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Li S, Yang Z, Yan W, Da C, Niu W, Qu T. Comparing OLIF Combined with Lateral Screw Fixation versus Minimally Invasive TLIF for Treating Single-Level Degenerative Lumbar Spondylolisthesis: A Retrospective Cohort Study. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38560988 DOI: 10.1055/a-2297-4416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The present study aimed to compare the clinical and radiologic outcomes of oblique lumbar interbody fusion (OLIF) combined with lateral screw fixation and minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) for the treatment of single-level degenerative lumbar spondylolisthesis (DLS). METHODS Data regarding clinical and radiologic outcomes for single-level DLS treated using OLIF combined with lateral screw fixation or Mis-TLIF between November 2017 and June 2020 were retrospectively analyzed. RESULTS Seventy-five patients with single-level DLS (≥2 years' follow-up) were included and divided into two groups according to the surgical method used: OLIF (n = 33) and Mis-TLIF (n = 42). Operative time, intraoperative blood loss, and length of hospital stay were significantly lower in the OLIF group than that in the Mis-TLIF group. There were no significant differences in preoperative low back pain (LBP), leg pain (LP), visual analog scale (VAS) scores, and Oswestry Disability Index (ODI) between the two groups, although the OLIF group had significantly lower LBP VAS scores at 1, 3, and 6 months postoperatively. Additionally, the LP VAS score was significantly lower in the Mis-TLIF group than that in the OLIF group at 1 month postoperatively, and the ODI of the OLIF group at 3 months postoperatively was significantly lower than that of the Mis-TLIF group. There was no significant difference in the preoperative and postoperative lumbar lordosis angles between the two groups, whereas the postoperative surgical segmental lordosis angle and disk height (at 1, 6, 12, and 24 months) in the OLIF group were significantly higher than those in the Mis-TLIF group. Additionally, there was no significant difference in complication rates between the two groups (18.2% in the OLIF group vs. 11.9% in the Mis-TLIF group; p = 0.520). CONCLUSION OLIF combined with lateral screw fixation yielded better clinical and radiologic outcomes than Mis-TLIF in patients with single-level DLS.
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Affiliation(s)
- Shuo Li
- Department of Orthopedics, Gansu Provincial Central Hospital, Lanzhou City, Gansu Province, People's Republic of China
| | - Zhiyun Yang
- Department of Orthopedics, Gansu Provincial Central Hospital, Lanzhou City, Gansu Province, People's Republic of China
| | - Weishun Yan
- Department of Orthopedics, Gansu Provincial Central Hospital, Lanzhou City, Gansu Province, People's Republic of China
| | - Chaoming Da
- Department of Orthopedics, Gansu Provincial Central Hospital, Lanzhou City, Gansu Province, People's Republic of China
| | - Weimin Niu
- Department of Orthopedics, Gansu Provincial Central Hospital, Lanzhou City, Gansu Province, People's Republic of China
| | - Tao Qu
- Department of Orthopedics, Gansu Provincial Central Hospital, Lanzhou City, Gansu Province, People's Republic of China
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Jia H, Zhang Z, Qin J, Bao L, Ao J, Qian H. Management for degenerative lumbar spondylolisthesis: a network meta-analysis and systematic review basing on randomized controlled trials. Int J Surg 2024; 110:3050-3059. [PMID: 38446872 PMCID: PMC11093486 DOI: 10.1097/js9.0000000000001228] [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: 12/04/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Consensus on the various interventions for degenerative lumbar spondylolisthesis (DLS) remains unclear. MATERIALS AND METHODS The authors searched PubMed, Embase, Cochrane Library, Web of Science, and major scientific websites until 01 November 2023, to screen eligible randomized controlled trials (RCTs) involving the treatment of DLS. The seven most common DLS interventions [nonsurgical (NS), decompression only (DO), decompression plus fusion without internal fixation (DF), decompression plus fusion with internal fixation (DFI), endoscopic decompression plus fusion (EDF), endoscopic decompression (ED), and circumferential fusion (360F)] were compared. The primary (pain and disability) and secondary (complications, reoperation rate, operation time, blood loss, length of hospital stay, and satisfaction) outcomes were analyzed. RESULTS Data involving 3273 patients in 16 RCTs comparing the efficacy of different interventions for DLS were reported. In terms of improving patient pain and dysfunction, there was a significant difference between surgical and NS. EDF showed the greatest improvement in short-term and long-term dysfunction (probability, 7.1 and 21.0%). Moreover, EDF had a higher complication rate (probability 70.8%), lower reoperation rate (probability, 20.2%), and caused greater blood loss (probability, 82.5%) than other surgical interventions. Endoscopic surgery had the shortest hospitalization time (EDF: probability, 42.6%; ED: probability, 3.9%). DF and DFI had the highest satisfaction scores. CONCLUSIONS Despite the high complication rate of EDF, its advantages include improvement in pain, lower reoperation rate, and shorter hospitalization duration. Therefore, EDF may be a good option for patients with DLS as a less invasive surgical approach.
