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Jitpakdee K, Sommer F, Gouveia E, Mykolajtchuk C, Boadi B, Berger J, Hussain I, Härtl R. Expandable cages that expand both height and lordosis provide improved immediate effect on sagittal alignment and short-term clinical outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). J Spine Surg 2024; 10:55-67. [PMID: 38567017 PMCID: PMC10982918 DOI: 10.21037/jss-23-106] [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: 09/27/2023] [Accepted: 01/07/2024] [Indexed: 04/04/2024]
Abstract
Background Failure to restore lordotic alignment is not an uncommon problem following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF), even with expandable cages that increase disc height. This study aims to investigate the effect of the expandable cage that is specifically designed to expand both height and lordosis. We evaluated the outcomes of MIS TLIF in restoring immediate postoperative sagittal alignment by comparing two different types of expandable cages. One cage is designed to solely increase disc height (Group H), while the other can expand both height and lordosis (Group HL). Methods Patients undergoing MIS TLIF using expandable cages were retrospectively reviewed, including 40 cases in Group H and 109 cases in Group HL. Visual analog scores of back and leg pain, and Oswestry disability index were collected. Disc height, disc angle, and sagittal alignment were measured. Complications were recorded, including early subsidence which was evaluated with computed tomography. Results Clinical and radiographic outcomes significantly improved in both groups postoperatively. Group HL showed superior improvement in segmental lordosis (4.4°±3.5° vs. 2.1°±4.8°, P=0.01) and disc angle (6.3°±3.8 vs. 2.2°±4.3°, P<0.001) compared to Group H. Overall incidence of early subsidence was 23.3%, predominantly observed during initial cases as part of the learning curve, but decreased to 18% after completion of the first 20 cases. Conclusions Expandable cages with a design specifically aimed at increasing lordotic angle can provide favorable outcomes and effectively improve immediate sagittal alignment following MIS TLIF, compared to conventional cages that only increase in height. However, regardless of the type of expandable cage used, it is crucial to avoid applying excessive force to achieve greater disc height or lordosis, as this may contribute to subsidence and a possible reduction in lordotic alignment restoration. Long-term results are needed to evaluate the clinical outcome, fusion rate, and maintenance of the sagittal alignment.
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Affiliation(s)
- Khanathip Jitpakdee
- Weill Cornell Medicine-Department of Neurosurgery, New York-Presbyterian Hospital – Och Spine, New York, NY, USA
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Fabian Sommer
- Weill Cornell Medicine-Department of Neurosurgery, New York-Presbyterian Hospital – Och Spine, New York, NY, USA
| | - Edna Gouveia
- Weill Cornell Medicine-Department of Neurosurgery, New York-Presbyterian Hospital – Och Spine, New York, NY, USA
- Department of Neurosurgery, Clinica Sagrada Esperança-Ilha, Luanda, Angola
| | - Catherine Mykolajtchuk
- Weill Cornell Medicine-Department of Neurosurgery, New York-Presbyterian Hospital – Och Spine, New York, NY, USA
| | - Blake Boadi
- Weill Cornell Medicine-Department of Neurosurgery, New York-Presbyterian Hospital – Och Spine, New York, NY, USA
| | - Jessica Berger
- Weill Cornell Medicine-Department of Neurosurgery, New York-Presbyterian Hospital – Och Spine, New York, NY, USA
| | - Ibrahim Hussain
- Weill Cornell Medicine-Department of Neurosurgery, New York-Presbyterian Hospital – Och Spine, New York, NY, USA
| | - Roger Härtl
- Weill Cornell Medicine-Department of Neurosurgery, New York-Presbyterian Hospital – Och Spine, New York, NY, USA
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Zhan X, Zhan X, Yu J, Moore G, Li F, Xi X, Zeng Z, Yin S, Yu Y, Cheng L. Correlation between direction of pedicle screw and restoration of lumbar degenerative scoliosis in degenerative lumbar spondylolisthesis: a retrospective study. Quant Imaging Med Surg 2023; 13:1740-1752. [PMID: 36915359 PMCID: PMC10006100 DOI: 10.21037/qims-22-483] [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: 05/15/2022] [Accepted: 12/11/2022] [Indexed: 01/15/2023]
Abstract
Background Inferior clinical outcomes have been reported in patients with degenerative lumbar spondylolisthesis (DLS) accompanied by lumbar degenerative scoliosis, but little attention has been paid to its radiologic assessment or preoperative planning. The aim of this study was to analyze the effect of transforaminal lumbar interbody fusion on patients with DLS and lumbar degenerative scoliosis and explore the surgical aspects benefiting the restoration of lumbar degenerative scoliosis. Methods All patients with DLS and lumbar degenerative scoliosis undergoing single-level unilateral transforaminal lumbar interbody fusion surgery between July 1, 2015, and April 30, 2021, were screened in this retrospective cohort study. Clinical outcomes including visual analog scale (VAS), Oswestry disability index (ODI), and radiographic parameters of sagittal and coronal alignment, cage spatial locations, and angle of pedicle screw (parallel, cranial, and caudad angle) were assessed. Coronal asymmetry was demonstrated by the intervertebral height difference between the medial and lateral margins of indexed intersegmental space. The correlations between Δintervertebral height difference (postoperative intervertebral height difference-preoperative intervertebral height difference) and radiographic parameters and clinical outcomes were analyzed by univariable, multivariable, mediation, and correlation analyses. Significance was set at a bilateral P<0.05. Results A total of 57 included patients were followed up for a minimum of 1 year. Reduction of VAS, ODI, and improvement of radiographic parameters were found after surgery. The cranial angle of the lower pedicle screw positively correlated with Δintervertebral height difference restoration (b=0.54; standard error=0.11; P<0.001). Conclusions Transforaminal lumbar interbody fusion surgery appears to be an effective approach to improving the radiographic and clinical outcomes of patients with DLS and lumbar degenerative scoliosis. The cranial direction of the lower pedicle screws in single-level unilateral transforaminal lumbar interbody fusion surgery may be associated with a better postoperative restoration of lumbar degenerative scoliosis.
