCID: PMC10998392 DOI: 10.1186/s12891-024-07376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/21/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND To identify the differences of lumbar lordosis (LL) and sacral slope (SS) angles between two types of postoperative lumbar disc re-herniation, including the recurrence of same level and adjacent segment herniation (ASH). METHODS We searched the medical records of lumbar disc herniation (LDH) patients with re-herniation with complete imaging data (n = 58) from January 1, 2013 to December 30, 2020 in our hospital. After matching for age and sex, 58 patients with LDH without re-herniation from the same period operated by the same treatment group in our hospital were served as a control group. Re-herniation patients were divided into two groups, same-level recurrent lumbar disc herniation group (rLDHG) and adjacent segment herniation group with or without recurrence (ASHG). The preoperative, postoperative and one month after operation LL and SS were measured on standing radiographs and compared with the control group by using t-test, ANOVA, and rank-sum test. Next, we calculated the odds ratios (ORs) by unconditional logistic regression, progressively adjusted for other confounding factors. RESULTS Compared with the control group, the postoperative LL and SS were significantly lower in LDH patients with re-herniation. However, there were no differences in LL and SS between ASHG and rLDHG at any stage. After progressive adjustment for confounding factors, no matter what stage is, LL and SS remained unassociated with the two types of re-herniation. CONCLUSIONS Low postoperative LL and SS angles are associated with degeneration of the remaining disc. Low LL and SS may be independent risk factors for re-herniation but cannot determine type of recurrence (same or adjacent disc level).
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Affiliation(s)
- Zhijia Shen
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu, 215123, China
| | - Wenhao Wang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Li Ni
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Hongcheng Zhao
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu, 215123, China
| | - Lianda Yang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu, 215123, China
| | - Huilin Yang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China.
| | - Linlin Zhang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China.
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Marcus JL, Westerhaus BD, Chernicki B, Giuffrida A. Basivertebral nerve ablation with concurrent lumbar laminotomy. BMJ Case Rep 2024; 17:e259695. [PMID: 38575334 PMCID: PMC11002411 DOI: 10.1136/bcr-2024-259695] [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: 04/06/2024] Open
Abstract
Lumbar radiculopathy due to impingement of nerve roots from facet hypertrophy and/or disc herniation can often coincide with vertebrogenic low back pain. This is demonstrated on MRI with foraminal stenosis and Modic changes. We examine the potential of using a combination of basivertebral nerve ablation (BVNA) and lumbar laminotomy as an alternative to traditional spinal fusion in specific patient populations. This unique combination of surgical techniques has not been previously reported in the medical literature. We report a man in his late 30s with chronic low back pain and lumbar radiculopathy, treated with BVNA and concurrent laminotomy. The patient reported progressive improvements in his mobility and pain over the next 2 years. We discuss the advantages of using this technique for lumbar radiculopathy and Modic changes compared with conventional surgical modalities.
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Affiliation(s)
- Jason L Marcus
- Nova Southeastern University Dr Kiran C Patel College of Osteopathic Medicine, Clearwater, Florida, USA
- Cantor Spince Center, Interventional Spine, Paley Orthopedic & Spine Institute, Fort Lauderdale, Florida, USA
| | - Benjamin D Westerhaus
- Cantor Spince Center, Interventional Spine, Paley Orthopedic & Spine Institute, Fort Lauderdale, Florida, USA
| | - Brendan Chernicki
- Nova Southeastern University Dr Kiran C Patel College of Osteopathic Medicine, Clearwater, Florida, USA
| | - Anthony Giuffrida
- Cantor Spince Center, Interventional Spine, Paley Orthopedic & Spine Institute, Fort Lauderdale, Florida, USA
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Xu Z, Zheng Q, Zhang L, Chen R, Li Z, Xu W. Biomechanical evaluation of different oblique lumbar interbody fusion constructs: a finite element analysis. BMC Musculoskelet Disord 2024; 25:97. [PMID: 38279094 PMCID: PMC10821608 DOI: 10.1186/s12891-024-07204-8] [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: 09/11/2023] [Accepted: 01/14/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Finite element analysis (FEA) was performed to investigate the biomechanical differences between different adjunct fixation methods for oblique lumbar interbody fusion (OLIF) and to further analyze its effect on adjacent segmental degeneration. METHODS We built a single-segment (Si-segment) finite element model (FEM) for L4-5 and a double-segment (Do-segment) FEM for L3-5. Each complete FEM was supplemented and modified, and both developed two surgical models of OLIF with assisted internal fixation. They were OLIF with posterior bilateral percutaneous pedicle screw (TINA