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Cômes PC, Gavotto A, Zouakia Z, Lonjon G, Amelot A, Edgard-Rosa G, Debono B. Repeat Discectomy or Instrumented Surgery for Recurrent Lumbar Disk Herniation: An Overview of French Spine Surgeons' Practice. Global Spine J 2024:21925682241249102. [PMID: 38652921 DOI: 10.1177/21925682241249102] [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] [Indexed: 04/25/2024] Open
Abstract
STUDY DESIGN Retrospective multicenter cohort study. OBJECTIVE Recurrent lumbar disc herniation (ReLDH) is a common condition requiring surgical intervention in a large proportion of cases. Evidence regarding the appropriate choice between repeat microdiscectomy (RD) and instrumented surgery (IS) is lacking. To understand the indications for either of the procedures and compare the results, we aimed to provide an overview of spine surgeon practice in France. METHODS This retrospective, multicenter analysis included adults who underwent surgery for ReLDHs between December 2020 and May 2021. Surgeons were asked which of the following factors determined their therapeutic choice: radio-clinical considerations, non-discal anatomical factors, patient preference, or surgeon background. Data on preoperative clinical status and radiologic findings were collected. Patient-reported outcome measures (PROMs) were assessed and compared using propensity scores preoperatively and at 3 and 12 months postoperatively. RESULTS The study included 150 patients (72 IS and 78 RD). Radioclinical elements, anatomical data, patient preferences, and surgeon background influenced the choice of RD in 57.7%, 1.3%, 25.6%, and 15.4% of the cases, respectively, and IS in 34.7%, 6.9%, 13.9%, and 44.5% of the cases, respectively. At 12 months, patient satisfaction, return to work, and changes in PROMs were not significantly different between the groups. CONCLUSIONS The decision-making process included both objective and subjective factors, resulting in patient satisfaction in 80.3% to 81.5% of cases, with significant clinical improvement in radicular symptoms in 75.8% to 91.8% of cases, and quality of life in 75.8% to 84.9% of cases, depending on the procedure performed.
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Affiliation(s)
- Pierre-Cyril Cômes
- Centre Francilien du Dos, Clinique des Franciscaines, Versailles, France
- Neurosurgical department, Foch Hospital, Suresnes, France
| | - Amandine Gavotto
- University Hospital Nice, Unité de Chirurgie Rachidienne, Nice, France
| | - Zineb Zouakia
- Service de recherche clinique, Hôpital Fondation A. de Rotschild, Paris, France
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean-Sud de France, Santé Cite, Paris, France
| | - Aymeric Amelot
- Département de neurochirurgie, University Hospital of Tours, Tours, France
| | - Grégory Edgard-Rosa
- Centre de Chirurgie Vertébrale (CCV) MONTPELLIER, Clinique du Parc, Castelnau-le-Lez, France
| | - Bertrand Debono
- Centre Francilien du Dos, Clinique des Franciscaines, Versailles, France
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Parisien A, Wai EK, ElSayed MS, Frei H. Subsidence of Spinal Fusion Cages: A Systematic Review. Int J Spine Surg 2022; 16:1103-1118. [PMID: 36289005 PMCID: PMC9807049 DOI: 10.14444/8363] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although many research studies investigating subsidence of intervertebral fusion cages have been published, to our knowledge, no study has comprehensively compared cage subsidence among all lumbar intervertebral fusion (LIF) techniques. This study aimed to review the literature reporting evidence of cage subsidence linked to LIF. The amount of subsidence was compared and associated with the procedures and corresponding implants used, and the effect of cage subsidence on clinical outcomes was investigated. METHODS For this systematic review, the MEDLINE and PubMed databases were used to identify relevant studies. Search terms included lumbar, lumbar vertebrae, lumbar spine, cage, spinal fusion, prosthesis, prosthesis implantation, implantation, implants, interbody, spacer, and subsidence. Studies included in this review were those having more than 10 patients and reporting the amount of subsidence observed using computed tomography or x-ray imaging after surgery and at follow-up visits after a minimum of 6 weeks postsurgery. Data and scale definitions related to subsidence were extracted from articles for comparison of subsidence prevalence between the 5 LIF surgical procedures. RESULTS Forty articles were identified for inclusion. The review included data from 390 anterior lumbar intervertebral fusions (ALIFs), 2130 lateral lumbar intervertebral fusions (LLIFs), 560 posterior lumbar intervertebral fusions (PLIFs), 245 oblique lumbar intervertebral fusions (OLIFs), and 1634 transverse lumbar intervertebral fusions (TLIFs) for a total of 4959 patients who underwent LIF surgery. The minimum and maximum percentages of the number of patients having subsidence for each procedure in the included studies were as follows: ALIF stand-alone, 6% and 23.1%; LLIF stand-alone, 8.7% and 39.6%; LLIF with posterior fixation, 3.3% and 20.7%; OLIF with posterior fixation, 4.4% and 36.9%; PLIF with posterior fixation, 7.4% and 31.8%; and TLIF, 0.0% and 51.2%. CONCLUSIONS The number of patients experiencing subsidence varied between studies within each fusion procedure. Our findings indicate that all 5 surgical methods are at risk of subsidence. Overall, ALIF without posterior fixation resulted in the lowest reported subsidence occurrence among the 5 surgical approaches. There is conflicting evidence on the association between subsidence and negative clinical outcomes. CLINICAL RELEVANCE This review defines and compares subsidence incidence between all LIF procedures and investigates the risk of symptomatic clinical outcomes. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ariane Parisien
- Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Eugene K. Wai
- Orthopeadic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Mostafa S.A. ElSayed
- Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Hanspeter Frei
- Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada, Hanspeter Frei, Mechanical and Aerospace Engineering, 3135 Mackenzie Carleton University, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada;
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Critical analysis of the evaluation of postoperative dysphagia following an anterior cervical discectomy and fusion. Am J Otolaryngol 2022; 43:103466. [PMID: 35427936 DOI: 10.1016/j.amjoto.2022.103466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Postoperative dysphagia is a known complication of anterior cervical discectomy and fusion (ACDF) with reported incidences ranging from 1 to 79%. No standardized guidelines exist for spine surgeons to evaluate postoperative dysphagia after ACDF. A systematic method may be beneficial in distinguishing transient postoperative dysphagia secondary to intubation from those with postoperative complications. This study evaluates the causes, recognition, and clinical evaluation of postoperative dysphagia following ACDF. METHODS International classification of disease (ICD) and current procedural terminology (CPT) codes were used to identify ACDF patients and compared to anterior lumbar discectomy and fusion (ALDF), serving as a control group, between the years 2015-2019 and those diagnosed with dysphagia within 1 year. Demographics, operative details, and clinical evaluation were reviewed. Exclusion criteria included history of head and neck procedures, cancer, stroke, radiation, and trauma. RESULTS One hundred thirty-one ACDF and 93 ALDF patients met inclusion criteria. Twenty-seven (20.6%) ACDF patients were diagnosed with dysphagia within 1 year. Less than half of the dysphagia patients had the word "dysphagia" documented in their 1-month spine surgeon follow up visit. Only 66% of dysphagia patients had specialist evaluation and one third of those patients were referred by their surgeon. Only six patients received diagnostic barium swallow evaluations. CONCLUSION Postoperative dysphagia risk increases in ACDF compared to ALDF, likely due to underlying anatomy. Postoperative dysphagia symptoms are not effectively documented by spine surgeons and as a result underevaluated by dysphagia specialists. Patients may benefit from more extensive pre- and post-operative screening, evaluation, and referral regarding dysphagia symptoms following ACDF.
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Lumbar discectomy with annulus fibrosus closure: a retrospective series of 53 consecutive patients. Neurochirurgie 2022; 68:393-397. [PMID: 34995566 DOI: 10.1016/j.neuchi.2021.12.009] [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: 09/16/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Lumbar disc herniation is most common degenerative alteration of the spine. Whenever surgical therapy proves to be necessary, recurrent disc herniation is most frequent concern. Here, primary aim was to determine the percentage of patients eligible for insertion of an annular closure device (ACD). Secondary aim to evaluate 12-month incidence of recurrent disc herniation at the operated level. Our hypothesis was that ACD might help in preventing recurrent disc herniation. METHODS Patients in a single XXX neurosurgical center underwent limited discectomy alone (n=41, group 1) versus limited discectomy plus ACD (n=12, group 2). Mean postoperative follow-up period was 12 months. RESULTS Twelve out of 53 patients (22.6 %) were eligible for ACD implantation. Patients of group 2 were significantly taller (mean 176 cm, p= 0.007) as compared with group 1 (mean 170). The only statistically significant difference of intraoperative parameters between group 1 and 2 was amount of nucleus materiel removed (p= 0.01), being greater in group 2 (mean 0.9) as compared with group 1 (mean 0.3). In group 1 six patients (6/41, 14.6%) presented with symptomatic reherniation at same level of surgery, while in group 2 only one patient experienced recurrence (1/12, 8.3%). No adverse events were reported. DISCUSSION In the current study one out of five patients with lumbar disc herniation was considered suitable for ACD placement. In vast majority of these patients reherniation was precluded on the short-term basis. Patients with ACD were taller and had intraoperatively a higher volume of the nucleus pulposus materiel removed.