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Affiliation(s)
- Xuqiang Zhan
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xinhua Zhan
- Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jili Yu
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | | | - Fuping Li
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Spine Surgery, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Xin Xi
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhili Zeng
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | | | - Yan Yu
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liming Cheng
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Tomita T, Kamei K, Yamauchi R, Nakagawa T, Omi H, Nitobe Y, Asari T, Kumagai G, Wada K, Ito J, Ishibashi Y. Posterior Oblique Square Decompression with a Three-Step Wanding Technique in Tubular Minimally Invasive Transforaminal Lumbar Interbody Fusion: Technical Report and Mid-Long-Term Clinical Outcomes. J Clin Med 2022; 11:jcm11061651. [PMID: 35329981 PMCID: PMC8951443 DOI: 10.3390/jcm11061651] [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: 01/17/2022] [Revised: 03/05/2022] [Accepted: 03/15/2022] [Indexed: 12/04/2022] Open
Abstract
Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the most common procedure in minimally invasive spine stabilization (MISt), details of the technique remain unclear. This technical report shows the mid-long-term clinical outcomes in patients who underwent posterior oblique square decompression (POSDe) with the three-step wanding technique of tubular MIS-TLIF for degenerative lumbar disease. Tubular MIS-TLIF (POSDe) was performed on 50 patients (males, 19; age, 69.2 ± 9.6 years), and traditional open surgery was performed (OS) on 27 (males, 4; age, 67.9 ± 6.6 years). We evaluated the clinical outcomes using the Visual Analog Scale for back pain, Japanese Orthopedic Association (JOA) scores, and JOA Back Pain Evaluation Questionnaire. We also assessed the fusion rate using the Bridwell grading system with computed tomography or plain radiography for at least 2 years postoperatively. Although there was no significant difference in the improvement rate of JOA scores between the two groups, the mean operation time and blood loss were significantly lower with MIS-TLIF than with OS. In the tubular MIS-TLIF group, there were no cases of deep wound infection; four cases had a pseudarthrosis, two had dural injury, and three had cage retropulsion. We revealed good clinical outcomes in patients who underwent POSDe.
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Affiliation(s)
- Takashi Tomita
- Department of Orthopaedic Surgery, Aomori Prefectural Central Hospital, Aomori 030-8553, Japan or (K.K.); (H.O.); (J.I.)
- Correspondence: ; Tel.: +81-17-726-8111
| | - Keita Kamei
- Department of Orthopaedic Surgery, Aomori Prefectural Central Hospital, Aomori 030-8553, Japan or (K.K.); (H.O.); (J.I.)
| | - Ryota Yamauchi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan or (R.Y.); (Y.N.); (T.A.); (G.K.); (K.W.); (Y.I.)
| | - Takahiro Nakagawa
- Department of Orthopaedic Surgery, National Defense Medical College, Saitama 359-8513, Japan;
| | - Hirotsugu Omi
- Department of Orthopaedic Surgery, Aomori Prefectural Central Hospital, Aomori 030-8553, Japan or (K.K.); (H.O.); (J.I.)
| | - Yoshiro Nitobe
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan or (R.Y.); (Y.N.); (T.A.); (G.K.); (K.W.); (Y.I.)
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan or (R.Y.); (Y.N.); (T.A.); (G.K.); (K.W.); (Y.I.)
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan or (R.Y.); (Y.N.); (T.A.); (G.K.); (K.W.); (Y.I.)
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan or (R.Y.); (Y.N.); (T.A.); (G.K.); (K.W.); (Y.I.)
| | - Junji Ito
- Department of Orthopaedic Surgery, Aomori Prefectural Central Hospital, Aomori 030-8553, Japan or (K.K.); (H.O.); (J.I.)
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori 036-8562, Japan or (R.Y.); (Y.N.); (T.A.); (G.K.); (K.W.); (Y.I.)
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Gray MT, Davis KP, McEntire BJ, Bal BS, Smith MW. Transforaminal lumbar interbody fusion with a silicon nitride cage demonstrates early radiographic fusion. J Spine Surg 2022; 8:29-43. [PMID: 35441113 PMCID: PMC8990392 DOI: 10.21037/jss-21-115] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Degeneration of the lumbar spine is common in aging adults and reflects a significant morbidity burden in this population. In selected patients that prove unresponsive to non-surgical treatment, posterior lumbar fusion (PLF) surgery, with or without adjunctive transforaminal lumbar interbody fusion (TLIF) can relieve pain and improve function. We describe here the radiographic fusion rates for PLF versus TLIF, using an intervertebral spinal cage made of silicon nitride ceramic (chemical formula Si3N4). METHODS This retrospective cohort analysis enrolled 99 patients from August 2013 to January 2017; 17 had undergone PLF at 24 levels, while 82 had undergone TLIF at 104 levels. All operations were performed by a single surgeon at one institution. Radiographic and clinical outcomes were compared between PLF and TLIF at 2 and 6 weeks and then at 3, 6, 12, and 24 months. RESULTS TLIF patients fused at higher rates compared to PLF at the 3-month (38.5% vs. 8.3%, P=0.006), 6-month (78.7% vs. 35.0%, P<0.001) and 12-month time periods (97.9% vs. 81.3%, P=0.018), with no difference at 24 months (100% vs. 94.4%, P=0.102). Index level segmental motion was significantly less and intervertebral disc height was improved in TLIF over PLF at all follow up intervals. Foraminal height was only greater in early follow up periods (2 weeks, 6 weeks and 3 months). TLIF patients experienced lover rates of PI-LL mismatch which was maintained across long term follow-up. Pelvic tilt was lower following TLIF compared to PLF, with no differences in complication rates between study groups. CONCLUSIONS Our retrospective series demonstrated that TLIF performed with silicon nitride interbody cages led to earlier radiographic fusion, greater restoration of disc and foraminal height, increased segmental rigidity and improved sagittal alignment when compared to PLF alone.
