1
|
Calek AK, Cornaz F, Suter M, Fasser MR, Farshad M, Widmer J. Endplate weakening during cage bed preparation significantly reduces endplate load capacity. 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/s00586-024-08289-4. [PMID: 38733400 DOI: 10.1007/s00586-024-08289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE To analyze the effect of endplate weakness prior to PLIF or TLIF cage implantation and compare it to the opposite intact endplate of the same vertebral body. In addition, the influence of bone quality on endplate resistance was investigated. METHODS Twenty-two human lumbar vertebrae were tested in a ramp-to-failure test. One endplate of each vertebral body was tested intact and the other after weakening with a rasp (over an area of 200 mm2). Either a TLIF or PLIF cage was then placed and the compression load was applied across the cage until failure of the endplate. Failure was defined as the first local maximum of the force measurement. Bone quality was assessed by determining the Hounsfield units (HU) on CT images. RESULTS With an intact endplate and a TLIF cage, the median force to failure was 1276.3N (693.1-1980.6N). Endplate weakening reduced axial endplate resistance to failure by 15% (0-23%). With an intact endplate and a PLIF cage, the median force to failure was 1057.2N (701.2-1735.5N). Endplate weakening reduced axial endplate resistance to failure by 36.6% (7-47.9%). Bone quality correlated linearly with the force at which endplate failure occurred. Intact and weakened endplates showed a strong positive correlation: intact-TLIF: r = 0.964, slope of the regression line (slope) = 11.8, p < 0.001; intact-PLIF: r = 0.909, slope = 11.2, p = 5.5E-05; weakened-TLIF: r = 0.973, slope = 12.5, p < 0.001; weakened-PLIF: r = 0.836, slope = 6, p = 0.003. CONCLUSION Weakening of the endplate during cage bed preparation significantly reduces the resistance of the endplate to subsidence to failure: endplate load capacity is reduced by 15% with TLIF and 37% with PLIF. Bone quality correlates with the force at which endplate failure occurs.
Collapse
Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Mauro Suter
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Calek AK, Cornaz F, Suter M, Fasser MR, Baumgartner S, Sager P, Farshad M, Widmer J. Load distribution on intervertebral cages with and without posterior instrumentation. Spine J 2024; 24:889-898. [PMID: 37924848 DOI: 10.1016/j.spinee.2023.10.017] [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: 05/10/2023] [Revised: 09/18/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND CONTEXT Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) are well-established procedures for spinal fusion. However, little is known about load sharing between cage, dorsal construct, and biological tissue within the instrumented lumbar spine. PURPOSE The aim of this study was to quantify the forces acting on cages under axial compression force with and without posterior instrumentation. STUDY DESIGN Biomechanical cadaveric study. METHODS Ten lumbar spinal segments were tested under uniaxial compression using load cell instrumented intervertebral cages. The force was increased in 100N increments to 1000N or a force greater than 500N on one load cell. Each specimen was tested after unilateral PLIF (uPLIF), bilateral PLIF (bPLIF) and TLIF each with/without posterior instrumentation. Dorsal instrumentation was performed with 55N of compression per side. RESULTS Cage insertion resulted in median cage preloads of 16N, 29N and 35N for uPLIF, bPLIF, and TLIF. The addition of compressed dorsal instrumentation increased the median preload to 224N, 328N, and 317N, respectively. With posterior instrumentation, the percentage of the external load acting on the intervertebral cage was less than 25% at 100N (uPLIF: 14.2%; bPLIF: 16%; TLIF: 11%), less than 45% at 500N (uPLIF: 31.8%; bPLIF: 41.1%; TLIF: 37.9%) and less than 50% at 1000N (uPLIF: 40.3%; bPLIF: 49.7%; TLIF: 43.4%). Without posterior instrumentation, the percentage of external load on the cages was significantly higher with values above 50% at 100N (uPLIF: 55.6%; bPLIF: 75.5%; TLIF: 66.8%), 500N (uPLIF: 71.7%; bPLIF: 79.2%; TLIF: 65.4%), and 1000N external load (uPLIF: 73%; bPLIF: 80.5%; TLIF: 66.1%). For absolute loads, preloads and external loads must be added together. CONCLUSIONS Without posterior instrumentation, the intervertebral cages absorb more than 50% of the axial load and the load distribution is largely independent of the loading amplitude. With posterior instrumentation, the external load acting on the cages is significantly lower and the load distribution becomes load amplitude dependent, with a higher proportion of the load transferred by the cages at high loads. The bPLIF cages tend to absorb more force than the other two cage configurations. CLINICAL SIGNIFICANCE Cage instrumentation allows some of the compression force to be transmitted through the cage to the screws below, better distributing and reducing the overall force on the pedicle screws at the end of the construct and on the rods.
Collapse
Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich CH-8008, Switzerland.
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich CH-8008, Switzerland
| | - Mauro Suter
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sina Baumgartner
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Sager
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich CH-8008, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
3
|
Limthongkul W, Thanapura C, Jitpakdee K, Praisarnti P, Kotheeranurak V, Yingsakmongkol W, Tanasansomboon T, Singhatanadgige W. Is Direct Decompression Necessary for Lateral Lumbar Interbody Fusion (LLIF)? A Randomized Controlled Trial Comparing Direct and Indirect Decompression With LLIF in Selected Patients. Neurospine 2024; 21:342-351. [PMID: 38569646 PMCID: PMC10992655 DOI: 10.14245/ns.2346906.453] [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: 08/26/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To compare the clinical and radiographic outcomes following lateral lumbar interbody fusion (LLIF) between direct and indirect decompression in the treatment of patients with degenerative lumbar diseases. METHODS Patients who underwent single-level LLIF were randomized into 2 groups: direct decompression (group D) and indirect decompression (group I). Clinical outcomes including the Oswestry Disability index and visual analogue scale of back and leg pain were collected. Radiographic outcomes including cross-sectional area (CSA) of thecal sac, disc height, foraminal height, foraminal area, fusion rate, segmental, and lumbar lordosis were measured. RESULTS Twenty-eight patients who met the inclusion criteria were eligible for the analysis, with a distribution of 14 subjects in each group. The average age was 66.1 years. Postoperatively, significant improvements were observed in all clinical parameters. However, these improvements did not show significant difference between both groups at all follow-up periods. All radiographic outcomes were not different between both groups, except for the increase in CSA which was significantly greater in group D (77.73 ± 20.26 mm2 vs. 54.32 ± 35.70 mm2, p = 0.042). Group I demonstrated significantly lower blood loss (68.13 ± 32.06 mL vs. 210.00 ± 110.05 mL, p < 0.005), as well as shorter operative time (136.35 ± 28.07 minutes vs. 182.18 ± 42.67 minutes, p = 0.002). Overall complication rate was not different. CONCLUSION Indirect decompression through LLIF results in comparable clinical improvement to LLIF with additional direct decompression over 1-year follow-up period. These findings suggest that, for an appropriate candidate, direct decompression in LLIF might not be necessary since the ligamentotaxis effect achieved through indirect decompression appears sufficient to relieve symptoms while diminishing blood loss and operative time.