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Kurzbuch AR, Fournier JY, Tuleasca C. The annular closure device - panacea of lumbar disc herniation: how closed is closed enough for the intervertebral disc space? Acta Neurochir (Wien) 2021; 163:1611-1612. [PMID: 33606100 DOI: 10.1007/s00701-021-04764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
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Aleinik AY, Mlyavykh SG, Qureshi S. Lumbar Spinal Fusion Using Lateral Oblique (Pre-psoas) Approach (Review). Sovrem Tekhnologii Med 2021; 13:70-81. [PMID: 35265352 PMCID: PMC8858408 DOI: 10.17691/stm2021.13.5.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 11/14/2022] Open
Abstract
Lumbar spinal fusion is one of the most common operations in spinal surgery. For its implementation, anterolateral (pre-psoas) approach (oblique lumbar interbody fusion, OLIF) is now increasingly used due to its high efficacy and safety. However, there is still little information on the clinical and radiological results of using this technique. The aim of the study was to analyze the safety and efficacy of OLIF in the treatment of lumbar spine disorders as presented in the literature.
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Affiliation(s)
- A Ya Aleinik
- Neurosurgeon, Institute of Traumatology and Orthopedics Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - S G Mlyavykh
- Director of the Institute of Traumatology and Orthopedics Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - S Qureshi
- Associate Attending Orthopedic Surgeon Hospital for Special Surgery, 535 East 70 St., New York, NY, 10021, USA;; Associate Professor of Orthopedic Surgery Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
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Safaee MM, Tenorio A, Osorio JA, Choy W, Amara D, Lai L, Molinaro AM, Zhang Y, Hu SS, Tay B, Burch S, Berven SH, Deviren V, Dhall SS, Chou D, Mummaneni PV, Eichler CM, Ames CP, Clark AJ. The impact of obesity on perioperative complications in patients undergoing anterior lumbar interbody fusion. J Neurosurg Spine 2020; 33:332-341. [PMID: 32330881 DOI: 10.3171/2020.2.spine191418] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior approaches to the lumbar spine provide wide exposure that facilitates placement of large grafts with high fusion rates. There are limited data on the effects of obesity on perioperative complications. METHODS Data from consecutive patients undergoing anterior lumbar interbody fusion (ALIF) from 2007 to 2016 at a single academic center were analyzed. The primary outcome was any perioperative complication. Complications were divided into those occurring intraoperatively and those occurring postoperatively. Multivariate logistic regression was used to assess the association of obesity and other variables with these complications. An estimation table was used to identify a body mass index (BMI) threshold associated with increased risk of postoperative complication. RESULTS A total of 938 patients were identified, and the mean age was 57 years; 511 were females (54.5%). The mean BMI was 28.7 kg/m2, with 354 (37.7%) patients classified as obese (BMI ≥ 30 kg/m2). Forty patients (4.3%) underwent a lateral transthoracic approach, while the remaining 898 (95.7%) underwent a transabdominal retroperitoneal approach. Among patients undergoing transabdominal retroperitoneal ALIF, complication rates were higher for obese patients than for nonobese patients (37.0% vs 28.7%, p = 0.010), a difference that was driven primarily by postoperative complications (36.1% vs 26.0%, p = 0.001) rather than intraoperative complications (3.2% vs 4.3%, p = 0.416). Obese patients had higher rates of ileus (11.7% vs 7.2%, p = 0.020), wound complications (11.4% vs 3.4%, p < 0.001), and urinary tract infections (UTI) (5.0% vs 2.5%, p = 0.049). In a multivariate model, age, obesity, and number of ALIF levels fused were associated with an increased risk of postoperative complication. An estimation table including 19 candidate cut-points, odds ratios, and adjusted p values found a BMI ≥ 31 kg/m2 to have the highest association with postoperative complication (p = 0.012). CONCLUSIONS Obesity is associated with increased postoperative complications in ALIF, including ileus, wound complications, and UTI. ALIF is a safe and effective procedure. However, patients with a BMI ≥ 31 kg/m2 should be counseled on their increased risks and warrant careful preoperative medical optimization and close monitoring in the postoperative setting.