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Affiliation(s)
| | - Kyle P. Davis
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - B. Sonny Bal
- SINTX Technologies Corporation, Salt Lake City, UT, USA
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Ohyama S, Aoki Y, Inoue M, Nakajima T, Sato Y, Watanabe A, Takahashi H, Kubota G, Nakajima A, Saito J, Eguchi Y, Orita S, Nakagawa K, Ohtori S. Predictors of Spontaneous Restoration of Lumbar Lordosis after Single-Level Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Diseases. Spine Surg Relat Res 2021; 5:397-404. [PMID: 34966866 PMCID: PMC8668222 DOI: 10.22603/ssrr.2020-0195] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Preoperative factors that predict postoperative restoration of lumbar lordosis (LL) are not well understood. To investigate whether preoperative postural correction of LL, sagittal malalignment, or lumbar flexibility are associated with the postoperative restoration of LL in patients treated with a single-level transforaminal lumbar interbody fusion (TLIF), a retrospective cohort study was conducted. Methods We enrolled 104 patients (mean age: 67.5±10.7 years old; 47 men and 57 women) with lumbar degenerative diseases treated with a single-level TLIF. The pre- and postoperative LL were examined using lateral radiographs in the standing position and computed tomography (CT) images in the supine position. The correlation between postoperative LL restoration and preoperative postural correction of LL (difference in LL between the standing and supine positions: D-LL), sagittal imbalance (pelvic incidence minus LL: PI-LL), and lumbar flexibility (difference in LL between the flexion and extension postures) were analyzed. Patients were divided into two groups according to the D-LL (D-LL≥0° and D-LL<0°). The rates of postoperative LL restoration (postoperative LL-preoperative LL in standing) were compared between the two groups. Results Multiple regression analysis performed after adjustment for age, gender, body mass index, and cage angle revealed that postoperative LL restoration was significantly correlated with D-LL (p<0.001), but not with PI-LL, and lumbar flexibility. Patients with a preoperative D-LL≥0° showed a significantly greater increase of LL after TLIF (7.1°±11.2°) than those with D-LL<0° (1.4°±6.6°) (p=0.003). Conclusions A preoperative evaluation of a lateral radiograph or CT taken in the supine position is useful in predicting postoperative improvement of sagittal alignment. Postoperative improvement of sagittal spinopelvic alignment would be expected when LL is corrected in the supine position preoperatively. Surgeons should pay attention to the postural correction of LL when performing short-segment fusion surgery for lumbar degenerative disease with sagittal malalignment.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Go Kubota
- Department of Orthopaedic Surgery, Sawara Prefectural Hospital, Katori, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
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Mathew J, Cerpa M, Lee NJ, Boddapati V, Marciano G, Sardar ZM, Lenke LG. Comparing hyperlordotic and standard lordotic cages for achieving segmental lumbar lordosis during transforaminal lumbar interbody fusion in adult spinal deformity surgery. J Spine Surg 2021; 7:318-325. [PMID: 34734136 DOI: 10.21037/jss-21-15] [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: 02/09/2021] [Accepted: 04/02/2021] [Indexed: 11/06/2022]
Abstract
Background Few studies directly compare the effect of interbody cages with different degrees of lordosis in producing segmental lumbar lordosis (SLL) in the transforaminal lumbar interbody fusion (TLIF) procedure. Thus, we aimed to investigate changes in SLL in hyperlordotic cages compared to standard lordotic cages in open TLIF procedures. Methods Thirty-eight consecutive patients who received open TLIF procedures performed by a single surgeon between 2017 and 2018 were reviewed. Twenty patients had "hyperlordotic cages" (20° lordosis), while 18 patients had "standard lordotic cages" (6° lordosis). Twenty-three patients had one-level TLIF procedures and 15 had two-level TLIF. Standard radiographic measurements, including SLL were assessed preoperatively, postoperatively, and at 1-year follow-up. SLL was measured from the superior endplate of the cephalad vertebra to the inferior endplate of the caudal vertebra. Changes in SLL were compared using Student's and paired t-tests. Results In one- and two-level open TLIF, both hyperlordotic and standard lordotic cages produced significant improvement in SLL. Among those receiving a one-level TLIF, SLL increased 7.8° (P=0.024) in those with standard lordotic cages; it increased 8.2° (P=0.020) in those with hyperlordotic cages. Among those receiving a two-level TLIF, SLL increased 13.9° (P=0.032) in those with standard lordotic cages; it increased 8.8° (P=0.023) in those with hyperlordotic cages. However, the improvement in SLL was not significantly different between the two cage types in either one or two-level TLIF procedures (P=0.917, P=0.389). At 1-year follow-up, there was no significant change in SLL, among standard lordotic and hyperlordotic cages (P=0.501, P=0.781). Conclusions Although it is theorized that hyperlordotic cages would increase SLL during open TLIF procedures more than standard lordotic cages, our data failed to demonstrate that. As our study examined cases performed by a single surgeon immediately before and after adoption of these lordotic cages, it is likely that surgical technique is of equal or greater importance in improving SLL than the amount of lordosis designed into interbody cages.