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Affiliation(s)
| | | | | | | | - Jun Ao
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Hu Qian
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
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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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Essa A, Shehade M, Rabau O, Smorgick Y, Mirovsky Y, Anekstein Y. Fusion's Location and Quality within the Fixated Segment Following Transforaminal Interbody Fusion (TLIF). Healthcare (Basel) 2023; 11:2814. [PMID: 37957959 PMCID: PMC10648832 DOI: 10.3390/healthcare11212814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/14/2023] [Indexed: 11/15/2023] Open
Abstract
Transforaminal interbody fusion (TLIF) has gained increased popularity over recent decades and is being employed as an established surgical treatment for several lumbar spine pathologies, including degenerative spondylosis, spondylolisthesis, infection, tumor and some cases of recurrent disc herniation. Despite the seemingly acceptable fusion rates after TLIF (up to 94%), the literature is still limited regarding the specific location and quality of fusion inside the fixated segment. In this single-institution, retrospective population-based study, we evaluated all post-operative computed tomography (CT) of patients who underwent TLIF surgery at a medium-sized medical center between 2010 and 2020. All CT studies were performed at a minimum of 1 year following the surgery, with a median of 2 years. Each CT study was evaluated for post-operative fusion, specifically in the posterolateral and intervertebral body areas. The fusion's quality was determined and classified in each area according to Lee's criteria, as follows: (1) definitive fusion: definitive bony trabecular bridging across the graft host interface; (2) probable fusion: no definitive bony trabecular crossing but with no gap at the graft host interface; (3) possible arthrosis: no bony trabecular crossing with identifiable gap at the graft host interface; (4) definite pseudarthrosis: no traversing trabecular bone with definitive gap. A total of 48 patients were included in this study. The median age was 55.6 years (SD ± 15.4). The median time from surgery to post-operative CT was 2 years (range: 1-10). Full definitive fusion in both posterolateral and intervertebral areas was observed in 48% of patients, and 92% showed definitive fusion in at least one area (either posterolateral or intervertebral body area). When comparing the posterolateral and the intervertebral area fusion rates, a significantly higher definitive fusion rate was observed in the posterolateral area as compared to the intervertebral body area in the long term follow-up (92% vs. 52%, p < 0.001). In the multivariable analysis, accounting for several confounding factors, including the number of fixated segments and cage size, the results remained statistically significant (p = 0.048). In conclusion, a significantly higher definitive fusion rate at the posterolateral area compared to the intervertebral body area following TLIF surgery was found. Surgeons are encouraged to employ bone augmentation material in the posterolateral area (as the primary site of fusion) when performing TLIF surgery.
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Affiliation(s)
- Ahmad Essa
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Munder Shehade
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Oded Rabau
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Unit, Department of Orthopedic Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel
| | - Yossi Smorgick
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Unit, Department of Orthopedic Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel
| | - Yigal Mirovsky
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Unit, Department of Orthopedic Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel
| | - Yoram Anekstein
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel; (M.S.); (O.R.); (Y.S.); (Y.M.); (Y.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Unit, Department of Orthopedic Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin 7033001, Israel
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Beucler N. Oblique lumbar interbody fusion (OLIF) and minimal invasive transforaminal lumbar interbody fusion (MIS TLIF): we should not compare two procedures that serve different purposes. Neurosurg Rev 2023; 46:111. [PMID: 37155078 DOI: 10.1007/s10143-023-02024-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 04/30/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Nathan Beucler
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, 83800 Cedex 9, Toulon, France.
- French Military Health Service Academy, Ecole du Val-de-Grâce, 1 place Alphonse Laveran, 75230 Cedex 5, Paris, France.
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