Collapse
Affiliation(s)
- Worawat Limthongkul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Chayapong Thanapura
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Sriracha, Chonburi, Thailand
| | - Pakawas Praisarnti
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Vit Kotheeranurak
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Sriracha, Chonburi, Thailand
| | - Wicharn Yingsakmongkol
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Teerachat Tanasansomboon
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Weerasak Singhatanadgige
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
4
|
Nayak R, Razzouk J, Ramos O, Mehta S, Harianja G, Wycliffe N, Danisa O, Cheng W. Oblique lateral interbody fusion at L5-S1: feasibility, surgical approach window, incision line, and influencing factors. 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/s00586-023-08017-4. [PMID: 38409532 DOI: 10.1007/s00586-023-08017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 10/20/2023] [Indexed: 02/28/2024]
Abstract
PURPOSE The primary aim of this study was to describe the feasibility, surgical approach window (SAW), and incision line (IL) for oblique lateral interbody fusion at L5-S1 (OLIF51) using computed tomography (CT). A secondary aim was to identify associations among approach characteristics and demographic and anthropometric factors. METHODS We performed a radiographic study of 50 male and 50 female subjects who received abdominal CT imaging. SAW was measured as the distance from the midline to the medial border of the iliac vessel. IL was measured at the skin surface corresponding to the distance between the center of the disc space and SAW lateral margin. OLIF51 feasibility was defined as the existence of at least a 1-cm SAW without retraction of soft tissues. RESULTS For the left side, the OLIF51 SAW and IL were 12.1 ± 4.6 and 175.1 ± 55.3 mm. For the right side, these measures were 10.0 ± 4.3 and 185.0 ± 52.5 mm. Correlations of r = 0.648 (p < 0.001) and r = 0.656 (p < 0.001) were observed between weight and IL on the left and right sides, respectively. OLIF51 was not feasible 23% of the time. CONCLUSION To our knowledge, this is the largest CT study to determine the feasibility of performing an OLIF51. Without the use of retraction, OLIF51 is not feasible 23% of the time. Left-sided OLIF51 allows for a larger surgical approach window and smaller incision compared to the right side. Larger incisions are required for adequate surgical exposure in patients with higher weight.
Collapse
Affiliation(s)
- Rusheel Nayak
- Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Jacob Razzouk
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Omar Ramos
- Twin Cities Spine Center, Minneapolis, MN, USA
| | - Shaurya Mehta
- University of California Riverside, Riverside, CA, USA
| | - Gideon Harianja
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Nathaniel Wycliffe
- Department of Radiology, Loma Linda University Health, Loma Linda, CA, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis VA Medical Center, 25805 Barton Road A106, Loma Linda, CA, 92354, USA.
| |
Collapse
|
5
|
Kotani Y, Ikeura A, Tanaka T, Saito T. Clinical and Radiologic Analysis of Minimally Invasive Anterior-Posterior Combined Surgery for Adult Spinal Deformity: Comparison of Oblique Lateral Interbody Fusion at L5/S1 (OLIF51) versus Transforaminal Interbody Fusion. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:107. [PMID: 38256368 PMCID: PMC10820572 DOI: 10.3390/medicina60010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Although adult spinal deformity (ASD) surgery brought about improvement in the quality of life of patients, it is accompanied by high invasiveness and several complications. Specifically, mechanical complications of rod fracture, instrumentation failures, and pseudarthrosis are still unsolved issues. To better improve these problems, oblique lateral interbody fusion at L5/S1 (OLIF51) was introduced in 2015 at my institution. The objective of this study was to compare the clinical and radiologic outcomes of anterior-posterior combined surgery for ASD between the use of OLIF51 and transforaminal interbody fusion (TLIF) at L5/S1. Materials and Methods: A total of 117 ASD patients received anterior-posterior correction surgeries either with the use of OLIF51 (35 patients) or L5/S1 TLIF (82 patients). In both groups, L1-5 OLIF and minimally invasive posterior procedures of hybrid or circumferential MIS were employed. The sagittal and coronal spinal alignment and spino-pelvic parameters were recorded preoperatively and at follow-up. The quality-of-life parameters and visual analogue scale were evaluated, as well as surgical complications at follow-up. Results: The average follow-up period was thirty months (13-84). The number of average fused segments was eight (4-12). The operation time and estimated blood loss were significantly lower in OLIF51 than in TLIF. The PI-LL mismatch, LLL, L5/S1 segmental lordosis, and L5 coronal tilt were significantly better in OLIF51 than TLIF. The complication rate was statistically equivalent between the two groups. Conclusions: The introduction of OLIF51 for adult spine deformity surgery led to a decrease in operation time and estimated blood loss, as well as improvement in sagittal and coronal correction compared to TLIF. The circumferential MIS correction and fusion with OLIF51 serve as an effective surgical modality which can be applied to many cases of adult spinal deformity.
Collapse
Affiliation(s)
- Yoshihisa Kotani
- Spine and Nerve Center, Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka 570-8507, Japan; (A.I.); (T.T.)
| | - Atsushi Ikeura
- Spine and Nerve Center, Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka 570-8507, Japan; (A.I.); (T.T.)
| | - Takahiro Tanaka
- Spine and Nerve Center, Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka 570-8507, Japan; (A.I.); (T.T.)