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Affiliation(s)
- Michael M Safaee
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Alexander Tenorio
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Joseph A Osorio
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Winward Choy
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Dominic Amara
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Lillian Lai
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Annette M Molinaro
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Yalan Zhang
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Serena S Hu
- 2Department of Orthopedic Surgery, Stanford University, Palo Alto; and
| | - Bobby Tay
- Departments of3Orthopedic Surgery and
| | | | | | | | - Sanjay S Dhall
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Charles M Eichler
- 4Vascular Surgery, University of California, San Francisco, California
| | - Christopher P Ames
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Aaron J Clark
- 1Department of Neurological Surgery, University of California, San Francisco
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Grgurevic L, Erjavec I, Gupta M, Pecin M, Bordukalo-Niksic T, Stokovic N, Vnuk D, Farkas V, Capak H, Milosevic M, Bubic Spoljar J, Peric M, Vuckovic M, Maticic D, Windhager R, Oppermann H, Sampath TK, Vukicevic S. Autologous blood coagulum containing rhBMP6 induces new bone formation to promote anterior lumbar interbody fusion (ALIF) and posterolateral lumbar fusion (PLF) of spine in sheep. Bone 2020; 138:115448. [PMID: 32450340 DOI: 10.1016/j.bone.2020.115448] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
In the present study, we evaluated an autologous bone graft substitute (ABGS) composed of recombinant human BMP6 (rhBMP6) dispersed within autologous blood coagulum (ABC) used as a physiological carrier for new bone formation in spine fusion sheep models. The application of ABGS included cervical cage for use in the anterior lumbar interbody fusion (ALIF), while for the posterolateral lumbar fusion (PLF) sheep model allograft devitalized bone particles (ALLO) were applied with and without use of instrumentation. In the ALIF model, ABGS (rhBMP6/ABC/cage) implants fused significantly when placed in between the L4-L5 vertebrae as compared to control (ABC/cage) which appears to have a fibrocartilaginous gap, as examined by histology and micro CT analysis at 16 weeks following surgery. In the PLF model, ABGS implants with or without ALLO showed a complete fusion when placed ectopically in the gutter bilaterally between two decorticated L4-L5 transverse processes at a success rate of 88% without instrumentation and at 80% with instrumentation; however the bone volume was 50% lower in the instrumentation group than without, as examined by histology, radiographs, micro CT analyses and biomechanical testing at 27 weeks following surgery. The newly formed bone was uniform within ABGS implants resulting in a biomechanically competent and histologically qualified fusion with an optimum dose in the range of 100 μg rhBMP6 per mL ABC, while in the implants that contained ALLO, the mineralized bone particles were substituted by the newly formed remodeling bone via creeping substitution. These findings demonstrate for the first time that ABGS (rhBMP6/ABC) without and with ALLO particles induced a robust bone formation with a successful fusion in sheep models of ALIF and PLF, and that autologous blood coagulum (ABC) can serve as a preferred physiological native carrier to induce new bone at low doses of rhBMP6 and to achieve a successful spinal fusion.
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Affiliation(s)
- Lovorka Grgurevic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Igor Erjavec
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Munish Gupta
- Department of Orthopedic Surgery, Washington University, St. Louis, MO 63110, USA
| | - Marko Pecin
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Tatjana Bordukalo-Niksic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Nikola Stokovic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Drazen Vnuk
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Vladimir Farkas
- Division of Molecular Biology, Rudjer Boskovic Institute, 10000 Zagreb, Croatia
| | - Hrvoje Capak
- Department of Radiology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Milan Milosevic
- Department of Environmental and Occupational Health and Sports, School of Public Health "Andrija Stampar", University of Zagreb School of Medicine, Rockefellerova 4, 10000 Zagreb, Croatia
| | - Jadranka Bubic Spoljar
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Mihaela Peric
- Center for Translational and Clinical Research, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Mirta Vuckovic
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Drazen Maticic
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | | | | | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia.