system) fixation (OLIF + BPS) and OLIF with lateral plate system (OLIF + LPS). The range of motion (ROM) and displacement of the vertebral body, cage stress, adjacent segment disc stress, and spinal ligament tension were recorded for the four models during flexion/extension, right/left bending, and right/left rotation by applying follower load. RESULTS For the BPS and LPS systems in the six postures of flexion, extension, right/left bending, and right/left rotation, the ROM of L4 in the Si-segment FEM were 0.32°/1.83°, 0.33°/1.34°, 0.23°/0.47°, 0.24°/0.45°, 0.33°/0.79°, and 0.34°/0.62°; the ROM of L4 in the Do-segment FEM were 0.39°/2.00°, 0.37°/1.38°, 0.23°/0.47°, 0.21°/0.44°, 0.33°/0.57°, and 0.31°/0.62°, and the ROM of L3 in the Do-segment FEM were 6.03°/7.31°, 2.52°/3.50°, 4.21°/4.38°, 4.21°/4.42°, 2.09°/2.32°, and 2.07°/2.43°. BPS system had less vertebral displacement, less cage maximum stress, and less spinal ligament tension in Si/Do-segment FEM relative to the LPS system. BPS system had a smaller upper adjacent vertebral ROM, greater intervertebral disc stress in terms of left and right bending as well as left and right rotation compared to the LPS system in the L3-4 of the Do-segment FEM. There was little biomechanical difference between the same fixation system in the Si/Do-segment FEM. CONCLUSIONS Our finite element analysis showed that compared to OLIF + LPS, OLIF + BPS (TINA) is more effective in reducing interbody stress and spinal ligament tension, and it better maintains the stability of the target segment and provides a better fusion environment to resist cage subsidence. However, OLIF + BPS (TINA) may be more likely to cause adjacent segment degeneration than OLIF + LPS.
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Affiliation(s)
- Zhengquan Xu
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Qingcong Zheng
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Liqun Zhang
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Rongsheng Chen
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Zhechen Li
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Weihong Xu
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China.
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Tabarestani TQ, Wang TY, Sykes DAW, Mehta VA, Yang LZ, Chow SC, Shaffrey CI, Wiggins WF, Chi JH, Abd-El-Barr MM. Two-Year Clinical and Radiographic Outcomes for Percutaneous Lumbar Interbody Fusion With an Expandable Titanium Cage Through Kambin's Triangle Without Facetectomy. Int J Spine Surg 2023; 17:760-770. [PMID: 37553259 PMCID: PMC10753344 DOI: 10.14444/8540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND There has been heightened interest in performing percutaneous lumbar interbody fusions (percLIFs) through Kambin's triangle, an anatomic corridor allowing entrance into the disc space. However, due to its novelty, there are limited data regarding the long-term benefits of this procedure. Our objective was to determine the long-term efficacy and durability of the percutaneous insertion of an expandable titanium cage through Kambin's triangle without facetectomy. METHODS A retrospective review of patients undergoing percLIF via Kambin's triangle using an expandable titanium cage was performed. Demographics, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), radiographic measurements, perioperative variables, and complications were recorded. VAS, ODI, and radiographic measurements were compared with baseline using the generalized estimating equations assuming normally distributed data. Fusion was assessed with computed tomography (CT) at 1 and 2 years after the procedure. RESULTS A total of 49 patients were included. Spondylolisthesis, lumbar lordosis (LL), sacral slope, pelvic tilt, and anterior/posterior disc space height were all significantly improved postoperatively at each time point of 3, 6, 12, and 24 months (P < 0.001). Pelvic incidence-LL mismatch decreased significantly at each follow-up (P < 0.001) with a mean reduction of 4° by 24 months. VAS back scores reduced by >2 points at the 6, 12, and 24 month follow-ups. ODI scores reduced by >15 points at the 12- and 24-month follow-ups. Of the patients who had 1- and 2-year CT images, fusion rates at those time points were 94.4% (17/18) and 87.5% (7/8), respectively. The mean annual rate of surgically significant adjacent segment disease was 2.74% through an average follow-up of 2.74 years. CONCLUSION These results highlight that percLIF, a procedure done without an endoscope or facetectomy, can be performed using an expandable titanium cage through Kambin's triangle with excellent radiographic and clinical results. CLINICAL RELEVANCE percLIF via Kambin's triangle is a safe and succesful procedure with long-term improvements in both clinical and radiographic outcomes. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Troy Q Tabarestani
- Duke University School of Medicine, Duke University Hospital, Durham, NC, USA
| | - Timothy Y Wang
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - David A W Sykes
- Duke University School of Medicine, Duke University Hospital, Durham, NC, USA
| | - Vikram A Mehta
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - Lexie Z Yang
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Walter F Wiggins
- Department of Radiology, Duke University Hospital, Durham, NC, USA
| | - John H Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