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka 573-1191, Japan;
| |
Collapse
|
6
|
Li W, Wei H, Zhang R. Different lumbar fusion techniques for lumbar spinal stenosis: a Bayesian network meta-analysis. BMC Surg 2023; 23:345. [PMID: 37968633 PMCID: PMC10652640 DOI: 10.1186/s12893-023-02242-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: 05/25/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE To comprehensively compare and assess the effects of different lumbar fusion techniques in patients with lumbar spinal stenosis (LSS). METHODS PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched up to December 24, 2022 in this network meta-analysis. Outcomes were pain (pain, low back pain, and leg pain), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), complications, reoperation, and fusion. Network plots illustrated the direct and indirect comparisons of different fusion techniques for the outcomes. League tables showed the comparisons of any two fusion techniques, based on both direct and indirect evidence. The efficacy of each fusion technique for LSS was ranked by rank probabilities. RESULTS Totally 29 studies involving 2,379 patients were eligible. For pain, percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) was most likely to be the best technique, followed by minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), extreme lateral interbody fusion (XLIF), and transforaminal lumbar interbody fusion (TLIF). Percutaneous endoscopic posterior lumbar interbody fusion (Endo-PLIF) had the greatest likelihood to be the optimal technique for low back pain, followed sequentially by MIS-TLIF, minimally invasive posterior lumbar interbody fusion (MIS-PLIF), XLIF, Endo-TLIF, TLIF, oblique lumbar interbody fusion (OLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF). MIS-PLIF was ranked the most effective technique concerning leg pain, followed by Endo-TLIF, MIS-TLIF, TLIF, Endo-PLIF, PLIF, OLIF, PLF, and XLIF. As regards JOA scores, Endo-TLIF had the maximum probability to be the best technique, followed by MIS-TLIF and TLIF. Endo-PLIF had the greatest likelihood to be the optimum technique for complications, followed by TLIF, MIS-TLIF, Endo-TLIF, OLIF, and XLIF. CONCLUSION Minimally invasive fusion techniques may be effective in the treatment of LSS, compared with traditional techniques. Minimally invasive techniques were likely non-inferior with regards to postoperative complications.
Collapse
Affiliation(s)
- Wei Li
- Department of Pain Treatment, Shunyi District Hospital of Beijing, Beijing, 101300, China.
| | - Haibin Wei
- Department of Pain Treatment, Shunyi District Hospital of Beijing, Beijing, 101300, China
| | - Ran Zhang
- Department of Pain Treatment, Shunyi District Hospital of Beijing, Beijing, 101300, China
| |
Collapse
|
7
|
Li XY, Wang YL, Yang S, Liao CS, Li SF, Han PY, Han PF. Efficacy of oblique lumbar interbody fusion versus transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:5657-5670. [PMID: 37079105 PMCID: PMC10449690 DOI: 10.1007/s00402-023-04880-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This meta-analysis aimed to compare the differences in postoperative efficacy between oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases. MATERIALS AND METHODS Strictly based on the search strategy, we searched the published papers on OLIF and TLIF for the treatment of lumbar degenerative diseases in PubMed, Embase, CINAHL, and Cochrane Library. A total of 607 related papers were retrieved, and 15 articles were finally included. The quality of the papers was evaluated according to the Cochrane systematic review methodology, and the data were extracted and meta-analyzed using Review manager 5.4 software. RESULTS Through comparison, it was found that in the treatment of lumbar degenerative diseases, the OLIF group had certain advantages over the TLIF group in terms of intraoperative blood loss, hospital stay, visual analog scale (VAS) for leg pain (VAS-LP), Oswestry disability index (ODI), disc height (DH), foraminal height (FH), fused segmental lordosis (FSL), and cage height, and the differences were statistically significant. The results were similar in terms of surgery time, complications, fusion rate, VAS for back pain (VAS-BP) and various sagittal imaging indicators, and there was no significant difference. CONCLUSIONS OLIF and TLIF can relieve low back pain symptoms in the treatment of lumbar degenerative diseases, but OLIF has certain advantages in terms of ODI and VAS-LP. In addition, OLIF has the advantages of minor intraoperative trauma and quick postoperative recovery.
Collapse
Affiliation(s)
- Xi-Yong Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Yun-Lu Wang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Su Yang
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Chang-Sheng Liao
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Song-Feng Li
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Peng-Yong Han
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China.
| | - Peng-Fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China.
| |
Collapse
|
8
|
Lee HR, Cho JH, Lee DH, Seok SY, Hwang CJ, Lee CS. Risk Factors for the Aggravation of Sagittal Balance After L5-S1 Posterior Lumbar Interbody Fusion. World Neurosurg 2023; 175:e653-e661. [PMID: 37030480 DOI: 10.1016/j.wneu.2023.04.002] [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: 03/25/2023] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To identify the risk factors for the aggravation of sagittal alignment after single-level L5-S1 PLIF. METHODS Eighty-six patients who underwent L5-S1 PLIF were divided into 2 groups according to the postoperative changes in the segmental angle (SA; group I: increase; group D: decrease). The 2 groups were compared in terms of demographic, clinical, and radiological outcomes. Multivariate logistic regression analysis was performed to identify the risk factors for aggravation of sagittal alignment. RESULTS Of the study patients, 39 (45%) were categorized as group I and 47 (55%) as group D. The demographic and clinical parameters were not significantly different between the 2 groups. Group D showed postoperative deteriorations in the local sagittal parameters, including lumbar lordosis (LL; P = 0.034), sacral slope (P = 0.012), and pelvic tilt (P = 0.003). In contrast, group I showed improved LL after surgery (P = 0.021). Large preoperative values of lumbosacral angle (LSA; odds ratio [OR], 1.287; P = 0.001), SA (OR, 1.448; P < 0.001), and flexion LSA (OR, 1.173; P = 0.011) were independent risk factors for the aggravation of sagittal balance. CONCLUSIONS Surgeons treating patients with large preoperative SA, LSA, and flexion LSA at L5-S1 level should be cautious of the possible aggravation of sagittal balance after L5-S1 PLIF and may consider different surgical approaches such as anterior or oblique lumbar interbody fusion.
