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Wu J, Ge T, Li G, Ao J, Sun Y. The analysis of segmental lordosis restored by oblique lumbar interbody fusion and related factors: building up preoperative predicting model. BMC Musculoskelet Disord 2024; 25:171. [PMID: 38402180 PMCID: PMC10893656 DOI: 10.1186/s12891-024-07293-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/19/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Oblique lumbar interbody fusion (OLIF) procedures have the potential to increase the segmental lordosis by inserting lordotic cages, however, the amount of segmental lordosis (SL) changes can vary and is likely influenced by several factors, such as patient characteristics, radiographic parameters, and surgical techniques. The objective of this study was to analyze the impact of related factors on the amount of SL changes in OLIF procedures and to build up predictive model for SL changes. METHODS This is a retrospective study involving prospectively enrolled patients. A total of 119 patients with 174 segments undergoing OLIF procedure were included and analyzed. The lordotic cages used in all cases had 6-degree angle. Radiographic parameters including preoperative and postoperative segmental disc angle (SDA, preSDA and postSDA), SDA changes on flexion-extension views (ΔSDA-FE), CageLocation and CageInclination were measured by two observers. Interobserver reliability of measurements were ensured by analysis of interclass correlation coefficient (ICC > 0.75). Pearson correlation coefficient analysis and multivariate linear regression were employed to identify factors related to SDA changes and to build up predictive model for SDA changes. RESULTS The average change of segmental disc angle (ΔSDA, postSDA-preSDA) was 3.9° ± 4.8° (95% confidence interval [CI]: 3.1°-4.6°) with preSDA 5.3° ± 5.0°. ΔSDA was 10.8° ± 3.2° with negative preSDA (kyphotic), 5.0° ± 3.7° with preSDA ranging from 0° to 6°, and 1.0° ± 4.1° with preSDA> 6°. Correlation analysis revealed a significant negative correlation between ΔSDA and preSDA (r = - 0.713, P < 0.001), CageLocation (r = - 0.183, P = 0.016) and ΔSDA-FE (r = - 0.153, P = 0.044). In the multivariate linear regression, preSDA and CageLocation were included in the predictive model, resulting in minimal adjusted R2 change (0.017) by including CageLocation. Therefore, the recommended predictive model was ΔSDA = 7.9-0.8 × preSDA with acceptable fit. (adjusted R2 = 0.508, n = 174, P < 0.001). CONCLUSIONS The restoration of segmental lordosis through OLIF largely depends on the preoperative segmental lordosis. The predictive model, which utilized preoperative segmental lordosis, facilitates preoperative planning for corrective surgery using the OLIF procedure.
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Affiliation(s)
- Jingye Wu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Tenghui Ge
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Guanqing Li
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Jintao Ao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Yuqing Sun
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China.
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Song Z, Zhang Z, Zheng J, Zhang K, Wang F, Ran M, Luo J. Short-term and mid-term evaluation of three types of minimally invasive lumbar fusion surgery for treatment of L4/L5 degenerative spondylolisthesis. Sci Rep 2024; 14:4320. [PMID: 38383595 PMCID: PMC10881486 DOI: 10.1038/s41598-024-54970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/19/2024] [Indexed: 02/23/2024] Open
Abstract
This was a single-centre retrospective study. Minimally invasive techniques for transforaminal lumbar interbody fusion (MIS-TLIF), oblique lumbar interbody fusion (OLIF), and percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) have been extensively used for lumbar degenerative diseases. The present study analyses the short-term and mid-term clinical effects of the above three minimally invasive techniques on L4/L5 degenerative spondylolisthesis. In this retrospective study, 98 patients with L4/L5 degenerative spondylolisthesis received MIS-TLIF, 107 received OLIF, and 114 received Endo-TLIF. All patients were followed up for at least one year. We compared patient data, including age, sex, body mass index (BMI), Oswestry disability index (ODI), visual analogue scale of low back pain (VAS-B), visual analogue scale of leg pain (VAS-L), surgical time, blood loss, drainage volume, hospital stay, complications, and neurological status. Moreover, we performed imaging evaluations, including lumbar lordosis angle (LLA), disc height (DH) and intervertebral fusion status. No significant differences were noted in age, sex, BMI, preoperative ODI, preoperative VAS-B, preoperative VAS-L, preoperative LLA, or preoperative DH. Patients who underwent OLIF had significantly decreased blood loss, a lower drainage volume, and a shorter hospital stay than those who underwent MIS-TLIF or Endo-TLIF (P < 0.05). The VAS-B in the OLIF group significantly decreased compared with in the MIS-TLIF and Endo-TLIF groups at 6 and 12 months postoperatively (P < 0.05). The VAS-L in the Endo-TLIF group significantly decreased compared with that in the MIS-TLIF and OLIF groups at 6 months postoperatively (P < 0.05). The ODI in the OLIF group was significantly better than that in the MIS-TLIF and Endo-TLIF groups at 6 months postoperatively (P < 0.05). No statistically significant differences in the incidence of complications and healthcare cost were found among the three groups. Follow-up LLA and DH changes were significantly lower in the OLIF group than in the other groups (P < 0.05). The intervertebral fusion rate was significantly higher in the OLIF group than in the other groups at 6 and 12 months postoperatively (P < 0.05). In conclusion, while MIS-TLIF, OLIF, and Endo-TLIF techniques can effectively treat patients with L4/5 degenerative spondylolisthesis, OLIF has more benefits, including less operative blood loss, a shorter hospital stay, a smaller drainage volume, efficacy for back pain, effective maintenance of lumbar lordosis angle and disc height, and a higher fusion rate. OLIF should be the preferred surgical treatment for patients with L4/5 degenerative spondylolisthesis.
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Affiliation(s)
- Zhaojun Song
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Zhi Zhang
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Jiazhuang Zheng
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Kai Zhang
- Operation Room of Suining Central Hospital, Sichuan, People's Republic of China
| | - Fandong Wang
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Maobo Ran
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Juan Luo
- Medical Record Department of Suining Central Hospital, Sichuan, People's Republic of China.
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Bereczki F, Turbucz M, Pokorni AJ, Hajnal B, Ronai M, Klemencsics I, Lazary A, Eltes PE. The effect of polymethylmethacrylate augmentation on the primary stability of stand-alone implant construct versus posterior stabilization in oblique lumbar interbody fusion with osteoporotic bone quality- a finite element study. Spine J 2024:S1529-9430(24)00039-1. [PMID: 38307174 DOI: 10.1016/j.spinee.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND CONTEXT Oblique lumbar interbody fusion (OLIF) can provide an ideal minimally invasive solution for achieving spinal fusion in an older, more frail population where decreased bone quality can be a limiting factor. Stabilization can be achieved with bilateral pedicle screws (BPS), which require additional incisions and longer operative time. Alternatively, a novel self-anchoring stand-alone lateral plate system (SSA) can be used, where no additional incisions are required. Based on the relevant literature, BPS constructs provide greater primary biomechanical stability compared to lateral plate constructs, including SSA. This difference is further increased by osteoporosis. Screw augmentation in spinal fusion surgeries is commonly used; however, in the case of OLIF, it is a fairly new concept, lacking a consensus-based guideline. PURPOSE This comparative finite element (FE) study aimed to investigate the effect of PMMA screw augmentation on the primary stability of a stand-alone implant construct versus posterior stabilization in OLIF with osteoporotic bone quality. STUDY DESIGN The biomechanical effect of screw augmentation was studied inside an in-silico environment using computer-aided FE analysis. METHODS A previously validated and published L2-L4 FE model with normal and osteoporotic bone material properties was used. Geometries based on the OLIF implants (BPS, SSA) were created and placed inside the L3-L4 motion segment with increasing volumes (1-6 cm3) of PMMA augmentation. A follower load of 400 N and 10 Nm bending moment (in the three anatomical planes) were applied to the surgical FE models with different bone material properties. The operated L3-L4 segmental range of motion (ROM), the inserted cage's maximal caudal displacements, and L4 cranial bony endplate principal stress values were measured. RESULTS The non-augmented values for the BPS construct were generally lower compared to SSA, and the difference was increased by osteoporosis. In osteoporotic bone, PMMA augmentation gradually decreased the investigated parameters and the difference between the two constructs as well. Between 3 cm3 and 4 cm3 of injected PMMA volume per screw, the difference between augmented SSA and standard BPS became comparable. CONCLUSIONS Based on this study, augmentation can enhance the primary stability of the constructs and decrease the difference between them. Considering leakage as a possible complication, between 3 cm3 and 4 cm3 of injected PMMA per screw can be an adequate amount for SSA augmentation. However, further in silico, and possibly in vitro and clinical testing is required to thoroughly understand the investigated biomechanical aspects. CLINICAL SIGNIFICANCE This study sheds light on the possible biomechanical advantage offered by augmented OLIF implants and provides a theoretical augmentation amount for the SSA construct. Based on the findings, the concept of an SSA device with PMMA augmentation capability is desirable.
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Affiliation(s)
- Ferenc Bereczki
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; School of PhD Studies, Semmelweis University, Üllői Str. 26, Budapest, Hungary
| | - Mate Turbucz
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; School of PhD Studies, Semmelweis University, Üllői Str. 26, Budapest, Hungary
| | - Agoston Jakab Pokorni
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; School of PhD Studies, Semmelweis University, Üllői Str. 26, Budapest, Hungary
| | - Benjamin Hajnal
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; School of PhD Studies, Semmelweis University, Üllői Str. 26, Budapest, Hungary
| | - Marton Ronai
- National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary
| | - Istvan Klemencsics
- National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary
| | - Aron Lazary
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Üllői Str. 78/b, Budapest, Hungary
| | - Peter Endre Eltes
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Üllői Str. 78/b, Budapest, Hungary.
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Loniewski S, Farah K, Mansouri N, Albader F, Settembre N, Litré CF, Malikov S, Fuentes S. Da Vinci Robotic Assistance for Anterolateral Lumbar Arthrodesis: Results of a French Multicentric Study. World Neurosurg 2024; 181:e685-e693. [PMID: 37898271 DOI: 10.1016/j.wneu.2023.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The da Vinci robot (DVR) is the most widely used robot in abdominal, urological, and gynecological surgery. Due to its minimally invasive approach, the DVR has demonstrated its effectiveness and improved safety in these different disciplines. The aim of our study was to report its use in an anterior approach of complex lumbar surgery. METHODS In a retrospective multicenter observational study, 10 robotic-assisted procedures were performed from March 2021 to May 2022. Six oblique lumbar interbody fusion procedures and 4 lumbar corpectomies were performed by anterolateral approach assisted by the DVR. The characteristics of the patients and the intraoperative and postoperative data were recorded. RESULTS Six men and 4 women underwent surgery (mean age 50.5 years; body mass index 28.6 kg/m2). No vascular injuries were reported, and no procedures required conversion to open surgery. Mean surgical time were 219 minutes for 1-level oblique lumbar interbody fusion (3 patients), 286 minutes for 2-level oblique lumbar interbody fusion (3 patients), and 390 minutes for corpectomy (4 patients). Four patients experienced nonserious adverse events due to lumbar plexus nerve damage. One patient had a vertebral body plate fracture requiring posterior revision surgery, and 1 patient had a psoas hematoma requiring transfusion. No abdominal wall complications or surgical site infection were found. Seven patients were reviewed at 12 months, none had complications, and all showed radiological evidence of fusion. CONCLUSIONS The use of the DVR in lumbar surgery allows a safe minimally invasive transperitoneal approach, but to date, only hybrid procedures have been performed.
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Affiliation(s)
- Stanislas Loniewski
- Department of Neurosurgery, Hôpital Maison Blanche, CHU de Reims, Reims, France.
| | - Kaissar Farah
- Department of Neurosurgery, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Nacer Mansouri
- Department of Neurosurgery, Hôpital Central, CHRU Nancy, Nancy, France
| | - Faisal Albader
- Department of Neurosurgery, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Nicla Settembre
- Department of Vascular surgery, Hôpitaux de Brabois, CHRU Nancy, Nancy, France
| | - Claude-Fabien Litré
- Department of Neurosurgery, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | - Serguei Malikov
- Department of Vascular surgery, Hôpitaux de Brabois, CHRU Nancy, Nancy, France
| | - Stéphane Fuentes
- Department of Neurosurgery, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
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Chung HW, Park KH, Lee HD, Jeon CH, Jeon JM, Chung NS. Risk factors for nonunion in oblique lateral interbody fusion. J Orthop Sci 2024; 29:59-63. [PMID: 36411226 DOI: 10.1016/j.jos.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 10/30/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Compared with posterior interbody fusion techniques, oblique lateral interbody fusion (OLIF) offers a larger fusion bed with greater intervertebral space access, use of larger cages, more sufficient discectomy, and better end-plate preparation. However, the fusion rate of OLIF is similar to that of other interbody fusions. This study aimed to examine the factors associated with nonunion in OLIF. METHODS This study examined 201 disc levels from 124 consecutive patients who underwent OLIF for lumbar degenerative diseases with 1-year regular follow-up. Demographic and surgical factors were reviewed from the medical records. Radiological factors measured were sagittal parameters, intervertebral disc angle (DA) before surgery and at the final follow-up, presence of vertebral end-plate lesions, and cage subsidence. Multivariable logistic regression analysis was performed to identify the factors associated with nonunion. RESULTS Among the 201 discs, 185 (92.0%) achieved union at 1-year followed up. Smoking, surgery at the L5-S1 level, not performing laminectomy, and a large intervertebral DA were factors associated with nonunion in OLIF (all P < 0.05). Multivariable logistic regression analysis showed two independent variables (surgery at L5-S1 level and not performing laminectomy) as risk factors for nonunion in OLIF. CONCLUSIONS Not performing laminectomy and surgery at the L5-S1 level were risk factors for nonunion in OLIF. To reduce the nonunion rate, surgeons should consider additional stabilization strategies for the L5-S1 OLIF and perform laminectomy.