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Affiliation(s)
- Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Meghan Cerpa
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Nathan J Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Gerard Marciano
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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Russo AJ, Schopler SA, Stetzner KJ, Shirk T. Minimally invasive transforaminal lumbar interbody fusion with expandable articulating interbody spacers significantly improves radiographic outcomes compared to static interbody spacers. J Spine Surg 2021; 7:300-309. [PMID: 34734134 DOI: 10.21037/jss-20-630] [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] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/15/2021] [Indexed: 12/22/2022]
Abstract
Background The goal of minimally invasive transforaminal lumbar interbody fusion (MI TLIF) is to restore and maintain disc height and lordosis until arthrodesis occurs, while minimizing muscle disruption and improving recovery time. The purpose of this study was to compare the radiographic outcomes in patients treated with an articulating expandable spacer in MI TLIF to more traditional static spacers. Methods This was a multi-site, multi-surgeon, Institutional Review Board-exempt, retrospective clinical study from a prospectively collected database. It included 48 patients with a diagnosis of degenerative disc disease (DDD) at one level from L2 to S1 with or without Grade 1 spondylolisthesis who underwent MI TLIF using either an articulating expandable or static interbody spacer. Twenty-seven patients were in the banana-shaped articulating expandable interbody spacer (ALTERA®, Globus Medical, Inc., Audubon, PA, USA) group, while 21 patients were in the static interbody spacer group. Both groups had supplemental posterior pedicle screw and rod fixation. Radiographic records were assessed for disc height, neuroforaminal height, and lordosis at baseline, 3 and 6 months, and final follow-up. Results The articulating expandable spacer group displayed significantly greater improvement in anterior disc height from baseline compared to the static spacer group at 6 weeks, 3 and 6 months, and final follow-up by averages of 2.6 mm (79%), 2.8 mm (92%), 3.4 mm (105%), and 3.8 mm (139%), respectively (P<0.05). Mean increases in posterior disc height were significantly greater in the expandable group compared to the static group by 1.2 mm (65%) and 1.7 mm (104%) at 6 months and final follow-up, respectively (P<0.05). Articulating expandable spacers produced significantly greater average improvement by 4.0 mm in neuroforaminal height from baseline to final follow-up compared to static spacers (P<0.05). Increases in intervertebral angle from baseline were significantly greater in the expandable group than in the static group at 3 and 6 months, and final follow-up by averages of 2.5°, 2.8°, and 3.1°, respectively (P<0.05). The articulating expandable spacer group resulted in significantly greater improvements in lumbar lordosis from baseline to 3 and 6 months than the static spacer group by 4.4° and 4.0°, respectively (P<0.05). Conclusions MI TLIF with articulating expandable interbody spacers provides significant restoration and maintenance of disc height, neuroforaminal height, and lordosis compared to static spacers in this comparative cohort. Long-term clinical outcomes are needed to correlate with these radiographic improvements.
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Affiliation(s)
| | | | | | - Torrey Shirk
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA, USA
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Moses ZB, Razvi S, Oh SY, Platt A, Keegan KC, Hamati F, Witiw C, David BT, Fontes RBV, Deutsch H, O'Toole JE, Fessler RG. A retrospective comparison of radiographic and clinical outcomes in single-level degenerative lumbar disease undergoing anterior versus transforaminal lumbar interbody fusion. J Spine Surg 2021; 7:170-180. [PMID: 34296029 DOI: 10.21037/jss-20-673] [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] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/29/2021] [Indexed: 11/06/2022]
Abstract
Background Single-level lumbar degenerative disc disease (DDD) remains a significant cause of morbidity in adulthood. Anterior lumbar interbody fusion (ALIF) and Transforaminal lumbar interbody fusion (TLIF) are surgical techniques developed to treat this condition. With limited studies on intermediate term outcomes in a single cohort, we compare radiographic and clinical outcomes in patients undergoing ALIF and TLIF. Methods A retrospective chart review was performed on 164 patients (111 TLIF; 53 ALIF) over a 60-month period. X-ray radiographs obtained pre-operatively, prior to discharge, and at one year were utilized for radiographic assessment. Segmental lordosis, lumbar lordosis and HRQOL scores were measured preoperatively and at one-year timepoints. Results Changes in lumbar lordosis and segmental lordosis were significantly greater after ALIF (4.6° vs. -0.6°, P=0.05; 4.7° vs. -0.7°, P<0.05) at one year (mean time, 366±20 days). At one year or greater, there was a greater reduction in mean VAS-leg score in TLIF patients (3.4 vs. 0.6, P<0.05) and ODI score (16.2 vs. 5.4, P<0.05). Similar outcomes were seen for VAS-back, SF-12 Physical Health, and SRS-30 Function/Activity. SF-12 Mental Health scores were found to be lower in patients undergoing TLIF (-3.5 vs. 2.7, P<0.05). Conclusions ALIF demonstrated a superior method of increasing lumbar and segmental lordosis. TLIF was utilized more in patients with higher pre-operative VAS-leg pain scores and therefore, showed a greater magnitude of VAS-leg pain improvement. TLIF also demonstrated a greater improvement in ODI scores despite similar baseline scores, suggesting a possible enhanced functional outcome.