Collapse
Affiliation(s)
- Hyung Rae Lee
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Uijeongbusi, Gyeonggido, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yun Seok
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeonsi, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
9
|
Tanaka M, Sonawane S, Meena U, Lu Z, Fujiwara Y, Taoka T, Uotani K, Oda Y, Sakaguchi T, Arataki S. Comparison of C-Arm-Free Oblique Lumbar Interbody Fusion L5-S1 (OLIF51) with Transforaminal Lumbar Interbody Fusion L5-S1 (TLIF51) for Adult Spinal Deformity. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050838. [PMID: 37241070 DOI: 10.3390/medicina59050838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Adult spinal deformity (ASD) surgery, L5-S1 lordosis is very important factor. The main objective of the research is to retrospectively compare symptomatic presentation and radiological presentation in the sequelae of oblique lumbar inter-body spinal fusion at L5-S1 (OLIF51) and transforaminal lumbar interbody fusion (TLIF) for ASD. Materials and Methods: We retrospectively evaluated 54 patients who underwent corrective spinal fusion for ASD between October 2019 and January 2021. Thirteen patients underwent OLIF51 (average 74.6 years old, group O) and 41 patients underwent TLIF51 (average 70.5 years old, group T). Mean follow-up period was 23.9 months for group O and 28.9 months for group T, ranging from 12 to 43 months. Clinical and radiographic outcomes are assessed using values including visual analogue scale (VAS) for back pain and Oswestry disability index (ODI). Radiographic evaluation was also collected preoperatively and at 6, 12, and 24 months postoperatively. Results: Surgical time in group O was less than that in group T (356 min vs. 492 min, p = 0.003). However, intraoperative blood loss of both groups were not significantly different (1016 mL vs. 1252 mL, p = 0.274). Changes in VAS and ODI were similar in both groups. L5-S1 angle gain and L5-S1 height gain in group O were significantly better than those of group T (9.4° vs. 1.6°, p = 0.0001, 4.2 mm vs. 0.8 mm, p = 0.0002). Conclusions: Clinical outcomes were not significantly different in both groups, but surgical time in OLIF51 was significantly less than that in TLIF51. The radiographic outcomes showed that OLIF51 created more L5-S1 lordosis and L5-S1 disc height compared with TLIF 51.
Collapse
Affiliation(s)
- Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Sumeet Sonawane
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Umesh Meena
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Zhichao Lu
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Yoshihiro Fujiwara
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Takuya Taoka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Yoshiaki Oda
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Tomoyoshi Sakaguchi
- Department of Rehabilitation, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Shinya Arataki
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| |
Collapse
|
10
|
Gagliardi MJ, Guiroy AJ, Camino-Willhuber G, Joaquim AF, Carazzo CA, Yasuda E, Cabrera JP, Morales Ciancio AR. Is Indirect Decompression and Fusion More Effective than Direct Decompression and Fusion for Treating Degenerative Lumbar Spinal Stenosis With Instability? A Systematic Review and meta-Analysis. Global Spine J 2023; 13:499-511. [PMID: 35486409 PMCID: PMC9972259 DOI: 10.1177/21925682221098362] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study design: Systematic Review and Meta-analysis.Objective: Surgical alternatives to treat lumbar spinal stenosis and instability include indirect (ALIF, OLIF, and LLIF) and direct (TLIF or posterior lumbar interbody fusion) decompression and fusion interventions. Although both approaches have proven to be effective in reducing symptoms, it is unknown if there is any difference in effectiveness between them. In this systematic review and meta-analysis, we aimed to evaluate postoperative pain and disability in patients treated whit indirect vs direct decompression and fusion approaches.Methods: We conducted a systematic review of the literature consulting several databases and identified studies that enrolled patients diagnosed with degenerative lumbar spinal stenosis and instability treated with indirect or direct decompression and fusion techniques. Our primary endpoints were the visual analogue scale, Oswestry Disability Index, and the Japanese Orthopedics Association Back Pain Evaluation Questionnaire 1 year after the procedure. Secondary outcomes included complication rate, blood loss, and surgical time.Results: Nine retrospective and comparative studies were included enrolling a total of 1004 participants. Both surgical strategies had satisfactory clinical outcomes with no significant difference at 1 year. Although the complication rate was similar for both groups, the profile of the adverse events was different. In addition, patients treated with indirect decompression and fusion had significantly less blood loss and operative times.Conclusions: Indirect and direct decompression and fusion techniques are similarly effective in treating patients with lumbar spinal stenosis and instability. The ID group had significantly lower intraoperative blood loss and surgical time values.
Collapse
Affiliation(s)
- Martin J. Gagliardi
- Department of Neurosurgery, St Michael’s Hospital, University of
Toronto, Toronto, ON, Canada,Department of Orthopedics, Hospital Español de
Mendoza, Mendoza, Argentina,Martin J. Gagliardi, M.D, Department of
Neurosurgery, St Michael’s Hospital, University of Toronto, 36 Queen Street,
Toronto, ON M5B 1W8, Canada.
| | - Alfredo J. Guiroy
- Department of Orthopedics, Hospital Español de
Mendoza, Mendoza, Argentina,The Paley Orthopedics and Spine
Institute, Saint Mary’s Medical
Center, West Palm Beach, FL, USA
| | | | - Andrei F. Joaquim
- Department of Neurosurgery, University of Campinas, Campinas, Brazil
| | - Charles A. Carazzo
- Department of Neurosurgery, São
Vicente de Paulo Hospital, University of Passo
Fundo, Passo Fundo, Brazil
| | - Ezequiel Yasuda
- Department of Neurosurgery,
Hospital de Clinicas, University of Buenos
Aires, Buenos Aires, Argentina
| | - Juan P. Cabrera
- Department of Neurosurgery, Hospital Clinico Regional de
Concepción, Concepción, Chile
| | - Alejandro R. Morales Ciancio
- Department of Orthopedics, Hospital Español de
Mendoza, Mendoza, Argentina,Department of Orthopaedics, Great Ormond Street
Hospital, London, UK
| |
Collapse
|
11
|
Lin GX, Xu WB, Kotheeranurak V, Chen CM, Deng ZH, Zhu MT. Comparison of oblique and transforaminal approaches to lumbar interbody fusion for lumbar degenerative disease: An updated meta-analysis. Front Surg 2023; 9:1004870. [PMID: 36726948 PMCID: PMC9885081 DOI: 10.3389/fsurg.2022.1004870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) are widely used in the treatment of lumbar degenerative diseases. A meta-analysis was performed to examine the clinical and radiological effects of these two techniques. Methods A search of relevant literature from several databases was conducted until November 2021. Perioperative outcomes, clinical and radiological results, and complications were analyzed. Results Fifteen qualified studies were included. OLIF showed a shorter operative time and length of hospital stay and less blood loss than TLIF. Early postoperative Visual Analogue Scale for back pain were significantly lower in OLIF than in TLIF (P = 0.004). Noteworthy, although the preoperative Oswestry Disability Index (ODI) of the OLIF group was higher than that of the TLIF group (P = 0.04), the postoperative ODI was significantly lower (P < 0.05). Radiologically, the results showed that the disc and foraminal heights of OLIF were significantly higher than those of TLIF postoperatively. Moreover, OLIF can restore more segmental lordosis than TLIF in the early postoperative period. Furthermore, OLIF showed better fusion rates than TLIF (P = 0.02), with no difference in cage subsidence (13.4% vs. 16.6%). No significant differences in overall and approach-related complications between the two groups. Conclusion The OLIF group showed an advantage in terms of operative time, hospitalization, intraoperative blood loss, early back pain relief, postoperative function recovery, disc and foraminal heights, early segmental lordosis, and fusion rate compared to TLIF. For both procedures, the incidence rates of overall and approach-related complications were comparable.
