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Chen X, Chen L, Tang J, Chen W, Song Z, Zhou Z, Zhuo H, Tan R, Jiang R, Zhao W, Liang D, Ren H, Shen G, Jiang X. Oblique Lumbar Interbody Fusion Combined with Posterior Percutaneous Pedicle Screw Internal Fixation: Does Variability in Cage Position Influence Clinical Outcomes? World Neurosurg 2024:S1878-8750(24)01176-8. [PMID: 38986951 DOI: 10.1016/j.wneu.2024.07.035] [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: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE The study investigates how cage positions in oblique lumbar interbody fusion (OLIF) combined with posterior percutaneous pedicle screw internal fixation (PPSF) affect lumbar canal and foraminal decompression and postoperative outcomes, providing guidance for optimal placement and efficacy assessment. METHODS This investigation assesses radiologic outcomes and follow-up data in relation to cage position variability among 80 patients who underwent L4/5 single-segment OLIF + PPSF from 2018 to 2022. RESULTS In the study involving 80 participants, the combination of OLIF and PPSF significantly improved lower back and leg symptoms in patients, leading to positive clinical outcomes during follow-up. The intervertebral disk height increased from an average of 8.10 ± 2.79 mm before surgery to 11.75 ± 2.14 mm after surgery (P < 0.001). Additionally, this surgical technique notably increased the FH (P < 0.001) and expanded the DCSA from 68.81 ± 53.89 mmˆ2 before surgery to 102.91 ± 60.46 mmˆ2 after surgery (P < 0.001). Linear results suggest that changes in the position of the cage do not affect spinal imaging parameters. There is no significant difference in the correction of spinal parameters or prognosis whether the cage is back, middle, ahead. CONCLUSIONS In the OLIF + PPSF procedure, strict requirements for cage position are not necessary to achieve predetermined spinal biomechanical parameters. The practice of repeated fluoroscopy to adjust cage position postimplantation does not provide added clinical benefits to the patient.
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Affiliation(s)
- Xingda Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liekun Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingjing Tang
- Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Wanyan Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zefeng Song
- Medical Department Dalian University of Technology, Dalian, China
| | - Zelin Zhou
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hang Zhuo
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Riwei Tan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | | | - Wenhua Zhao
- Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - De Liang
- Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Hui Ren
- Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - Gengyang Shen
- Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - Xiaobing Jiang
- Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China.
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Ogata Y, Kotani T, Sunami T, Okuwaki S, Ohyama S, Iijima Y, Sakashita K, Iwata S, Okuyama K, Sakuma T, Akazawa T, Minami S, Ohtori S, Koda M, Yamazaki M. The Optimal Patient Position on the Surgical Table for Lateral Lumbar Interbody Fusion in Adult Spinal Deformity Using Three-Dimensional Computed Tomography: A Retrospective Study. Spine Surg Relat Res 2024; 8:180-187. [PMID: 38618217 PMCID: PMC11007247 DOI: 10.22603/ssrr.2023-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/30/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Lateral lumbar interbody fusion (LLIF) techniques have been extensively used in adult spinal deformity surgery. Preoperative knowledge of the optimal position of the patient on the surgical table is essential for a safe procedure. Therefore, this study aims to determine the optimal angle for positioning the patient on the surgical table during LLIF using three-dimensional computed tomography (3DCT). Methods Data from 59 patients (2 males, 57 females, mean age 66.3±8.6 years) with adult spinal deformities treated by performing corrective spinal surgery were included in this observational retrospective study. Simulated fluoroscopic images were obtained using 3DCT images rotated from the reference position with the spinous process of S1 as the midline to the position with the spinous process in the center of the bilateral pedicle of T12-L5. The rotation angle of each vertebra was measured and defined as the optimal rotation angle (ORA). The angle that bisected the angle between the maximum and minimum ORA was defined as the optimal mean angle of the maximum and minimum ORA (OMA) and considered the optimal angle for the patient's position on the surgical table, as this position could minimize the rotation angle of the surgical table during surgery. A multiple regression analysis was performed to predict OMA. Results Multiple regression analysis revealed the following equation: OMA=1.959+(0.238×lumbar coronal Cobb angle)+(-0.208×sagittal vertical axis). Conclusions When the patient is placed on the surgical table by rotating them at the OMA, the rotation of the surgical table can be reduced, ensuring a safe and efficient surgical procedure.
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Affiliation(s)
- Yosuke Ogata
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Takahiro Sunami
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Shun Okuwaki
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Shuhei Ohyama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Kotaro Sakashita
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Shuhei Iwata
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Kohei Okuyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
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Song Y, Wang H. Effect of Stand-Alone Oblique Lateral Interbody Fusion (OLIF) in Treating Lumbar Spine Lesions. Med Sci Monit 2023; 29:e940872. [PMID: 38008931 PMCID: PMC10691287 DOI: 10.12659/msm.940872] [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: 04/22/2023] [Accepted: 09/26/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the safety and early clinical results of stand-alone oblique lateral interbody fusion (OLIF) in the fusion of lumbar spine lesions and to explore the indications for surgery. MATERIAL AND METHODS A total of 92 cases of lumbar spine lesions treated with stand-alone OLIF in 2 medical centers from October 2014 to December 2018 were retrospectively analyzed. We included 30 males and 62 females, ages 32-83 years. RESULTS Our results showed that the operation time was 60.92±27.40 min (average 36.6 min) and the intraoperative blood loss was 68.22±141.6 ml (average 23.8 ml). The height of the intervertebral space was restored - before the operation (9.23±1.94 mm) and (12.68±2.01 mm) after the operation - and it was 10.18±2.14 mm at the last follow-up. There was a significant difference between the postoperative and preoperative values (t=9.27, P<0.0001), and there was also a significant difference between the final follow-up and postoperative comparison value (t=8.43, P<0.0001). CONCLUSIONS The use of stand-alone OLIF in treating fusion of lumbar spine lesions showed excellent clinical efficacy and achieved the expected clinical improvements.
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An B, Ren B, Han Z, Mao K, Liu J. Comparison between oblique lumbar interbody fusion and posterior lumbar interbody fusion for the treatment of lumbar degenerative diseases: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:856. [PMID: 37950267 PMCID: PMC10636879 DOI: 10.1186/s13018-023-04312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Although oblique lumbar interbody fusion (OLIF) has produced good results for lumbar degenerative diseases (LDDs), its efficacy vis-a-vis posterior lumbar interbody fusion (PLIF) remains controversial. This meta-analysis aimed to compare the clinical efficacy of OLIF and PLIF for the treatment of LDDs. METHODS A comprehensive assessment of the literature was conducted, and the quality of retrieved studies was assessed using the Newcastle-Ottawa Scale. Clinical parameters included the visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain, disability, and functional levels. Statistical analysis related to operative time, intraoperative bleeding, length of hospital stay, lumbar lordosis angle, postoperative disc height, and complication rates was performed. The PROSPERO number for the present systematic review is CRD42023406695. RESULTS In total, 574 patients (287 for OLIF, 287 for PLIF) from eight studies were included. The combined mean postoperative difference in ODI and lumbar VAS scores was - 1.22 and - 0.43, respectively. In postoperative disc, height between OLIF and PLIF was 2.05. The combined advantage ratio of the total surgical complication rate and the mean difference in lumbar lordosis angle between OLIF and PLIF were 0.46 and 1.72, respectively. The combined mean difference in intraoperative blood loss and postoperative hospital stay between OLIF and PLIF was - 128.67 and - 2.32, respectively. CONCLUSION Both the OLIF and PLIF interventions showed good clinical efficacy for LDDs. However, OLIF demonstrated a superior advantage in terms of intraoperative bleeding, hospital stay, degree of postoperative disc height recovery, and postoperative complication rate.
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Affiliation(s)
- Bochen An
- Medical School of Chinese PLA, Beijing, 100089, China
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100089, China
| | - Bowen Ren
- Medical School of Chinese PLA, Beijing, 100089, China
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100089, China
| | - Zhenchuan Han
- Department of Orthopedics, Chinese PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Keya Mao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100089, China.
| | - Jianheng Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100089, China.
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CreveCoeur TS, Sperring CP, DiGiorgio AM, Chou D, Chan AK. Antepsoas Approaches to the Lumbar Spine. Neurosurg Clin N Am 2023; 34:619-632. [PMID: 37718108 DOI: 10.1016/j.nec.2023.06.009] [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] [Indexed: 09/19/2023]
Abstract
Lumbar interbody fusion (LIF) is a well-established approach in treating spinal deformity and degenerative conditions of the spine. Since its inception in the 20th century, LIF has continued to evolve, allowing for minimally invasive approaches, high fusion rates, and improving disability scores with favorable complication rates. The anterior to the psoas (ATP) approach utilizes a retroperitoneal pathway medial to the psoas muscle to access the L1-S1intervertebral disc spaces. In contrast to the transpsoas arppoach, its primary advantage is avoiding transgressing the psoas muscle and the contained lumbar plexus, which potentially decreases the risk of injury to the lumbar plexus. Avoiding transgression of the psoas may minimize the risk of transient or permanent neurological deficits secondary to lumbar plexus injury. Indications for ATP approaches may expand as it is shown to be a safe and effective method of achieving spinal arthrodesis.
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Affiliation(s)
- Travis S CreveCoeur
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University College of Physicians and Surgeons, 710 West 168th Street, New York, NY 10033, USA
| | - Colin P Sperring
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University College of Physicians and Surgeons, 710 West 168th Street, New York, NY 10033, USA
| | - Anthony M DiGiorgio
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Dean Chou
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY 10034, USA
| | - Andrew K Chan
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University College of Physicians and Surgeons, 5141 Broadway, 3FW, Room 20, New York, NY 10034, USA.
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Yang W, Cai Z, Liu X, Yuan W, Ma R, Chen Z, Zhang J, Wu P, Ge Z. Imaging study of the effect of postural changes on the retroperitoneal oblique corridor in degenerative lumbar scoliosis. 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 2023; 32:3659-3665. [PMID: 37249664 DOI: 10.1007/s00586-023-07788-0] [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: 02/10/2023] [Revised: 02/10/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE To investigate the effect of postural changes on access for the OLIF of L2 to L5 in patients with degenerative lumbar scoliosis. METHODS Twenty-one individuals with degenerative lumbar scoliosis were chosen at random, 11 with left-sided convexity and 10 with left-sided concavity. Axial T2-weighted images were used to measure the following variables: (1) the distance between the left psoas major muscle and the abdominal aorta; (2) the angle of the surgical access; (3) the distance between the psoas major muscle attachment point and the vertebral body's transverse axis; (4) the region of the psoas major muscle above the vertebrae; and (5) the width-to-thickness ratio. A statistical analysis of the measured parameters was done. RESULTS The L2-5 segment in the supine position had a significantly longer window distance in the left convex and left concave groups than in the right lateral recumbent posture (P < 0.05). In all segments, the left concave group outperformed the left convex group, which was substantially higher in the right lateral recumbent posture than in the supine position (P < 0.05). After the position change, the spanning area was significantly higher compared to the same segment in the supine position. The psoas major muscle's morphology was stretched. CONCLUSIONS The right lateral recumbent position limits access to OLIF for degenerative lumbar scoliosis, and the "safety window" for OLIF operation in the parietal region is smaller in the left convex group compared to the left concave group, posing a higher risk of intraoperative vascular and neurological injury.
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Affiliation(s)
- Wei Yang
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zecheng Cai
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Xiaoyin Liu
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Wenqi Yuan
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Rong Ma
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Zhen Chen
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jianqun Zhang
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Peng Wu
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Zhaohui Ge
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China.