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Ye YP, Hu JW, Zhang YG, Xu H. Impact of lumbar interbody fusion surgery on postoperative outcomes in patients with recurrent lumbar disc herniation: Analysis of the US national inpatient sample. J Clin Neurosci 2019; 70:20-26. [PMID: 31630917 DOI: 10.1016/j.jocn.2019.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/05/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
Little information is available on associations between different lumbar interbody fusion (LIF) surgeries and postoperative outcomes. The present study aims to comprehensively investigate whether different LIF techniques are associated with postoperative outcomes such as complications and length of hospital stay. The United States Nationwide Inpatient Sample (NIS) was searched for patients diagnosed with recurrent lumbar disc herniation who underwent lumbar interbody fusion (LIF) surgeries between 2005 and 2014. Patients were categorized based on LIF approaches: anterior lumbar interbody fusion (ALIF); lateral lumbar interbody fusion (LLIF); or posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF). A total of 2625 patients were included in this study. After adjusting for age, severity of illness, and comorbidities, patients who received LLIF and PLIF/TLIF approaches had significantly shorter hospital stays than those receiving ALIF (LLIF vs. ALIF, β = -0.64; PLIF/TLIF vs. ALIF, β = -0.40). In addition, patients who received LLIF and PLIF/TLIF approaches had significantly lower risk of digestive system complications compared to those receiving ALIF (LLIF vs. ALIF, aOR = 0.25; PLIF/TLIF vs. ALIF, aOR = 0.18). In conclusion, in patients with recurrent lumbar disc herniation, LLIF and PLIF/TLIF approaches are associated with shorter hospital stays and lower risk of digestive system complications than ALIF. However, LIF approaches do not correlate significantly with the risk of postoperative bleeding or nervous system complications.
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Affiliation(s)
- Yong-Ping Ye
- Department of Orthopaedics, 900 Hospital of the Joint Logistics Team, Fuzhou 350025, Fujian, China.
| | - Jian-Wei Hu
- Department of Orthopaedics, 900 Hospital of the Joint Logistics Team, Fuzhou 350025, Fujian, China
| | - Yong-Guang Zhang
- Department of Orthopaedics, 900 Hospital of the Joint Logistics Team, Fuzhou 350025, Fujian, China
| | - Hao Xu
- Department of Orthopaedics, 900 Hospital of the Joint Logistics Team, Fuzhou 350025, Fujian, China
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Choy WJ, Phan K, Diwan AD, Ong CS, Mobbs RJ. Annular closure device for disc herniation: meta-analysis of clinical outcome and complications. BMC Musculoskelet Disord 2018; 19:290. [PMID: 30115053 PMCID: PMC6097319 DOI: 10.1186/s12891-018-2213-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Background Lumbar intervertebral disc herniation is a common cause of lower back and leg pain, with surgical intervention (e.g. discectomy to remove the herniated disc) recommended after an appropriate period of conservative management, however the existing or increased breach of the annulus fibrosus persists with the potential of reherniation. Several prosthesis and techniques to reduce re-herniation have been proposed including implantation of an annular closure device (ACD) – Barricaid™ and an annular tissue repair system (AR) – Anulex-Xclose™. The aim of this meta-analysis is to assist surgeons determine a potential approach to reduce incidences of recurrent lumbar disc herniation and assess the current devices regarding their outcomes and complications. Methods Four electronic full-text databases were systematically searched through September 2017. Data including outcomes of annular closure device/annular repair were extracted. All results were pooled utilising meta-analysis with weighted mean difference and odds ratio as summary statistics. Results Four studies met inclusion criteria. Three studies reported the use of Barricaid (ACD) while one study reported the use of Anulex (AR). A total of 24 symptomatic reherniation were reported among 811 discectomies with ACD/AR as compared to 51 out of 645 in the control group (OR: 0.34; 95% CI: 0.20,0.56; I2 = 0%; P < 0.0001). Durotomies were lower among the ACD/AR patients with only 3 reported cases compared to 7 in the control group (OR: 0.54; 95% CI: 0.13, 2.23; I2 = 11%; P = 0.39). Similar outcomes for post-operative Oswestry Disability Index and visual analogue scale were obtained when both groups were compared. Conclusion Early results showed the use of Barricaid and Anulex devices are beneficial for short term outcomes demonstrating reduction in symptomatic disc reherniation with low post-operative complication rates. Long-term studies are required to further investigate the efficacy of such devices.
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Affiliation(s)
- Wen Jie Choy
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia
| | - Kevin Phan
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.,Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | - Ashish D Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George & Sutherland Clinical School, University of New South Wales, Kogarah, 2217, New South Wales, Australia
| | - Chon Sum Ong
- Newcastle University Medicine Malaysia (NUMed), Johor, Malaysia
| | - Ralph J Mobbs
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia. .,NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia. .,Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
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