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Affiliation(s)
- Hee-Woong Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Ki-Hoon Park
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Chang-Hoon Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Jong-Min Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea.
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Han NR, Osman A, Hu W, Huang YF, Liu YL, Ma ZJ. Effect of spinal orthosis on clinical outcomes of patients after oblique lumbar interbody fusion: a randomized controlled trial study protocol. Trials 2023; 24:787. [PMID: 38049917 PMCID: PMC10696774 DOI: 10.1186/s13063-023-07796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Oblique lumbar interbody fusion (OLIF) is an internationally popular minimally invasive technology for the treatment of various lumbar diseases. Since its introduction to China in 2014, OLIF technology has clearly shown its superiority in reconstructing intervertebral stability, restoring intervertebral space height, achieving indirect decompression, and restoring normal lumbar sequence. However, some patients still suffer from persistent symptoms after OLIF, including low back pain and soreness, which indirectly affect the overall surgical efficacy and patient satisfaction. Therefore, some clinicians recommend that patients routinely use spinal orthoses after OLIF to reduce the stress on the lower back muscles and ligaments, thereby relieving or avoiding postoperative residual symptoms or new symptoms. Accordingly, spinal orthosis use after OLIF has emerged as an essential option. However, the role of spinal orthoses in OLIF and their specific impact on postoperative patient clinical outcomes have remained unclear, and there is a lack of strong clinical evidence to indirectly or directly support the role of spinal orthoses in OLIF and demonstrate their impact on patient clinical outcomes. This study aims to investigate the role of spinal orthoses in OLIF by grouping patients based on the use or nonuse of spinal orthosis after OLIF, thus providing a better basis for the majority of patients and physicians. METHODS/DESIGN We plan to conduct a 1-year randomized controlled trial involving 60 subjects. The subjects will be randomized into two groups: group A (those wearing spinal orthoses after surgery) and group B (those not wearing spinal orthoses after surgery). The clinical outcomes of these patients will be evaluated using the Oswestry disability index, visual analog scale, and Brantigan, Steffee, Fraser 1 day before surgery and 2 weeks and 1, 6, and 12 months after surgery. DISCUSSION This randomized controlled trial aims to provide a reference for further comprehensive trial design. The findings of this study will provide a better and more scientific basis for the choice of postoperative rehabilitation and treatment for patients undergoing such a procedure. TRIAL REGISTRATION This study has been registered in the Chinese Clinical Trial Registry (Registration No.: ChiCTR2200059000). Registration date: April 22, 2022. Registration website: http://www.chictr.org.cn/showproj.aspx?proj=166310.
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Affiliation(s)
- Nian-Rong Han
- Xinjiang Medical University, 393 Xinyi Rd, Xinshi District, Ürümqi, Ürümqi, 830011, Xinjiang, China
| | - Akram Osman
- Xinjiang Medical University, 393 Xinyi Rd, Xinshi District, Ürümqi, Ürümqi, 830011, Xinjiang, China
| | - Wei Hu
- Xinjiang Medical University, 393 Xinyi Rd, Xinshi District, Ürümqi, Ürümqi, 830011, Xinjiang, China.
| | - Yi-Fei Huang
- Xinjiang Medical University, 393 Xinyi Rd, Xinshi District, Ürümqi, Ürümqi, 830011, Xinjiang, China
| | - Yan-Lu Liu
- Xinjiang Medical University, 393 Xinyi Rd, Xinshi District, Ürümqi, Ürümqi, 830011, Xinjiang, China
| | - Zhan-Jun Ma
- Xinjiang Medical University, 393 Xinyi Rd, Xinshi District, Ürümqi, Ürümqi, 830011, Xinjiang, China
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Wu Y, Ma J, Dai J, Wang Y, Bai H, Lu B, Chen J, Fan X, Ma X. Design and Biomechanical Evaluation of a Bidirectional Expandable Cage for Oblique Lateral Interbody Fusion. World Neurosurg 2023; 180:e644-e652. [PMID: 37805128 DOI: 10.1016/j.wneu.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Oblique lateral interbody fusion (OLIF) surgery is a minimally invasive spinal surgery technique that has become increasingly popular in recent years. The primary objective of the current study was to design a minimally invasive expandable fusion device that can reduce iatrogenic nerve damage and minimize endplate damage during OLIF surgery, while restoring intervertebral height and alignment. The second objective was to use finite element analysis to evaluate the biomechanical stability of the newly designed expandable fusion device after implantation into the intervertebral space. METHODS A new bidirectional expandable cage was designed in this study. A finite element model (FEM) of L3-L5 lumbar segment was modified to simulate decompression and fusion. The modified FEMs were constructed in the following cases: intact model, bidirectional expandable cage (alone, with unilateral pedicle screws [UPSs], and with bilateral pedicle screws [BPSs]) model, conventional OLIF cage (alone, with UPSs, and with BPSs) model. To simulate physiological loadings, the models were subjected to a follower compressive pre-load of 400 N, in addition to 8.0 Nm of flexion, extension, lateral bending, and axial rotation moments. RESULT All modified FEMs exhibited a significant reduction in motion at L3-L5 compared to the intact model. Among the fusion models, the bidirectional expandable cage (BEC) with BPS model displayed the highest stiffness and demonstrated a reduced range of motion (48.5%-75.7%). Additionally, the peak stress on the endplate in the conventional OLIF cage (Conv-OLIF) model was generally lower than that in the BEC models. The cage in the BEC ALONE model exhibited the highest stress (93.87-176.3 MPa) on the endplate in most motion modes, while the cage in the Conv-OLIF+BPS model had the lowest stress (16.67-30.58 MPa) on the endplate in most motion modes. The maximum stress on the fixation in the BEC fusion models was generally lower than that in the Conv-OLIF fusion group under the same loading conditions. The OLIF ALONE model had the lowest stress on the adjacent disc, while the stress level in the BEC ALONE model was very close to it. CONCLUSIONS The BEC implanted models had higher stiffness, and more proper stress distribution on the posterior fixation was comparable to that of the Conv-OLIF models. However, the endplate stress peaks and cage stress peaks of the BEC models were slightly higher than those of the Conv-OLIF models, though still within a clinically acceptable range. Taking into account both biomechanical and clinical perspectives, BEC-assisted unilateral pedicle screw fixation meet clinical demand and may serve as a viable alternative to Conv-OLIF fusion.
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Affiliation(s)
- Yanfei Wu
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, People's Republic of China; Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China
| | - Jianxiong Ma
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China
| | - Jing Dai
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, People's Republic of China; Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China
| | - Ying Wang
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China
| | - Haohao Bai
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China
| | - Bin Lu
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China
| | - Jiahui Chen
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, People's Republic of China; Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China
| | - Xiancheng Fan
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China
| | - Xinlong Ma
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, People's Republic of China; Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China.
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Liu C, Geng Y, Li Y. Oblique lateral internal fusion combined with percutaneous pedicle screw fixation in severe lumbar spinal stenosis: clinical and radiographic outcome. J Orthop Surg Res 2023; 18:882. [PMID: 37981677 PMCID: PMC10658976 DOI: 10.1186/s13018-023-04373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Oblique lumbar interbody fusion (OLIF) has been a popular technique for treating lumbar degenerative diseases. Previous studies have shown its efficiency in lumbar spinal stenosis; yet, only a few studies have investigated its application to severe lumbar spinal stenosis. Herein, we investigated the clinical and radiographic outcome of OLIF with percutaneous pedicle screws in the treatment of severe lumbar spinal stenosis. METHODS A total of 15 patients who underwent OLIF with percutaneous pedicle screws were retrospectively analysed. All patients were diagnosed with severe lumbar stenosis (Schizas grade C or D) through preoperative magnetic resonance image (MRI) and received OLIF combined with percutaneous pedicle screw surgery. Clinical outcomes, including visual analogue scale (VAS)-back and VAS-leg scores, and Oswestry Disability Index (ODI), as well as mean disc height (DH), mean foraminal height (FH), segmental lumbar lordosis (SLL) and cross-sectional area (CSA) of the spinal canal, were analysed before and after surgery and at the last follow-up. Intraoperative data, complications and fusion rate were also investigated. RESULTS OLIF combined with percutaneous pedicle screws was performed on 18 segments in 15 patients. Mean follow-up was 23.1 ± 4.6 months (range 15-29 months). VAS-back, VAS-leg, and ODI scores were significantly improved at the last follow-up. DH increased from 8.86 ± 3.06 mm before surgery to 13.31 ± 2.14 mm after; at the last follow-up, DH was 11.69 ± 1.87 mm. FH increased from 17.85 ± 2.26 mm before surgery to 22.09 ± 1.36 mm after; at the last follow-up, FH was 20.41 ± 0.99 mm. CSA of the spinal canal increased from 30.83 ± 21.15 mm2 before surgery to 74.99 ± 33.65 mm2 after the operation and 81.22 ± 35.53 mm2 at the last follow-up. The segmental LL before surgery, after surgery and at last follow-up was 20.27 ± 6.25 degrees, 20.83 ± 6.52 degrees and 19.75 ± 5.87 degrees, respectively. All patients have gained fusion at the last follow-up. CONCLUSION OLIF with percutaneous pedicle screws could achieve satisfactory clinical and radiographic effects through indirect compression by increasing DH, FH and CSA of the spinal canal in severe lumbar stenosis patients.
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Affiliation(s)
- Chen Liu
- Department of Spine Surgery, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China
- Spine Research Center of Wannan Medical College, No. 22 Wenchang West Road, Wuhu, 241001, Anhui, China
- Key Laboratory of Non-Coding RNA Transformation Research of Anhui Higher Education Institution, Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Yin Geng
- Department of Spine Surgery, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China
- Spine Research Center of Wannan Medical College, No. 22 Wenchang West Road, Wuhu, 241001, Anhui, China
| | - Yifeng Li
- Department of Spine Surgery, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China.
- Spine Research Center of Wannan Medical College, No. 22 Wenchang West Road, Wuhu, 241001, Anhui, China.
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Pan CC, Lee CH, Chen KH, Yen YC, Su KC. Comparative Biomechanical Analysis of Unilateral, Bilateral, and Lateral Pedicle Screw Implantation in Oblique Lumbar Interbody Fusion: A Finite Element Study. Bioengineering (Basel) 2023; 10:1238. [PMID: 38002362 PMCID: PMC10669710 DOI: 10.3390/bioengineering10111238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/07/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023] Open
Abstract
Oblique lumbar interbody fusion (OLIF) can be combined with different screw instrumentations. The standard screw instrumentation is bilateral pedicle screw fixation (BPSF). However, the operation is time consuming because a lateral recumbent position must be adopted for OLIF during surgery before a prone position is adopted for BPSF. This study aimed to employ a finite element analysis to investigate the biomechanical effects of OLIF combined with BPSF, unilateral pedicle screw fixation (UPSF), or lateral pedicle screw fixation (LPSF). In this study, three lumbar vertebra finite element models for OLIF surgery with three different fixation methods were developed. The finite element models were assigned six loading conditions (flexion, extension, right lateral bending, left lateral bending, right axial rotation, and left axial rotation), and the total deformation and von Mises stress distribution of the finite element models were observed. The study results showed unremarkable differences in total deformation among different groups (the maximum difference range is approximately 0.6248% to 1.3227%), and that flexion has larger total deformation (5.3604 mm to 5.4011 mm). The groups exhibited different endplate stress because of different movements, but these differences were not large (the maximum difference range between each group is approximately 0.455% to 5.0102%). Using UPSF fixation may lead to higher cage stress (411.08 MPa); however, the stress produced on the endplate was comparable to that in the other two groups. Therefore, the length of surgery can be shortened when unilateral back screws are used for UPSF. In addition, the total deformation and endplate stress of UPSF did not differ much from that of BPSF. Hence, combining OLIF with UPSF can save time and enhance stability, which is comparable to a standard BPSF surgery; thus, this method can be considered by spine surgeons.
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Affiliation(s)
- Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-C.P.); (C.-H.L.); (K.-H.C.)