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Wu H, Cheung JPY, Zhang T, Shan Z, Zhang X, Liu J, Fan S, Zhao F. The Role of Hounsfield Unit in Intraoperative Endplate Violation and Delayed Cage Subsidence with Oblique Lateral Interbody Fusion. Global Spine J 2023; 13:1829-1839. [PMID: 34736351 PMCID: PMC10556897 DOI: 10.1177/21925682211052515] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective clinical case series. OBJECTIVES To investigate the risk factors for intraoperative endplate violations and delayed cage subsidence after oblique lateral interbody fusion (OLIF) surgery. Secondly, to examine whether low Hounsfield unit (HU) values at different regions of the endplate are associated with intraoperative endplate violation or delayed cage subsidence. METHODS 61 patients (aged 65.1 ± 9.5 years; 107 segments) who underwent OLIF with or without posterior instrumentation from May 2015 to April 2019 were retrospectively studied. Intraoperative endplate violation was measured on sagittal reconstructed computerized tomography (CT) images immediate postoperatively, while delayed cage subsidence was evaluated using lateral radiographs and defined at 1-month follow-up or later. Demographic information and clinical parameters such as age, body mass index, bone mineral density, number of surgical levels, cage dimension, disc height restoration, visual analogue scale (VAS), and HU at different regions of the endplate were obtained. RESULTS Total postoperative cage subsidence was identified in 45 surgical levels (42.0%) in 26 patients (42.6%) up till postoperative 1-year follow-up. Low HU value at the ipsilateral epiphyseal ring was an independent risk factor for intraoperative endplate violation (P = .008) with a cut-off value of 326.21 HUs. Low HU values at the central endplate had a significant correlation with delayed cage subsidence in stand-alone cases (P = .013) with a cut-off value of 296.42 HUs. VAS scores were not different at 1 week postoperatively in cases with or without intraoperative endplate violation (3.12 ± .73 vs 2.89 ± .72, P = .166) and showed no difference at 1 year with or without delayed cage subsidence (1.95 ± .60 vs 2.26 ± .85, P = .173). CONCLUSIONS Intraoperative endplate violation and delayed cage subsidence are not uncommon with OLIF surgery. HUs of the endplate are good predictors for intraoperative endplate violation and cage subsidence since they can represent the regional bone quality of the endplate in contact with the implant. VAS improvements were not affected by intraoperative endplate violation or delayed cage subsidence at 1-year follow-up. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hao Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Zhi Shan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuyang Zhang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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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.
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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
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Zhang B, Hu Y, Kong Q, Feng P, Liu J, Ma J. Comparison of Oblique Lumbar Interbody Fusion Combined with Posterior Decompression (OLIF-PD) and Posterior Lumbar Interbody Fusion (PLIF) in the Treatment of Adjacent Segmental Disease(ASD). J Pers Med 2023; 13:jpm13020368. [PMID: 36836602 PMCID: PMC9966658 DOI: 10.3390/jpm13020368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND An unintended consequence following lumbar fusion is the development of adjacent segment disease (ASD). Oblique lumbar interbody fusion combined with posterior decompression (OLIF-PD) is another feasible option for ASD, and there is no literature report on this combined surgical strategy. METHODS A retrospective analysis was performed on 18 ASD patients requiring direct decompression in our hospital between September 2017 and January 2022. Among them, eight patients underwent OLIF-PD revision and ten underwent PLIF revision. There were no significant differences in the baseline data between the two groups. The clinical outcomes and complications were compared between the two groups. RESULTS The operation time, operative blood loss and postoperative hospital stay in the OLIF-PD group were significantly lower than those in the PLIF group. The VAS of low back pain in the OLIF-PD group was significantly better than that in the PLIF group during the postoperative follow-up. The ODI at the last follow-up in the OLIF-PD group and the PLIF group were significantly relieved compared with those before operation. The excellent and good rate of the modified MacNab standard at the last follow-up was 87.5% in the OLIF-PD group and 70% in the PLIF group. There was a statistically significant difference in the incidence of complications between the two groups. CONCLUSION For ASD requiring direct decompression after posterior lumbar fusion, compared with traditional PLIF revision surgery, OLIF-PD has a similar clinical effect, but has a reduced operation time, blood loss, hospital stay and complications. OLIF-PD may be an alternative revision strategy for ASD.
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Affiliation(s)
- Bin Zhang
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Yuan Hu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Qingquan Kong
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence:
| | - Pin Feng
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Junlin Liu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Junsong Ma
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
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Xu Q, Lu Z, Chen P, Li B, Zheng X, Jiang S, Jiang L. Acceptable Fusion Rate of Single-Level OLIF Using Pure Allograft Combined with Posterior Instrumentation through the Wiltse Approach: A 2-Year Follow-Up Study. Orthop Surg 2023; 15:801-809. [PMID: 36718553 PMCID: PMC9977589 DOI: 10.1111/os.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Autogenic bone grafts have shown successful fusion rates in the treatment of degenerative lumbar disorders, but taking too many autogenic bones may result in donor site ischemia or infection. This study aimed to evaluate the outcomes of single-level oblique lumbar interbody fusion (OLIF) using pure allograft combined with posterior pedicle screw instrumentation through the Wiltse approach. METHODS A retrospective case analysis was performed on a series of consecutive patients who received a single-level OLIF procedure combined with posterior pedicle screw instrumentation through the Wiltse approach between July 1, 2017, and December 31, 2019, in which pure allogenic bone graft was used and filled in the large window of the cage. The patients were followed up as scheduled at 1 day and 3, 6, 12, 24 months after operation. Clinical outcome was assessed by multiple questionnaires, including Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score rating system, short form-36 health survey (SF-36), and visual analog scale (VAS) for low back pain. Radiographic outcome was evaluated by measuring the parameters such as disc height, lumbar lordosis, and segmental angle on the standard standing lateral radiographs, and the space angle of the fusion level on the dynamic views of the lateral radiographs. Subsidence of the cage and intervertebral fusion status were evaluated on both the radiographic and CT scan images. RESULTS A total of 34 patients were finally included in this study. At 2-year follow-up, the VAS for low back pain, ODI, JOA, and SF-36 scores all had significant improvement (p < 0.001). Substantial increase of anterior and posterior disc heights was observed (p < 0.001). Both lumbar lordosis and segmental angle became larger (p < 0.05). No visible change of the space angle of the fusion level was found on the dynamic views. The 1-year fusion rate of 73.5% on CT scans proceeded to 82.4% at 2-year follow-up. The fusion rate was as high as 91.2% according to Bridwell interbody fusion grading system on radiographic images. The clinical outcomes in patients with incomplete fusion were just as good as those with complete fusion. The six patients with cage subsidence had higher ODI (p < 0.001) and lower JOA (p < 0.001) and SF-36 PCS (p = 0.011) scores than those without cage subsidence. CONCLUSION The use of pure allograft in single-level OLIF resulted in an acceptable fusion rate and satisfactory clinical effect at 2-year follow-up. Supplementation of posterior pedicle screw through the minimally invasive Wiltse approach ensured the favorable outcomes both clinically and radiographically.
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Affiliation(s)
- Qingyin Xu
- Spine CenterXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Zeyu Lu
- Spine CenterXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Pengbo Chen
- Spine CenterXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Bo Li
- Spine CenterXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Xinfeng Zheng
- Spine CenterXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Shengdan Jiang
- Spine CenterXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Leisheng Jiang
- Spine CenterXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
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11
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Huo Y, Ding W, Rudd S, Yang D, Ma L, Zhao R, Yang S. Incidence and risk factors of lumbar plexus injury in patients undergoing oblique lumbar interbody fusion surgery. 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 2023; 32:336-344. [PMID: 36370208 DOI: 10.1007/s00586-022-07439-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/25/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the incidence and risk factors of lumbar plexus injury (LPI) after oblique lumbar interbody fusion (OLIF) surgery. METHODS A total of 110 patients who underwent OLIF surgery between January 2017 and January 2021 were retrospectively reviewed. Patients were divided into two groups: the group with LPI (LPI group) and the group without LPI (non-LPI group). The baseline demographic data, surgical variables and radiographic parameters were compared and analyzed between these two groups. RESULTS Among all participants, 13 (8.5%) had LPI-related symptoms postoperatively (short-term), and 6 (5.5%) did not fully recover after one year (long-term). Statistically, there were no significant differences in the baseline demographic data, surgery duration, intraoperative blood loss, preoperative diagnosis, surgical procedures used and incision length. Compared with the non-LPI group, patients in the LPI group had a narrower OLIF channel space. In LPI group, the anterior edge of left psoas major muscle overpasses the anterior edge of surgical intervertebral disk (IVD) on axial MRI. Logistic regression analysis revealed that narrow OLIF channel space and the anterior edge of left psoas major muscle overpassing the anterior edge of surgical IVD on axial MRI were independently associated with both short-term and long-term LPI. CONCLUSION Narrow OLIF channel space and the anterior edge of left psoas major muscle overpassing the anterior edge of surgical IVD are significant risk factors of OLIF surgery-related LPI. Surgeons should use preoperative imaging to adequately assess these risk factors to reduce the occurrence of LPI.
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Affiliation(s)
- Yachong Huo
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139Ziqiang Rd, Shijiazhuang, 050051, China
| | - Wenyuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139Ziqiang Rd, Shijiazhuang, 050051, China. .,Hebei Joint International Research Centre for Spinal Diseases, 139Ziqiang Rd, Shijiazhuang, 050051, China.
| | - Samuel Rudd
- School of Chemical Engineering, The University of Queensland, St Lucia 4067, Brisbane, Australia
| | - Dalong Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139Ziqiang Rd, Shijiazhuang, 050051, China
| | - Lei Ma
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139Ziqiang Rd, Shijiazhuang, 050051, China
| | - Ruoyu Zhao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139Ziqiang Rd, Shijiazhuang, 050051, China
| | - Sidong Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139Ziqiang Rd, Shijiazhuang, 050051, China. .,Hebei Joint International Research Centre for Spinal Diseases, 139Ziqiang Rd, Shijiazhuang, 050051, China.
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12
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Qiu MG, Zhou SG, Lin SS, Hu X, Lin C, Lin KF. Early effect of standalone oblique lateral interbody fusion vs. combined with lateral screw fixation of the vertebral body on single-level lumbar degenerative disc disease: A pilot study. J Back Musculoskelet Rehabil 2022; 36:709-719. [PMID: 36565101 DOI: 10.3233/bmr-220156] [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: 12/24/2022]
Abstract
BACKGROUND For the treatment of single-level lumbar degenerative disc disease (DDD), oblique lateral interbody fusion (OLIF) has clinical advantages. Whether internal fixation needs to be combined for treatment has been the subject of debate. OBJECTIVE To compare the early clinical effects of standalone oblique lateral interbody fusion (S-OLIF) versus OLIF combined with lateral screw fixation of the vertebral body (F-OLIF) on single-level lumbar DDD. METHODS A retrospective analysis was performed on the data of 34 patients for whom the OLIF technique was applied to treat single-level lumbar DDD from August 2018 to May 2021. Patients were divided into the S-OLIF (n= 18) and F-OLIF groups (n= 16). Intraoperative blood loss, operative time, and length of hospital stay were recorded. The pain visual analogue scale (VAS) and Oswestry disability index (ODI) before and after the operation were evaluated. The disc height (DH), foraminal height (FH), fused segment lordosis (FSL), lumbar lordosis (LL), cage subsidence, and fusion by CT examination were measured before and after the operation. RESULTS The S-OLIF group experienced a shorter operative time and less intraoperative blood loss than the F-OLIF group, and the differences were statistically significant (p< 0.05), but the difference in the length of hospital stay was not statistically significant. The postoperative VAS score and ODI of the two groups were significantly lower than those before the operation, but the postoperative differences between the two groups were not statistically significant. Differences were not statistically significant in postoperative FH, DH, FSL and LL of the two groups. Both groups were followed up for no less than 12 months. In the two groups, fusion was achieved at the last follow-up visit. CONCLUSION According to short-term follow-up results, both S-OLIF and F-OLIF can achieve reliable and stable fusion and good clinical effect in the treatment of single-level lumbar DDD.