Collapse
Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wen-Bin Xu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan,Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan,Correspondence: Ming-Tao Zhu Zhi-Hong Deng Chien-Min Chen
| | - Zhi-Hong Deng
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,Correspondence: Ming-Tao Zhu Zhi-Hong Deng Chien-Min Chen
| | - Ming-Tao Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,Correspondence: Ming-Tao Zhu Zhi-Hong Deng Chien-Min Chen
| |
Collapse
|
12
|
Chung HW, Jeon CH, Lee HD, Chung NS. Effectiveness of supplemental screw fixation for the prevention of anterior cage migration in oblique lateral interbody fusion at L5-S1. J Orthop Sci 2022; 27:1172-1176. [PMID: 34364752 DOI: 10.1016/j.jos.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/01/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The anterior cage at L5-S1 segment is more vulnerable to anterior migration because of the sacral slope, the greater disc angle (DA), the higher shear force, and the weaker pedicle screw fixation at S1. We hypothesized that a supplemental screw (SS) fixation is effective for the prevention of anterior cage migration in oblique lateral interbody fusion (OLIF) at L5-S1. METHODS This study involved 61 consecutive patients who underwent OLIF at L5-S1 and had more than 1-year regular follow-up. In the first 35 cases, the anterior cage was fixed with pedicle screws only (non-SS group). In the remaining 26 cases, the anterior cage was fixed with a SS and pedicle screws (SS group). Radiological parameters including anterior disc height (ADH), posterior disc height (PDH), DA, cage migration, cage subsidence, and fusion rate at L5-S1 were compared between the two groups. RESULT Of the total 61 patients, fifteen (24.6%) patients had an anterior cage migration of >2 mm and six (9.8%) patients had an anterior cage migration of >5 mm. Baseline demographic characteristics were similar between the two groups. The mean cage migration was 2.0 ± 3.1 mm in the non-SS group and 0.9 ± 0.9 mm in the SS group (P = 0.038). Thirteen (37.1%) patients had a cage migration of >2 mm in the non-SS group, while only two (7.7%) had a cage migration of >2 mm in the SS group (P = 0.002). There were no significant differences in the ADH, PDH, DA, cage subsidence, and fusion rate between the two groups (all P > 0.05). There was no SS-related complication in the SS group. CONCLUSIONS SS fixation in front of the anterior L5-S1 cage is simple, safe, and effective for the prevention of anterior cage migration in OLIF at L5-S1.
Collapse
Affiliation(s)
- Hee-Woong Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Chang-Hoon Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea.
| |
Collapse
|
13
|
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: 15] [Impact Index Per Article: 7.5] [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
Collapse
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;
| |
Collapse
|
14
|
Wang J, Liu J, Hai Y, Zhang Y, Zhou L. OLIF versus MI-TLIF for patients with degenerative lumbar disease: Is one procedure superior to the other? A systematic review and meta-analysis. Front Surg 2022; 9:1014314. [PMID: 36311941 PMCID: PMC9606620 DOI: 10.3389/fsurg.2022.1014314] [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: 08/08/2022] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To compare the effectiveness and safety of oblique lateral interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative lumbar disease. METHODS We searched relevant studies in Embase, PubMed, Cochrane, and Web of Science databases comprehensively from inception to March 2022. The data were extracted from included studies, including operation indications, radiographic parameters, and clinical outcomes. Random or fixed-effects models were used in all meta-analyses according to the between-study heterogeneity. RESULTS In total, 30 studies, including 2,125 patients, were included in this meta-analysis. Our study found similar disk height, length of hospital stay, visual analog scale (VAS), and Oswestry disability index(ODI) between the two groups. However, the OLIF showed an advantage in restoring lumbar lordotic angle compared with MI-TLIF, with the pooled mean change of 17.73° and 2.61°, respectively. Additionally, the operative time and blood loss in the OLIF group appeared to be less compared with the MI-TLIF group. Regarding complications, the rates of the two groups were similar (OLIF 14.0% vs. MI-TLIF 10.0%), but the major complications that occurred in these two procedures differed significantly. CONCLUSION The results of disk height, length of hospital stay, VAS, and ODI between the OLIF and MI-TLIF groups were similar. And the OLIF was superior in restoring lumbar lordotic angle, operative time, and blood loss. However, the OLIF group's complication rate was higher, although not significantly, than that in the MI-TLIF group.