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-C.P.); (C.-H.L.); (K.-H.C.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-C.P.); (C.-H.L.); (K.-H.C.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Yu-Chun Yen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan;
- Department of Biomedical Engineering, HungKuang University, Taichung 433, Taiwan
- Department of Chemical and Materials Engineering, Tunghai University, Taichung 407, Taiwan
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10
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Hao J, Tang X, Jiang N, Wang H, Jiang J. Biomechanical stability of oblique lateral interbody fusion combined with four types of internal fixations: finite element analysis. Front Bioeng Biotechnol 2023; 11:1260693. [PMID: 37818236 PMCID: PMC10561304 DOI: 10.3389/fbioe.2023.1260693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
Objective: Using finite element analysis to identify the optimal internal fixation method for oblique lateral lumbar interbody fusion (OLIF), providing guidance for clinical practice. Methods: A finite element model of the L4 - L5 segment was created. Five types of internal fixations were simulated in the generated L4-L5 finite element (FE) model. Then, six loading scenarios, i.e., flexion, extension, left-leaning, right-leaning, rotate left, and rotate right, were simulated in the FE models with different types of fixations. The biomechanical stability of the spinal segment after different fixations was investigated. Results: Regarding the range of motion (ROM) of the fused segment, OLIF + Bilateral Pedicle Screws (BPS) has a maximum ROM of 1.82° during backward bending and the smallest ROM in all directions of motion compared with other models. In terms of the von Mises stress distribution on the cage, the average stress on every motion direction of OLIF + BPS is about 17.08MPa, and of OLIF + Unilateral Vertebral Screw - Pedicle Screw (UVS-PS) is about 19.29 MPa. As for the von Mises stress distribution on the internal fixation, OLIF + BPS has the maximum internal fixator stress in left rotation (31.85 MPa) and OLIF + Unilateral Pedicle Screw (UPS) has the maximum internal fixator stress in posterior extension (76.59 MPa). The data of these two models were smaller than those of other models. Conclusion: OLIF + BPS provides the greatest biomechanical stability, OLIF + UPS has adequate biomechanical stability, OLIF + UVS-PS is inferior to OLIF + UPS synthetically, and OLIF + Double row vertical screw (DRVS) and Individual OLIF (IO) do not present significant obvious advantages.
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Affiliation(s)
- Jiayu Hao
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian University of Technology, Dalian, China
| | - XianSheng Tang
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Nizhou Jiang
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian University of Technology, Dalian, China
| | - Hong Wang
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian University of Technology, Dalian, China
| | - Jian Jiang
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian University of Technology, Dalian, China
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11
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Gu Y, Kong Q, Lavelle W. Editorial: Novel techniques of minimally invasive spine surgery for various pathologies. Front Surg 2023; 10:1267438. [PMID: 37727378 PMCID: PMC10505725 DOI: 10.3389/fsurg.2023.1267438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Yutong Gu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
| | - Qingquan Kong
- Department of Orthopaedic Surgery, West China Hospital of Sichuan University, Sichuan, China
| | - William Lavelle
- SUNY Upstate Medical University, Syracuse, NY, United States
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12
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Li XY, Wang YL, Yang S, Liao CS, Li SF, Han PY, Han PF. Efficacy of oblique lumbar interbody fusion versus transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:5657-5670. [PMID: 37079105 PMCID: PMC10449690 DOI: 10.1007/s00402-023-04880-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This meta-analysis aimed to compare the differences in postoperative efficacy between oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases. MATERIALS AND METHODS Strictly based on the search strategy, we searched the published papers on OLIF and TLIF for the treatment of lumbar degenerative diseases in PubMed, Embase, CINAHL, and Cochrane Library. A total of 607 related papers were retrieved, and 15 articles were finally included. The quality of the papers was evaluated according to the Cochrane systematic review methodology, and the data were extracted and meta-analyzed using Review manager 5.4 software. RESULTS Through comparison, it was found that in the treatment of lumbar degenerative diseases, the OLIF group had certain advantages over the TLIF group in terms of intraoperative blood loss, hospital stay, visual analog scale (VAS) for leg pain (VAS-LP), Oswestry disability index (ODI), disc height (DH), foraminal height (FH), fused segmental lordosis (FSL), and cage height, and the differences were statistically significant. The results were similar in terms of surgery time, complications, fusion rate, VAS for back pain (VAS-BP) and various sagittal imaging indicators, and there was no significant difference. CONCLUSIONS OLIF and TLIF can relieve low back pain symptoms in the treatment of lumbar degenerative diseases, but OLIF has certain advantages in terms of ODI and VAS-LP. In addition, OLIF has the advantages of minor intraoperative trauma and quick postoperative recovery.
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Affiliation(s)
- Xi-Yong Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Yun-Lu Wang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Su Yang
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Chang-Sheng Liao
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Song-Feng Li
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Peng-Yong Han
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China.
| | - Peng-Fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China.
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Loniewski S, Farah K, Malikov S, Fuentes S. Da Vinci robotic-assisted anterolateral lumbar arthrodesis: operative technique. Acta Neurochir (Wien) 2023; 165:2711-2716. [PMID: 37368035 DOI: 10.1007/s00701-023-05676-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Minimally invasive approaches for lumbar fusion are aimed at reducing soft tissue injury in order to minimize surgical morbidity and facilitate recovery. METHOD Applied to oblique lateral lumbar interbody fusion (OLIF), Da Vinci® robot (DVR) assistance can help specially in obese patients. Positioning and important anatomical landmarks are reviewed. Indications, advantages, and limitations are discussed, and a step-by-step description of the procedure is presented. OLIF can be achieved efficiently through this approach with lesser blood loss, shorter hospital stays, and reduced rate of general complications. CONCLUSION The use of DVR assistance for OLIF is a promising new technique.
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Affiliation(s)
- Stanislas Loniewski
- Neurosurgery Department, CHU de Reims, 45 rue Cognacq Jay, 51100, Reims, France.
| | - Kaissar Farah
- Neurosurgery Department, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Serguei Malikov
- Vascular Surgery Department, Hôpitaux de Brabois, CHRU Nancy, rue du Morvan, 54511, Vandœuvre-lès-Nancy, France
| | - Stéphane Fuentes
- Neurosurgery Department, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
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Limthongkul W, Wathanavasin W, Kotheeranurak V, Tangdamrongtham T, Tanasansomboon T, Yingsakmongkol W, Singhatanadgige W. Comparing Efficacy of Lumbar Disc Space Preparation via an Anterior-to-Psoas Approach Between Intraoperative Conventional Fluoroscopy and Computed Tomographic-Based Navigation System: A Cadaveric Study. World Neurosurg 2023; 176:e226-e231. [PMID: 37201786 DOI: 10.1016/j.wneu.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To compare the efficacy of intervertebral disc space preparation via an anterior-to-psoas (ATP) approach using conventional fluoroscopy (Flu) and computer tomography (CT)-based navigation by evaluating the disc remaining area. METHODS We equally assigned 24 lumbar disc levels from 6 cadavers into Flu and CT-based navigation (Nav) groups. Two surgeons performed disc space preparation using the ATP approach in both groups. Digital images of each vertebral endplate were obtained, and the remaining disc tissue was calculated in total and in quadrants. Operative time, number of attempts at disc removal, endplate violation area, number of endplate violation segments, and access angle were recorded. RESULTS The overall percentage of remaining disc tissue was significantly less in the Nav group than in the Flu group (32.7% vs. 43.3% respectively, P < 0.001). A significant difference was found in the posterior-ipsilateral (4.2% vs. 7.1%, P = 0.005) and posterior-contralateral (6.1% vs. 10.9%, P = 0.002) quadrants, respectively. No significant between-group difference was found concerning operative time, number of attempts at disc removal, endplate violation area, number of endplate violation segments, or access angle. CONCLUSIONS Intraoperative CT-based navigation may improve vertebral endplate preparation quality for an ATP approach, especially in the posterior quadrants. This technique may offer an effective alternative disc space and endplate preparation methods and may help enhance the fusion rates.
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Affiliation(s)
- Worawat Limthongkul
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Waranyoo Wathanavasin
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vit Kotheeranurak
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | | | - Teerachat Tanasansomboon
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Wicharn Yingsakmongkol
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Weerasak Singhatanadgige
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
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15
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Zhao L, Hou W, Shi H, Jiang W, Cao M, Wan D. Risk factors for postoperative sympathetic chain dysfunction following oblique lateral lumbar interbody fusion: a multivariate analysis. Eur Spine J 2023; 32:2319-2325. [PMID: 37219709 DOI: 10.1007/s00586-023-07761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/06/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Postoperative sympathetic chain dysfunction (PSCD) was a relatively common complication after anterior lumbar interbody fusion due to the manipulation adjacent to the lumbar sympathetic chain (LSC). This study aimed to investigate the incidence of PSCD and identify its related independent risk factors after oblique lateral lumbar interbody fusion (OLIF) surgery. METHODS PSCD was defined as either of the following in the affected lower limb compared to the contralateral: (1) increase in skin temperature by 1 ºC or more, (2) reduced skin perspiration, (3) limb swelling or skin discoloration. Consecutive patients who underwent OLIF at L4/5 level from February 2018 and May 2022 at a single institution were retrospectively reviewed and divided into two groups: patients with PSCD and patients without PSCD. Binary logistic regression analyses were performed on patients' demographic, comorbidities, radiological datum and perioperative factors to identify independent risk factors for PSCD. RESULTS Twelve (5.7%) of 210 patients experienced PSCD following OLIF surgery. Multivariate logistic regression analysis identified the identification of lumbar dextroscoliosis (OR = 7.907, P = 0.012) and the presence of "tear-drop" psoas (OR = 7.216, P = 0.011) as independent risk factors for the PSCD following OLIF. CONCLUSION This study identified the lumbar dextroscoliosis and the "tear-drop" psoas as independent risk factors for the development of PSCD after OLIF. Spine alignment examination and the morphological identification of psoas major muscle should be highly noticed for the PSCD prevention following OLIF.
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Affiliation(s)
- Long Zhao
- Department of Spine Surgery, Sichuan Orthopaedic Hospital, No. 132 West First Loop, Chengdu, 610041, People's Republic of China
| | - Wei Hou
- Department of Spine Surgery, Sichuan Orthopaedic Hospital, No. 132 West First Loop, Chengdu, 610041, People's Republic of China
| | - Huagang Shi
- Department of Spine Surgery, Sichuan Orthopaedic Hospital, No. 132 West First Loop, Chengdu, 610041, People's Republic of China
| | - Wenbin Jiang
- Department of Spine Surgery, Sichuan Orthopaedic Hospital, No. 132 West First Loop, Chengdu, 610041, People's Republic of China
| | - Min Cao
- Department of Spine Surgery, Sichuan Orthopaedic Hospital, No. 132 West First Loop, Chengdu, 610041, People's Republic of China
| | - Dun Wan
- Department of Spine Surgery, Sichuan Orthopaedic Hospital, No. 132 West First Loop, Chengdu, 610041, People's Republic of China.
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Lu Z, Ding A, Yu Q, Wang H, Ma L. Effect of the preoperative assessment of the anteroposterior diameters of the spinal canal and dural area on the efficacy of oblique lumbar interbody fusion in patients with lumbar spinal stenosis. J Orthop Surg Res 2023; 18:440. [PMID: 37337281 DOI: 10.1186/s13018-023-03913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE The purpose of this study was to quantify the degree of lumbar spinal stenosis by assessing the anterior and posterior vertebral canal diameter and dural area, determine the sensitivity of the anterior and posterior spinal canal diameter, dural area and dural occupying rate in predicting the postoperative efficacy of oblique lumbar interbody fusion (OLIF) for patients with single-stage lumbar spinal stenosis, and identify the corresponding indicators suggesting that OLIF surgery should not be performed. METHODS In a retrospective analysis of patients who had previously undergone OLIF surgery in our hospital, we included a total of 104 patients with lumbar spinal stenosis who had previously undergone single-stage surgery in our hospital. Three independent observers were employed to measure the anterior and posterior diameter of the spinal canal (AD, mm), dural area (CSA, mm2), the spinal canal area (SCA, mm2), and the ratio of the dural area to the spinal canal area (DM, %) at the disc level with the most severe stenosis on MRI. According to the values of AD and CSA in preoperative MRI, patients were divided into three groups: A, B, and C (Group A: AD > 12 and 100 < CSA ≤ 130, group B: Except A and C, group C: AD ≤ 10 and CSA ≤ 75). Preoperative and postoperative clinical outcome scores (Japanese Orthopaedic Association [JOA] score, VAS score, modified Macnab standard) of 104 patients were statistically. RESULTS There were significant differences in the preoperative and postoperative clinical correlation scores among the mild, moderate and severe lumbar spinal stenosis groups. The improvement rate of the post treatment JOA score, the difference between the preoperative and postoperative VAS score, and the modified Macnab standard were compared pairwise. There was no statistical significance in the improvement rate of the post treatment JOA score, the difference between the preoperative and postoperative VAS score, and the modified Macnab standard between Group A and Group B (P = 0.125, P = 0.620, P = 0.803). There were statistically significant differences between Group A and Group C and between Group B and Group C in the improvement rate of the JOA score, the difference in the pre- and postoperative VAS score, and the modified Macnab standard. The anterior and posterior vertebral canal diameter and dural area are sensitive predictors of the postoperative efficacy of OLIF surgery for single-stage lumbar spinal stenosis. Moreover, when the anterior and posterior vertebral canal diameter was less than 6.545 mm and the dural area was less than 34.43 mm2, the postoperative effect of OLIF surgery was poor. CONCLUSIONS All the patients with mild, moderate, and severe lumbar spinal stenosis achieved curative effects after OLIF surgery. Patients with mild and moderate lumbar spinal stenosis had better curative effects, and there was no significant difference between them, while patients with severe lumbar spinal stenosis had poor curative effects. Both the anteroposterior diameter of the spinal canal and the dural area of the spinal canal were sensitive in predicting the curative effect of OLIF surgery for single-stage lumbar spinal stenosis. When the anterior and posterior vertebral canal diameter was less than 6.545 mm and the dural area was less than 34.43 mm2, the postoperative effect of OLIF surgery was poor.