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Affiliation(s)
- Mei-Guang Qiu
- Department of Orthopedics, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China.,Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Shi-Guo Zhou
- Department of Orthopedics, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China.,Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Shi-Shui Lin
- Department of Orthopedics, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China.,Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xu Hu
- Department of Orthopedics, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China.,Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Cheng Lin
- Department of Orthopedics, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China.,Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Ke-Feng Lin
- Department of Orthopedics, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China.,Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
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13
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Lee JS, Son DW, Lee SH, Sung SK, Lee SW, Song GS, Kim YH, Choi CH. Surgical outcome of minimal invasive oblique lateral interbody fusion with percutaneous pedicle screw fixation in the treatment of adult degenerative scoliosis. Medicine (Baltimore) 2022; 101:e31879. [PMID: 36482617 PMCID: PMC9726324 DOI: 10.1097/md.0000000000031879] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Oblique lateral interbody fusion is performed for lumbar spinal restoration and stabilization, without extensive paraspinal muscle damage or massive bleeding. This study aimed to confirm the radiological and clinical outcomes of minimally invasive oblique lateral interbody fusion (OLIF) with percutaneous pedicle screw fixation (PPSF) as treatment for adult degenerative lumbar scoliosis. Medical records of 40 patients with degenerative lumbar spinal deformities who underwent selective OLIF and PPSF at our hospital between April 2018 and February 2021 were retrospectively reviewed. The study population comprised 7 male and 33 female patients aged 55-79 years. Standing radiography was performed, and the coronal cobb angle, distance between the C7 plumb line and central sacral vertical line, sagittal vertical axis, pelvic tilt, lumbar lordosis (LL), pelvic incidence (PI), and difference between PI and LL (PI-LL) were measured. Coronal scoliosis was defined as a lumbar coronal plane curve of > 15°. All patients achieved statistically significant improvements in coronal and sagittal alignment. The coronal cobb angle was corrected from 18.82° to 11.52°, and the central sacral vertical line was reduced from 18.30 mm to 15.47 mm. The sagittal vertical axis was significantly reduced from 45.95 mm to 32.72 mm. In contrast, the pelvic tilt and LL were minimally changed. For subgroup analyses, patients were divided into the convex and concave groups according to the direction of coronal curve correction. Vertebral body rotation was superior in the convex group than in the concave group. Furthermore, we checked for asymmetric facet degeneration at the upper instrumented vertebra (UIV) level at 1 year postoperatively. Of the 22 patients who underwent more than 3 level fusion surgery, 8 patients were confirmed the postoperative asymmetric facet degeneration in above UIV. Minor complications occurred in 16 patients, who recovered without any problems. Revision surgery was not performed in all cases. Minimally invasive OLIF with PPSF has a lower risk of complications and favorable surgical outcomes in patients with adult degenerative lumbar scoliosis. Access from the convex side is advantageous for the correction of the rotated vertebra. Extending the UIV level to the neutral vertebra can reduce the occurrence of postoperative asymmetric facet degeneration.
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Affiliation(s)
- Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- * Correspondence: Dong Wuk Son, Department of Neurosurgery, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626-770, Korea (e-mail: )
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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Nazierhan S, Li C, Guo R, Lu L, Aikeremu D, Xu K, Wang H. MIS-TLIF or CLIF for single segmental lumbar degenerative disease. Medicine (Baltimore) 2022; 101:e31534. [PMID: 36343021 PMCID: PMC9646494 DOI: 10.1097/md.0000000000031534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We aimed to compare the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and Crenel lateral interbody fusion (CLIF) on single segmental lumbar degenerative disease. Patients with single segmental lumbar degenerative disease undergoing MIS-TLIF (n = 28) and CLIF (n = 28) were enrolled from April to October 2017. Preoperative medical history, anthropometric data, and clinical data were recorded. Visual analogue scores and Oswestry disability index (ODI) were assessed. Radiography was performed before and after surgery. X-ray films were evaluated according to the Bridwell method, visual analogue scores and ODI scores were evaluated. There were no significant differences in the gender, age, clinical diagnosis, involved segment or preoperative ODI score between 2 groups (P > .05). During 12-month follow-up, MIS-TLIF group had less intraoperative blood loss, drainage, postoperative bedridden time, and hospital stay (P < .05), but more operation time and radiation exposure time compared with CLIF group (P < .05). CLIF group reported less pain than MIS-TLIF group (P > .05). Both groups had similar lumbar fusion rate (P > .05). Overall, CLIF has less complications, less trauma and faster recovery for the treatment of single segmental lumbar degenerate disease when compared with MIS-TLIF. Evaluation of more patients and long-term follow-up are still needed to further validate our findings.
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Affiliation(s)
- Shaxika Nazierhan
- Department of Orthopedics, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Chenxi Li
- Oncological Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Rui Guo
- Department of Orthopedics, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Linsong Lu
- Department of Orthopedics, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Dilimulati Aikeremu
- Department of Orthopedics, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Kuo Xu
- Department of Orthopedics, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Hao Wang
- Department of Orthopedics, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
- * Correspondence: Hao Wang: Department of Orthopedics, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Urumqi 830001, Xinjiang Uygur Autonomous Region, China (e-mail: )
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15
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Wu H, Shan Z, Zhang T, Liu J, Fan S, Zhao F, Cheung JPY. Small Preoperative Dural Sac Cross-Sectional Area and Anteriorly Placed Fusion Cages Are Risk Factors for Indirect Decompression Failure after Oblique Lateral Interbody Fusion. World Neurosurg 2022; 167:e1032-e1044. [PMID: 36067941 DOI: 10.1016/j.wneu.2022.08.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE 1) To investigate if implant-related factors such as cage size and cage position are associated with radiologic improvement after indirect decompression with oblique lateral interbody fusion (OLIF). 2) To investigate the risk factors associated with indirect decompression failure (IDF) at the surgical levels after OLIF. METHODS From February 2015 to December 2019, 92 consecutive patients (188 levels) with lumbar spinal stenosis who underwent indirect decompression via OLIF with or without posterior instrumentation were studied retrospectively. Radiographic variables were measured preoperatively and postoperatively. The radiographic results were compared for cages with different heights and positions. IDF was defined as revision surgery within 6 months or persistent compressive symptoms 6 months after surgery. RESULTS Postoperative improvements were observed in all measured radiographic parameters except for segmental lordosis. Taller cages were associated with more shrinkage of the bulging disc and greater increase in dural sac diameter. Cages placed posteriorly showed larger postoperative subarticular diameters. Twelve patients (16 levels) had IDF. Multivariate logistic regression showed that after adjusting for age, sex, and body mass index, smaller preoperative dural sac cross-sectional area and anterior positioning of cages were both independent risk factors for IDF. CONCLUSIONS OLIF is an effective procedure for indirect decompression. To avoid reoperation for lumbar spinal stenosis, surgeons should aim to place the center of the cage at the posterior half of the lower endplate. Surgical levels with a preoperative dural sac cross-sectional area <44 mm2 may not be suitable for indirect decompression.
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Affiliation(s)
- Hao Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Zhi Shan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong.
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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.
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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
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17
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Neuromonitoring in Lateral Interbody Fusion: A Systematic Review. World Neurosurg 2022; 168:268-277.e1. [DOI: 10.1016/j.wneu.2022.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
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Bhatti AUR, Cesare J, Wahood W, Alvi MA, Onyedimma CE, Ghaith AK, Akinnusotu O, El Sammak S, Freedman BA, Sebastian AS, Bydon M. Assessing the differences in operative and patient-reported outcomes between lateral approaches for lumbar fusion: a systematic review and indirect meta-analysis. J Neurosurg Spine 2022; 37:498-514. [PMID: 35453114 DOI: 10.3171/2022.2.spine211164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior-to-psoas lumbar interbody fusion (ATP-LIF), more commonly referred to as oblique lateral interbody fusion, and lateral transpsoas lumbar interbody fusion (LTP-LIF), also known as extreme lateral interbody fusion, are the two commonly used lateral approaches for performing a lumbar fusion procedure. These approaches help overcome some of the technical challenges associated with traditional approaches for lumbar fusion. In this systematic review and indirect meta-analysis, the authors compared operative and patient-reported outcomes between these two select approaches using available studies. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, the authors conducted an electronic search using the PubMed, EMBASE, and Scopus databases for studies published before May 1, 2019. Indirect meta-analysis was conducted on fusion rate, cage movement (subsidence plus migration), permanent deficits, and transient deficits; results were depicted as forest plots of proportions (effect size [ES]). RESULTS A total of 63 studies were included in this review after applying the exclusion criteria, of which 26 studies investigated the outcomes of ATP-LIF, while 37 studied the outcomes of LTP-LIF. The average fusion rate was found to be similar between the two groups (ES 0.97, 95% CI 0.84-1.00 vs ES 0.94, 95% CI 0.91-0.97; p = 0.561). The mean incidence of cage movement was significantly higher in the ATP-LIF group compared with the LTP-LIF group (stand-alone: ES 0.15, 95% CI 0.06-0.27 vs ES 0.09, 95% CI 0.04-0.16 [p = 0.317]; combined: ES 0.18, 95% CI 0.07-0.32 vs ES 0.02, 95% CI 0.00-0.05 [p = 0.002]). The mean incidence of reoperations was significantly higher in patients undergoing ATP-LIF than in those undergoing LTP-LIF (ES 0.02, 95% CI 0.01-0.03 vs ES 0.04, 95% CI 0.02-0.07; p = 0.012). The mean incidence of permanent deficits was similar between the two groups (stand-alone: ES 0.03, 95% CI 0.01-0.06 vs ES 0.05, 95% CI 0.01-0.12 [p = 0.204]; combined: ES 0.03, 95% CI 0.01-0.06 vs ES 0.03, 95% CI 0.00-0.08 [p = 0.595]). The postoperative changes in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were both found to be higher for ATP-LIF relative to LTP-LIF (VAS: weighted average 4.11 [SD 2.03] vs weighted average 3.75 [SD 1.94] [p = 0.004]; ODI: weighted average 28.3 [SD 5.33] vs weighted average 24.3 [SD 4.94] [p < 0.001]). CONCLUSIONS These analyses indicate that while both approaches are associated with similar fusion rates, ATP-LIF may be related to higher odds of cage movement and reoperations as compared with LTP-LIF. Furthermore, there is no difference in rates of permanent deficits between the two procedures.
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Affiliation(s)
- Atiq Ur Rehman Bhatti
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph Cesare
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 4University of Wisconsin, Madison, Wisconsin
| | - Waseem Wahood
- 5Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida; and
| | - Mohammed Ali Alvi
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Chiduziem E Onyedimma
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Abdul Karim Ghaith
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Sally El Sammak
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brett A Freedman
- 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arjun S Sebastian
- 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Application of Offset Dingo Instruments in Anterior to Psoas (ATP)/Oblique Lumbar Interbody Fusion (OLIF) Procedure: A Retrospective Study of 80 Patients. Neurochirurgie 2022; 68:575-582. [PMID: 35667474 DOI: 10.1016/j.neuchi.2022.05.005] [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: 03/24/2022] [Revised: 05/06/2022] [Accepted: 05/29/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Oblique lumbar interbody fusion (OLIF) is a minimally invasive lumbar fusion procedure that has flourished in recent years. However, complications related to the anterior-to-psoas (ATP) approach have been reported. The purpose of this study was to assess the OLIF technique using offset design "Dingo" instruments for the treatment of degenerative lumbar disorders. METHODS A retrospective review was performed to identify patients between March 2018 and November 2020 who underwent OLIF with conventional or modified instruments with a minimum follow-up of 12 months. Demographic data were recorded. Operation time, intraoperative blood loss, and length of hospital stay were compared between cohorts. Imaging parameters were measured and compared between cohorts before and after surgery. Clinical outcomes were assessed at each follow-up visit. All complications were reviewed. RESULTS A total of 80 consecutive patients were included. The mean follow-up times for the conventional group and modified group were 14.5 months and 16.3 months, respectively. The incidence of hip flexion weakness was 27.5% and 7.5% for the conventional cohort and modified cohort, respectively. The modified group was associated with a shorter operation time, shorter length of hospital stay, higher postoperative disk height and better cage position. The symptoms of all patients improved after surgery. At 1-week follow-up, the modified group showed significantly better clinical scores. CONCLUSIONS OLIF with modified instruments and techniques shows promising outcomes in reducing approach-related complications. Additionally, the modified technique is associated with a better cage position, shorter length of hospital stay and less postoperative pain in the early period.
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Zhu L, Wang JW, Zhang L, Feng XM. Outcomes of Oblique Lateral Interbody Fusion for Adult Spinal Deformity: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:142-154. [PMID: 33438462 PMCID: PMC8965311 DOI: 10.1177/2192568220979145] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVES To evaluate clinical and radiographic outcomes, and perioperative complications of oblique lateral interbody fusion (OLIF) for adult spinal deformity (ASD). METHODS We performed a systematic review and meta-analysis of related studies reporting outcomes of OLIF for ASD. The clinical outcomes were assessed by visual analogue scale (VAS) and Oswestry Disability Index (ODI). The radiographic parameters were evaluated by sagittal vertical axis (SVA), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence-lumbar lordosis (PI-LL), Cobb angle and fusion rate. A random effects model and 95% confidence intervals (CI) were performed to investigate the results. RESULTS A total of 16 studies involving 519 patients were included in the present study. The mean difference of VAS-back score, VAS-leg score and ODI score before and after surgery was 5.1, 5.0 and 32.3 respectively. The mean correction of LL was 20.6°, with an average of 6.9° per level and the mean correction of Cobb was 16.4°, with an average of 4.7° per level. The mean correction of SVA, PT, SS, TK and PI-LL was 59.3 mm, 11.7°, 6.9°, 9.4° and 20.6° respectively. The mean fusion rate was 94.1%. The incidence of intraoperative and postoperative complications was 4.9% and 29.6% respectively. CONCLUSIONS OLIF is an effective and safe surgery method in the treatment of mild or moderate ASD and it has advantages in less intraoperative blood loss and lower perioperative complications.