Collapse
Affiliation(s)
- Jianqiang Wang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jingwei Liu
- Department of Orthopedic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China,Correspondence: Yong Hai Lijin Zhou
| | - Yiqi Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lijin Zhou
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China,Correspondence: Yong Hai Lijin Zhou
| |
Collapse
|
15
|
Abbasi H, Storlie NR, Aya KL. Transfacet Oblique Lateral Lumbar Interbody Fusion: Technical Description and Early Results. Cureus 2022; 14:e26533. [PMID: 35928391 PMCID: PMC9345626 DOI: 10.7759/cureus.26533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2022] [Indexed: 11/05/2022] Open
|
16
|
Chung NS, Lee HD, Chung HW, Jeon CH. Influence of Vascular Anatomy on the Radiologic Outcomes in Oblique Lateral Interbody Fusion at L5-S1. Clin Spine Surg 2022; 35:E36-E40. [PMID: 34224422 DOI: 10.1097/bsd.0000000000001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The objective of this study was to evaluate whether the anatomy of the left common iliac vein (LCIV) affects the radiologic outcomes in oblique lateral interbody fusion (OLIF) at L5-S1. SUMMARY OF BACKGROUND DATA Upward mobilization and retraction of the LCIV is an essential technique in OLIF at L5-S1. However, mobilization of the LCIV is sometimes difficult and may affect the surgical outcomes in OLIF at L5-S1. METHODS This study involved 52 consecutive patients who underwent OLIF at L5-S1 and had >1-year regular follow-up. The configuration of LCIV on preoperative axial magnetic resonance images of the lumbar spine was categorized into 3 types according to the difficulty of mobilization: type I (no requirement for mobilization), type II (potentially easy mobilization), and type III (potentially difficult mobilization). Radiologic parameters included anterior/posterior disk heights (ADH/PDH), disk angle (DA), cage migration, cage subsidence, cage position, and fusion rate at L5-S1. Intraoperative/perioperative events associated with OLIF at L5-S1 were reviewed. Radiologic outcomes among the LCIV types were compared. RESULTS There were 19 men and 33 women with a mean age of 62.8±9.7 years. The mean follow-up duration was 24.8±15.5 months. The LCIV anatomy was type I in 25 (48.1%) patients, type II in 14 (26.9%), and type III in 13 (25.0%). The mean ADH increased from 7.0±4.7 to 16.9±4.1 mm at the last follow-up (P<0.001), and the mean PDH increased from 2.7±1.7 to 4.9±1.6 mm (P<0.001). The mean DA increased from 5.4±5.4 to 16.9±6.5 degrees (P<0.001). There were no significant differences in ADH, PDH, and DA at the last follow-up among the LCIV types. Two (3.8%) major and 2 (3.8%) minor LCIV injuries were identified, all of which had a type III LCIV. CONCLUSIONS OLIF at L5-S1 showed favorable radiologic outcomes regardless of the LCIV anatomy. However, type III LCIV patients had a high rate of intraoperative vascular injury.
Collapse
Affiliation(s)
- Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Geyounggi-do Province, South Korea
| | | | | | | |
Collapse
|
17
|
Jang JS, Ko MJ, Lee YS, Park SW, Wui SH. Importance of Surgical Order for Minimizing Vascular Injury During the L5-S1 Approach in Multilevel Oblique Lateral Interbody Fusion Surgery. Korean J Neurotrauma 2022; 18:287-295. [PMID: 36381430 PMCID: PMC9634293 DOI: 10.13004/kjnt.2022.18.e42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 11/06/2022] Open
Abstract
Objective In oblique lateral interbody fusion (OLIF) surgery at the L5-S1 level (OLIF51), anatomical complexity and the possibility of vascular injury during retraction of the common iliac vein (CIV) make the surgery challenging. We radiologically evaluated patients who underwent OLIF surgery to determine approaches that can make OLIF51 surgery easier during multilevel OLIF. Methods We retrospectively analyzed 275 consecutive patients who underwent OLIF surgery between September 2014 and December 2019. The distance between the left and right CIVs (dCIV) was measured using an axial image at the L5 lower endplate level, and the height of the iliocaval junction (hCIV) was measured from the L5 lower endplate to the iliocaval junction in the sagittal image. The sum of anterior disc height of each level (sADH) was calculated. Results Eighty-two patients (33 males and 49 females) were enrolled. The number of three- (L2-3-4-5), two- (L3-4-5), and one-level (L4-5) fusions was 13, 21, and 48, respectively. Changes between the pre- and postoperative sADH, dCIV, and hCIV values were 17.1±4.7, 7.7±3.5, and 13.1±4.7 mm in three-level fusion; 10.6±4.1, 5.6±3.7, and 7.0±3.1 in two-level fusion; and 4.3±2.5, 3.3±2.7, and 3.0±2.0 mm in one-level fusion, respectively. As the number of surgical levels increased, the changes in sADH, dCIV, and hCIV significantly increased. Conclusions The dCIV and hCIV values increased when the upper segment underwent surgery before OLIF51 during multilevel OLIF.
Collapse
Affiliation(s)
- Ju-Sung Jang
- Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Young-Seok Lee
- Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Seong Hyun Wui
- Department of Neurosurgery, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| |
Collapse
|
18
|
Chung NS, Jeon CH, Lee HD, Chung HW. Factors affecting disc angle restoration in oblique lateral interbody fusion at L5-S1. Spine J 2021; 21:2019-2025. [PMID: 34339888 DOI: 10.1016/j.spinee.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Optimal restoration of the L5-S1 disc angle (DA) is an important surgical goal in spinal reconstructive surgery. Anterior approach is beneficial for L5-S1 DA reconstruction and fusion. However, factors associated with a greater DA restoration in oblique lateral interbody fusion (OLIF) at L5-S1 have not been studied. PURPOSE This study aimed to identify factors that aid in achieving a greater DA in OLIF at L5-S1. STUDY DESIGN/SETTING A retrospective analysis. PATIENT SAMPLE This study involved 61 consecutive patients who underwent OLIF at L5-S1 for lumbar degenerative disease and were followed for more than 1 year. Patients with incomplete data or posterior column osteotomy at L5-S1 were excluded. OUTCOME MEASURES The L5-S1 DA was measured preoperatively, postoperatively, and at the last follow-up on standing lateral lumbar radiographs. The associations between demographics and/or surgical and/or radiological factors and the L5-S1 DA at the last follow-up were analyzed using multiple regression analysis. METHODS Demographics and surgical factors were reviewed from the medical records with respect to age, sex, body mass index, bone mineral density, diagnosis, surgery level, cage parameters (cage lordotic angle and height), laminectomy performed and/or not performed, estimated blood loss, operative time, configuration of the left common iliac vein. Radiological factors were measured with respect to sagittal parameters, the L5-S1 disc parameters, and the postoperative cage parameters. RESULTS The mean preoperative DA at L5-S1 was 5.4±5.0°, which increased to 18.9±5.6° postoperatively (p<.001) and was maintained as 16.5±5.9° at the last follow-up (p<.001). The preoperative DA, end plate lesions, anterior spur, facet joint osteoarthritis, or cage position at L5-S1 did not affect the DA at the last follow-up (all p>.05). Multiple regression analysis showed four independent variables, including increased age, increased cage lordotic angle, laminectomy performed, and absence of cage subsidence as the factors associated with the greater DA at L5-S1. CONCLUSIONS OLIF at L5-S1 showed favorable DA restoration regardless of the preoperative conditions. To achieve a greater DA, surgeons should try to distract the anterior disc space for insertion of a larger lordotic cage. Laminectomy during posterior fixation is recommended for achieving additional DA restoration.