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Affiliation(s)
- Zhe Lu
- Hebei Medical University, Shijiazhuang, China
| | - Aoran Ding
- Hebei Medical University, Shijiazhuang, China
| | - Qingsong Yu
- Hebei Medical University, Shijiazhuang, China
| | | | - Lei Ma
- Hebei Medical University, Shijiazhuang, China.
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Mundis GM, Ito K, Lakomkin N, Shahidi B, Malone H, Iannacone T, Akbarnia B, Uribe J, Eastlack R. Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion. Medicina (Kaunas) 2023; 59:1149. [PMID: 37374353 DOI: 10.3390/medicina59061149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Mitigating post-operative complications is a key metric of success following interbody fusion. LLIF is associated with a unique complication profile when compared to other approaches, and while numerous studies have attempted to report the incidence of post-operative complications, there is currently no consensus regarding their definitions or reporting structure. The aim of this study was to standardize the classification of complications specific to lateral lumbar interbody fusion (LLIF). Materials and Methods: A search algorithm was employed to identify all the articles that described complications following LLIF. A modified Delphi technique was then used to perform three rounds of consensus among twenty-six anonymized experts across seven countries. Published complications were classified as major, minor, or non-complications using a 60% agreement threshold for consensus. Results: A total of 23 articles were extracted, describing 52 individual complications associated with LLIF. In Round 1, forty-one of the fifty-two events were identified as a complication, while seven were considered to be approach-related occurrences. In Round 2, 36 of the 41 events with complication consensus were classified as major or minor. In Round 3, forty-nine of the fifty-two events were ultimately classified into major or minor complications with consensus, while three events remained without agreement. Vascular injuries, long-term neurologic deficits, and return to the operating room for various etiologies were identified as important consensus complications following LLIF. Non-union did not reach significance and was not classified as a complication. Conclusions: These data provide the first, systematic classification scheme of complications following LLIF. These findings may improve the consistency in the future reporting and analysis of surgical outcomes following LLIF.
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Affiliation(s)
| | - Kenyu Ito
- Aichi Spine Hospital, Aichi, Inuyama 484-0066, Japan
| | - Nikita Lakomkin
- Mayo Clinic College of Medicine and Science, Rochester, NY 55905, USA
| | - Bahar Shahidi
- San Diego Department of Orthopaedic Surgery, University of California, La Jolla, CA 92093, USA
| | - Hani Malone
- Scripps Clinic Medical Group, San Diego, CA 92037, USA
| | | | - Behrooz Akbarnia
- San Diego Department of Orthopaedic Surgery, University of California, La Jolla, CA 92093, USA
- San Diego Spine Foundation, San Diego, CA 92121, USA
| | - Juan Uribe
- Barrow Neurological Institute, Phoenix, AZ 85013, USA
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Emami A, Patel N, Coban D, Saela S, Sinha K, Faloon M, Hwang KS. Comparing clinical and radiological outcomes between single-level OLIF and XLIF: A systematic review and meta-analysis. N Am Spine Soc J 2023; 14:100216. [PMID: 37234475 PMCID: PMC10205548 DOI: 10.1016/j.xnsj.2023.100216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 05/28/2023]
Abstract
Background Context Oblique lumbar interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF) are 2 popular minimally invasive spinal fusion techniques with unique approach-related complication profiles. Accordingly, patient-specific anatomical factors, such as vascular anatomy or iliac crest height, greatly influence which technique to use. Previous studies comparing these approaches do not account for the inability of XLIF to access the L5-S1 disc space and therefore do not exclude this level in their analysis. The purpose of this study was to compare radiological and clinical outcomes of these techniques in the L1-L5 region. Methods A query of 3 electronic databases (PubMed, CINAHL plus, and SCOPUS) was performed, without time restriction, to identify studies that evaluated outcomes of single-level OLIF and/or XLIF between L1 and L5. Based on heterogeneity, a random effects meta-analysis was performed to evaluate the pooled estimation of each variable between the groups. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<.05 level. Results A total of 1,010 patients (408 OLIF, 602 XLIF) were included from 24 published studies. Improvements in disc height (OLIF: 4.2 mm; XLIF: 5.3 mm), lumbar segmental (OLIF: 2.3°; XLIF: 3.1°), and lumbar lordotic angles (OLIF: 5.3°; XLIF: 3.3°) showed no significant difference. The rate of neuropraxia was significantly greater in the XLIF group at 21.2% versus 10.9% in the OLIF group (p<.05). However, the rate of vascular injury was higher in the OLIF cohort at 3.2% (95% CI:1.7-6.0) as compared to 0.0 (95% CI: 0.0-1.4) in the XLIF cohort. Improvements in VAS-b (OLIF: 5.6; XLIF: 4.5) and ODI (OLIF: 37.9; XLIF: 25.6) scores were not significantly different between the 2 groups. Conclusions This meta-analysis demonstrates similar clinical and radiological outcomes between single-level OLIF and XLIF from L1 to L5. XLIF had significantly higher rates of neuropraxia, whereas OLIF had greater rates of vascular injury.
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Affiliation(s)
- Arash Emami
- Corresponding author: Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 504 Valley Road, Suite 203, Wayne, NJ 07470, USA. Tel.: (973) 686-0700×199; fax: (973) 686-0701.
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Itthipanichpong T, Tanasansomboon T, Jaruthien N, Jenvorapoj S, Singhatanadgige W, Yingsakmongkol W, Limthongkul W. Lumbar sympathetic chain tract and mobility of oblique lumbar interbody fusion approach: a cadaveric study. World Neurosurg 2023:S1878-8750(23)00491-6. [PMID: 37037371 DOI: 10.1016/j.wneu.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES To assess lumbar sympathetic chain (LSC) relation to the surgical corridor for oblique lumbar approach and the ability to mobilize the LSC. METHODS Forty-three cadavers were included. Left-sided anterior retroperitoneal approach was performed in a supine position. Distance between the great vessels and psoas muscle (oblique corridor) and distance between great vessels and LSC at L2/3, L3/4, and L4/5 disc levels were measured. Mobilization of LSC at each disc level was done either close to or away from the psoas muscle and each mobilization distance was measured. RESULTS The presence rates of LSC in oblique corridor were 19.5%, 43%, and 75.7% at L2/3, L3/4, and L4/5 levels, respectively. At L2/3 disc level, mean distance between psoas muscle and LSC and its mobility were 0.61±1.31 mm, and 2.72±1.24 mm, respectively. At L3/4 disc level, mean distance between psoas muscle and LSC and its mobility were 1.72±2.53 mm, and 3.11±1.02 mm, respectively. At L4/5 disc level, mean distance between psoas muscle and LSC and its mobility were 2.94±3.52 mm, and 2.53±1.03 mm, respectively. The mean width of corridor of L2/3, L3/4, and L4/5 were 10.73±5.82, 12.63±5.02, and 15.43±6.31 mm, respectively. CONCLUSION The LSC tract usually lies in the oblique corridor in L4/5 but keeps decreasing in prevalence when approaching L3/4 and L2/3 levels. It can be mobilized a few millimeters close to or away from the psoas muscle. Care should be taken to prevent LSC injury, particularly when the LSC needs to be retracted along with the psoas muscle.
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Affiliation(s)
- Thun Itthipanichpong
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Teerachat Tanasansomboon
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nonn Jaruthien
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Weerasak Singhatanadgige
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Wicharn Yingsakmongkol
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Worawat Limthongkul
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
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Becker L, Adl Amini D, Ziegeler K, Muellner M, Diekhoff T, Hughes AP, Pumberger M. Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5. Arch Orthop Trauma Surg 2023; 143:1753-1759. [PMID: 34999995 PMCID: PMC10030414 DOI: 10.1007/s00402-021-04303-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/08/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. MATERIAL AND METHODS We assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group. RESULTS Patients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group. CONCLUSIONS For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dominik Adl Amini
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th S, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Lefèvre E, Szadkowski M, Fière V, Vieira TD, Ould-Slimane M, d'Astorg H. Implications of cage impactions in single-level OLIF treatment of degenerative spondylolisthesis. Orthop Traumatol Surg Res 2023; 109:103385. [PMID: 35933020 DOI: 10.1016/j.otsr.2022.103385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/03/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Cage impactions (CI) of Oblique Lumbar Interbody Fusion (OLIF) appear to be a frequent mechanical complication with a potential functional impact. OBJECTIVES To determine the rate of CI occurrence, their risk factors and clinical implications in the case of combined single-level arthrodesis. METHOD A retrospective analysis of prospectively collected data was performed. All our patients with degenerative spondylolisthesis initially underwent OLIF combined with pedicle screw fixation (PSF). Intraoperative control with an image intensifier and a standard radiograph in the immediate postoperative period made it possible to assess the occurrence of CI, depending on the position of the implant. Secondary subsidence was sought on the standing radiological examination using EOS biplanar radiography during follow-up. The pelvic parameters were analyzed, as well as the occurrence of bone fusion. The clinical evaluation was made at≥1 year, by the Oswestry Disability Index (ODI), the walking distance (WD) and the Visual Analogue Scale (VAS). RESULTS In all, 130 patients out of the 131 included were analyzed. A CI occurred in 25.3% (n=33) of cases and of these, 94% (n=32) occurred intraoperatively. Postmenopausal women had more CI with an odds ratio (OR) of 5.8 (P=0.034). The "CI" group had a 9.5% lower ODI score than the "non-CI" group (P=0.0040), but both provided excellent ODI gains of 30.8±16 and 32.9±15.5% (P<0.0001). An "anterior" position of the implant allowed a greater gain in lumbar lordosis (P<0.001) but was associated with greater CI occurrence (P<0.001), with an OR of 6.75 (P=0.0018). CONCLUSION The occurrence of intraoperative cage impaction is a frequent event when performing OLIF. Postmenopausal women have an approximately 6 times greater risk of impaction than men, and patients with an "anterior" implant placement have a 7 times greater risk than with central placement. The negative impact of cage impactions on the clinical score (ODI) was significant after one year of follow-up. LEVEL OF EVIDENCE IV, non-comparative cohort study.
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Affiliation(s)
- Emeric Lefèvre
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Marc Szadkowski
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Vincent Fière
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
| | | | - Henri d'Astorg
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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Tung KK, Tseng WC, Wu YC, Chen KH, Pan CC, Lu WX, Shih CM, Lee CH. Comparison of radiographic and clinical outcomes between ALIF, OLIF, and TLIF over 2-year follow-up: a comparative study. J Orthop Surg Res 2023; 18:158. [PMID: 36864438 PMCID: PMC9979469 DOI: 10.1186/s13018-023-03652-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/26/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Regarding the increasing adoption of oblique lateral interbody fusion (OLIF) for treating degenerative lumbar disorders, we aimed to evaluate whether OLIF, one of the options for anterolateral approach lumbar interbody fusion, demonstrate clinical superiority over anterior lumbar interbody fusion (ALIF) or posterior approach, represented by transforaminal lumbar interbody fusion (TLIF). METHODS Patients who received ALIF, OLIF, and TLIF for symptomatic degenerative lumbar disorders during the period 2017-2019 were identified. Radiographic, perioperative, and clinical outcomes were recorded and compared during 2-year follow-up. RESULTS A total of 348 patients with 501 correction levels were enrolled in the study. Fundamental sagittal alignment profiles were substantially improved at 2-year follow-up, particularly in the anterolateral approach (A/OLIF) group. The Oswestry disability index (ODI) and EuroQol-5 dimension (EQ-5D) in the ALIF group were superior when compared to the OLIF and TLIF group 2-year following surgery. However, comparisons of VAS-Total, VAS-Back, and VAS-Leg revealed no statistically significance across all approaches. TLIF demonstrated highest subsidence rate of 16%, while OLIF had least blood loss and was suitable for high body mass index patients. CONCLUSIONS Regarding treatment for degenerative lumbar disorders, ALIF of anterolateral approach demonstrated superb alignment correction and clinical outcome. Comparing to TLIF, OLIF possessed advantage in reducing blood loss, restoring sagittal profiles and the accessibility at all lumbar level while simultaneously achieving comparable clinical improvement. Patient selection in accordance with baseline conditions, and surgeon preference both remain crucial issues circumventing surgical approach strategy.