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Aimar E, Iess G, Labiad I, Mezza F, Bona A, Ciuffi A, Grassia F, Isidori A, Zekaj E, Bonomo G. Degenerative L4-L5 spondylolisthesis and stenosis surgery: does over-level flavectomy technique influence clinical outcomes and rates of cranial adjacent segment disease? Acta Neurochir (Wien) 2023; 165:3107-3117. [PMID: 37632571 DOI: 10.1007/s00701-023-05761-w] [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: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND One of the most dreaded long-term complications related to L4-L5 lumbar arthrodesis is the onset of adjacent segment disease, which most frequently occurs at the cranial level. Few studies have compared the rates of cranial adjacent segment disease (CASD) in patients undergoing lumbar fusion associated with total laminectomy at the same level with those undergoing partial laminectomy. No study has examined the role of selective over-level flavectomy (OLF; i.e., L3-L4). METHODS A total of 299 patients undergoing posterolateral arthrodesis (PLA) for L4-L5 degenerative spondylolisthesis were retrospectively analyzed with a 5-year follow-up. 148 patients underwent PLA + L4-L5 flavectomy + L4 partial laminectomy (control group), while 151 underwent PLA + L4-L5 flavectomy + total L4 laminectomy + L3-L4 flavectomy (OLF group). Rates of reoperations due to CASD were examined utilizing Cox proportional hazard models, while clinical improvement at follow-up (measured in ODI) was analyzed using generalized linear models (GLMs). Adjustments for potential confounders were made (grade of lumbar lordosis, age, sex, BMI, intervertebral disc degeneration, and presurgical cranial spinal stenosis). RESULTS At 5 years from the operation, 16 patients (10.8%) in the control group had undergone revision surgery for CASD compared to 5 patients (3.3%) in the OLF group (p = 0.013). Survival analysis and GLM demonstrated that the OLF group had a significantly lower incidence of CASD and presented more favorable clinical outcome. There were no differences in the rate of discal degeneration or the onset of Meyerding's grade I degenerative spondylolisthesis at the adjacent segment. BMI was the only other significant predictor of ODI improvement and of the incidence of CASD. CONCLUSIONS In patients with L4-L5 degenerative spondylolisthesis and stenosis, the OLF technique may lower rates of CASD and improve clinical outcomes by preventing cranial spinal stenosis without increasing iatrogenic instability or accelerating intervertebral disc degenerative changes.
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Affiliation(s)
- Enrico Aimar
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy.
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Lumbardy, Milan, Italy.
- Università degli Studi di Milano, Lumbardy, Milan, Italy.
| | - Ikrame Labiad
- Università degli Studi di Milano, Lumbardy, Milan, Italy
| | - Federica Mezza
- Department of Economics, Bocconi University, Lumbardy, Milan, Italy
| | - Alberto Bona
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Andrea Ciuffi
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Fabio Grassia
- Department of Neurosurgery, Anschutz medical campus, Aurora, CO, USA
| | - Alessandra Isidori
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Edvin Zekaj
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Lumbardy, Milan, Italy
- Università degli Studi di Milano, Lumbardy, Milan, Italy
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Galetta MS, Lorentz NA, Lan R, Chan C, Zabat MA, Raman T, Protopsaltis TS, Fischer CR. Reoperation Rates Due to Adjacent Segment Disease Following Primary 1 to 2-Level Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2023; 48:1295-1299. [PMID: 36972142 DOI: 10.1097/brs.0000000000004645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE To investigate the effect of the approach of the transforaminal lumbar interbody fusion [TLIF; open vs . minimally invasive (MIS)] on reoperation rates due to ASD at 2 to 4-year follow-up. SUMMARY OF BACKGROUND DATA Adjacent segment degeneration is a complication of lumbar fusion surgery, which may progress to adjacent segment disease (ASD) and cause debilitating postoperative pain potentially requiring additional operative management for relief. MIS TLIF surgery has been introduced to minimize this complication but the impact on ASD incidence is unclear. MATERIALS AND METHODS For a cohort of patients undergoing 1 or 2-level primary TLIF between 2013 and 2019, patient demographics and follow-up outcomes were collected and compared among patients who underwent open versus MIS TLIF using the Mann-Whitney U test, Fischer exact test, and binary logistic regression. RESULTS Two hundred thirty-eight patients met the inclusion criteria. There was a significant difference in revision rates due to ASD between MIS and open TLIFs at 2 (5.8% vs . 15.4%, P =0.021) and 3 (8% vs . 23.2%, P =0.03) year follow-up, with open TLIFs demonstrating significantly higher revision rates. The surgical approach was the only independent predictor of reoperation rates at both 2 and 3-year follow-ups (2 yr, P =0.009; 3 yr, P =0.011). CONCLUSIONS Open TLIF was found to have a significantly higher rate of reoperation due to ASD compared with the MIS approach. In addition, the surgical approach (MIS vs . open) seems to be an independent predictor of reoperation rates.