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Affiliation(s)
- Lei Zhu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jun-Wu Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China,Xin-Min Feng and Liang Zhang, Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou 225001, China. Emails: ;
| | - Xin-Min Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China,Xin-Min Feng and Liang Zhang, Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou 225001, China. Emails: ;
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Zhou J, Yuan C, Liu C, Zhou L, Wang J. Hounsfield unit value on CT as a predictor of cage subsidence following stand-alone oblique lumbar interbody fusion for the treatment of degenerative lumbar diseases. BMC Musculoskelet Disord 2021; 22:960. [PMID: 34789220 PMCID: PMC8600787 DOI: 10.1186/s12891-021-04833-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To investigate the correlation between vertebral Hounsfield unit (HU) values and cage subsidence in patients treated with stand-alone (SA) OLIF. METHODS A retrospective review of collected data was performed on 76 patients who underwent SA OLIF. We utilized the HU value for lumbar bone mineral density (BMD) obtained on preoperative CT. The vertebral HU values of patients with subsidence were compared to those without subsidence. The correlation between cage subsidence and clinical score was investigated. RESULTS Sixteen patients (21.1%) had at least radiographic evidence of interbody cage subsidence. The average cage subsidence was 2.5 ± 1.3 mm (range 0.9-4.8 mm). There were no significant differences in sex, BMI, preoperative diagnoses, or fused level (p > 0.05); however, there were significant differences between the cage subsidence group and the nonsubsidence group in age, average of the lowest T-score, and average HU value, including for the L1 vertebrae, L1-L4 horizontal plane, and L1-L4 sagittal plane (p < 0.05). The average HU value of the L1-L4 horizontal plane showed a more predictable AUC of 0.909 (95% CI, 0.834-0.984; P < 0.001) compared with the average of the lowest T-score following an AUC of 0.791 (95% CI, 0.674-0.909; P < 0.001). Based on logistic regression analysis, the average HU value of the L1-L4 horizontal plane (OR, 0.912; 95% CI, 0.861-0.966; P = 0.002) was an independent factor influencing cage subsidence. CONCLUSIONS Patients with lower average HU values of the lumbar vertebrae are at a much higher risk of developing cage subsidence after SA OLIF. Measurement of preoperative HU values on preexisting CT scans could be rapid, simple and feasible.
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Affiliation(s)
- Jing Zhou
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Chao Yuan
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Chao Liu
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Lei Zhou
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Jian Wang
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing, 400037, People's Republic of China.
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Single-stage debridement via autogenous iliac bone graft through the OLIF corridor and lateral fixation in treating spontaneous single-level lumbar pyogenic spondylodiscitis. BMC Musculoskelet Disord 2021; 22:947. [PMID: 34781926 PMCID: PMC8591950 DOI: 10.1186/s12891-021-04815-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/25/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of the present study was to investigate the efficacy and safety of mini-open oblique debridement and lumbar interbody fusion combined with lateral screw fixation for treating single-level pyogenic spondylodiscitis. METHODS Twelve patients with single-level lumbar pyogenic spondylodiscitis underwent OLIF combined with lateral screw fixation were analyzed. Patients underwent follow-up for 12 to 24 months. The clinical characteristics, etiological examinations, operative time, intraoperative blood loss, Oswestry Disability Index (ODI), visual analog scale score (VAS), postoperative complications, and the bony fusion rate were recorded. RESULTS The mean follow-up period of time was 14.8 months. The average operative time and intra-operative blood loss were 129.0 ± 19.76 min and 309.2 ± 92.96 mL, respectively. No severe intra-operative complications were observed during surgery, except in 1 case that develops abdominal pain and distension after surgery, 2 cases that develop left-sided transient thigh pain/numbness and 8 cases that complains of donor site (iliac crest) pain. All of these symptoms disappeared 8 weeks after surgery. Tissue sample cultures were obtained from all patients intraoperatively and four (33.3%) were positive, including 2 with Staphylococcus aureus, 1 with Staphylococcus epidermidis, and 1 with Escherichia coli. During an average of 22.5 ± 2.1 days (range, 14-29 days) after surgery, WBC, CPR, and ESR levels in all patients had returned to normal. All patients were pain free with no recurring infection. Solid bony fusions were observed in all cases within 6 months, including 10 with I grade fusion, 2 with II grade fusion according to the classification suggested by Burkus et al. No fixation failure was observed during follow up and solid bony fusions were observed in all 12 patients at finally follow-up. A significant postoperative increase was also observed in the mean segmental height and lordosis (P < 0.05), followed by a slight decrease of segmental height and lordosis at final follow-up. At the final follow up, the mean VAS (1.5 ± 0.6) and ODI (18.9 ± 7.6) were significantly lower than VAS (8.4 ± 2.7) and ODI (71.2 ± 16.5) before surgery (P < 0.01). CONCLUSION Single-stage debridement with autogenous iliac bone graft through the OLIF corridor and lateral fixation was a feasible surgical approach in our consecutive 12 cases of pyogenic spondylitis.
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周 晶, 周 蕾, 刘 超, 袁 超, 王 建. [CT value of vertebral body predicting Cage subsidence after stand-alone oblique lumbar interbody fusion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1449-1456. [PMID: 34779172 PMCID: PMC8586776 DOI: 10.7507/1002-1892.202105058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/13/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the correlation between CT value and Cage subsidence in patients with lumbar degenerative disease treated with stand-alone oblique lumbar interbody fusion (OLIF). METHODS The clinical data of 35 patients with lumbar degenerative diseases treated with stand-alone OLIF between February 2016 and October 2018 were retrospectively analyzed. There were 15 males and 20 females; the age ranged from 29 to 81 years, with an average of 58.4 years. There were 39 operative segments, including 32 cases of single-segment, 2 cases of double-segment, and 1 case of three-segment. Preoperative lumbar CT was used to measure the CT values of the axial position of L 1 vertebral body, the axial and sagittal positions of L 1-4 vertebral body, surgical segment, and the axial position of upper and lower vertebral bodies as the bone mineral density index, and the lowest T value was recorded by dual-energy X-ray absorptiometry. The visual analogue scale (VAS) and Oswestry disability index (ODI) scores were recorded before operation and at last follow-up. At last follow-up, the lumbar interbody fusion was evaluated by X-ray films of the lumbar spine and dynamic position; the lumbar lateral X-ray film was used to measure the subsidence of the Cage, and the patients were divided into subsidence group and nonsubsidence group. The univariate analysis on age, gender, body mass index, lowest T value, CT value of vertebral body, disease type, and surgical segment was performed to initially screen the influencing factors of Cage subsidence; further the logistic regression for multi-factor analysis was used to screen fusion independent risk factors for Cage subsidence. The receiver operating characteristic (ROC) curve and area under curve (AUC) were used to analyze the CT value and the lowest T value to predict the Cage subsidence. Spearman correlation analysis was used to determine the correlation between Cage subsidence and clinical results. RESULTS All the 35 patients were followed up 27-58 months, with an average of 38.7 months. At last follow-up, the VAS and ODI scores were significantly decreased when compared with preoperative scores ( t=32.850, P=0.000; t=31.731, P=0.000). No recurrent lower extremity radiculopathy occurred and no patient required revision surgery. Twenty-seven cases (77.1%) had no Cage subsidence (nonsubsidence group); 8 cases (22.9%) had at least radiographic evidence of Cage subsidence, the average distance of Cage subsidence was 2.2 mm (range, 1.1-4.2 mm) (subsidence group). At last follow-up, there was 1 case of fusion failure both in the subsidence group and the nonsubsidence group, there was no significant difference in the interbody fusion rate (96.3% vs. 87.5%) between two groups ( P=0.410). Univariate analysis showed that the CT value of vertebral body (L 1 axial position, L 1-4 axial and sagittal positions, surgical segment, and upper and lower vertebral bodies axial positions) and the lowest T value were the influencing factors of Cage subsidence ( P<0.05). According to ROC curve analysis, compared with AUC of the lowest T value [0.738, 95% CI (0.540, 0.936)], the AUC of the L 1-4 axis CT value was 0.850 [95% CI (0.715, 0.984)], which could more effectively predict Cage subsidence. Multivariate analysis showed that the CT value of L 1-4 axis was an independent risk factor for Cage subsidence ( P<0.05). CONCLUSION The CT value measurement of the vertebral body based on lumbar spine CT before stand-alone OLIF can predict the Cage subsidence. Patients with low CT values of the lumbar spine have a higher risk of Cage subsidence. However, the Cage subsidence do not lead to adverse clinical results.
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Affiliation(s)
- 晶 周
- 中国人民解放军陆军军医大学第二附属医院骨科(重庆 400037)Department of Orthopedics, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400037, P.R.China
| | - 蕾 周
- 中国人民解放军陆军军医大学第二附属医院骨科(重庆 400037)Department of Orthopedics, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400037, P.R.China
| | - 超 刘
- 中国人民解放军陆军军医大学第二附属医院骨科(重庆 400037)Department of Orthopedics, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400037, P.R.China
| | - 超 袁
- 中国人民解放军陆军军医大学第二附属医院骨科(重庆 400037)Department of Orthopedics, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400037, P.R.China
| | - 建 王
- 中国人民解放军陆军军医大学第二附属医院骨科(重庆 400037)Department of Orthopedics, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400037, P.R.China
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Matsukura Y, Yoshii T, Morishita S, Sakai K, Hirai T, Yuasa M, Inose H, Kawabata A, Utagawa K, Hashimoto J, Tomori M, Torigoe I, Yamada T, Kusano K, Otani K, Sumiya S, Numano F, Fukushima K, Tomizawa S, Egawa S, Arai Y, Shindo S, Okawa A. Comparison of Lateral Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion as Corrective Surgery for Patients with Adult Spinal Deformity-A Propensity Score Matching Analysis. J Clin Med 2021; 10:jcm10204737. [PMID: 34682860 PMCID: PMC8539171 DOI: 10.3390/jcm10204737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Lateral lumbar interbody fusion (LLIF) is increasingly performed as corrective surgery for patients with adult spinal deformity (ASD). This paper compares the surgical results of LLIF and conventional posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) in ASD using a propensity score matching analysis. We retrospectively reviewed patients with ASD who received LLIF and PLIF/TLIF, and investigated patients’ backgrounds, radiographic parameters, and complications. The propensity scores were calculated from patients’ characteristics, including radiographic parameters and preoperative comorbidities, and one–to-one matching was performed. Propensity score matching produced 21 matched pairs of patients who underwent LLIF and PLIF/TLIF. All radiographic parameters significantly improved in both groups at the final follow-up compared with those of the preoperative period. The comparison between both groups demonstrated no significant difference in terms of postoperative pelvic tilt, lumbar lordosis (LL), or pelvic incidence–LL at the final follow-up. However, the sagittal vertical axis tended to be smaller in the LLIF at the final follow-up. Overall, perioperative and late complications were comparable in both procedures. However, LLIF procedures demonstrated significantly less intraoperative blood loss and a smaller incidence of postoperative epidural hematoma compared with PLIF/TLIF procedures in patients with ASD.
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Affiliation(s)
- Yu Matsukura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
- Correspondence: ; Tel.: +81-3-5803-5272; Fax: +81-3-5803-5281
| | - Shingo Morishita
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Kenichiro Sakai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi 332-8558, Japan; (K.S.); (M.T.); (I.T.); (Y.A.)
