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Pradeep K, Pal B, Mukherjee K, Shetty GM. Finite element analysis of implanted lumbar spine: Effects of open laminectomy plus PLF and open laminectomy plus TLIF surgical approaches on L3-L4 FSU. Med Eng Phys 2024; 128:104178. [PMID: 38789215 DOI: 10.1016/j.medengphy.2024.104178] [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: 08/28/2023] [Revised: 03/15/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Several finite element (FE) studies reported performances of various lumbar fusion surgical approaches. However, comparative studies on the performance of Open Laminectomy plus Posterolateral Fusion (OL-PLF) and Open Laminectomy plus Transforaminal Interbody Fusion (OL-TLIF) surgical approaches are rare. In the current FE study, the variation in ranges of motions (ROM), stress-strain distributions in an implanted functional spinal unit (FSU) and caudal adjacent soft structures between OL-PLF and OL-TLIF virtual models were investigated. The implanted lumbar spine FE models were developed from subject-specific computed tomography images of an intact spine and solved for physiological loadings such as compression, flexion, extension and lateral bending. Reductions in the ROMs of L1-L5 (49 % to 59 %) and L3-L4 implanted FSUs (91 % to 96 %) were observed for both models. Under all the loading cases, the maximum von Mises strain observed in the implanted segment of both models exceeds the mean compressive yield strain for the vertebra. The maximum von Mises stress and strain observed on the caudal adjacent soft structures of both the implanted models are at least 22 % higher than the natural spine model. The findings indicate the risk of failure in the implanted FSUs and higher chances of adjacent segment degeneration for both models.
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Affiliation(s)
- Kishore Pradeep
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology (IIEST), Shibpur, Howrah 711103, West Bengal, India
| | - Bidyut Pal
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology (IIEST), Shibpur, Howrah 711103, West Bengal, India.
| | - Kaushik Mukherjee
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110 016, India
| | - Gautam M Shetty
- QI Spine Clinic, Mumbai, India; Knee & Orthopaedic Clinic, Mumbai, India
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Jäckle K, Assmann L, Roch PJ, Klockner F, Meier MP, Hawellek T, Lehmann W, Weiser L. Clinical outcome after dorso-ventral stabilization of the thoracolumbar and lumbar spine with vertebral body replacement and dorsal stabilization. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08324-4. [PMID: 38811437 DOI: 10.1007/s00586-024-08324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/16/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Surgical stabilization of the spine by vertebral body replacement (VBR) is used for spinal disorders such as traumatic fractures to provide an anatomical re-adjustment of the spine to prevent late detrimental effects and pain [1-4]. This study addresses the clinical outcome after a ventral intervention with VBR and bisegmental fusion. METHODS The study includes 76 patients (mean age: 59.34 ± 15.97; 34 females and 42 males) with fractures in the lower thoracic and lumbar spine. They were selected from patients of our hospital who received an anterolateral VBR surgery on the corresponding lower spine region over a nine-year period. Only patients were examined with X-rays and complete follow-up records. Exclusion criteria were changes due to degeneration and pathological fractures. Patients were divided into two groups, the thoracotomy group (Th10-L1) and the lumbotomy group (L2-5), respectively. Minimum one year after surgery, patients were asked about their well-being using a precasted questionnaire. RESULTS No significant differences with respect to the subjective impression of the patients concerning their back pain, spinal functional impairment, their general functional status and their quality of life impairment. Unfortunately, however, only a rather modest but significant increase of the post-surgical life quality was reported. CONCLUSIONS Patients who underwent VBR in the lower thoracic or lumbar spine show modest long-term well-being. The results suggest that injuries to the lower thoracic or lumbar spine requiring vertebral body replacement should be classified as severe injuries since they adversely affect the patients' long-term well-being. TRIAL REGISTRATION Study of clinical outcome of patients after vertebral body replacement of the ventral thoracal and lumbal spine, DRKS00031452. Registered 10th March 2023 - Prospectively registered. Trial registration number DRKS00031452.
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Affiliation(s)
- K Jäckle
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medicine Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany.
| | - L Assmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medicine Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - P J Roch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medicine Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - F Klockner
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medicine Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - M-P Meier
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medicine Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - T Hawellek
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medicine Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - W Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medicine Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - L Weiser
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medicine Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
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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.
