Axial lumbar interbody fusion: a 6-year single-center experience

Comparative analysis of surgical methods for the treatment of grade I and II spondylolisthesis of the L5 vertebra

Objective. To analyze clinical and radiological results of surgical treatment of patients with isthmic spondylolisthesis of the L5 vertebra using anterior axial fusion and transpedicular stabilization with interbody fusion performed through the posterior approach.

Material and Methods. The study involved 71 patients with isthmic grade I and II spondylolisthesis of the L5 vertebra. The patients were divided into two groups: the study group included 25 patients, and the control group – 46. All patients of the study group underwent presacral axial fusion. Patients in the control group underwent transpedicular stabilization combined with TLIF. The results of surgical treatment of patients were assessed using the MacNab scale, the ODI questionnaire and the VAS scale, and the severity of neurological disorders was assessed using the Francel scale.

Results. The duration of surgical intervention in the study group averaged 67 ± 23 min, and in the control group – 135 ± 45 min. The length of hospital stay in the study group was 3 ± 1 days, and in the control group – 5 ± 2 days. Good results were obtained in all cases. In the postoperative period, the average indicators of pain syndrome in the study group after 14 days were 2.0 ± 1.0 points, after 1 month – 1.0 ± 0.7 points and after 1 year – 0.5 ± 0.5 points, and in the control group 2.5 ± 0.5 points, 2 ± 1 points and 0.5 ± 0.3 points, respectively. The average indicators of the general condition in the study group according to the ODI after 14 days was 32.3 ± 8.1 %, after 1 month – 8.1 ± 4.4 % and after 1 year – 4.3 ± 1.8 %, and in the control group 30.2 ± 5.2 %, 6.3 ± 2.2 % and 2.1 ± 1.9 %, respectively. When assessing the duration of the surgical intervention, it turned out that performing presacral axial fusion reduced the duration of the operation by 2 times, and the length of the hospital stay – by 1.5 times.

Conclusion. The results of surgical treatment of patients with grade I and II isthmic spondylolisthesis without sagittal imbalance using transpedicular fixation combined with TLIF and those using presacral axial fusion are comparable. However, due to reducing intraoperative trauma, the method of presacral axial fusion allows to reduce the surgery duration and the length of hospital stay.

Paracoccygeal Transsacral Approach: A Rare Approach for Axial Lumbosacral Interbody Fusion

Lumbosacral interbody fusion is a mainstay of surgical treatment for degenerative spinal pathologies causing chronic pain and functional impairment. However, the optimal technique for this procedure remains controversial. Well-established open approaches, including anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF), have historically been the standard of practice. A recent paradigm shift in spinal surgery has led to the investigation of minimally invasive approaches to mitigate tissue damage without compromising outcomes. This extensive review aims to examine current clinical and biomechanical evidence on the paracoccygeal transsacral approach to an axial lumbosacral interbody fusion. Since this technique was first described in 2004, accumulating evidence suggests it results in high fusion rates, consistent improvements in pain and function, reduced perioperative morbidity, and low rates of complication. Although early clinical outcomes have been promising, there is a paucity of comparative data investigating outcomes of the paracoccygeal transsacral approach to traditional alternatives and other minimally invasive techniques. Here, we summarize current evidence and discuss pertinent topics for the spinal surgeon considering this novel approach, including indications, advantages, relevant anatomy, contraindications, and technical considerations.

Validation of Pre-operative Templating for Total Disc Replacement Surgery

Objectives

This was an analytic retrospective observational study. The aims were (1) to validate patient-specific templating process by comparing postoperative range of motion (ROM) with that predicted by the model, (2) to retrospectively determine the ideal implant size, height, configuration, and location to evaluate if the ROM achieved could have been improved, and (3) to correlate postoperative ROM and clinical outcome.

Background

Previous research revealed that after total disc replacement surgery, 34% of patients with less than 5° of postoperative ROM developed adjacent segment disease. The match between patient anatomy (size, facet orientation, disc height) and implant parameters are likely to affect postoperative ROM and clinical outcomes.

Methods

Seventeen consecutive patients were implanted with 22 ProDisc-L devices between 2008 and 2015. Three-dimensional finite element (FE) models of the implanted segment were constructed from preoperative computed tomography scans and virtually implanted with the ProDisc-L implant. ROM was determined with the endpoints of facet impingement in flexion and implant contact in extension. FE templating was used to determine the optimal implant size and location. ROM was then measured directly from flexion and extension radiographs and compared to predicted ROM. Pre and postoperative Oswestry Disability Index (ODI) data were used to correlate ROM with clinical outcomes.

Results

No significant difference was found between the actual and predicted ROM. The computational templating procedure identified an optimal ROM that was significantly greater than actual ROM. The ROM in our cohort could have been improved by an average of 1.2° or 12% had a different implant size or position been used.

Conclusions

FE analyses accurately predicted ROM in this cohort and can facilitate selection of the optimal implant size and location that we believe will increase the chance of achieving clinical success with the application of this technology.

A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques

BACKGROUND

Chronic low back pain is a common health problem for adult workers and causes an enormous economic burden. With the improvement of minimally invasive surgical techniques (MIS) in spinal fusion and the development of fusion devices, more lumbar operations are today being performed through a less invasive technique. When compared with open surgeries (OS), MIS has demonstrated better clinical outcomes including operation time, blood loss, complication rates and length of hospital stay. The aim of this review was to identify and summarize evidence on the time to return to work and the duration of post-operation narcotic use for patients who had lumbar spinal fusion operations using MIS and OS techniques.

METHODS

A systematic literature review was performed including studies identified from PubMed, EMBASE, the Cochrane Collaboration, and the Centre for Review and Dissemination (CRD) (January 2004–April 2014) for publications reporting on time to return to work and post-operation narcotic use after MIS or OS lumbar spinal fusion surgeries.

RESULTS

Out of a total of 36 included studies, 28 reported on the time to return to work and 17 on the narcotic use after MIS or OS. Four studies described the time to return to work directly comparing MIS and OS. Three studies, from the US, directly compared the duration of narcotic use between MIS- transforaminal lumbar interbody fusion (TLIF) and OS-TLIF. In addition to the time to return to work, 23 studies reported on the rate of return to work and the employment rate before and after surgery, and two Swedish studies presented sick leave data.

CONCLUSION

There is a gap of good quality data describing the time to return to work and narcotic use after lumbar spinal fusion operations using MIS or OS techniques. However, the current systematic literature review indicates that patients who have lumbar spinal fusion operations, with the MIS procedure, generally return to work after surgery more quickly and require less post-operation narcotics for pain control compared to patients who have OS.

Minimally invasive transaxial lumbosacral interbody fusion: a ten year single-centre experience

PURPOSE

Our aim was to evaluate mid- and long-term results in a cohort of patients who underwent minimally invasive transaxial lumbosacral fixation and to identify clinical and other parameters that can aid in proper patient selection.

METHODS

Over a period of ten years, we assessed 164 patients who had a complete follow-up of a minimum of one year (average 54 months). On follow-up, we recorded clinical status, fusion status, visual analogue scale (VAS), Oswestry Lower Back Pain Disability Index (ODI) scores and patient satisfaction.

RESULTS

There were no intra- or peri-operative complications. Overall clinical success rate was 73.8 %. Only sex (female), working status (still working), body mass index (BMI) (lower) and presence of Modic II changes (absent) were correlated with a good result.

CONCLUSIONS

Transaxial fixation is a safe, minimally invasive technique that can offer good results in patients with single-level degenerative disc disease (DDD) at the lumbosacral level, with minimal operative risk.