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Masato Yuasa
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Hiroyuki Inose
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Atsuyuki Kawabata
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Kurando Utagawa
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Jun Hashimoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Masaki Tomori
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi 332-8558, Japan; (K.S.); (M.T.); (I.T.); (Y.A.)
| | - Ichiro Torigoe
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi 332-8558, Japan; (K.S.); (M.T.); (I.T.); (Y.A.)
| | - Tsuyoshi Yamada
- Department of Orthopaedic Surgery, Kudanzawa Hospital, 1-6-12 Kudanminami, Chiyoda-ku, Tokyo 102-0074, Japan; (T.Y.); (K.K.); (K.O.); (S.S.)
| | - Kazuo Kusano
- Department of Orthopaedic Surgery, Kudanzawa Hospital, 1-6-12 Kudanminami, Chiyoda-ku, Tokyo 102-0074, Japan; (T.Y.); (K.K.); (K.O.); (S.S.)
| | - Kazuyuki Otani
- Department of Orthopaedic Surgery, Kudanzawa Hospital, 1-6-12 Kudanminami, Chiyoda-ku, Tokyo 102-0074, Japan; (T.Y.); (K.K.); (K.O.); (S.S.)
| | - Satoshi Sumiya
- Department of Orthopaedic Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama 231-8682, Japan; (S.S.); (F.N.)
| | - Fujiki Numano
- Department of Orthopaedic Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama 231-8682, Japan; (S.S.); (F.N.)
| | - Kazuyuki Fukushima
- Department of Orthopaedic Surgery, Saku General Hospital, 3400-28 Nakagomi, Saku 385-0051, Japan;
| | - Shoji Tomizawa
- Department of Orthopaedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasu 279-0001, Japan;
| | - Satoru Egawa
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi 332-8558, Japan; (K.S.); (M.T.); (I.T.); (Y.A.)
| | - Shigeo Shindo
- Department of Orthopaedic Surgery, Kudanzawa Hospital, 1-6-12 Kudanminami, Chiyoda-ku, Tokyo 102-0074, Japan; (T.Y.); (K.K.); (K.O.); (S.S.)
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
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Golubovsky JL, Ejikeme T, Winkelman R, Steinmetz MP. Osteobiologics. Oper Neurosurg (Hagerstown) 2021; 21:S2-S9. [PMID: 34128067 DOI: 10.1093/ons/opaa383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/06/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Osteobiologics are engineered materials that facilitate bone healing and have been increasingly used in spine surgery. Autologous iliac crest bone grafts have been used historically, but morbidity associated with graft harvesting has led surgeons to seek alternative solutions. Allograft bone, biomaterial scaffolds, growth factors, and stem cells have been explored as bone graft substitutes and supplements. OBJECTIVE To review current and emerging osteobiologic technologies. METHODS A literature review of English-language studies was performed in PubMed. Search terms included combinations of "spine," "fusion," "osteobiologics," "autologous," "allogen(e)ic," "graft," "scaffold," "bone morphogenic protein," and "stem cells." RESULTS Evidence supports allograft bone as an autologous bone supplement or replacement in scenarios where minimal autologous bone is available. There are promising data on ceramics and P-15; however, comparative human trials remain scarce. Growth factors, including recombinant human bone morphogenic proteins (rhBMPs) 2 and 7, have been explored in humans after successful animal trials. Evidence continues to support the use of rhBMP-2 in lumbar fusion in patient populations with poor bone quality or revision surgery, while there is limited evidence for rhBMP-7. Stem cells have been incredibly promising in promoting fusion in animal models, but human trials to this point have only involved products with questionable stem cell content, thereby limiting possible conclusions. CONCLUSION Engineered stem cells that overexpress osteoinductive factors are likely the future of spine fusion, but issues with applying viral vector-transduced stem cells in humans have limited progress.
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Affiliation(s)
- Joshua L Golubovsky
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tiffany Ejikeme
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Robert Winkelman
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael P Steinmetz
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Yang SL, Liu XY, Ma R, Zhang JQ, Liang SM, Chen Z, Pan Z, Ma ZJ, Ding XL, Kang Y, Wang ZQ, Ge ZH. Treatment of Degenerative Lumbar Scoliosis with Oblique Lumbar Interbody Fusion in Conjunction with Unilateral Pedicle Screw Fixation via the Wiltse Approach. Orthop Surg 2021; 13:1181-1190. [PMID: 33945217 PMCID: PMC8274200 DOI: 10.1111/os.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/29/2020] [Accepted: 01/26/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the clinical outcomes of oblique lumbar interbody fusion (OLIF) in conjunction with unilateral pedicle screw fixation (UPSF) via the Wiltse approach in treating degenerative lumbar scoliosis (DLS). Methods The article is a retrospective analysis. Twelve patients with DLS who underwent combined OLIF and UPSF between July 2017 and December 2018 were included. The study included 2 male and 10 female patients, with a mean age at the time of the operation of 67.2 ± 9.1 years. The surgical characteristics and complications were evaluated. The clinical and radiological data such as the correction of deformity, coronal and sagittal profile were analyzed. Results The mean follow‐up time of the study was 26.8 ± 1.8 months. At the final follow‐up, all patients who underwent combined OLIF and UPSF achieved statistically significant improvements in coronal Cobb angle (from 19.6° ± 4.8° to 6.9° ± 3.8°, P < 0.01), distance between the C7 plumb line and central sacral vertebral line (from 2.5 ± 1.7 cm to 0.9 ± 0.6 cm, P < 0.01), sagittal vertebral axis (from 4.3 ± 4.3 cm to 1.5 ± 1.0 cm, P = 0.03), lumbar lordosis (from 29.4° ± 8.6° to 40.8° ± 5.8°, P < 0.01), pelvic tilt (from 27.6° ± 10.8° to 18.3° ± 7.0°, P < 0.01), pelvic incidence‐lumbar lordosis mismatch (from 23.3° ± 10.5° to 11.9° ± 8.4°, P < 0.01), and cross‐sectional area of the dural sac (from 87.33 ± 39.41 mm2 to 124.70 ± 39.26 mm2, P < 0.01). The visual analogue score for back and leg pain and Oswestry Disability Index of all patients significantly improved postoperatively (P < 0.01). One case of lumbar plexus injury was found after surgery. During the follow‐up period, one patient had cage subsidence. A fusion rate of 100% and good positioning of the pedicle screws were achieved in all patients at the final follow‐up. Conclusion OLIF in conjunction with UPSF is a safe and effective minimally invasive procedure for correcting both coronal and sagittal deformities, as it results in an improved quality of life in patients with DLS.
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Affiliation(s)
| | - Xiao-Yin Liu
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Rong Ma
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jian-Qun Zhang
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | | | - Zhen Chen
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zong Pan
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zong-Jun Ma
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiao-Li Ding
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yi Kang
- Ningxia Medical University, Yinchuan, China
| | | | - Zhao-Hui Ge
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
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Kim WJ, Shin HM, Song DG, Lee JW, Park KY, Chang SH, Bae JH, Choy WS. Comparison of Clinical Outcomes and Complications of Primary and Revision Surgery Using a Combined Anterior and Posterior Approach in Patients with Adult Spinal Deformity and Sagittal Imbalance. Clin Orthop Surg 2021; 13:196-206. [PMID: 34094010 PMCID: PMC8173245 DOI: 10.4055/cios20217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
Backgroud The purpose of this study was to compare clinical outcomes and complications of primary and revision surgery in patients with adult spinal deformity (ASD) accompanied by sagittal imbalance. Revision surgery has been associated with poor clinical outcomes and increased risk of complications. Previous studies comparing primary versus revision surgery included data for a wide variety of diseases and ages, but few investigated patients with ASD with sagittal imbalance undergoing anterior and posterior combined surgery. Methods Retrospective cohort analysis of prospectively collected data. We identified 60 consecutive patients with ASD combined with sagittal imbalance who underwent primary or revision surgery; of these, 6 patients were excluded for lack of a minimal 2-year follow-up. Patients' surgical and radiological data, clinical outcomes, and complications were reviewed. Results There were 30 patients in the primary group and 24 patients in the revision group. Patient characteristics, including the prevalence of sarcopenia, were similar between the two groups. Pedicle subtraction osteotomy was performed more frequently in the revision group although there was no statistically significant difference between groups. The primary group had more proximal junctional problems, whereas the revision group had more rod breakage (p < 0.05). There were significant improvements in clinical outcomes in both groups when the preoperative and 2-year postoperative values were compared. The Oswestry disability index and visual analog scale score were similar in both groups 2 years postoperatively. Conclusions Considering the greater pain and disability at the time of the revision procedure, revision patients benefited more from surgery at the 2-year follow-up than the primary surgery patients. Complication rates were similar between the groups except for proximal junctional problems and rod breakage. Therefore, revision surgery should not be avoided in the treatment of ASD patients with sagittal imbalance.
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Affiliation(s)
- Whoan Jeang Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Hyun Min Shin
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Dae Geon Song
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jae Won Lee
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Kun Young Park
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Shann Haw Chang
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jin Hyun Bae
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
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Cui J, Guo X, Zheng Z, Liu H, Wang H, Li Z, Wang J. Perioperative Complications in 255 Patients Who Underwent Lateral Anterior Lumbar Interbody Fusion (LaLIF) Surgery. 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 2021; 30:2311-2322. [PMID: 33871706 DOI: 10.1007/s00586-021-06843-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the perioperative complications of lateral anterior lumbar interbody fusion (LaLIF) surgery. METHODS The participants were patients who underwent LaLIF surgery for degenerative lumbar diseases between April 2016 and November 2020. The collected data were classified into intraoperative and early-stage postoperative (1 month) complications. Intraoperative complications were subcategorized into nerve root injury, sympathetic chain injury, segmental artery injury, iliolumbar vein injury, peritoneum laceration, temporary psoas injury, endplate damage, and vertebral body fractures. Postoperative complications were subcategorized into surgical site infection, cage migration, cage subsidence and psoas major hematoma. RESULTS In the 255 included patients, 39 complications (15.3%) were reported. One patient (0.4%) had residual neurological symptoms (numbness) at the last follow-up after conservative management. The most common complications were temporary psoas injury (3.9%), followed by sympathetic chain injury (2.7%) and endplate damage (2.0%). The most frequent postoperative complication was cage migration (1.6%), followed by cage subsidence (1.2%), and surgical site infection (0.8%). CONCLUSION The complication rates for LaLIF are generally low and comparable to those for conventional OLIF and XLIF that have been reported in other studies. Almost all complications were transient after LaLIF. Severe complications can be avoided by using sufficient muscle relaxant, instruments with the required characteristics and vertical trajectories in multiple steps.
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Affiliation(s)
- Jiaming Cui
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China.,Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518000, China
| | - Xingyu Guo
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Zhaomin Zheng
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China. .,Pain Research Center, Sun Yat-Sen University, Guangzhou, 510080, China.
| | - Hui Liu
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Hua Wang
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Zemin Li
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Jianru Wang
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China.
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Rich CW, Philbrick B, Malcolm JG, Refai D, Rodts GE, Gary MF. Early experience with oblique lateral interbody fusion (OLIF) with posterior percutaneous screw placement (OLIFwPPS): Case series with clinical and radiographic outcomes. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Inclusion of L5-S1 in oblique lumbar interbody fusion-techniques and early complications-a single center experience. Spine J 2021; 21:418-429. [PMID: 33091611 DOI: 10.1016/j.spinee.2020.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The oblique prepsoas retroperitoneal approach to the lumbar spine for interbody fusion or oblique lumbar interbody fusion (OLIF) provides safe access to nearly all lumbar levels. A wide interval between the psoas and aorta allows for a safe and straightforward left-sided oblique approach to the discs above L5. Inclusion of L5-S1 in this approach, however, requires modifications in the technique to navigate the complex and variable vascular anatomy distal to the bifurcation of the great vessels. While different oblique approaches to L5-S1 have been described in the literature, to our knowledge, no previous study has provided guidance for the choice of technique. PURPOSE Our objectives were to evaluate our early experience with the safety of including L5-S1 in OLIF using 3 different approach techniques, as well as to compare early complications between OLIF with and without L5-S1 inclusion. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Of the 87 patients who underwent lumbar interbody fusion at 167 spinal levels via an OLIF approach, 19 included L5-S1 (group A) and 68 did not (group B). OUTCOME MEASURES Demographics, levels fused, indications, operative time (ORT), estimated blood loss (EBL), vascular ligation, intraoperative blood transfusion, length of stay (LOS), discharge to rehabilitation facility, and complications (intraoperative, early ≤90 days, and delayed >90 days) were retrospectively assessed and compared between the groups. METHODS A retrospective chart and imaging review of all consecutive patients who underwent OLIF at a single institution was performed. Indications for OLIF included symptomatic lumbar degenerative stenosis, deformity, and spondylolisthesis. The L5-S1 level, when included, was approached via one of the following 3 techniques: (1) a left-sided intrabifurcation approach; (2) left-sided prepsoas approach; and (3) right-sided prepsoas approach. Vascular anatomic variations at the lumbosacral junction were evaluated using the preoperative magnetic resonance imaging (MRI), and a "facet line" was proposed to assess this relationship. A minimum of 6 months of follow-up data were assessed for approach-related morbidities. RESULTS Demographics and operative indications were similar between the groups. The mean follow-up was 10.8 (6-36) months. ORT was significantly longer in group A than in group B (322 vs. 256.3 min, respectively; p=.001); however, no difference in ORT between the two groups was found in the subanalyses for 2- and 3-level surgeries. Differences in EBL (260 vs. 207.91 cc, p=.251) and LOS (2.76 vs. 2.48 days, p=.491) did not reach statistical significance. Ligation of the iliolumbar vein, segmental veins, median sacral vessels, or any vascular structure, as needed for adequate exposure, was required in 13 (68.4%) patients from group A and 4 (5.9%) from group B (p<.00001). Two patients suffered minor vascular injuries (1 in each group); however, no major vascular injuries were seen. Complications were not significantly different between groups A and B, or between the three approaches to L5-S1, and trended lower in the latter part of the series as the learning curve progressed. CONCLUSIONS Inclusion of L5-S1 in OLIF is safe and feasible through three different approaches but likely involves greater operative complexity. In our early experience, inclusion of L5-S1 showed no increase in early complications. This is the first series that reports the use of 3 different oblique approaches to L5-S1. The proposed "facet line" in the preoperative MRI may guide the choice of approach.