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Affiliation(s)
- Matthew S Galetta
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York City, NY
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Chen S, Suo S, Xie Z, He J, Li J, Duan D, Qiao G, Zhang W. Establishment of an animal model of adjacent segment degeneration after interbody fusion and related experimental studies. J Orthop Surg Res 2023; 18:666. [PMID: 37679790 PMCID: PMC10483717 DOI: 10.1186/s13018-023-04072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 08/03/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Degenerative spine conditions are common and frequent clinical diseases, and adjacent segment disease (ASD) after spinal fusion (SF) is a common complication after spinal fusion (SF). In this study, we established an animal model of ASD after interbody fusion to observe the morphologic changes of adjacent segment (AS) disks and to determine the expression and significance of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) in ASD tissues to provide a good experimental basis and reference for clinical prevention and treatment of ASD after interbody fusion. METHODS Thirty-six male and female New Zealand rabbits weighing 2.0-2.5 kg were randomly divided into control group (group A) and experimental groups (groups B, C, and D), with 9 rabbits in each group, of which groups B, C, and D were the 4-, 8-, and 12-week groups, respectively. Autologous iliac bone grafts were used as the bone graft material. In the experimental groups, a SF was performed on the C2-C3 intervertebral space. The C3-4 adjacent segments were examined. In the experimental group, the animals were subjected to gross observation, X-ray examination, hand touch inspection, and micro-computed tomography (micro-CT) 4, 8, and 12 weeks after surgery. The micromorphologic changes of the cervical disks in the segments of the control group and experimental groups were observed under light microscopy. Immunohistochemistry and Western blotting were used to detect the expression of TNF-α and IL-1β in the AS tissues after interbody fusion in the control and experimental groups. RESULTS The measurement data of the rabbit cervical spine bony structures indicated that the length of the vertebral body and the sagittal diameter of the lower end of the vertebral body decreased gradually from the 2nd-6th cervical vertebrae, and the difference was statistically significant (P < 0.05). The difference in the transverse diameter of the lower end of the vertebral body was not statistically significant (P > 0.05), the change in the oblique diameter of the lower end of the vertebral body fluctuated, and the difference was statistically significant (P < 0.05). The fusion rate of the cervical spine by hand touch inspection was 22.2% (2/9), 55.6% (5/9), and 88.9% (8/9) in groups B, C, and D, respectively. The differences in bone volume-to-total volume (BV/TV) and X-ray scores were statistically significant in groups B, C, and D (P < 0.05). Significant degeneration occurred in groups B, C, and D compared with group A. The expression of TNF-α and IL-1β in the intervertebral disk tissue was significantly higher in groups B, C, and D compared with group A (P < 0.05), and increased with time. CONCLUSION In this study, an animal model of ASD after interbody fusion fixation in rabbits was successfully established. Postoperative imaging and hand touch inspection showed a positive correlation between the amount of new intervertebral bone and the degree of fusion with time. The results of immunohistochemistry and Western blot showed that TNF-α and IL-1β were highly expressed in the AS tissues of the experimental group after interbody fusion, and the degree of disk degeneration was positively correlated with the time after interbody fusion.