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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
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Biomechanical and clinical studies on lumbar spine fusion surgery: a review. Med Biol Eng Comput 2023; 61:617-634. [PMID: 36598676 DOI: 10.1007/s11517-022-02750-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
Low back pain is associated with degenerative disc diseases of the spine. Surgical treatment includes fusion and non-fusion types. The gold standard is fusion surgery, wherein the affected vertebral segment is fused. The common complication of fusion surgery is adjacent segment degeneration (ASD). The ASD often leads to revision surgery, calling for a further fusion of adjacent segments. The existing designs of nonfusion type implants are associated with clinical problems such as subsidence, difficulty in implantation, and the requirement of revision surgeries. Various surgical approaches have been adopted by the surgeons to insert the spinal implants into the affected segment. Over the years, extensive biomechanical investigations have been reported on various surgical approaches and prostheses to predict the outcomes of lumbar spine implantations. Computer models have been proven to be very effective in identifying the best prosthesis and surgical procedure. The objective of the study was to review the literature on biomechanical studies for the treatment of lumbar spinal degenerative diseases. A critical review of the clinical and biomechanical studies on fusion spine surgeries was undertaken. The important modeling parameters, challenges, and limitations of the current studies were identified, showing the future research directions.
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Nie JW, Hartman TJ, Jacob KC, Patel MR, Vanjani NN, MacGregor KR, Oyetayo OO, Zheng E, Singh K. Minimally Invasive Transforaminal versus Anterior Lumbar Interbody Fusion in Patients Undergoing Revision Fusion: Clinical Outcome Comparison. World Neurosurg 2022; 167:e1208-e1218. [PMID: 36075354 DOI: 10.1016/j.wneu.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aim to compare perioperative/postoperative clinical outcomes between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and anterior lumbar interbody fusion (ALIF) in patients presenting for revision surgery. METHODS A retrospective database was reviewed for procedures between November 2005 and December 2021. Revision MIS-TLIF/ALIFs were included, whereas primary fusions or diagnosis of infection/malignancy/trauma were excluded. Patients were grouped into MIS-TLIF/ALIF cohorts. Preoperatively/postoperatively collected patient-reported outcome measures (PROMs) included visual analog scale back/leg score, Oswestry Disability Index, Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), and Short-Form 12-Item Survey Mental/Physical Composite Scores. RESULTS A total of 164 patients were eligible, with 84 patients in the MIS-TLIF cohort. The presence of degenerative spondylolisthesis and central stenosis, narcotic consumption on postoperative day 0/1, and postoperative urinary retention rates was greater in the MIS-TLIF cohort (P ≤ 0.036, all). Preoperative PROMs between cohorts did not significantly differ. Significantly favorable postoperative PROM scores were shown in the MIS-TLIF cohort with PROMIS-PF at 12 weeks/6 months (P ≤ 0.033, all). Most patients in both cohorts achieved overall minimum clinically important difference for visual analog scale back/leg score, Oswestry Disability Index, Short-Form 12-Item Survey Physical Composite Score, and PROMIS-PF. No differences were noted between cohorts within rates of MCID achievement. CONCLUSIONS Patients undergoing revision fusion via MIS-TLIF or ALIF reported similar 1-year postoperative mean outcomes and rates of meaningful clinical achievement for physical function, mental health, disability, and back/leg pain. However, patients undergoing revision MIS-TLIF reported improved physical function at 12 weeks and 6 months. Perioperatively, patients undergoing revision MIS-TLIF were noted to consume significantly greater quantities of narcotics.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Li F, Zhan X, Xi X, Zeng Z, Ma B, Xie N, Zhu R, Tsai TY, Li G, Yu Y, Cheng L. Do the positioning variables of the cage contribute to adjacent facet joint degeneration? Radiological and clinical analysis following intervertebral fusion. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:776. [PMID: 34268389 PMCID: PMC8246202 DOI: 10.21037/atm-20-7718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/05/2021] [Indexed: 12/28/2022]
Abstract