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Sharma M, Chhawra S, Jain R, Sharma S. Full Endoscopic Lumbar Transforaminal Interbody Fusion in DDD Lumbar Degenerative Disc Disease: A Latest Technique. Int J Spine Surg 2021; 14:S71-S77. [PMID: 33900948 PMCID: PMC7888205 DOI: 10.14444/7168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Lumbar interbody fusion has long been used in the treatment of degenerative disc disease. Lumbar spinal interbody fusion surgery traditionally is an open surgical technique. Although lumbar spinal interbody fusions using endoscopy have been reported, the endoscope was used partially for the interbody fusion. We are reporting a case where lumbar interbody fusion with discectomy was entirely done through direct visualization with the endoscope. METHODS We report a case of a 55-year-old woman who underwent the transforaminal percutaneous full-endoscopic lumbar interbody fusion technique (FELTIF) under continuous and direct visualization at the L5-S1 level. To facilitate the interbody fusion, a foraminoplasty with complete resection of the superior articular process (SAP) and a partial pediculectomy of the S1 pedicle was performed. End plate sparing decortication techniques were used under direct video endoscopic visualization. The cage and bone graft insertion occurred through the endoscopic working cannula, thereby protecting the retracted traversing and exiting nerve roots at the surgical level. Posterior supplemental fixation with percutaneous pedicle screws was performed to complete the circumferential fusion. RESULT The VAS leg score was reduced to 2 from preoperative score of 7 and the VAS back score reduced 3 from preoperative score of 9. Her neurogenic symptom score improved from 8 before surgery to 1 at the last follow-up. The fusion is assessed by plain radiographs in follow up. CONCLUSIONS We concluded that the insertion of an interbody fusion cage device directly through an endoscopic working cannula was technically feasible. Future research should focus on examining the clinical outcomes of this technique. LEVEL OF EVIDENCE 4.
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Cui JM, Wang JR, Zheng ZM, Liu H, Wang H, Li ZM. Lateral-anterior lumbar interbody fusion (LaLIF) for lumbar degenerative disease: Technical notes, surgical system, and mid-term outcomes. J Orthop Translat 2021; 28:12-20. [PMID: 33575167 PMCID: PMC7859168 DOI: 10.1016/j.jot.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background Many modified lateral lumbar interbody fusion techniques for lumbar degenerative diseases have been described by different authors. However, relatively high rates of vascular injury, peritoneal laceration, and even ureteral injury have been reported. Purpose The objectives of this study were firstly to present the detailed, standardized technical notes and describe the required standard characteristics of the designed surgical system of LaLIF and secondly to evaluate clinical outcomes and highlight the approach-related complications. Methods The mini-open LaLIF is described in a step-wise manner. The outcome measures were operative parameters, self-report measures, radiographic measures, and complications within 1 month of surgery. Operative parameters measured included operative time, intraoperative blood loss, and length of hospital stay. The self-report measures include Visual Analogue Scale (VAS), Oswestry disability index (ODI), and Short Form 36 Health Survey (SF-36) score. The radiographic measures including the intervertebral foraminal height (FH), intervertebral disc height (DH), and intervertebral foraminal area (FA) were assessed with plain radiography. The complication profiles were classified into intraoperative and postoperative (up to 1 month). Intraoperative complications were subcategorized into neurologic, vascular, ureteral, peritoneal, and vertebral injuries. Postoperative complications were subcategorized into infection, cage migration, and subsidence. Results A total of 126 patients who underwent LaLIF between April 2016 and December 2018 by a senior author were retrospectively reviewed. There were 54 males and 72 females (range 42–89 years old, average 65 ± 11 years old). The mean follow-up was 20 ± 11 months (range 6–38 months). The LaLIF was conducted at 188 levels in 126 patients, with 1 level in 75 cases, 2 levels in 42, 3 levels in 7, and 4 levels in 2 cases. There were 114 patients who underwent stand-alone LaLIF and 12 patients required secondary posterior fixation. The mean operative time, intraoperative blood loss, and length of hospital stay were recorded. The patient-reported outcome scores (VAS, ODI, and SF-36) and radiographic parameters (FH, DH, and FA) demonstrated a significant improvement after surgery and at the last follow-up. There were 25 (19.8%) complications in the 126 patients. The intraoperative complications accounted for 19 cases (15.1%) and postoperative accounted for 6 cases (4.8%). The most frequent complications were neurological injury (6.3%) and temporary psoas injury (6.3%). Conclusions The mini-open LaLIF, as a reproducible novel technique, can be performed safely at L2-L5. It is associated with reliable mid-term clinical outcomes and an acceptable complication profile when compared to traditional LLIF due to the advancements in the modified incision site, direct visualization, and usage of strictly vertical trajectory in multiple steps with the specially designed LaLIF system. Translational potential statement To make the lateral lumbar fusion process repeatable and also maintain a shallow learning curve, especially for surgeons in the early stages of learning, by using instruments with the required standard characteristics, the standardized surgical steps, modified incision site, vertical trajectory, and the direct visualization during the entire procedure.
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Affiliation(s)
- Jia-Ming Cui
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Jian-Ru Wang
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Zhao-Min Zheng
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Hui Liu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Hua Wang
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Ze-Min Li
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
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Li R, Shao X, Li X, Liu Y, Jiang W. Comparison of clinical outcomes and spino-pelvic sagittal balance in degenerative lumbar spondylolisthesis: Minimally invasive oblique lumbar interbody fusion (OLIF) versus transforaminal lumbar interbody fusion (TLIF). Medicine (Baltimore) 2021; 100:e23783. [PMID: 33545942 PMCID: PMC7837863 DOI: 10.1097/md.0000000000023783] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/15/2020] [Indexed: 01/03/2023] Open
Abstract
Spino-pelvic sagittal parameters are closely related to the lumbar degenerative diseases. The present study aims to compare clinical results and spino-pelvic sagittal balance treated with oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in patients with degenerative lumbar spondylolisthesis at single segment.We retrospectively reviewed and compared 28 patients who underwent OLIF (OLIF group) and 35 who underwent TLIF (TLIF group). Radiological results were evaluated with disc height (DH), foraminal height (FH), fused segment lordosis (FSL), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and sacral slope (SS). Clinical results were evaluated with the Oswestry Disability Index (ODI) and VAS for back and leg pain.The OLIF group showed higher improvement of DH and FH than the TLIF group at all time points after surgery (P < .05). No significant differences were found in PT, PI, and SS between the 2 groups (P > .05). Significant restoration of spino-pelvic sagittal balance was observed in the 2 groups after surgery. Significant differences in postoperative lumbar lordosis and fused segment lordosis were found between the 2 groups (P < .05). Significant difference in the improvement of symptoms was observed between the 2 groups. The OLIF group had lower VAS scores for back pain and ODI compared after surgery (P < .05).It can be concluded that there are exactly differences in improvement of radiographic parameters between 2 approaches, which confirmed that OLIF is better in restoring spinal alignment. Besides, due to the unique minimally invasive approach, OLIF did exhibit a greater advantage in early recovery after surgery.
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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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Lin GX, Rui G, Sharma S, Mahatthanatrakul A, Kim JS. The correlation of intraoperative distraction of intervertebral disc with the postoperative canal and foramen expansion following oblique lumbar interbody fusion. 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 2020; 30:151-163. [PMID: 32960343 DOI: 10.1007/s00586-020-06604-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 08/04/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the correlation of intraoperative distraction of intervertebral disc with the postoperative central canal and foramen expansion by oblique lumbar interbody fusion (OLIF) with indirect decompression. METHODS Patients who underwent OLIF between October 2013 and April 2017 were included. Clinical outcomes included back and leg pain evaluated by visual analog scale (VAS) and Oswestry Disability Index (ODI). Intraoperative radiographic parameters of height ratio [(HR) = disc height/intervertebral body height)] and cage location were evaluated on intraoperative fluoroscopic images. Disc height (DH), foraminal height (FH), cross-sectional area of spinal canal (CSAC), and CSA of the foramen (CSAF) were measured. RESULTS A total of 47 patients involving 62 levels were enrolled in this study. Mean follow-up was 43.8 ± 12.0 months. These patients reported an improvement of 61.7% in VAS back, 68.1% in VAS leg, and 46% in ODI (all p < 0.01). Radiographic parameters including HR, DH, FH, CSAC, and CSAF were also significantly increased by 32.6%, 48.2%, 21.4%, 44.0%, and 40.1% (left-side CSAF) or 45.4% (right-side CSAF), respectively (p < 0.05). HR increment was correlated with CSA (canal and foramen) increment. Slightly higher improvements of HR, DH, FH, CSAC, and CSAF (both sides) were noted when cage was located at middle rather than anterior (p > 0.05). CONCLUSIONS The ligamentotaxis effect of OLIF is capable of supporting indirect decompression of central canal and neural foramina and clinical improvement. HR is a reliable intraoperative assessment method. In addition, intraoperative HR increment was correlated with postoperative neural elements expansion.
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Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Sagar Sharma
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea
| | | | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea.
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Kotheeranurak V, Singhatanadgige W, Ratanakornphan C, Yingsakmongkol W, Hynes RA, Limthongkul W. Neutral hip position for the oblique lumbar interbody fusion (OLIF) approach increases the retroperitoneal oblique corridor. BMC Musculoskelet Disord 2020; 21:583. [PMID: 32867737 PMCID: PMC7461341 DOI: 10.1186/s12891-020-03592-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prepsoas lateral approach for spinal fusion, oblique lateral lumbar interbody fusion (OLIF), is considered one of the minimally invasive spinal fusion methods and is gaining popularity due to improved outcomes with copious supporting evidence. To date, no publication has studied the various positions of the left hip in actual patients which might affect the retroperitoneal oblique corridor (ROC). The study aimed to find the relevancy of the left hip position and the size of ROC. METHODS We recruited 40 consecutive patients who needed diagnostic MRI from the out-patient clinic. MRI scan from L2 to L5 was performed in the supine, right lateral decubitus with hip flexion, and right lateral decubitus with hip in a neutral position. The retroperitoneal oblique corridor (ROC) was measured at the intervertebral disc level and compared. RESULTS ROC of the hip in neutral position was significantly larger than hip flexion in all levels (p < 0.05); there was no significant difference in the ROC among levels (p = 0.22). ROC seems to be largest at L2/3 followed by L3/4 and L4/5 respectively in all positions. CONCLUSIONS The retroperitoneal oblique corridors of L2 to L5 were significantly increased when the hip is in the neutral position, while the psoas cross-sectional area and anterior thickness were minimized in this position. Surgeons might benefit from a neutral position of the left hip in the oblique lateral lumbar interbody fusion (OLIF) procedure. In conclusion, the retroperitoneal oblique corridors of L2 to L5 were significantly increased when the hip is in the neutral position, while the psoas cross-sectional area and anterior thickness were minimized in this position. Surgeons might benefit from a neutral position of the left hip in the oblique lateral lumbar interbody fusion procedure.
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Affiliation(s)
- Vit Kotheeranurak
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Sriracha, Thailand
| | - Weerasak Singhatanadgige
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand
| | | | - Wicharn Yingsakmongkol
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand
| | | | - Worawat Limthongkul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand.