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Affiliation(s)
- Ziev B Moses
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Sharmeen Razvi
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Seok Yoon Oh
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew Platt
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C Keegan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Fadi Hamati
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher Witiw
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian T David
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Ricardo B V Fontes
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Harel Deutsch
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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9
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Weiner JA, McCarthy MH, Swiatek P, Louie PK, Qureshi SA. Narrative review of intraoperative image guidance for transforaminal lumbar interbody fusion. Ann Transl Med 2021; 9:89. [PMID: 33553382 PMCID: PMC7859762 DOI: 10.21037/atm-20-1971] [Citation(s) in RCA: 3] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent advancements in imaging technology have changed the landscape of transforaminal lumbar interbody fusion (TLIF) with the objective of improving safety and efficacy for the patient and surgical team. Spine surgery, and specifically TLIFs, involve challenging anatomy and command precise surgical accuracy, creating an essential role for intraoperative imaging, navigation, and robotics. Traditionally, surgeons have relied upon fluoroscopy for pedicle screw and interbody placement. More recently, intraoperative 3-dimensional navigation (ION) has risen in popularity in TLIF surgery. This technology utilizes intra-operative advanced imaging, such as computed tomography (CT) and 3D-fluroscopy, to accurately track instruments and implants in relation to the patient’s anatomy. ION has demonstrated improved accuracy of pedicle screw placement, decreased operating room times, and lower radiation exposure to the surgeon and staff. However, conventional fluoroscopy, 3D fluoroscopy, intraoperative CT, image-guided navigation, and robot-assisted surgery all have a role in TLIF surgery. Numerous studies have been published regarding the benefits and pitfalls of these intraoperative tools in spine surgery, but there is a relative lack of research regarding some of the newer technologies surrounding TLIF. As future studies are published, and technology continues to evolve, surgeons must stay abreast of novel techniques to maximize patient safety and outcomes. Over the coming decade, we can expect intraoperative navigation and robotics to play a more significant role in spine surgery.
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Affiliation(s)
- Joseph A Weiner
- Northwestern University Department of Orthopaedic Surgery, Chicago, IL, USA
| | - Michael H McCarthy
- Hospital for Special Surgery Department of Orthopedic Surgery, New York, NY, USA
| | - Peter Swiatek
- Northwestern University Department of Orthopaedic Surgery, Chicago, IL, USA
| | - Philip K Louie
- Hospital for Special Surgery Department of Orthopedic Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery Department of Orthopedic Surgery, New York, NY, USA
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Li N, Dai M, Zhang B, He D, Wei Y, Duan F, Sun Y, Liu B, Mo F, Tian W. Risk factors for cage retropulsion after transforaminal lumbar interbody fusion in older patients. Ann Transl Med 2020; 8:1660. [PMID: 33490172 PMCID: PMC7812186 DOI: 10.21037/atm-20-7416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 11/06/2022]
Abstract
Background To investigate the incidence of cage retropulsion (CR) following transforaminal lumbar interbody fusion (TLIF) and the associated risk factors in older patients with lumbar disorders. Methods Between January 2015 and December 2017, 1,880 older patients (aged >60 years) who underwent open TLIF were preliminarily enrolled in this retrospective study. The patients' medical records were reviewed, and the risk factors potentially associated with CR were analyzed. Results A total of 1,662 patients (692 males and 970 females, with an average age of 68.7±5.2 years) who met the eligibility criteria were finally enrolled in this study. Following TLIF, 29 older patients (1.74%) developed CR including 12 patients with spinal stenosis, 7 patients with degenerative spondylolisthesis, 5 patients had degenerative disc diseases, 3 patients had surgical history, and 2 patients suffered isthmic spondylolisthesis. Of the 29 patients, 21 patients suffered lower back pain and/or sciatica (72.4%), while 8 patients were asymptomatic (27.6%). In multivariate analysis, screw loosening [odds ratio (OR) =7.315; 95% confidence interval (CI): 3.4-15.7] and endplate injury (OR =4.947; 95% CI: 2.3-10.6) were found to be independently associated with CR in older patients after TLIF. Conclusions The incidence of CR following TLIF in older patients is 1.74%. Screw loosening and endplate injury are risk factors for CR in older patients with TLIF.
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Affiliation(s)
- Nan Li
- Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Min Dai
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Yi Wei
- Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Fangfang Duan
- Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Yuqing Sun
- Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Bo Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Fengbo Mo
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
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Kolcun JPG, Brusko GD, Wang MY. Endoscopic transforaminal lumbar interbody fusion without general anesthesia: technical innovations and outcomes. Ann Transl Med 2019; 7:S167. [PMID: 31624733 DOI: 10.21037/atm.2019.07.92] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Innovations in surgical techniques and technologies have enabled spine surgeons to offer patients less morbid alternatives to traditional spine procedures. This review will explore the development of the endoscopic transforaminal lumbar interbody fusion (TLIF) without general endotracheal anesthesia (GETA) and discuss the technical refinements and innovations learned from experiences with this technique. The Awake TLIF employs several key technological innovations: (I) conscious sedation; (II) endoscopic visualization; (III) an expandable interbody device; (IV) recombinant human bone morphogenetic protein; (V) long-acting local analgesia; and (VI) percutaneous instrumentation. Technical refinements, including premedication for prophylaxis against nausea, vomiting, and epistaxis, were made as a result of early experiences with this technique. Results from the first 100 patients to undergo the Awake TLIF demonstrated durable clinical benefit beyond one year postoperatively. Operating time, blood loss, and hospital length of stay averages well below those generally seen with conventional MIS TLIF. Patients achieved a significant reduction in Oswestry Disability Index from baseline of -12.3 points (P<0.0001). In this initial 100 patient cohort, four conversions to GETA were required and four complications resulted, three of which occurred during the first 50 cases. To date, over 200 Awake TLIF cases and the first three-level procedure have been performed. Endoscopic TLIF without the use of general anesthesia is a novel but promising approach for short-segment lumbar fusion. Continued technical innovations will likely afford greater improvements in outcomes, both in the acute and long-term recovery periods.