Collapse
Affiliation(s)
- Nam-Su Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chang-Hoon Jeon
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Han-Dong Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hee-Woong Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
| |
Collapse
|
19
|
Tan MWP, Sayampanathan AA, Jiang L, Guo CM. Comparison of Outcomes Between Single-level Lateral Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion: A Meta-analysis and Systematic Review. Clin Spine Surg 2021; 34:395-405. [PMID: 33298799 DOI: 10.1097/bsd.0000000000001107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a meta-analysis and systematic review of the available literature. OBJECTIVE This study aims to compare the clinical and radiologic outcomes of single-level lateral lumbar interbody fusion (LLIF) with single-level transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA In the treatment of adult spinal deformity, LLIF allows interbody fusion while avoiding complications associated with an anterior or transforaminal approach, although the clinical outcomes of LLIF compared with other approaches have not been well established. METHODS We searched PubMed, Embase, and Scopus for 385 unique studies. On the basis of our exclusion criteria, 8 studies remained for our systematic review. Data were analyzed using Review Manager 5.3 using Mantel-Haenszel statistics and random effect models. This study identified self-reported Visual Analog Scale (VAS), Oswestry Disability Index, length of stay, blood loss, complication rate, and radiologic parameters (disk height, lumbar lordosis, segmental lordosis). RESULTS Our meta-analysis showed that LLIF contributed to decreased blood loss [mean difference (MD)=-67.62 mL, 95% confidence interval (CI): -104 to -30.90, P<0.001], superior restoration of segmental lordosis (MD=1.91 degrees, 95% CI: 0.71-3.10, P=0.002), lumbar lordosis (MD=1.95 degrees, 95% CI: 0.15-3.74, P=0.03), and disk height (MD=2.18 mm, 95% CI: 1.18-3.17, P<0.001) when compared with TLIF. However, current data suggests no significant difference in clinical outcomes between LLIF and TLIF based on overall complication rates (P=0.22), length of hospital stay (P=0.65), postoperative Oswestry Disability Index (P=0.13), postoperative VAS Back Pain (P=0.47) and VAS Leg Pain (P=0.16). CONCLUSIONS LLIF is an increasingly popular option for single-level anterior column reconstruction. When compared with single-level TLIF, single-level LLIF is associated with greater changes in lumbar lordosis and disk height. The single-level LLIF is a viable alternative to TLIF, demonstrating comparable clinical outcomes and better restoration of spinopelvic parameters. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Marcus Wei Ping Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | | | | |
Collapse
|
20
|
Zhang QY, Tan J, Huang K, Xie HQ. Minimally invasive transforaminal lumbar interbody fusion versus oblique lateral interbody fusion for lumbar degenerative disease: a meta-analysis. BMC Musculoskelet Disord 2021; 22:802. [PMID: 34537023 PMCID: PMC8449429 DOI: 10.1186/s12891-021-04687-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/12/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lateral interbody fusion (OLIF) are widely used in the treatment of lumbar degenerative diseases. In the present study, a meta-analysis was conducted to compare the clinical and radiographic efficacy of these two procedures. METHODS A systematic literature review was performed, and the quality of retrieved studies was evaluated with the Newcastle-Ottawa Scale (NOS). Clinical outcomes, including operation time, intraoperative blood loss, improvement in Visual Analogue Scale (VAS), improvement in Oswestry Disability Index (ODI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate and complications, in addition to radiographic outcomes, including restoration of disc height, disc angle, overall lumbar lordosis, fusion rate and subsidence, were extracted and input into a fixed or random effect model to compare the efficacy of MIS-TLIF and OLIF. RESULTS Seven qualified studies were included. Clinically, OLIF resulted in less intraoperative blood loss and shorter operation time than MIS-TLIF. Improvement of VAS for leg pain was more obvious in the OLIF group (P < 0.0001), whereas improvement of VAS for back pain (P = 0.08) and ODI (P = 0.98) as well as JOABPEQ effectiveness rate (P = 0.18) were similar in the two groups. Radiographically, OLIF was more effective in restoring disc height (P = 0.01) and equivalent in improving the disc angle (P = 0.18) and lumbar lordosis (P = 0.48) compared with MIS-TLIF. The fusion rate (P = 0.11) was similar in both groups, while the subsidence was more severe in the MIS-TLIF group (P < 0.00001). CONCLUSIONS The above evidence suggests that OLIF is associated with a shorter operation time (with supplementary fixation in the prone position) and less intraoperative blood loss than MIS-TLIF and can lead to better leg pain alleviation, disc height restoration and subsidence resistance. No differences regarding back pain relief, functional recovery, complications, disc angle restoration, lumbar lordosis restoration and fusion rate were found. However, due to the limited number of studies, our results should be confirmed with high-level studies to fully compare the therapeutic efficacy of MIS-TLIF and OLIF. TRIAL REGISTRATION PROSPERO ID: CRD42020201903 .
Collapse
Affiliation(s)
- Qing-Yi Zhang
- Laboratory of Stem Cell and Tissue Engineering, Orthopaedic Research Institute, Department of Orthopaedics, West China Hospital, Sichuan University, Keyuan fourth Road, Gaopeng Avenue, Chengdu, Sichuan, 610041, People's Republic of China
| | - Jie Tan
- Laboratory of Stem Cell and Tissue Engineering, Orthopaedic Research Institute, Department of Orthopaedics, West China Hospital, Sichuan University, Keyuan fourth Road, Gaopeng Avenue, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kai Huang
- Laboratory of Stem Cell and Tissue Engineering, Orthopaedic Research Institute, Department of Orthopaedics, West China Hospital, Sichuan University, Keyuan fourth Road, Gaopeng Avenue, Chengdu, Sichuan, 610041, People's Republic of China
| | - Hui-Qi Xie
- Laboratory of Stem Cell and Tissue Engineering, Orthopaedic Research Institute, Department of Orthopaedics, West China Hospital, Sichuan University, Keyuan fourth Road, Gaopeng Avenue, Chengdu, Sichuan, 610041, People's Republic of China.