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Affiliation(s)
- Kuan-Kai Tung
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Cheng Tseng
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Che Wu
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Hui Chen
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan ,grid.411432.10000 0004 1770 3722Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan ,grid.412550.70000 0000 9012 9465Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan ,Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Chien-Chou Pan
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan ,Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Wen-Xian Lu
- Department of Orthopedics, Feng Yuan Hospital Ministry of Health and Welfare, Taichung, Taiwan
| | - Cheng-Min Shih
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan ,grid.411432.10000 0004 1770 3722Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan. .,Post Baccalaureate Medicine, School of Medicine, National Chung Hsing University, Taichung, Taiwan. .,Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cawley D, Shafafy R, Agu O, Molloy S. Anterior spinal fusion (ALIF/ OLIF/LLIF) with lumbosacral transitional vertebra: A systematic review and proposed treatment algorithm. Brain Spine 2023; 3:101713. [PMID: 38021000 PMCID: PMC10668067 DOI: 10.1016/j.bas.2023.101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 12/01/2023]
Abstract
•Key anterior approaches differences in LSTV include vascular (aortic bifurcation/iliocaval confluence), muscular (psoas) and osseus anatomy (inter-crestal tangent/pubic symphysis), when compared to non-LSTV.•There are increased surgical deviations but not significantly greater complications for anterior approaches in LSTV.•Vascular awareness while accessing L45 will be in the presence of a more cephalad ABF and ICC with sacralized L5, and access to the deeper L56 level will be in the presence of a more caudal ABF and ICC in lumbarized S1.
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Affiliation(s)
- D.T. Cawley
- Mater Private Hospital, Dublin, Republic of Ireland
- National University of Ireland, Galway, Republic of Ireland
| | - R. Shafafy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
| | - O. Agu
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
| | - S. Molloy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
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Lin GX, Xu WB, Kotheeranurak V, Chen CM, Deng ZH, Zhu MT. Comparison of oblique and transforaminal approaches to lumbar interbody fusion for lumbar degenerative disease: An updated meta-analysis. Front Surg 2023; 9:1004870. [PMID: 36726948 PMCID: PMC9885081 DOI: 10.3389/fsurg.2022.1004870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) are widely used in the treatment of lumbar degenerative diseases. A meta-analysis was performed to examine the clinical and radiological effects of these two techniques. Methods A search of relevant literature from several databases was conducted until November 2021. Perioperative outcomes, clinical and radiological results, and complications were analyzed. Results Fifteen qualified studies were included. OLIF showed a shorter operative time and length of hospital stay and less blood loss than TLIF. Early postoperative Visual Analogue Scale for back pain were significantly lower in OLIF than in TLIF (P = 0.004). Noteworthy, although the preoperative Oswestry Disability Index (ODI) of the OLIF group was higher than that of the TLIF group (P = 0.04), the postoperative ODI was significantly lower (P < 0.05). Radiologically, the results showed that the disc and foraminal heights of OLIF were significantly higher than those of TLIF postoperatively. Moreover, OLIF can restore more segmental lordosis than TLIF in the early postoperative period. Furthermore, OLIF showed better fusion rates than TLIF (P = 0.02), with no difference in cage subsidence (13.4% vs. 16.6%). No significant differences in overall and approach-related complications between the two groups. Conclusion The OLIF group showed an advantage in terms of operative time, hospitalization, intraoperative blood loss, early back pain relief, postoperative function recovery, disc and foraminal heights, early segmental lordosis, and fusion rate compared to TLIF. For both procedures, the incidence rates of overall and approach-related complications were comparable.
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Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wen-Bin Xu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan,Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan,Correspondence: Ming-Tao Zhu Zhi-Hong Deng Chien-Min Chen
| | - Zhi-Hong Deng
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,Correspondence: Ming-Tao Zhu Zhi-Hong Deng Chien-Min Chen
| | - Ming-Tao Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,Correspondence: Ming-Tao Zhu Zhi-Hong Deng Chien-Min Chen
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Li J, Chen Y, Wu H, Gan K, Bei D, Fan T, Chen J, Zhao F, Chen B. Can oblique lateral interbody fusion ( OLIF) create more lumbosacral lordosis in lumbar spine surgery than minimally invasive transforaminal interbody fusion (MIS-TLIF)? Front Surg 2023; 9:1063354. [PMID: 36684176 PMCID: PMC9852049 DOI: 10.3389/fsurg.2022.1063354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/09/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To compare the differences in the correction effect for lumbosacral lordosis and clinical outcomes between OLIF with/without posterior pedicle screw fixation (PSF) and MIS-TLIF through a retrospective cohort study. Method There were 98 consecutive patients originally enrolled for the study, but 15 patients were excluded due to intraoperative endplate injury or osteotomy performed for severe spinal deformity. Thus, 83 patients included in this study (36 males and 47 females, mean age 65.8 years) underwent single to three-segment OLIF (including OLIF + PSF and OLIF Standalone) or MIS-TLIF surgery from 2016 to 2018. The operation time, bleeding and blood transfusion, fusion rate, complication, pre-and postoperative visual analogue scale (VAS), Oswestry Disability Index (ODI) were evaluated. In addition, radiological parameters including lumbosacral lordosis (LL), fused segment lordosis (FSL), anterior disc height (ADH) and posterior disc height (PDH) were measured. The clinical outcomes, LL, FSL, ADH and PDH restored and were compared between the OLIF group, OLIF subgroups and MIS-TLIF group. Results The average operation time and intraoperative bleeding were significantly less in the OLIF group than in the MIS-TLIF group (163 ± 68 vs. 233 ± 79 min, 116 ± 148 vs. 434 ± 201 ml, P < 0.001). There was no statistically significant difference between the OLIF group and the MIS-TLIF group in VAS and ODI improvements, fusion rate, complication, LL and FSL correction (P > 0.05). The ADH and PDH increases in the OLIF group were more than that in MIS-TLIF group (P < 0.001). The correction of LL was significantly more in the OLIF + PSF group than in the MIS-TLIF group (9.9 ± 11.1 vs. 4.2 ± 6.1deg, P = 0.034). Conclusion OLIF and MIS-TLIF are both safe and effective procedures, capable of restoring lumbosacral lordosis and disc height partly. Combined with PSF, OLIF can achieve a better correction effect of lumbosacral lordosis than MIS-TLIF.
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Affiliation(s)
- Jie Li
- Department of Orthopaedic Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo, Zhejiang, China
| | - Yilei Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Hao Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Kaifeng Gan
- Department of Orthopaedic Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo, Zhejiang, China
| | - Dikai Bei
- Department of Orthopaedic Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo, Zhejiang, China
| | - Tengdi Fan
- Department of Orthopaedic Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo, Zhejiang, China
| | - Jian Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Fengdong Zhao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China,Correspondence: Binhui Chen Fengdong Zhao
| | - Binhui Chen
- Department of Orthopaedic Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo, Zhejiang, China,Correspondence: Binhui Chen Fengdong Zhao
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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. Eur Spine J 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Li J, Chen Y, Wu H, Gan K, Bei D, Fan T, Chen J, Chen B. Corrigendum: Can oblique lateral interbody fusion ( OLIF) create more lumbosacral lordosis in lumbar spine surgery than minimally invasive transforaminal interbody fusion (MIS-TLIF)? Front Surg 2023; 10:1171387. [PMID: 37188099 PMCID: PMC10179492 DOI: 10.3389/fsurg.2023.1171387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fsurg.2022.1063354.].
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, Ningbo Medical Centre Li Huili Hospital, Ningbo, China
- Correspondence: Jie Li Binhui Chen
| | - Yilei Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
- Correspondence: Jie Li Binhui Chen
| | - Hao Wu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Kaifeng Gan
- Department of Spine Surgery, Ningbo Medical Centre Li Huili Hospital, Ningbo, China
| | - Dikai Bei
- Department of Spine Surgery, Ningbo Medical Centre Li Huili Hospital, Ningbo, China
| | - Tengdi Fan
- Department of Spine Surgery, Ningbo Medical Centre Li Huili Hospital, Ningbo, China
| | - Jian Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Binhui Chen
- Department of Spine Surgery, Ningbo Medical Centre Li Huili Hospital, Ningbo, China
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Wu J, Ao J, Xu Z, Li G, Ge T, Wang Y, Tao X, Tian W, Sun Y. Comparisons of oblique lumbar interbody fusion and transforaminal lumbar interbody fusion for degenerative spondylolisthesis: a prospective cohort study with a 2-year follow-up. Front Surg 2023; 10:1115823. [PMID: 37181603 PMCID: PMC10172686 DOI: 10.3389/fsurg.2023.1115823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Objective This study aimed to compare the clinical outcomes between oblique (OLIF) and transforaminal lumbar interbody fusion (TLIF) for patients with degenerative spondylolisthesis during a 2-year follow-up. Methods Patients with symptomatic degenerative spondylolisthesis who underwent OLIF (OLIF group) or TLIF (TLIF group) were prospectively enrolled in the authors' hospital and followed up for 2 years. The primary outcomes were treatment effects [changes in visual analog score (VAS) and Oswestry disability index (ODI) from baseline] at 2 years after surgery; these were compared between two groups. Patient characteristics, radiographic parameters, fusion status, and complication rates were also compared. Results In total, 45 patients were eligible for the OLIF group and 47 patients for the TLIF group. The rates of follow-up were 89% and 87% at 2 years, respectively. The comparisons of primary outcomes demonstrated no different changes in VAS-leg (OLIF, 3.4 vs. TLIF, 2.7), VAS-back (OLIF, 2.5 vs. TLIF, 2.1), and ODI (OLIF, 26.8 vs. TLIF, 30). The fusion rates were 86.1% in the TLIF group and 92.5% in the OLIF group at 2 years (P = 0.365). The OLIF group had less estimated blood loss (median, 200 ml) than the TLIF group (median, 300 ml) (P < 0.001). Greater restoration of disc height was obtained by OLIF (mean, 4.6 mm) than the TLIF group (mean, 1.3 mm) in the early postoperative period (P < 0.001). The subsidence rate was lower in the OLIF group than that in the TLIF group (17.5% vs. 38.9%, P = 0.037). The rates of total problematic complications were not different between the two groups (OLIF, 14.6% vs. TLIF, 26.2%, P = 0.192). Conclusion OLIF did not show better clinical outcomes than TLIF for degenerative spondylolisthesis, except for lesser blood loss, greater disc height restoration, and lower subsidence rate.
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Mok JM, Forsthoefel C, Diaz RL, Lin Y, Amirouche F. Biomechanical Comparison of Unilateral and Bilateral Pedicle Screw Fixation after Multilevel Lumbar Lateral Interbody Fusion. Global Spine J 2022:21925682221149392. [PMID: 36583232 DOI: 10.1177/21925682221149392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Human Cadaveric Biomechanical Study. OBJECTIVES Lumbar Lateral Interbody Fusion (LLIF) utilizing a wide cage has been reported as having favorable biomechanical characteristics. We examine the biomechanical stability of unilateral pedicle screw and rod fixation after multilevel LLIF utilizing 26 mm wide cages compared to bilateral fixation. METHODS Eight human cadaveric specimens of L1-L5 were included. Specimens were attached to a universal testing machine (MTS 30/G). Three-dimensional specimen range of motion (ROM) was recorded using an optical motion-tracking device. Specimens were tested in 3 conditions: 1) intact, 2) L1-L5 LLIF (4 levels) with unilateral rod, 3) L1-L5 LLIF with bilateral rods. RESULTS From the intact condition, LLIF with unilateral rod decreased flexion-extension by 77%, lateral bending by 53%, and axial rotation by 26%. In LLIF with bilateral rods, flexion-extension decreased by 83%, lateral bending by 64%, and axial rotation by 34%. Comparing unilateral and bilateral fixation, LLIF with bilateral rods reduced ROM by a further 23% in flexion-extension, 25% in lateral bending, and 11% in axial rotation. The difference was statistically significant in flexion-extension and lateral bending (P < .005). CONCLUSIONS Considerable decreases in ROM were observed after multilevel (4-level) LLIF utilizing 26 mm cages supplemented with both unilateral and bilateral pedicle screws and rods. The addition of bilateral fixation provides a 10-25% additional decrease in ROM. These results can inform surgeons of the incremental biomechanical benefit when considering unilateral or bilateral posterior fixation after multilevel LLIF.