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Affiliation(s)
- John Paul G Kolcun
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - G Damian Brusko
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Kelly JP, Alcala-Marquez C, Dawson JM, Mehbod AA, Pinto MR. Treatment of degenerative spondylolisthesis by instrumented posterolateral versus instrumented posterolateral with transforaminal lumbar interbody single-level fusion. J Spine Surg 2019; 5:351-357. [PMID: 31663046 DOI: 10.21037/jss.2019.08.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to compare outcomes of patients with degenerative spondylolisthesis treated by posterolateral lumbar fusion (PLF) versus PLF with transforaminal lumbar interbody fusion (PLF + TLIF). Studies of PLF versus PLF + TLIF have shown either equivalence or support for PLF + TLIF in lumbar spine surgery. Many are heterogeneous in the conditions treated, with few considering only spondylolisthesis of degenerative origin. Radiographic outcomes tend to favor PLF + TLIF, but this has not translated into better clinical outcomes. Methods This was a retrospective cohort study. Forty-nine patients undergoing single-level PLF and seventy patients undergoing single-level PLF + TLIF with two-year follow-up were retrospectively reviewed. Demographics, Oswestry Disability Index (ODI), implant cost, surgical data, and complications were analyzed. Results There was no difference in ODI improvement at two-year follow-up between the cohorts (P=0.97). Dural tears were more common in the PLF cohort (P<0.01), but otherwise complication and reoperation rates were similar. Implant cost (P<0.01) and operative time (P=0.01) were higher in the PLF + TLIF cohort. Conclusions The addition of a TLIF to a PLF did not result in a functional improvement in the treatment of degenerative spondylolisthesis as measured by the ODI.
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Kobayashi K, Ando K, Kato F, Kanemura T, Sato K, Hachiya Y, Matsubara Y, Kamiya M, Sakai Y, Yagi H, Shinjo R, Ishiguro N, Imagama S. Predictors of Prolonged Length of Stay After Lumbar Interbody Fusion: A Multicenter Study. Global Spine J 2019; 9:466-472. [PMID: 31431867 PMCID: PMC6686383 DOI: 10.1177/2192568218800054] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective analysis of a prospectively database. OBJECTIVES To identify factors associated with prolonged length of stay (LOS) in posterior /transforaminal lumbar interbody fusion (PLIF/TLIF). METHODS The subjects were patients who underwent PLIF/TLIF at 10 facilities from 2012 to 2014. A total of 1168 such patients with a mean age of 65.9 ± 12.5 years (range 18-87 years) were identified in the database. Operations were PLIF (n = 675), TLIF (n = 443), minimally invasive surgery (MIS)-PLIF (n = 22), and MIS-TLIF (n = 32). Age, gender, body mass index, ambulatory status, comorbidities, perioperative American Society of Anesthesiologists (ASA) grade, operative factors, and complications were examined. LOS was defined as the number of calendar days from the operation to hospital discharge. LOS was categorized as normal (<75th percentile) or prolonged (≥75th percentile). RESULTS The average LOS was 20.8 ± 9.8 days (range 7-77 days). There was a significant correlation between LOS and age (P < .05). Reoperation during hospitalization was performed in 20 cases for surgical site infection (n = 12), epidural hematoma (n = 5), and screw misplacement (n = 3). In multivariate analysis, prolonged LOS was associated with preoperative variables of age ≥70 years (odds ratio [OR] 1.87, 95% CI 1.38-2.54), and ASA class ≥III (OR 1.52, 95% CI 1.04-2.25); surgical variables of open procedures (OR 5.84, 95% CI 1.74-19.63), fused levels ≥3 (OR 5.17, 95% CI 3.17-8.43), operative time ≥300 minutes (OR 1.88, 95% CI 1.15-3.07), and estimated blood loss ≥500 mL (OR 1.71, 95% 1.07-2.75). CONCLUSIONS The factors identified in this study should help with obtaining informed consent, surgical planning and complication prevention to reduce health care costs associated with prolonged LOS.
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Affiliation(s)
| | - Kei Ando
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Koji Sato
- Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | | | | | | | - Yoshihito Sakai
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hideki Yagi
- Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | | | - Naoki Ishiguro
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Nagoya University Graduate School of Medicine, Nagoya, Japan,Shiro Imagama, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi 466-8550, Japan.
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Wu AM, Hu ZC, Li XB, Feng ZH, Chen D, Xu H, Huang QS, Lin Y, Wang XY, Zhang K, Zhao J, Ni WF. Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis: minimum two-year follow up. Ann Transl Med 2018; 6:105. [PMID: 29707554 DOI: 10.21037/atm.2018.02.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Compare the efficacy and safety of minimally invasive and open transforaminal lumbar interbody fusion (TLIF) in the treatment of single segmental lumbar spondylolisthesis. Methods From 2010-01 to 2015-10, in total, 167 patients with single segmental spondylolisthesis treated by TLIF were included, 79 cases in minimally invasive TLIF (MI-TLIF) group and 88 cases in open TLIF group. The peri-operative parameters of operative time, estimated blood loss and length of postoperative hospital stay was recorded, as well as complications. Visual Analogue Scale (VAS) of low back pain and leg pain, and Oswestry Disability Index (ODI) were used to assess the pain and functional outcomes at pre-operatively, 3 months/1 year/2 years/5 years after operation. The radiographic parameters of posterior height of the intervertebral space and segmental lordosis were measured too. Results No significantly difference was found at baseline characteristic data of age, gender ratio, the percentage of degenerative and isthmic spondylolisthesis, the percentage of slip, and segmental distribution between MI-TLIF and open TLIF groups. MI-TLIF group had less estimated intra-operative blood loss (163.7±49.6 mL) than open TLIF group (243.3±70.2 mL, P<0.001) and had shorter post-operative hospital stay (5.8±1.4 days) than open TLIF group (7.3±2.9 days, P<0.001). Both MI-TLIF and open TLIF can significantly reduce the VAS of low back pain, VAS of leg pain, ODI, and improve the posterior height of the intervertebral space and segmental lordosis, but no significantly difference was found of them between two groups. Conclusions Our study suggests that MI-TLIF is a safe and effective choice in the treatment of lower grade lumbar spondylolisthesis (grade II or less), and it has advantages of less blood loss, postoperative hospital stay when compared to open TLIF.