| |
Collapse
|
21
|
Pham MH, Hassan O, Diaz-Aguilar LD, Lehman RA. Complications Associated With Oblique Lumbar Interbody Fusion at L5-S1: A Systematic Review of the Literature. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
22
|
Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis. Life (Basel) 2021; 11:life11070696. [PMID: 34357068 PMCID: PMC8305484 DOI: 10.3390/life11070696] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 01/03/2023] Open
Abstract
Preoperative pathology requiring fusion surgery has a great impact on postoperative outcomes. However, the previous clinical and meta-analysis studies did not control for the pathology. In this systematic review, the authors aimed to compare oblique lumbar interbody fusion (OLIF) with transforaminal interbody fusion (TLIF) as an interbody fusion technique in lumbar fusion surgery for patients with degenerative spondylolisthesis (DS). We systematically searched for relevant articles in the available databases. Among the 3022 articles, three studies were identified and met the inclusion criteria. In terms of radiological outcome, the amount of disc height restoration was greater in the OLIF group than in the TLIF group, but there was no significant difference between the two surgical techniques (p = 0.18). In the clinical outcomes, the pain improvement was not significantly different between the two surgical techniques. In terms of surgical outcomes, OLIF resulted in a shorter length of hospital stay and less blood loss than TLIF (p < 0.0001 and p = 0.02, respectively). The present meta-analysis indicated no significant difference in clinical, radiological outcomes, and surgical time between TLIF and OLIF for DS, but the lengths of hospital stay and blood loss were better in OLIF than TLIF. Though encouraging, these findings were based on low-quality evidence from a small number of retrospective studies that are prone to bias.
Collapse
|
23
|
Bodon G, Kiraly K, Baksa G, Barany L, Kiss M, Hirt B, Pussert A, Timothy J, Stubbs L, Khajavi K, Braly B. Applied anatomy and surgical technique of the lateral single-position L5-S1 fusion. Clin Anat 2021; 34:774-784. [PMID: 33909306 DOI: 10.1002/ca.23733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
The latest development in the anterior lumbar interbody fusion (ALIF) procedure is its application in the lateral position to allow for simultaneous posterior percutaneous screw placement. The technical details of the lateral ALIF technique have not yet been described. To describe the surgical anatomy relevant to the lateral ALIF approach we performed a comprehensive anatomical study. In addition, the preoperative imaging, patient positioning, planning of the skin incision, positioning of the C-arm, surgical approach, and surgical technique are discussed in detail. The technique described led to the successful use of the lateral ALIF technique in our clinical cases. No lateral ALIF procedure needed to be aborted during these cases. Our present work gives detailed anatomical background and technical details for the lateral ALIF approach. This teaching article can provide readers with sufficient technical and anatomical knowledge to assist them in performing their first lateral ALIF procedure.
Collapse
Affiliation(s)
- Gergely Bodon
- Department of Orthopaedic Surgery and Traumatology, Klinikum Esslingen, Esslingen am Neckar, Germany.,Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embriology, Semmelweis University, Budapest, Hungary.,Clinical Anatomy Tübingen, University of Tübingen, Tübingen, Germany
| | - Kristof Kiraly
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embriology, Semmelweis University, Budapest, Hungary
| | - Gabor Baksa
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embriology, Semmelweis University, Budapest, Hungary
| | - Laszlo Barany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embriology, Semmelweis University, Budapest, Hungary
| | - Mate Kiss
- Department of Orthopaedic Surgery and Traumatology, Klinikum Esslingen, Esslingen am Neckar, Germany
| | - Bernhard Hirt
- Clinical Anatomy Tübingen, University of Tübingen, Tübingen, Germany
| | - Arndt Pussert
- Department of Orthopaedic Surgery and Traumatology, Klinikum Esslingen, Esslingen am Neckar, Germany
| | - Jake Timothy
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Lenny Stubbs
- Oklahoma Heart Hospital, Oklahoma City, Oklahoma, USA
| | - Kaveh Khajavi
- Georgia Spine & Neurosurgery Center, Atlanta, Georgia, USA
| | - Brett Braly
- The Spine Clinic of Oklahoma City, Oklahoma City, Oklahoma, USA
| |
Collapse
|
24
|
Introducing V-Line as a New Strategy to Choose Surgical Corridor in Oblique Lumbar Interbody Fusion at the L5-S1 Segment. DISEASE MARKERS 2021; 2021:5584372. [PMID: 33968282 PMCID: PMC8084645 DOI: 10.1155/2021/5584372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/21/2022]
Abstract
Purpose A retrospective imaging study assessing the availability of oblique lumbar interbody fusion at the level of L5-S1 (OLIF51) and to choose ideal surgical corridor in OLIF51 by introducing V-line. Methods The axial views through the center of L5-S1 disc were reviewed. We adopt 18 mm as the width of the simulated surgical corridor. The midline of the surgical corridor is at the center of L5-S1 disc. According to the traction distance of the left iliac vein (LCIV) and psoas major (PM), we defined all the subjects as V (+) (traction-difficultly LCIV), V (-) (traction-friendly LCIV), P (+) (traction-difficultly PM), and P (-) (traction-friendly PM). V-line was defined as a straight line dividing equally the simulated surgical corridor. All cases were divided into 2 groups: The V-line (+) group, more than half of the LCIV region, is located in the ventral part of V-line; the V-line (-) group, more than half of the LCIV region, is located in the dorsal part of V-line. Multiple variables regressive analysis was conducted to analyze the independent risk factors of V-line (+). Results V-line (+) was found in 36 (38.7%) patients and V-line (-) in 57 (61.3%). Incidence of V (+) and P (+) was 35.4% (33/93) and 30.1% (28/93), respectively. 16.1% (15/93) subjects processed V (+) and P (+) at the same time. The independent risk factor of V-line (+) were gender of male (P = 0.034, OR: 12.152) and medial position of LCIV (P < 0.001, OR: 265.085). High iliac crest was a significant independent protective factor (P = 0.001, OR: 0.750). Conclusions Most patients were suitable for OLIF51. V-line could assess the injury risk of LCIV. For patients who are V-line (+), mainly among males having the LCIV near the midline or the iliac crest relatively low, a surgical corridor external to the LCIV should be taken into consideration.
Collapse
|