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Affiliation(s)
- Song Chen
- Department of Orthopaedics, The Affiliated Hospital of Hebei Engineering University, No. 81, Congtai Road, Congtai District, Handan, 056000, China.
| | - Shiqi Suo
- Department of Gynecology, The Affiliated Hospital of Hebei Engineering University, Handan, 056000, China
| | - Zhitao Xie
- Department of Orthopaedics, The Affiliated Hospital of Hebei Engineering University, No. 81, Congtai Road, Congtai District, Handan, 056000, China
| | - Jinglan He
- Department of Orthopaedics, The Affiliated Hospital of Hebei Engineering University, No. 81, Congtai Road, Congtai District, Handan, 056000, China
| | - Jiaqi Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Zi-Qiang Road, Shijiazhuang, 050000, Hebei, China
| | - Dengke Duan
- Department of Orthopaedics, Handan First Hospital, Handan, 056000, China
| | - Guoyong Qiao
- Department of Orthopaedics, The Affiliated Hospital of Hebei Engineering University, No. 81, Congtai Road, Congtai District, Handan, 056000, China
| | - Wei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Zi-Qiang Road, Shijiazhuang, 050000, Hebei, China.
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Lee HJ, Lee SJ, Jung JM, Lee TH, Jeong C, Lee TJ, Jang JE, Lee JW. Biomechanical Evaluation of Lateral Lumbar Interbody Fusion with Various Fixation Options for Adjacent Segment Degeneration: A Finite Element Analysis. World Neurosurg 2023; 173:e156-e167. [PMID: 36775239 DOI: 10.1016/j.wneu.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Adjacent segment degeneration (ASD) is a common phenomenon after lumbar fusion. Lateral lumbar interbody fusion (LLIF) may provide an alternative treatment method for ASD. This study used finite element analysis to evaluate the biomechanical effects of LLIF with various fixation options and identify an optimal surgical strategy for ASD. METHODS A validated L1-S1 finite element model was modified for simulation. Six finite element models of the lumbar spine were created and were divided into group 1 (L4-5 posterior lumbar interbody fusion [PLIF] + L3-4 LLIF) and group 2 (L5-S1 PLIF + L4-5 LLIF). Each group consisted of 1) cage-alone, 2) cage + lateral screw fixation (LSF), and 3) cage + bilateral pedicle screw fixation (BPSF) models. The range of motion, intradiscal pressure, and facet loads of adjacent segments as well as interbody cage stress were analyzed. RESULTS The stress on the LLIF cage-superior endplate interface was highest in the cage-alone model followed by the cage + LSF model and cage + BPSF model. The increase in range of motion, intradiscal pressure, and facet loads at the adjacent segment was highest in the cage + BPSF model followed by the cage + LSF model and cage-alone model. However, the biomechanical effect on the adjacent segment seemed similar in the cage-alone and cage + LSF models. CONCLUSIONS LLIF with BPSF is recommended when performing LLIF surgery for ASD after L4-5 and L5-S1 PLIF. Considering cage subsidence and biomechanical effects on the adjacent segment, LLIF with LSF may be a suboptimal option for ASD surgery.
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Affiliation(s)
- Hyun Ji Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Jong-Myung Jung
- Department of Neurosurgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea.
| | - Tae Hoon Lee
- Department of Orthopedic Surgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea
| | - Chandong Jeong
- Department of Orthopedic Surgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea
| | - Tae Jin Lee
- Department of Orthopedic Surgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea
| | - Ji-Eun Jang
- R&D Center, GS Medical Co., Ltd., Cheongju, Republic of Korea
| | - Jae-Won Lee
- R&D Center, GS Medical Co., Ltd., Cheongju, Republic of Korea
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9
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[Research progress of effect of cage height on outcomes of lumbar interbody fusion surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1440-1444. [PMID: 36382465 PMCID: PMC9681583 DOI: 10.7507/1002-1892.202205096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To summarize the effect of cage height on outcomes of lumbar interbody fusion surgery and the importance of the cage height selection. METHODS The related literature was widely reviewed to summarize the research progress on the complications caused by inappropriate height of the cage and the methods of selecting cage height. RESULTS Inappropriate height of the cage can lead to endplate injury, cage subsidence, internal fixation failure, adjacent segmental degeneration, over-distraction related pain, insufficient indirect decompression, instability of operation segment, poor interbody fusion, poor sequence of spine, and cage displacement. At present, the selection of the cage height is based on the results of the intraoperative model test, which is reliable but high requirements for surgical experience and hard to standardize. CONCLUSION The inappropriate height of the cage may have an adverse impact on the postoperative outcome of patients. It is important to develop a selection standard of the cage height by screening the related influential factors.
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