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Correlation study of radiographic characteristics and operative difficulty in lateral-anterior lumbar interbody fusion (LaLIF) at the L4-5 level: a novel classification for case selection. 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 2020; 30:97-107. [PMID: 32816081 DOI: 10.1007/s00586-020-06570-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/15/2020] [Accepted: 08/12/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To analyze correlations between the realistic surgical difficulty of LaLIF and anatomic characteristics in radiographic images, in order to develop a simple classification to provide guiding information for case selection and evaluate the potential risks of the technique. METHODS Ninety-six consecutive cases who underwent LaLIF surgeries at the L4-5 level with MR T2-weighted images were analyzed. A novel classification based on the anatomic relationships among the disk, great vessels, and psoas muscle was used for grouping. Clinical outcomes and realistic surgical difficulty parameters were recorded, and comparisons were made among different types of classifications. RESULTS Of the 96 analyzed cases, the time of surgical exposure was significantly longer for type C than for type B, and both of these were longer than that of type A. The VAS and ODI were significantly improved at a 1-year follow-up. There was no statistically significant difference among the three types. Type C had the highest incidence of complications, while Type A had the lowest. Analyses of another 304 MRI cases obtained in outpatient clinics showed that the distribution of the three types among these cases was consistent with that of the surgical cohort. CONCLUSION Our novel and simple classification provides useful information for case selection. Type A provided the best indication and is most appropriate for a beginner in this technique. Type C includes the most challenging situations, which may have a high incidence of complications and require sophisticated surgical skills to achieve satisfactory outcomes and avoid approach-related complications.
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Chang SY, Nam Y, Lee J, Chang BS, Lee CK, Kim H. Clinical Significance of Radiologic Improvement Following Single-Level Oblique Lateral Interbody Fusion With Percutaneous Pedicle Screw Fixation. Orthopedics 2020; 43:e283-e290. [PMID: 32501518 DOI: 10.3928/01477447-20200521-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/29/2019] [Indexed: 02/03/2023]
Abstract
Indirect decompression using oblique lateral interbody fusion (OLIF) improves spinal canal dimensions by reducing spondylolisthesis and restoring intervertebral disk height in patients with degenerative lumbar diseases. However, the clinical significance of these radiological improvements has not been fully evaluated in the literature. To examine the relationship between the clinical and radiological outcomes following OLIF, the authors prospectively studied 41 patients who underwent single-level OLIF with percutaneous pedicle screw fixation for lumbar degenerative disease, including degenerative and spondylolytic spondylolisthesis and spinal stenosis with disk height loss. Clinical scores were obtained preoperatively and at 1 year postoperatively using multiple questionnaires. Radiological outcomes were evaluated using plain radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) at 1 year postoperatively. Following a single-level OLIF, all categories of clinical scores showed statistically significant improvement. Rate of cage subsidence was 14.6% and 31.7% at 1 week and 1 year postoperatively, respectively. Patients with subsidence had higher Oswestry Disability Index (P=.026) scores and lower physical composite summary scores on the Short Form-36 Health Survey (P=.007). On CT scan, 28 (68.3%) patients showed a complete interbody fusion and 13 (31.7%) had intermediate fusion. All parameters from the MRI, except for foraminal width, showed significant improvement at 1 year postoperatively. The improvement ratio of foraminal height was associated with the percent improvement of lower-extremity radiating pain (Pearson coefficient=0.384; P=.013) and the walking ability score of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (Pearson coefficient=0.319; P=.042) at 1 year postoperatively. Restoration of foraminal height while preserving the endplates is associated with favorable results following OLIF. [Orthopedics. 2020;43(4):e283-e290.].
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Jain D, Ray WZ, Vaccaro AR. Advances in Techniques and Technology in Minimally Invasive Lumbar Interbody Spinal Fusion. JBJS Rev 2020; 8:e0171. [DOI: 10.2106/jbjs.rvw.19.00171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Mono- und mehrsegmentaler ventraler minimalinvasiver Zugang zur Lendenwirbelsäule (OLIF) zur Korrektur von Deformitäten. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:200-208. [DOI: 10.1007/s00064-020-00658-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/26/2019] [Accepted: 10/07/2019] [Indexed: 10/24/2022]
Abstract
Zusammenfassung
Operationsziel
Minimalinvasiver anterolateraler Zugang zur Lendenwirbelsäule („oblique lateral interbody fusion“ [OLIF]) zur Korrektur von lumbalen Deformitäten.
Indikationen
Ventrales Release bei degenerativer Lumbalskoliose oder segmentalen Kyphosen und interkorporelle Korrekturspondylodese.
Kontraindikationen
Absolute Kontraindikationen bestehen nicht. Relative Kontraindikationen sind vorangegangene (linksseitige) retroperitoneale Eingriffe bzw. Zustand nach Peritonitis mit ausgeprägten retroperitonealen Vernarbungen. Gefäßanomalien mit extrem lateral verlaufender V. iliaca communis (v. a. bei Segmentationsstörungen im vorletzten Bewegungssegment).
Operationstechnik
Über einen kleinen Hautschnitt im Bereich der linken Flanke und Wechselschnitttechnik durch die Bauchwandmuskulatur retroperitoneales Eingehen auf die laterale anteriore Lendenwirbelsäule monosegmental bzw. von L1–L5. Retraktion des M. psoas und Ausräumen des Bandscheibenfaches ggf. mit Durchtrennung des vorderen Längsbandes. Interkorporelles Release und Interposition eines Implantates zur ventralen Korrekturspondylodese.
Weiterbehandlung
Frühmobilisation nach dorsaler Instrumentation nach Abklingen der Narkose unter Thromboseprophylaxe. Leichte Kost bis zum ersten Stuhlgang. Tragen einer rumpfstabilisierenden Orthese je nach Art und Ausdehnung des Eingriffes bis zu 12 Wochen. Keine Einschränkungen bezüglich Gehstrecke, Stehen und Sitzen unmittelbar postoperativ nach Schmerzvorgabe.
Ergebnisse
Es wurden 15 konsekutive Patienten mit degenerativer lumbaler Skoliose im Sinne einer ventrodorsalen Fusionsoperation versorgt. Die operative ventrale Versorgung beinhaltete 1 bis 4 Segmente. Erfasst wurden die zugangsspezifischen Komplikationen sowie die prä- und postoperativen radiologischen Parameter. Bei keinem der 15 linksseitig retroperitoneal durchgeführten ventralen Zugänge wurden intraoperative oder postoperative zugangsspezifische Komplikationen festgestellt. Im gesamten Patientenkollektiv konnte eine signifikante Reduktion des a.p.-Cobb-Winkels von präoperativ 16° ± 6° auf 3° ± 2° postoperativ (p < 0,001) erreicht werden.
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Li R, Li X, Zhou H, Jiang W. Development and Application of Oblique Lumbar Interbody Fusion. Orthop Surg 2020; 12:355-365. [PMID: 32174024 PMCID: PMC7967883 DOI: 10.1111/os.12625] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/24/2019] [Accepted: 01/01/2020] [Indexed: 12/21/2022] Open
Abstract
The present study reviewed the relevant recent literature regarding the development and application of oblique lumbar interbody fusion (OLIF), with a particular focus on its application and associated complications. The study evaluated the rationality of this technique and demonstrated the direction of future research by collecting data on previous operative outcomes and complications. A literature search was performed in Pubmed and Web of Science, including the following keywords and abbreviations: anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), direct lateral interbody fusion (DLIF), extreme lateral interbody fusion (XLIF), oblique lateral interbody fusion (OLIF), adjacent segment disease (ASD), and adult degenerative scoliosis (ADS). A search of literature published from January 2005 to January 2019 was conducted and all studies evaluating development and application of OLIF were included in the review. According to the literature, the indications for OLIF are various. OLIF has excellent orthopaedic effects in degenerative scoliosis patients and the incidence of bony fusion is higher than for other approaches. It also provides a better choice for revision surgery. It has various advantages in many aspects, but the complications cannot be ignored. As a new minimally invasive technique, the advantages of OLIF are obvious, but further evaluation is needed to compare its operation‐related data with that of traditional open surgery. In addition, more prospective studies are required to compare minimally invasive and open spinal surgery to confirm its specific efficacy, risk, advantages, learning curve, and ultimate clinical efficacy.
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Affiliation(s)
- Renjie Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuefeng Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weimin Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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Liu J, Ding W, Yang D, Wu H, Hao L, Hu Z, Fan S, Zhao F. Modic Changes (MCs) Associated with Endplate Sclerosis Can Prevent Cage Subsidence in Oblique Lumbar Interbody Fusion (OLIF) Stand-Alone. World Neurosurg 2020; 138:e160-e168. [PMID: 32081816 DOI: 10.1016/j.wneu.2020.02.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the association between Modic changes (MCs) and endplate sclerosis; and to investigate the effect of MCs and endplate sclerosis on cage subsidence in oblique lumbar interbody fusion (OLIF) stand-alone. METHODS We included 78 inpatients who underwent OLIF stand-alone from August 2015 to August 2017. All patients underwent computed tomography (CT) and magnetic resonance imaging. The presence and the types of MCs were assessed. Endplate sclerosis was evaluated from sagittally reconstructed CT images. Cage subsidence was evaluated at the 1-, 3-, 6-, and 12-month follow-up. RESULTS Of 78 patients, 92 discs underwent OLIF without posterior instrumentation; 32 of 92 (34.8%) had MCs. Type I, II, and III MCs were seen in 10 (10.9%), 19 (20.7%), and 3 (3.2%) endplates, respectively. Among 32 endplates with MCs, 10 (31.3%) showed evidence of sclerosis on CT images, including 2 of 10 endplates (20%) with type I MCs, 5 of 19 (26.3%) with type II, and 3 of 3 (100%) with type III. Among 60 endplates without MCs, 5 (8.3%) showed evidence of sclerosis. Cage subsidence rate in the no-MCs group was higher than that in the MCs group (P <0.01). We found only 1 case of cage subsidence in the MCs group (n = 32), which was classified as MCs type I, whereas 6 cases of cage subsidence were observed in the no-MCs group (n = 60). Hounsfield unit ratios for sclerotic and no-sclerotic endplates were 2.2 ± 0.3 and 1.1 ± 0.1, respectively. No subsidence of cage was found in the sclerotic endplates group (n = 15), whereas 7 cases of cage subsidence were found in the no-sclerotic group (n = 77). CONCLUSION MCs associated with endplate sclerosis can prevent cage subsidence in OLIF stand-alone.
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Affiliation(s)
- Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Wenyuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dalong Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hao Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Lu Hao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhijun Hu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China.
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Liu J, He Y, Huang B, Zhang X, Shan Z, Chen J, Fan S, Zhao F. Reoccurring discogenic low back pain (LBP) after discoblock treated by oblique lumbar interbody fusion (OLIF). J Orthop Surg Res 2020; 15:22. [PMID: 31959197 PMCID: PMC6971953 DOI: 10.1186/s13018-020-1554-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/12/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the efficacy of OLIF in the treatment of reoccurring discogenic low back pain (LBP) after discoblock Methods We included 108 patients with LBP that was suspected to be discogenic (such as high intensity zone, Schmorl’s nodes, Modic changes Type I, etc.), from August 2015 to August 2017. All patients underwent discography, and patients whose LBP was confirmed to be discogenic received discoblock. Patients who had reoccurring pain after discoblock underwent OLIF. Perioperative parameters and complications were recorded. The VAS and Oswestry Disability Index (ODI) were assessed at preoperation, and 1 week and 1, 3, 6, and 12 months after the surgery. The fusion rate was evaluated. Results Of 108 patients, 89 were confirmed to have discogenic LBP, and 32/89 patients with reoccurring LBP pain after discoblock underwent OLIF. Twenty-eight patients were followed up for ≥ 1 year. The OLIF operation lasted for 92 ± 34 min. Blood loss during the operation was 48 ± 15 ml. The mean incision length was 3.0 ± 0.6 cm. The average length of stay was 4.8 ± 1.9 days. The VAS and ODI scores decreased from 8.1 ± 1.7 preoperatively to 0.9 ± 0.4, and from 71.2 ± 11.3 to 9.3 ± 3.1, 12 months postoperatively, respectively. The total incidence of complications was 15.6%, including 2 cases of cage subsidence, 2 cases of ipsilateral hip flexor weakness, and 1 case of ipsilateral anterior thigh pain. All symptoms relieved or disappeared during follow-up. The fusion rate was 96.9%. Conclusions Reoccurring discogenic LBP after discoblock should be considered as a suitable group for treatment by OLIF.
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Affiliation(s)
- Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Yongqing He
- Department of Orthopaedics, Haining County People's Hospital, Haining, People's Republic of China
| | - Bao Huang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Xuyang Zhang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Zhi Shan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Jian Chen
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China.