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Affiliation(s)
- James M Mok
- NorthShore University HealthSystem, Skokie, IL, USA
| | - Craig Forsthoefel
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Ye Lin
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Farid Amirouche
- NorthShore University HealthSystem, Skokie, IL, USA
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
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Pu X, Wang X, Nie H, Xie T, Yang Z, Zhao L, Lin R, Zeng J. Spontaneous facet joint fusion in patients following oblique lateral lumbar interbody fusion combined with lateral single screw-rod fixation: prevalence, characteristics and significance. Eur Spine J 2022; 31:3580-9. [PMID: 36264348 DOI: 10.1007/s00586-022-07424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/06/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To explore the characteristics of spontaneous facet joint fusion (SFJF) in patients after oblique lateral lumbar interbody fusion combined with lateral single screw-rod fixation (OLIF-LSRF). METHODS We randomly selected 300 patients from 723 patients treated with OLIF-LSRF into a cross-sectional study based on the pilot study results. A novel fusion classification system was designed to evaluate the fusion status of the facet joints at three time points. Ultimately, the prevalence, characteristics, and significance of SFJF were analyzed. RESULTS A total of 265 (333 levels) qualified cases were included in our study. The novel classification for SFJF has excellent reliability (kappa > 0.75). The rate of SFJF was 15.20% (45/296 levels) at 3 months postoperatively, 31.34% (89/284 levels) at 6 months postoperatively, and 33.63% (112/333 levels) at the last follow-up. The circumferential fusion rate was 31.53% (105/333 levels) at the last follow-up. The location of SFJF was mostly on the right facet joint (P < 0.001), and the rate of SFJF increased significantly from 3 to 6 months after the operation (P < 0.001). The average age of patients with SFJF was older than that of patients without SFJF (P < 0.001). There was no significant difference in Visual Analog Scale or Oswestry Disability Index scores between patients with and without SFJF. CONCLUSION In the OLIF-LSRF procedure, SFJF occurs mostly at 3-6 months postoperatively, especially in elderly patients and at the right facet joint. OLIF-LSRF has the potential for circumferential fusion.
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Godolias P, Tataryn ZL, Frieler S, Nunna R, Charlot K, Tran A, Plümer J, Cibura C, Al-Awadi H, Daher Z, Dudda M, Schildhauer TA, Chapman J, Oskouian R. Complication rates following stand-alone lateral interbody fusion: a single institution series after 10 years of experience. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03408-7. [PMID: 36239820 DOI: 10.1007/s00590-022-03408-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This retrospective single institution study's goal was to analyze and report the complications from stand-alone lateral lumbar interbody fusions (LLIF). METHODS This research was approved by the institutional review board (STUDY2021000113). We retrospectively reviewed the database of patients with adult degenerative spine deformity treated via LLIF at our institution between January 2016 and December 2020. RESULTS Stand-alone LLIF was performed in 158 patients (145 XLIF, 13 OLIF; mean age 65 y.; 88 f., 70 m.). Mean surgical time was 85 min (± 24 min). Mean follow-up was 14 months (± 5 m). Surgical blood loss averaged 120 mL (± 187 mL) and the mean number of fused levels was 1.2 (± 0.4 levels). Overall complication rate was 19.6% (31 total; 23 approach-related, 8 secondary complications). CONCLUSION Lateral interbody fusion appears to be a safe surgical intervention with relatively low complication- and revision rates.
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Affiliation(s)
- Periklis Godolias
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital Essen-Werden, Propsteistrasse 2, 45239, Essen, Germany.
| | - Zachary L Tataryn
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Sven Frieler
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Ravi Nunna
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Kaarina Charlot
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Angela Tran
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Jonathan Plümer
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Charlotte Cibura
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Hamzah Al-Awadi
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Zeyad Daher
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Marcel Dudda
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Thomas A Schildhauer
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Jens Chapman
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Rod Oskouian
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lin GX, Chen CM, Jhang SW, Zhu MT, Lyu P, Hu BS. Characteristics and hotspots of the 50 most cited articles in the field of pre-psoas oblique lumbar interbody fusion. Front Surg 2022; 9:1004839. [PMID: 36311953 PMCID: PMC9597085 DOI: 10.3389/fsurg.2022.1004839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the past decade, the field of pre-psoas oblique lumbar interbody fusion (OLIF) has developed rapidly, and with it, the literature on OLIF has grown considerably. This study was designed to analyze the top 50 articles in terms of the number of citations through bibliometric research to demonstrate the research characteristics and hotspots of OLIF. METHOD Searching the Web of Science database yielded the 50 most cited publications in the OLIF field as of July 10, 2022. The publications were ranked according to the number of citations. The following sources were evaluated: the year of publications, the number of citations, authors, countries, institutions, journals, research topics, and keyword hotspots. RESULTS The most productive period was from 2017 to 2020, with 41 articles. The number of citations varied from 10 to 140, with an average of 35.52, and 1,776 citations were found. World Neurosurgery published the most articles (12), China produced the most articles (16), and the Catholic University of Korea produced the most studies (6). The corresponding author who produced the most articles was J.S. Kim (5), and the first author who produced the most publications was S. Orita (3). The main research topics were anatomical morphology, surgical techniques, indications, outcomes, and complications. The top 10 most cited keywords were "complications," "decompression," "spine," "surgery," "outcomes," "transpsoas approach," "spondylolisthesis," "anterior," "disease," and "injury." CONCLUSIONS Certain articles can be distinguished from others using citation analysis as an accurate representation of their impact due to their long-term effectiveness and peer recognition. With these publications, researchers are provided with research priorities and hotspots through influential literature in the field of OLIF.
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Affiliation(s)
- Guang-Xun Lin
- The School of Clinical Medicine, The Third Clinical Medical College, Fujian Medical University, China,Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan,Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan,College of Nursing and Health Sciences, Dayeh University, Taiwan
| | - Shang-Wun Jhang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Tao Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,Correspondence: Bao-Shan Hu Ming-Tao Zhu Pengfei Lyu
| | - Pengfei Lyu
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China,Correspondence: Bao-Shan Hu Ming-Tao Zhu Pengfei Lyu
| | - Bao-Shan Hu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,Correspondence: Bao-Shan Hu Ming-Tao Zhu Pengfei Lyu
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Wang W, Xiao B, Wang H, Qi J, Gu X, Yu J, Ye X, Xu G, Xi Y. Oblique lateral interbody fusion stand-alone vs. combined with percutaneous pedicle screw fixation in the treatment of discogenic low back pain. Front Surg 2022; 9:1013431. [PMID: 36299573 PMCID: PMC9589912 DOI: 10.3389/fsurg.2022.1013431] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Oblique lateral interbody fusion (OLIF) has unique advantages in the treatment of discogenic low back pain (DBP). However, there are few studies in this area, and no established standard for additional posterior internal fixation. The purpose of this study was to investigate the efficacy of OLIF stand-alone vs. combined with percutaneous pedicle screw fixation (PPSF) in the treatment of DBP. Methods This retrospective case-control study included forty patients. All patients were diagnosed with DBP by discography and discoblock. Perioperative parameters (surgery duration, blood loss, and muscle damage), complications, Visual analog scale (VAS), and Oswestry Disability Index (ODI) were assessed. Imaging data including cage subsidence, cage retropulsion, fusion rate, and adjacent spondylosis degeneration (ASD) were analyzed. Results There were 23 patients in the OLIF stand-alone group and 17 patients in the OLIF + PPSF group. The mean surgery duration, blood loss, and muscle damage in the OLIF stand-alone group were significantly better than those in the OLIF + PPSF group (P < 0.05). However, there was no significant difference in the average hospitalization time between the two groups (P > 0.05). There was no significant difference in the VAS and ODI scores between the two groups before surgery (P > 0.05), and VAS and ODI scores significantly improved after surgery (P < 0.05). The VAS and ODI scores in the OLIF stand-alone group were significantly better than those in the OLIF + PPSF group at 1 month (P < 0.05), While there was no significant difference between the two groups at 12 months and last follow up (P > 0.05). At the last follow-up, there was no significant difference in cage subsidence, fusion rate, ASD and complication rate between the two groups (P > 0.05). Conclusion OLIF stand-alone and OLIF + PPSF are both safe and effective in the treatment of DBP, and there is no significant difference in the long-term clinical and radiological outcomes. OLIF stand-alone has the advantages of surgery duration, blood loss, muscle damage, and early clinical effect. More clinical data are needed to confirm the effect of OLIF stand-alone on cage subsidence and ASD. This study provides a basis for the clinical application of standard DBP treatment with OLIF.
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Affiliation(s)
- Weiheng Wang
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Bing Xiao
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Haotian Wang
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Junqiang Qi
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xin Gu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiangming Yu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojian Ye
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guohua Xu
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yanhai Xi
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Jain M, Sahoo A, Naik S, Kumar P, Mishra D. Assessment of the psoas muscle changes following the oblique lateral interbody fusion ( OLIF) approach: A prospective observational study. J Orthop 2022; 33:60-65. [PMID: 35864925 PMCID: PMC9294652 DOI: 10.1016/j.jor.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Traditional open posterior fusion techniques involve stripping of the posterior paraspinal muscles with protracted retraction, which can lead to ischemia and denervation. This may result in poor clinical outcomes despite a well-performed surgery. Oblique lumbar interbody fusion (OLIF) is a minimally invasive modified retroperitoneal anterior approach in the corridor between the psoas major (PM) and great vessels. The purpose of this research was to study changes in psoas properties and clinical outcomes in terms of the loss of hip flexion in patients undergoing OLIF surgery. Methods Patients with lumbar pathologies who underwent instrumented OLIF at our center were included. These patients were examined clinically at baseline and 6 months postoperatively. The Oswestry disability index (ODI) and visual analog scale (VAS) scores for back pain and leg pain were noted. Magnetic resonance imaging (MRI) scans were obtained preoperatively and postoperatively (minimum 6 months) to compare the cross-sectional areas (CSAs) of the PM. Results In total, 17 patients (male: female = 8:9) with a mean age of 46.06 ± 10.49 years were included. The operation time was 154.94 ± 32.33 min, estimated blood loss was 190 ± 56 mL, and mean CSAs of the right and left psoas were, respectively, 9.94 ± 3.19 and 10.65 ± 3.74 cm2 preoperatively and 10.00 ± 3.06 and 8.53 ± 2.81 cm2 at follow-up. Qualitative measurements revealed that muscle atrophy on the left side (approach side) was 19.12% ± 3.14% and fatty degeneration had occurred in 13 of 17 (76.5%) patients. Postoperatively, all patients had significant improvement in the VAS (back and leg) and ODI scores. Furthermore, 3 of 17 (17.6%) patients had mild hip weakness (4/5) on the left side immediately postoperatively, but it resolved in 6 months. Moreover, 2 of 17 (11.8%) patients complained of paraesthesia. Conclusion OLIF does cause injury to the PM but it is clinically insignificant according to MRI scans and clinical evaluations.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Auroshish Sahoo
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Suprava Naik
- Department of Radiology, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Pankaj Kumar
- Department of Surgery, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Dipun Mishra
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
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Xie T, Pu L, Zhao L, Lu Y, Yang Z, Wang X, Song Y, Zeng J. Influence of coronal-morphology of endplate and intervertebral space to cage subsidence and fusion following oblique lumbar interbody fusion. BMC Musculoskelet Disord 2022; 23:633. [PMID: 35788206 PMCID: PMC9252057 DOI: 10.1186/s12891-022-05584-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/24/2022] [Indexed: 02/08/2023] Open
Abstract
Background Endplate morphology is considered to be one of the influencing factors of cage subsidence after lumbar interbody fusion (LIF). Previous radiographic evaluations on the endplate mostly used sagittal X-ray or MRI. However, there are few studies on the CT evaluation of the endplate and intervertebral space (IVS), especially the evaluation of coronal morphology and its influence on subsidence and fusion after LIF. We aimed to measure and classify the shapes of the endplate and IVS using coronal CT imaging and evaluate the radiographic and clinical outcomes of different shapes of the endplate/IVS following oblique lateral lumbar interbody fusion (OLIF). Methods A total of 137 patients (average age 59.1 years, including 75 males and 62 females) who underwent L4-5 OLIF combined with anterolateral fixation from June 2018 to June 2020 were included. The endplate concavity depth (ECD) was measured on the preoperative coronal CT image. According to ECD, the endplate was classified as flat (< 2 mm), shallow (2–4 mm), or deep (> 4 mm). The L4-5 IVS was further classified according to endplate type. The disc height (DH), DH changes, subsidence rate, fusion rate, and Oswestry Disability Index (ODI) in different endplate/IVS shapes were evaluated during 1-year follow up. Results The ECD of L4 inferior endplate (IEP) was significantly deeper than that of L5 superior endplate (SEP) (4.2 ± 1.1 vs 1.6 ± 0.8, P < 0.01). Four types of L4-5 IVS were identified: shallow-shallow (16, 11.7%), shallow-flat (45, 32.9%), deep-shallow (32, 23.4%), and deep-flat (44, 32.1%). A total of 45 (32.9%) cases of cage subsidence were observed. Only one (6.3%) subsidence event occurred in the shallow-shallow group, which was significantly lower than in the other three groups (19 shallow-flat, 6 deep-shallow, and 19 deep-flat) (P < 0.05). Meanwhile, the shallow-shallow group had the highest fusion rate (15, 93.8%) and the highest rate of reach minimal clinically important difference (MCID) ODI among the four types. For a single endplate, the shape of L4 IEP is the main influencing factor of the final interbody fusion rate, and the shallow shape L4 IEP facilitates fusion ( OR = 2.85, p = 0.03). On the other hand, the flat shape L5 SEP was the main risk factor to cage subsidence (OR = 4.36, p < 0.01). Conclusion The L4-5 IVS is asymmetrical on coronal CT view and tends to be fornix-above and flat-down. The shallow-shallow IVS has the lowest subsidence rate and best fusion result, which is possibly because it has a relatively good degree in matching either the upper or lower interface of the cage and endplates. These findings provide a basis for the further improvements in the design of OLIF cages. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05584-3.