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Affiliation(s)
- Ai-Min Wu
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China.,Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200000, China
| | - Zhi-Chao Hu
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China
| | - Xiao-Bin Li
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China
| | - Zhen-Hua Feng
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China
| | - Dong Chen
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China
| | - Hui Xu
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China
| | - Qi-Shan Huang
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China
| | - Yan Lin
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China
| | - Xiang-Yang Wang
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China
| | - Kai Zhang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200000, China
| | - Jie Zhao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200000, China
| | - Wen-Fei Ni
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325000, China
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McAnany SJ, Patterson DC, Overley S, Alicea D, Guzman J, Qureshi SA. The Effect of Obesity on the Improvement in Health State Outcomes following Minimally Invasive Transforaminal Interbody Fusion. Global Spine J 2016; 6:744-748. [PMID: 27853657 PMCID: PMC5110345 DOI: 10.1055/s-0036-1579747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 09/07/2015] [Accepted: 01/15/2016] [Indexed: 02/07/2023] Open
Abstract
Study Design Observational study. Objective Studies have shown a correlation between obesity and lumbar spine pathology, but also that obese patients have higher rates of complication following lumbar spine surgery. It is unknown if obese patients have clinical gains following lumbar spine surgery comparable to the gain of normal-weight patients. This study investigated the correlation of obesity and the delta change in outcomes in a single surgeon's cohort of normal-weight and obese patients undergoing minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF). Methods A retrospective review was performed of a single surgeon's patients at an academic medical center who underwent MIS TLIF between July 2011 and December 2013. Statistical analyses included independent sample t test for continuous variables, Fisher exact test for categorical data, and repeated measures two-way analysis of variance to assess the interaction between obesity status and the change in Short-Form Health Survey 12 (SF-12) results. Results Thirty-eight patients from a single institution were reviewed, and 19 had a body mass index greater than 30. The nonobese and obese postoperative SF-12 mental composite scores (MCS; 52.70 ± 2.50 versus 52.16 ± 1.91; p = 0.87) and physical composite scores (PCS; 45.56 ± 2.72 versus 41.03 ± 2.65; p = 0.24) did not show any significant differences. There was no significant interaction between obesity and change in SF-12 MCS (F [1, 36] = 0.96, p = 0.33) or SF-12 PCS (F [1, 36] = 0.74, p = 0.40) between the pre- and postoperative scores. There was a significant effect of obesity on SF-12 PCS scores (F [1, 36] = 7.15, p = 0.01). Conclusions Patients undergoing MIS TLIF sustain meaningful and significant gains in SF-12 MCS and PCS that is not impacted by their obesity status.
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Affiliation(s)
- Steven J. McAnany
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States
| | - Diana C. Patterson
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States
| | - Samuel Overley
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States
| | - Daniel Alicea
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States
| | - Javier Guzman
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States
| | - Sheeraz A. Qureshi
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States,Address for correspondence Sheeraz A. Qureshi, MD, MBA Department of Orthopaedic Surgery, Mount Sinai Medical Center5 East 98th Street, 9th Floor, New York, NY 10029United States
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Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 2016; 1:2-18. [PMID: 27683674 DOI: 10.3978/j.issn.2414-469x.2015.10.05] [Citation(s) in RCA: 353] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity. The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF). The indications may include: discogenic/facetogenic low back pain, neurogenic claudication, radiculopathy due to foraminal stenosis, lumbar degenerative spinal deformity including symptomatic spondylolisthesis and degenerative scoliosis. In general, traditional posterior approaches are frequently used with acceptable fusion rates and low complication rates, however they are limited by thecal sac and nerve root retraction, along with iatrogenic injury to the paraspinal musculature and disruption of the posterior tension band. Minimally invasive (MIS) posterior approaches have evolved in an attempt to reduce approach related complications. Anterior approaches avoid the spinal canal, cauda equina and nerve roots, however have issues with approach related abdominal and vascular complications. In addition, lateral and OLIF techniques have potential risks to the lumbar plexus and psoas muscle. The present study aims firstly to comprehensively review the available literature and evidence for different lumbar interbody fusion (LIF) techniques. Secondly, we propose a set of recommendations and guidelines for the indications for interbody fusion options. Thirdly, this article provides a description of each approach, and illustrates the potential benefits and disadvantages of each technique with reference to indication and spine level performed.