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Wang C, Zeng J, Yang Z. [Guiding role of imaging evaluation in oblique lumbar interbody fusion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1572-1577. [PMID: 31823561 PMCID: PMC8355787 DOI: 10.7507/1002-1892.201904021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/02/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To summarize the guiding role of imaging evaluation of oblique lumbar interbody fusion (OLIF) in recent years. METHODS The reports of OLIF surgical imaging research at home and abroad in recent years were extensively reviewed and analyzed. RESULTS Preoperative imaging evaluation plays an important role in guiding the operation of OLIF, the placement of fusion Cage, the selection of indications, and the reduction of complications. CONCLUSION Detailed preoperative imaging evaluation can correctly estimate the indications of OLIF, and avoid the nerve, blood vessel, and muscle injuries.
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Affiliation(s)
- Chaoyang Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jiancheng Zeng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| | - Zhiqiang Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Liu J, Feng H. Oblique Lateral Interbody Fusion (OLIF) with Supplemental Anterolateral Screw and Rod Instrumentation: A Preliminary Clinical Study. World Neurosurg 2019; 134:e944-e950. [PMID: 31734420 DOI: 10.1016/j.wneu.2019.11.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to evaluate the technical details, clinical effectiveness, and complications of oblique lateral interbody fusion supplemented with anterolateral screw-rod instrumentation in managing degenerative lumbar diseases. METHODS The clinical data of 14 patients with lumbar degenerative diseases who underwent oblique lateral interbody fusion and anterolateral screw-rod instrumentation in the Department of Neurosurgery, Sichuan Provincial People's Hospital, from April 2015 to May 2018, were retrospectively analyzed. The duration of operation, estimated blood loss, radiological exposure, length of hospital stay, and complications were recorded. The visual analog scale score, Oswestry Disability Index, and radiologic parameters were evaluated before and after surgery. RESULTS The diagnosis included degenerative/isthmic spondylolisthesis (grade I), degenerative lumbar stenosis, disc hernia with instability, and adjacent segment disease. The follow-up period was 12-45 months. The clinical symptoms improved significantly after the operation according to the visual analog scale and Oswestry Disability Index scores. The average operation time, blood loss, and length of hospital stay were 72.50 ± 21.46 minutes, 53.21 ± 19.07 mL, and 5.57 ± 2.21 days, respectively. The postoperative radiographic examination demonstrated increased intervertebral height and foramen area (P < 0.05). The radiologic fusion rate was 95% at the last follow-up; cage subsidence was found in 1 case. No major complications, such as vascular injury, ureteral injury, or infection, occurred. CONCLUSIONS As an alternative method of instrumentation, anterolateral screw-rod fixation minimized the total operation time, blood loss, radiological exposure, and soft tissue disruption, and realized 1-stage intervertebral fusion and instrumentation through a single small incision.
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Affiliation(s)
- Jinping Liu
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Hailong Feng
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
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Tong YJ, Liu JH, Fan SW, Zhao FD. One-stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series. Orthop Surg 2019; 11:1109-1119. [PMID: 31701667 PMCID: PMC6904647 DOI: 10.1111/os.12562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022] Open
Abstract
Objective Surgery is indicated when antibiotic treatment fails in pyogenic spondylodiscitis, which is caused by pathogens such as the Staphylococcus species. The aim of the present study was to investigate the efficacy and safety of the oblique lateral interbody fusion (OLIF) corridor approach combined with posterior pedicle screw fixation for treating pyogenic spondylodiscitis. Methods This was a retrospective case series study. A total of 11 patients with an average age of 60.7 years (range, 40–70 years; 10 males and 1 females) with lumbar pyogenic spondylodiscitis who underwent single‐stage debridement and reconstruction using the OLIF corridor combined with posterior pedicle screw fixation were recruited in our study from June 2016 to July 2017. All patients had single‐level pyogenic spondylodiscitis between T12 and L5. The baseline data, perioperative outcomes (operative time, intra‐operative blood loss, and intra‐operative complication), postoperative laboratory tests (erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP], white blood count [WBC], and tissue culture results), long‐term complications (recurrence, fixation failure, and bony non‐fusion rates), and duration of antibiotic administration were reviewed. Outcomes evaluated using a variety of scales including visual analog scale (VAS) score and Oswestry disability index (ODI), were compared pre‐operatively and post‐operatively. Results The mean follow‐up period of time was 18.3 months. The average operative time and intra‐operative blood loss were 217.0 ± 91.91 min and 220.9 ± 166.10 mL, respectively. There were no intra‐operative complications, except in 1 patient who encountered somatosensory evoked potentials changes and 1 patient who had motor evoked potentials changes, both without post‐surgery neurological deficits. Causative organisms were identified in 4 patients: Staphylococcus aureus in 1 patient and Streptococcus in 3 patients. At approximately 8.8 weeks after surgery, WBC, CRP, and ESR had returned to normal levels. All patients were pain free with no recurring infection. There was no fixation failure during follow up. Solid bony fusions were observed in all cases within 6 months. At the final follow up, the mean VAS (0.6 ± 0.69) and ODI (14.4 ± 4.27) were significantly lower than those before surgery (P < 0.05). Conclusion One‐stage debridement with autogenous iliac bone graft through the OLIF corridor combined with posterior pedicle screw fixation is effective and safe for single‐level spontaneous lumbar pyogenic spondylodiscitis after antibiotic treatment fails.
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Affiliation(s)
- Yong-Jun Tong
- Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China.,Department of Orthopaedics, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jun-Hui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Shun-Wu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Feng-Dong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China
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Yoo JS, Ahn J, Patel DS, Hrynewycz NM, Brundage TS, Singh K. An evaluation of biomaterials and osteobiologics for arthrodesis achievement in spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S168. [PMID: 31624734 PMCID: PMC6778273 DOI: 10.21037/atm.2019.06.80] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 12/31/2022]
Abstract
An increasing variety of orthobiologic materials, including autologous and allogeneic bone graft, bone marrow aspirate, demineralized bone matrix, ceramics, and growth factors are available to the spine surgeon. Although autologous bone graft remains the gold standard material, concerns for failure in achieving fusion have prompted evaluation of current and new biologic materials. As such, this review attempts to summarize the available biologic materials with their pertinent characteristics, advantages, disadvantages, and primary uses.
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Affiliation(s)
- Joon S Yoo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Junyoung Ahn
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Dillon S Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nadia M Hrynewycz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Thomas S Brundage
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Relationship Between Alterations of Spinal/Pelvic Sagittal Parameters and Clinical Outcomes After Oblique Lumbar Interbody Fusion. World Neurosurg 2019; 133:e156-e164. [PMID: 31476474 DOI: 10.1016/j.wneu.2019.08.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To elucidate the correlation between changes in spinal/pelvic sagittal parameters and clinical treatment outcomes after oblique lumbar interbody fusion (OLIF). METHODS Eighty-two patients with lumbar degenerative disease (LDD) treated by OLIF were retrospectively analyzed. The visual analog scale (VAS) score and Oswestry Disability Index (ODI) score were compared before and after surgery. Disk height (DH) and various spinal/pelvic sagittal parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA), were measured preoperatively and at the last postoperative follow-up. The correlation between the changes in sagittal parameters before and after surgery and the clinical treatment outcomes were observed. RESULTS ODI score, VAS score, and DH were significantly better at the last follow-up compared with before surgery. The change in PI was not statistically significant before and after surgery. PT significantly decreased and SS and LL significantly increased after surgery. Significant linear relationships were found for several independent variables (difference in DH before and after surgery, postoperative LL, difference in LL before and after surgery, PI-LL match status, and SVA status) and the dependent variable ODI. The difference in DH before and after surgery showed the strongest correlation. The percentages of PI-LL match were 37% before surgery and 66% after surgery. The percentage of the normal SVA was 9% before surgery and 62% after surgery. CONCLUSIONS OLIF for treatment of LDD had significant clinical outcomes, effectively restored the spinal/pelvic sagittal balance, and helped to improve the patients' clinical conditions.
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Farah K, Leroy HA, Karnoub MA, Obled L, Fuentes S, Assaker R. Does the hip positioning matter for oblique lumbar interbody fusion approach? A morphometric study. 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 2019; 29:306-313. [PMID: 31410621 DOI: 10.1007/s00586-019-06107-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate whether left hip positioning widened the access corridor using oblique lateral interbody fusion (OLIF) approach during right lateral decubitus (RLD). METHODS Ten healthy adult volunteers underwent a T2 lumbosacral MRI (1.5 T) in the supine position, RLD position with left hip in extension and then in flexion. L2-L3 to L5-S1 disc spaces were identified. At each level, left psoas surface (in cm2), access corridor (in mm) and vessel movement were calculated in the three positions. Paired t test was used for comparison. RESULTS The mean surface of the left psoas ranged from 7.83 to 17.19 cm2 in the three positions (p > 0.05). From L2-3 to L4-5, in RLD, when the left hip shifted from extension to flexion, nor the access corridor nor vessel movements were significantly different. When the volunteers shifted from supine to RLD position with hip in extension, arteries moved 3.66-5.61 mm to the right (p < 0.05 at L2-3, L3-4 and L5-S1), while the venous structures moved 0.92-4.96 mm (p < 0.05 at L2-3) to the right. When the position shifted from supine to RLD with hip in flexion, the arterial structures moved 0.47-4.88 mm (p < 0.05 at L2-3 and L3-4) to the right, while the venous structures moved - 0.94 to 4.13 mm (p < 0.05 at L2-3 and L3-4) to the right. CONCLUSION Hip positioning was not associated with a significant widening of the surgical corridor. To perform OLIF, we advocate for RLD position with left hip in extension to move away the vascular structures and reduce the psoas volume. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Kaissar Farah
- Department of Neurosurgery, Lille University Hospital, Lille, France. .,Department of Neurosurgery and Spine Unit, La Timone University Hospital, Marseille, France.
| | | | | | - Louis Obled
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Stephane Fuentes
- Department of Neurosurgery and Spine Unit, La Timone University Hospital, Marseille, France
| | - Richard Assaker
- Department of Neurosurgery, Lille University Hospital, Lille, France
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Jin C, Xie M, He L, Xu W, Han W, Liang W, Qian Y. Oblique lumbar interbody fusion for adjacent segment disease after posterior lumbar fusion: a case-controlled study. J Orthop Surg Res 2019; 14:216. [PMID: 31311556 PMCID: PMC6636144 DOI: 10.1186/s13018-019-1276-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/10/2019] [Indexed: 12/03/2022] Open
Abstract
Background This study assessed clinical and radiographic outcomes of oblique lumbar interbody fusion (OLIF) in comparison with posterior reoperation for adjacent segment disease (ASD). Methods A total of 26 patients with symptomatic ASD after lumbar fusion were included in this retrospective case-controlled study conducted from January 2013 to December 2018. Twelve patients underwent single-segment OLIF with or without posterior instrumentation (OLIF group), whereas 14 patients underwent posterior reoperation (posterior approach group). The clinical outcomes included operative time, blood loss, hospital stay, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and complications. Preoperative and postoperative radiographic outcomes were compared. Results The operative time (60.6 ± 16.1 min vs. 150.9 ± 28.5 min, respectively; P < 0.05) and the blood loss in the OLIF group 89.2 ± 49.0 ml vs. 340.7 ± 130.2 ml, respectively; P < 0.05) were significantly lower than those in the posterior group. The hospital stay was lower in the OLIF group than in the posterior approach group (6.6 ± 1.3 days vs. 9.5 ± 2.5 days, respectively; P < 0.05). In the posterior approach group, 6 of 14 patients (42.8%) had issue with dural tear, while none in the OLIF group had such issue (P < 0.05). The ODI score (13.2 ± 4.2 vs. 19.2 ± 7.2, respectively; P = 0.014) and the VAS back pain score were lower in the OLIF group postoperatively and at last follow-up. In the OLIF group, the radiographic outcomes were significantly improved postoperatively. Conclusions Due to our results and early experiences, we proposed that OLIF was safe and effective for ASD. Compared with posterior reoperation, OLIF results in shorter operative time and hospital stay, lesser blood loss, and lower risk of dural injury.
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Affiliation(s)
- Cong Jin
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhongxing North Road, Shaoxing, 312000, Zhejiang, China
| | - Minghua Xie
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhongxing North Road, Shaoxing, 312000, Zhejiang, China
| | - Lei He
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhongxing North Road, Shaoxing, 312000, Zhejiang, China
| | - Wenbin Xu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weiqi Han
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhongxing North Road, Shaoxing, 312000, Zhejiang, China
| | - Wengqing Liang
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhongxing North Road, Shaoxing, 312000, Zhejiang, China
| | - Yu Qian
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhongxing North Road, Shaoxing, 312000, Zhejiang, China.
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