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Affiliation(s)
- Tianhang Xie
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Liming Pu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Long Zhao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Yufei Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Zhiqiang Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Xiandi Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Jiancheng Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China.
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Fan W, Yang G, Zhou T, Chen Y, Gao Z, Zhou W, Gu Y. One-stage freehand minimally invasive pedicle screw fixation combined with mini-access surgery through OLIF approach for the treatment of lumbar tuberculosis. J Orthop Surg Res 2022; 17:242. [PMID: 35440015 PMCID: PMC9019983 DOI: 10.1186/s13018-022-03130-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare one-stage freehand minimally invasive pedicle screw fixation (freehand MIPS) combined with mini-access surgery through OLIF approach with posterior approach for treatment of lumbar tuberculosis (TB), and evaluate its feasibility, efficacy and safety in debridement, bone graft fusion and internal fixation. Methods 48 patients with single segment lumbar TB from June 2014 to June 2017 were included. Among them, 22 patients underwent one-stage freehand MIPS combined with mini-access surgery through OLIF approach (group 1), 26 patients were treated with posterior open surgery (group 2). Duration of operation, blood loss, and stay time in hospital were compared. Pre- and postoperative visual analog scale (VAS) pain scores, Oswestry disability index (ODI), erythrocyte sedimentation rate, complications and images were also recorded. Results Patients in group 1 showed significantly less blood loss (165 ± 73 ml vs 873 ± 318 ml, P < 0.001), shorter stay time in hospital (6/4–8 days vs 12/8–15 days, P < 0.001), while longer duration of operation (185 ± 14 min vs 171 ± 12 min, P < 0.001) than group 2 did. VAS scores significantly decreased after surgery in both groups, however, VAS scores of group 1 were significantly lower than that of group 2 immediately after surgery and during follow-ups (P < 0.001). ODI of group 1 was also significantly lower than that of group 2 at 12-month after surgery (P < 0.001). Conclusion One-stage freehand MIPS combined with mini-access surgery through OLIF approach is a feasible, efficient and safe method in treating single segment lumbar TB. It shows advantages of less surgical trauma and faster postoperative recovery.
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Affiliation(s)
- Wenshuai Fan
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Guangling Yang
- Department of Orthopaedic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Tianyao Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Yanchao Chen
- Department of Orthopaedic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Zhenchao Gao
- Department of Orthopaedic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Weili Zhou
- Department of Orthopaedic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Yutong Gu
- Department of Orthopaedic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China. .,Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032, China.
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Kim BS, Han MS, Lee TK, Kim JY, Lee JK, Moon BJ. What clinicians should consider when performing oblique lumbar interbody fusion in a patient with long vertebral body osteophytes. World Neurosurg 2022; 163:e450-e457. [PMID: 35405315 DOI: 10.1016/j.wneu.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Oblique lumbar interbody fusion (OLIF) is known as a minimally invasive technique for disc space augmentation. Motor weakness after OLIF has been known to occur in some cases. This study aimed to report the incidence and potential risk factors for motor weakness following OLIF. MATERIALS AND METHODS We enrolled 36 patients and 57 segments who underwent OLIF. Computed tomography was performed before and after OLIF. Clinical data, including age, sex, presenting symptoms, bone mineral density, visual analog scale score, operating segments, and postoperative complications, were collected. We divided the patients into groups with and without neurologic deficit. The disc height was measured and compared between the two groups. We also divided the segments into groups with and without neurologic deficit. Foramen height and osteophyte length were measured and compared between the two groups. RESULTS The neurologic deficit group included three patients (8%), whereas non-neurologic deficit group included 33 patients (92%). The neurologic deficit group included five segments (4%), whereas the non-neurologic deficit group included 109 segments (96%). The disc and foramen heights did not differ significantly between the groups with and without neurologic deficit; however, the osteophyte lengths were longer in the neurologic deficit group. CONCLUSION In our study, vertebral osteophyte length was found to be a potential risk factor for motor weakness after OLIF. For patients with long osteophytes, additional laminectomy following OLIF or another surgical approach for direct decompression should be considered.
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Affiliation(s)
- Bo-Seob Kim
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Tae-Kyu Lee
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Jae-Young Kim
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Bong Ju Moon
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea.
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Zhang X, Guo Y, Li Y. Comparison of the clinical efficacy of two fixation methods combined with OLIF in the treatment of lumbar spondylolisthesis in adult patients. J Orthop Surg Res 2022; 17:115. [PMID: 35189897 PMCID: PMC8862256 DOI: 10.1186/s13018-022-02991-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background To observe the clinical efficacy of an anterior single rob-screw fixation (ASRSF) combined with the oblique lumbar intervertebral fusion (OLIF) approach compared with a posterior percutaneous screw fixation (PPSF) combined with OLIF in the treatment of lumbar spondylolisthesis. Method This is a retrospective case–control study. Patients with degenerative lumbar spondylolisthesis (DLS) treated with either ASRSF combined with OLIF or PPSF combined with OLIF from January 2016 to January 2018 were enrolled in this study. None of the patients had posterior decompression. The visual analog scale (VAS) and Oswestry dysfunction index (ODI) were used for clinical efficacy assessment. The pre- and post-operational disc height, height of foramen, subsidence, and migration of cages, fusion rate and surgery-related complications were compared between the two groups. Results Fifty-three patients were included in this single-center study. According to the fixation methods, patients were divided into the ASRSF group (group A, 25 cases) and the PPSF group (group B, 28 cases). There was no statistical difference in surgery-related complications between groups. There was a significant difference in the VAS score at one-week post-surgery (2.3 ± 0.5 vs. 3.5 ± 0.4, P = 0.01), and three months post-operation (2.2 ± 0.3 vs. 3.0 ± 0.3, P = 0.01). Comparison of post-operative imaging data showed that there was a significant difference in the height of the foramen between groups at three months post-surgery(18.1 ± 2.3 mm vs. 16.9 ± 1.9 mm, P = 0.04). At 24 months post-surgery, the ODI was 12.65 ± 3.6 in group A and 19.1 ± 3.4 in group B (P = 0.01). Twelve months after surgery, the fusion rate in group A at 72.0% and 78.6% in group B was not statistically significant (P = 0.75). Fusion was identified in all patients at 24 months post-surgery. Conclusion When compared to PPSF, ASRSF combined with OLIF for DLS can reduce post-operative low back pain in the initial stages, maintain the height of the foramen and improve the performance of lumbar function.
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Affiliation(s)
- Xinliang Zhang
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, 710000, Shaanxi, China
| | - Yunshan Guo
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, 710000, Shaanxi, China
| | - Yibing Li
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, 710000, Shaanxi, China.
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Qin Y, Zhao B, Yuan J, Xu C, Su J, Hao J, Lv J, Wang Y. Does cage position affect the risk of cage subsidence after oblique lumbar interbody fusion in the osteoporotic lumbar spine: a finite element analysis. World Neurosurg 2022; 161:e220-e228. [PMID: 35123023 DOI: 10.1016/j.wneu.2022.01.107] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to evaluate the biomechanical effects of different cage positions with stand-alone (SA) methods and bilateral pedicle screw fixation (BPSF) in the osteoporotic lumbar spine after OLIF. METHODS A finite element (FE) model of an intact L3-L5 lumbar spine was constructed. After validation, an osteoporosis model (OP) was constructed by assigning osteoporotic material properties. SA models (SA1, SA2, SA3) and BPSF models (BPSF1, BPSF2, BPSF3) in which a cage was placed in the anterior, middle and posterior third of the L5 superior endplate (SEP) were constructed at the L4-L5 segment of the OP. The L4-L5 range of motion (ROM), the stress of the L5 SEP, the stress of the cage and the stress of fixation were compared among the different models. RESULTS According to the degree of ROM of L4-L5, the stress of the L5 SEP and the stress of the cage for most physiological motions, the SA and BPSF models were ranked as follows: SA2<SA1<SA3, BPSF2<BPSF1<BPSF3. In BPSF2, the stress of fixation was minimal in most motions. At the same cage position, the ROM of L4-L5, the stress of the L5 SEP and the stress of the cage in the BPSF models were significantly reduced compared with those in SA models; compared with SA2, BPSF2 had a maximum reduction of 83.24%, 70.71% and 73.52% in these parameters, respectively.results CONCLUSIONS: Placing the cage in the middle third of the L5 SEP for OLIF could reduce the maximum stresses of the L5 SEP, the cage and the fixation, which may reduce the risk of postoperative cage subsidence, endplate collapse and fixation fracture in the osteoporotic lumbar spine. Compared with SA OLIF, BPSF could provide sufficient stability for the surgical segment and may reduce the incidence of the aforementioned complications.
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Affiliation(s)
- Yichuan Qin
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Bin Zhao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Jie Yuan
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Chaojian Xu
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Junqiang Su
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Jiaqi Hao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Jie Lv
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Yongfeng Wang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China.
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Fang G, Chen S, Zhuang W, Huang W, Sang H. Biomechanical Evaluation and Preliminary Clinical Results of Anterolateral Screw Fixation for Oblique Lumbar Interbody Fusion Surgery. World Neurosurg 2022; 160:e372-e380. [PMID: 35026455 DOI: 10.1016/j.wneu.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The most common complication of oblique lumbar interbody fusion (OLIF) is endplate fracture/subsidence. The aim of this study was to evaluate biomechanical stability in patients undergoing OLIF surgery with anterolateral screw fixation (ASF). METHODS Based on a previously validated model technique, L4-L5 functional surgical models corresponding to the ASF and bilateral pedicle screw fixation (BPSF) methods were created. Finite element models were developed to compare the biomechanics of the ASF and BPSF groups. We retrospectively analyzed 18 patients with lumbar degenerative diseases who underwent OLIF with ASF in Shenzhen Hospital of Southern Medical University from April 2020 to April 2021. Intraoperative and postoperative complications were observed. RESULTS Compared with the BPSF model, the maximum stresses of the L4 inferior endplate and L5 superior endplate were greatly increased in the ASF model. The contact surface between the vertebrae and screw (CSVS) in the ASF model produced nearly 100% more stress than the BPSF model at all moments. In clinical practice, after a 12-month follow-up, 7 adverse events were observed, including 3 cases of left thigh pain/numbness, 3 cases of cage subsidence, and 1 case of screw loosening. CONCLUSIONS OLIF surgery with ASF could not reduce the maximum stresses on the endplate and CSVS, which may be a potential risk factor for cage subsidence and screw loosening.
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Affiliation(s)
- Guofang Fang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Shenggui Chen
- School of Mechanical Engineering, Dongguan University of Technology, Dongguan, China
| | - Weida Zhuang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Wenhua Huang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hongxun Sang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Shenzhen, China.
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Limthongkul W, Chantharakomen R, Tanasansomboon T, Yingsakmongkol W, Yoong-Leong Oh J, Kotheeranurak V, Singhatanadgige W. Comparison of unremoved intervertebral disc location between two lateral lumbar interbody fusion (LLIF) techniques. World Neurosurg 2022:S1878-8750(22)00014-6. [PMID: 35017077 DOI: 10.1016/j.wneu.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare location and amount of unremoved intervertebral disc between XLIF and OLIF. METHODS Postoperative magnetic resonance images (MRI) of patients who underwent XLIF and OLIF for degenerative spine diseases were reviewed. An axial cut T2-weight image which was the middle cut of operated disc space was selected. We divided disc area into 5 zones: central, left anterior, left posterior, right anterior, and right posterior. Disc area was measured using Picture Archiving and Communication System (PACs) program. The angle of intervertebral cage was also measured. RESULTS A total of 61 levels of XLIF from 51 patients and 62 levels of OLIF from 34 patients were included. The area of unremoved disc at left anterior, right anterior, and left posterior zones of OLIF were significantly more than XLIF (55.7±41.5 vs 29.8±33.3 mm2, 57.9±43.6 vs 34.1±33.1 mm2 and 50.5±41.8 vs 31.5±35.9 mm2 respectively; P<0.01). No significant differences were found at the right posterior and central zones. A 9.2º±6.1º and 0.7º±4.9º cage angulation from left anterior to right posterior was found in OLIF and XLIF respectively with statistical significance. CONCLUSIONS Our study found a greater area of unremoved disc in OLIF compared to XLIF. The common locations were in the contralateral side of the surgical approach, right anterior in OLIF, and right posterior in XLIF. The greater area of the unremoved disc in the anterior zone after OLIF due to oblique corridor to disc space may cause cage malposition. Meticulous disc removal should be done especially in OLIF to prevent complications.