Background Compared to other risk factors, adjacent facet joint degeneration (AFD) is the main contributor to adjacent segment disease (ASD). The interbody cage may be a potential indirect risk of AFD. This study investigated the correlations among the lumbar sagittal balance parameters, the inter-body cage's intraoperative positioning variables, and adjacent facet joint degeneration following the transforaminal lumbar interbody fusion (TLIF) technique. Methods Patients who accepted single-level TLIF for symptomatic lumbar degenerative disease and were followed up for at least six months were enrolled in this study. According to the inclusive and exclusive criteria, 93 patients were included (44 males and 49 females). X-ray and computed tomography (CT) images were obtained before and six months after surgery. The vertebral contour and the center of the marker mass in the cage were calculated using a geometric algorithm. Orthopedic surgeons measured the disc height, lordosis angle, and facet joint degeneration. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and the visual analog scale (VAS), were used to assess the clinical outcomes. The Student’s t-test, Wilcoxon rank-sum test, and Chi-square test were used for the statistical analyses. Results The average age was 53.7 years old (range, 27–84 years). The average functional disability outcome assessed by the ODI was 61.2, and the average back and leg pain assessed by the VAS was 6.2 and 6.9, respectively. The patients were categorized into a normal group and an abnormal (AFD) group according to whether the facet joint degeneration was aggravated. The abnormal group had a higher back pain VAS score (P=0.031) and lower sagittal vertical position (P=0.027). The other parameters were similar at baseline (P>0.05). The cage’s sagittal vertical position decreased significantly with AFD aggravation (OR, 0.737; 95% CI, 0.561–0.969). Conclusions In patients with AFD aggravation, the preoperative VAS and postoperative ODI scores were significantly higher. The cage position parameters were related to AFD. A lower cage center was associated with a greater incidence of AFD.
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Affiliation(s)
- Fuping Li
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Spine Surgery, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Xinhua Zhan
- Jiading Branch of Shanghai General Hospital, Shanghai, China.,Department of Orthopedics, Jiangqiao Hospital, Shanghai, China
| | - Xin Xi
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhili Zeng
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Ma
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ning Xie
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rui Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Guoan Li
- Orthopedic Bioengineering Research Center, Department of Orthopedic Surgery, Newton-Wellesley, Hospital/Harvard Medical School, Wellesley, MA, USA
| | - Yan Yu
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liming Cheng
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Sayari AJ, Patel DV, Yoo JS, Singh K. Device solutions for a challenging spine surgery: minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Expert Rev Med Devices 2019; 16:299-305. [PMID: 30917071 DOI: 10.1080/17434440.2019.1601013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Lumbar interbody fusion remains a mainstay in the treatment of degenerative spinal pathology. Interbody devices are often used in an attempt to improve fusion rates and outcomes. Minimally invasive techniques lend unique advantages, but are challenging and often plagued with complications. Specifically, minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has a steep learning curve and there is a lack of concise information on solutions to optimize outcomes. AREAS COVERED This review details an appropriate surgical technique of MIS TLIF and includes an overview of the components that go into a successful procedure. A thorough literature search of the PubMed database was completed to provide a comprehensive analysis of the interbody devices, posterolateral fixation, and osteobiologics. EXPERT OPINION MIS TLIFs have demonstrated successful clinical and radiographic outcomes and have become a mainstay for treating various degenerative lumbar pathologies. As minimally invasive techniques continue to evolve, devices and biologics will continue to expand the indications for MIS TLIFs and will optimize long-term outcomes.
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Affiliation(s)
- Arash J Sayari
- a Department of Orthopaedic Surgery , Rush University Medical Center , Chicago , IL , USA
| | - Dil V Patel
- a Department of Orthopaedic Surgery , Rush University Medical Center , Chicago , IL , USA
| | - Joon S Yoo
- a Department of Orthopaedic Surgery , Rush University Medical Center , Chicago , IL , USA
| | - Kern Singh
- a Department of Orthopaedic Surgery , Rush University Medical Center , Chicago , IL , USA
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Spinal Biologics in Minimally Invasive Lumbar Surgery. Minim Invasive Surg 2018; 2018:5230350. [PMID: 29850240 PMCID: PMC5907390 DOI: 10.1155/2018/5230350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/25/2018] [Indexed: 12/28/2022] Open
Abstract
As the use of minimally invasive spine (MIS) fusion approaches continues to grow, increased scrutiny is being placed on its outcomes and efficacies against traditional open fusion surgeries. While there are many factors that contribute to the success of achieving spinal arthrodesis, selecting the optimal fusion biologic remains a top priority. With an ever-expanding market of bone graft substitutes, it is important to evaluate each of their use as it pertains to MIS techniques. This review will summarize the important characteristics and properties of various spinal biologics used in minimally invasive lumbar surgeries and compare their fusion rates via a systematic review of published literature.
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