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Chandra VVR, M Prasad BC, Hanu TG, Kale PG. Comparison between Oblique Lumbar Interbody Fusion ( OLIF) and Minimally Invasive Transforaminal Lumbar Interbody Fusion (MISTLIF) for Lumbar Spondylolisthesis. Neurol India 2022; 70:127-134. [PMID: 35263865 DOI: 10.4103/0028-3886.338732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Lumbar interbody fusion has gained popularity for the treatment of spondylolisthesis in recent years. Both procedures have their own advantages and disadvantages. OBJECTIVE The aim of this study was to compare the clinical and radiological outcomes of MIS TLIF and OLIF in terms of visual analog score, Oswestry Disability Index, Intraoperative blood loss, and various other parameters. MATERIAL AND METHODS This is a retrospective matched-pair comparative analysis between two groups who underwent Single level either OLIF or MISTLIF for spondylolisthesis operated from January 2017 to January 2020 at a Single institute by a Single surgeon. RESULTS Statistically there is no difference in various preoperative parameters between the two groups. The intraoperative blood loss is 112.5 mL in OLIF, and 144.6 mL is MISTLIF. The duration of surgery in OLIF is 4.41 h and 3.16 h in MISTLIF. The mean duration of the requirement of postoperative analgesia is 3 months after OLIF and 5 months after MISTLIF. The time taken for returning to regular activities is less in OLIF than MISTLIF. CONCLUSIONS Although both OLIF and MISTLIF have almost equivalent outcomes, OLIF is better than MISTLIF in having lesser intraoperative blood loss and achieving better lordotic correction.
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Affiliation(s)
- Vemula V R Chandra
- Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Chittoor Dist., Andhra Pradesh, India
| | - Bodapati C M Prasad
- Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Chittoor Dist., Andhra Pradesh, India
| | - Tammireddy G Hanu
- Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Chittoor Dist., Andhra Pradesh, India
| | - Pavan G Kale
- Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Chittoor Dist., Andhra Pradesh, India
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Tung KK, Hsu FW, Ou HC, Chen KH, Pan CC, Lu WX, Chin NC, Shih CM, Wu YC, Lee CH. The Morphological Changes in Adjacent Segments Amongst Patients Receiving Anterior and Oblique Lumbar Interbody Fusion: A Retrospective Study. J Clin Med 2021; 10:jcm10235533. [PMID: 34884235 PMCID: PMC8658535 DOI: 10.3390/jcm10235533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 12/30/2022] Open
Abstract
Adjacent segment disease (ASD) is troublesome condition that has proved to be highly related to spinal malalignment after spinal surgery. Hence, we aimed to evaluate the morphological changes after anterior lumbar interbody fusion (ALIF) and oblique LIF (OLIF) to establish the differences between the two surgical methods in terms of possible ASD avoidance. Fifty patients, half of whom received ALIF while the other half received OLIF, were analyzed with image studies and functional outcomes during the pre-operative and post-operative periods, and 2 years after surgery. Image measurements obtained included spinal-pelvic parameters, index lordosis (IL), segmental lordosis (SL), anterior disc height (ADH), posterior disc height (PDH) and adjacent segment disc angle (ASDA). The ADH and PDH in the adjacent segment decreased in the two groups while OLIF showed greater decrease without radiological ASD noted at 2-year follow-up. Both groups showed an increase in IL after surgery while ALIF showed greater improvement. No statistical difference was identified in functional outcomes between LIFs. We suggest that both ALIF and OLIF can restore adequate lordosis and prevent ASD after surgery. However, it should be noted that patient selection remains crucial when making any decision involving which of the two methods to use.
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Affiliation(s)
- Kuan-Kai Tung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
| | - Fang-Wei Hsu
- Department of Orthopedics, Kuang Tien General Hospital, Taichung 433, Taiwan;
| | - Hsien-Che Ou
- Department of Medicine Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
- Department of Biomedical Engineering, Hung Kuang University, Taichung 433304, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung 43301, Taiwan
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
- Department of Rehabilitation Science, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Wen-Xian Lu
- Department of Orthopedics, Feng Yuan Hospital Ministry of Health and Welfare, Taichung 420, Taiwan;
| | - Ning-Chien Chin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
- Department of Physical Therapy, Hung Kuang University, Taichung 433304, Taiwan
- PhD Degree Program of Biomedical Science and Engineering, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Yun-Che Wu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Food Science and Technology, Hung Kuang University, Taichung 433304, Taiwan
- Correspondence: ; Tel.: +886-4-23592525
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Kuzmik GA, Wozny TA, Ammanuel S, Eichler CM, Mummaneni PV, Chou D. Oblique Lumbar Interbody Fusion From L2 to S1: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E438. [PMID: 34409982 DOI: 10.1093/ons/opab283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
This surgical video demonstrates the technique of an oblique lumbar interbody fusion (OLIF) in the lumbar spine from L2 to L5 as well as an oblique approach to the L5-S1 level. It demonstrates the surgical approach, technical nuances of OLIF, and pearls of the surgery. The video discusses the importance of the release of the disc space to allow for height restoration and deformity correction, endplate preparation to enhance arthrodesis, and appropriate implant sizing. The concept of the approach is the minimally invasive blunt dissection through the abdominal wall musculature and mobilization of the retroperitoneal fat. Unlike the transpsoas approach, the surgery is performed anterior to the psoas, avoiding the lumbar plexus.1 For L5-S1, the approach is still performed in the lateral position but with an oblique approach. A vascular surgeon performs the L5-S1 approach, and the disc space is accessed through the iliac bifurcation.2 The discectomy and interbody fusion are performed similarly to a standard anterior lumbar interbody fusion (ALIF), but in a lateral position and at an oblique angle. The patient consented to this procedure and for filming a video of this case.
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Affiliation(s)
- Gregory A Kuzmik
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Simon Ammanuel
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Charles M Eichler
- Division of Vascular Surgery, Department of Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Dean Chou
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
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Han XG, Tang GQ, Han X, Xing YG, Zhang Q, He D, Tian W. Comparison of Outcomes between Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion and Oblique Lumbar Interbody Fusion in Single-Level Lumbar Spondylolisthesis. Orthop Surg 2021; 13:2093-2101. [PMID: 34596342 PMCID: PMC8528977 DOI: 10.1111/os.13151] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the safety and effectiveness of robot‐assisted minimally invasive transforaminal lumbar interbody fusion (Mis‐TLIF) and oblique lumbar interbody fusion (OLIF) for the treatment of single‐level lumbar degenerative spondylolisthesis (LDS). Methods This is a retrospective study. Between April 2018 and April 2020, a total of 61 patients with single‐level lumbar degenerative spondylolisthesis and treated with robot‐assisted OLIF (28 cases, 16 females, 12 males, mean age 50.4 years) or robot‐assisted Mis‐TLIF (33 cases, 18 females, 15 males, mean age 53.6 years) were enrolled and evaluated. All the pedicle screws were implanted percutaneously assisted by the TiRobot system. Surgical data included the operation time, blood loss, and length of postoperative hospital stay. The clinical and functional outcomes included Oswestry Disability Index (ODI), Visual Analog scores (VAS) for back and leg pain, complication, and patient's satisfaction. Radiographic outcomes include pedicle screw accuracy, fusion status, and disc height. These data were collected before surgery, at 1 week, 3 months, 6 months, and 12 months postoperatively. Results There were no significantly different results in preoperative measurement between the two groups. There was significantly less blood loss (142.4 ± 89.4 vs 291.5 ± 72.3 mL, P < 0.01), shorter hospital stays (3.2 ± 1.8 vs 4.2 ± 2.5 days, P < 0.01), and longer operative time (164.9 ± 56.0 vs 121.5 ± 48.2 min, P < 0.01) in OLIF group compared with Mis‐TLIF group. The postoperative VAS scores and ODI scores in both groups were significantly improved compared with preoperative data (P < 0.05). VAS scores for back pain were significantly lower in OLIF group than Mis‐TLIF group at 1 week (2.8 ± 1.2 vs 3.5 ± 1.6, P < 0.05) and 3 months postoperatively (1.6 ± 1.0 vs 2.1 ± 1.1, P < 0.05), but there was no significant difference at further follow‐ups. ODI score was also significantly lower in OLIF group than Mis‐TLIF group at 3 months postoperatively (22.3 ± 10.0 vs 26.1 ± 12.8, P < 0.05). There was no significant difference in the proportion of clinically acceptable screws between the two groups (97.3% vs 96.2%, P = 0.90). At 1 year, the OLIF group had a higher interbody fusion rate compared with Mis‐TLIF group (96.0% vs 87%, P < 0.01). Disc height was significantly higher in the OLIF group than Mis‐TLIF group (12.4 ± 3.2 vs 11.2 ± 1.3 mm, P < 0.01). Satisfaction rates at 1 year exceeded 90% in both groups and there was no significant difference (92.6% for OLIF vs 91.2% for Mis‐TLIF, P = 0.263). Conclusion Robot‐assisted OLIF and Mis‐TLIF both have similar good clinical outcomes, but OLIF has the additional benefits of less blood loss, less postoperative hospital stays, higher disc height, and higher fusion rates. Robots are an effective tool for minimally invasive spine surgery.
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Affiliation(s)
- Xiao-Guang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Guo-Qing Tang
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Xiao Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yong-Gang Xing
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Qi Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
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Pham MH, Gupta M, Stone LE, Osorio JA, Lehman RA. Minimally Invasive L5-S1 Oblique Lumbar Interbody Fusion With Simultaneous Robotic Single Position Posterior Fixation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E543. [PMID: 34432879 DOI: 10.1093/ons/opab301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
The unique anatomy at L5-S1 presents different challenges and considerations to be made when compared to other areas in the lumbar spine. In this way, the oblique lumbar interbody fusion (OLIF) is more closely related to a supine anterior lumbar interbody fusion (ALIF) except that the former is performed in a lateral position down a smaller minimally invasive retroperitoneal corridor. This lateral positioning at L5-S1, however, provides an opportunity for single-position surgery simultaneously with posterior fixation, which is not afforded by other approaches. We present here a case of a 57-yr-old male with a prior right-sided L5-S1 microdiscectomy who presents with worsening lumbar radiculopathy and foot drop. He subsequently underwent a minimally invasive L5-S1 OLIF with posterior instrumentation placed bilaterally while remaining in a single lateral position (Mazor X Stealth Edition, Medtronic, Dublin, Ireland). Both the anterior OLIF surgeon and posterior instrumentation surgeon were able to work simultaneously. There is currently a need for further high-quality operative videos showing the L5-S1 OLIF technique, and to our knowledge, this is the first video demonstrating a 2-surgeon near-simultaneous workflow approach using a spinal robotics platform at this level. There is no identifying information in this video. A patient consent was obtained for the surgical procedure and for publishing of the material included in the video.
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Affiliation(s)
- Martin H Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - Mihir Gupta
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - Lauren E Stone
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - Joseph A Osorio
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - Ronald A Lehman
- Department of Orthopedic Surgery, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Tung KK, Wu YC, Chen KH, Pan CC, Lu WX, Chin NC, Shih CM, Hsu FW, Lee CH. The radiological outcome in lumbar interbody fusion among rheumatoid arthritis patients: a 20-year retrospective study. BMC Musculoskelet Disord 2021; 22:658. [PMID: 34353311 PMCID: PMC8344185 DOI: 10.1186/s12891-021-04531-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical outcomes amongst Rheumatoid Arthritis (RA) patients have shown satisfactory results being reported after lumbar surgery. The increased adoption of the interbody fusion technique has been due to a high fusion rate and less invasive procedures. However, the radiographic outcome for RA patients after receiving interbody fusion has scarcely been addressed in the available literature. METHODS Patients receiving interbody fusion including ALIF, OLIF, and TLIF were examined for implant cage motion and fusion status at two-year follow-up. Parameters for the index correction level including ADH, PDH, WI, SL, FW, and FH were measured and compared at pre-OP, post-OP, and two-year follow-up. RESULTS We enrolled 64 RA patients at 104 levels (mean 64.0 years old, 85.9% female) received lumbar interbody fusion. There were substantial improvement in ADH, PDH, WI, SL, FW, and FH after surgery, with both ADH and PDH having significantly dropped at two-year follow up. The OLIF group suffered from a higher subsidence rate with no significant difference in fusion rate when compared to TLIF. The fusion rate and subsidence rate for all RA patients was 90.4 and 28.8%, respectively. CONCLUSIONS We revealed the radiographic outcomes of lumbar interbody fusions towards symptomatic lumbar disease in RA patients with good fusion outcome despite the relative high subsidence rate amongst the OLIF group. Those responsible for intra-operative endplate management should be more cautious to avoid post-OP cage subsidence.
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Affiliation(s)
- Kuan-Kai Tung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Che Wu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan.,Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan.,Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Wen-Xian Lu
- Department of Orthopedics, Feng Yuan Hospital Ministry of Health and Welfare, Taichung, Taiwan
| | - Ning-Chien Chin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan.,PhD Degree Program of Biomedical Science and Engineering, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Fang-Wei Hsu
- Department of Orthopedics, Kuang Tien General Hospital, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan. .,National Chung Hsing University, Taichung, Taiwan. .,Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan.
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