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Affiliation(s)
- Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia;; Prince of Wales Private Hospital, Randwick, Sydney, Australia;; University of New South Wales (UNSW), Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia;; Prince of Wales Private Hospital, Randwick, Sydney, Australia;; University of New South Wales (UNSW), Sydney, Australia
| | - Greg Malham
- Neuroscience Institute, Epworth Hospital, Richmond VIC, Australia
| | - Kevin Seex
- Neurosurgery Department, Macquarie University, Sydney, Australia
| | - Prashanth J Rao
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia;; Prince of Wales Private Hospital, Randwick, Sydney, Australia;; University of New South Wales (UNSW), Sydney, Australia
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17
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Etemadifar MR, Hadi A, Masouleh MF. Posterolateral instrumented fusion with and without transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis: A randomized clinical trial with 2-year follow-up. J Craniovertebr Junction Spine 2016; 7:43-9. [PMID: 27041885 PMCID: PMC4790148 DOI: 10.4103/0974-8237.176623] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although posterolateral fusion and pedicle screw fixation are a relatively common treatment method for the treatment of spondylolisthesis, controversy exists about the necessity of adding interbody fusion to posterolateral fusion. The aim of our study was to assess the functional disability, pain, and complications in patients with spondylolisthesis treated by posterolateral instrumented fusion (PLF) with and without transforaminal lumbar interbody fusion (TLIF) in a randomized clinical trial. MATERIALS AND METHODS From February 2007 to February 2011, 50 adult patients with spondylolisthesis were randomly assigned to be treated with PLF or PLF+TLIF techniques (25 patients in each group) by a single surgeon. Back pain, leg pain, and disability were assessed before treatment and until 2 years after surgical treatment using visual analog scale (VAS) and oswestry disability index (ODI). Patients were also evaluated for postoperative complications such as infection, neurological complications, and instrument failure. RESULTS All patients completed the 24 months of follow-up. Twenty patients were females and 30 were males. Average age of the patients was 53 ± 11 years for the PLF group and 51 ± 13 for the PLF + TLIF group. Back pain, leg pain, and disability score were significantly improved postoperatively compared to preoperative scores (P < 0.001). At 3 months of follow-up, there was no statistically significant difference in VAS score for back pain and leg pain in both groups; however, after 6 months and 1 year and 2 years follow-up, the reported scores for back pain and leg pain were significantly lower in the PLF+TLIF group (P < 0.05). The ODI score was also significantly lower in the PLF+TLIF group at 1 year and 2 years of follow-up (P < 0.05). One screw breakage and one superficial infection occurred in the PLF+TLIF group, which had no statistical significance (P = 0.373). CONCLUSION It seems that accompanying TLIF with PLF might lead to better functional improvement and pain reduction in patients with spondylolisthesis.
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Affiliation(s)
| | - Abdollah Hadi
- Department of Orthopedic Spinal Surgery, Isfahan University of Medical Science, Isfahan, Iran
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18
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Abstract
Background: In a recent study entitled: “More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion (XLIF): A review”, Epstein documented that more nerve root injuries occurred utilizing minimally invasive surgery (MIS) versus open lumbar surgery for diskectomy, decompression of stenosis (laminectomy), and/or fusion for instability. Methods: In large multicenter Spine Patient Outcomes Research Trial reviews performed by Desai et al., nerve root injury with open diskectomy occurred in 0.13–0.25% of cases, occurred in 0% of laminectomy/stenosis with/without fusion cases, and just 2% for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion. Results: In another MIS series performed largely for disc disease (often contained nonsurgical disc herniations, therefore unnecessary procedures) or spondylolisthesis, the risk of root injury was 2% for transforaminal lumbar interbody fusion (TLIF) versus 7.8% for posterior lumbar interbody fusion (PLIF). Furthermore, the high frequencies of radiculitis/nerve root/plexus injuries incurring during anterior lumbar interbody fusions (ALIF: 15.8%) versus extreme lumbar interbody fusions (XLIF: 23.8%), addressing disc disease, failed back surgery, and spondylolisthesis, were far from acceptable. Conclusions: The incidence of nerve root injuries following any of the multiple MIS lumbar surgical techniques (TLIF/PLIF/ALIF/XLIF) resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques. Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients?
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Affiliation(s)
- Nancy E Epstein
- Department of Winthrop NeuroScience, Winthrop University Hospital, Mineola, New York, USA
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Epstein NE. More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review. Surg Neurol Int 2016; 7:S83-95. [PMID: 26904372 PMCID: PMC4743267 DOI: 10.4103/2152-7806.174895] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/02/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In the lumbar spine, do more nerve root injuries occur utilizing minimally invasive surgery (MIS) techniques versus open lumbar procedures? To answer this question, we compared the frequency of nerve root injuries for multiple open versus MIS operations including diskectomy, laminectomy with/without fusion addressing degenerative disc disease, stenosis, and/or degenerative spondylolisthesis. METHODS Several of Desai et al. large Spine Patient Outcomes Research Trial studies showed the frequency for nerve root injury following an open diskectomy ranged from 0.13% to 0.25%, for open laminectomy/stenosis with/without fusion it was 0%, and for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion it was 2%. RESULTS Alternatively, one study compared the incidence of root injuries utilizing MIS transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) techniques; 7.8% of PLIF versus 2% of TLIF patients sustained root injuries. Furthermore, even higher frequencies of radiculitis and nerve root injuries occurred during anterior lumbar interbody fusions (ALIFs) versus extreme lateral interbody fusions (XLIFs). These high frequencies were far from acceptable; 15.8% following ALIF experienced postoperative radiculitis, while 23.8% undergoing XLIF sustained root/plexus deficits. CONCLUSIONS This review indicates that MIS (TLIF/PLIF/ALIF/XLIF) lumbar surgery resulted in a higher incidence of root injuries, radiculitis, or plexopathy versus open lumbar surgical techniques. Furthermore, even a cursory look at the XLIF data demonstrated the greater danger posed to neural tissue by this newest addition to the MIS lumbar surgical armamentariu. The latter should prompt us as spine surgeons to question why the XLIF procedure is still being offered to our patients?
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Affiliation(s)
- Nancy E Epstein
- Department of Neurousrgery, Winthrop Neuroscience, Winthrop University Hospital, Mineola, New York, USA
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Bodiu A. Diagnosis and operatory treatment of the patients with failed back surgery caused by herniated disk relapse. J Med Life 2014; 7:533-7. [PMID: 25713616 PMCID: PMC4316133] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 10/27/2014] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED THE OBJECT OF STUDY: Analysis of surgical treatment results in patients with recurrent lumbar disc herniation by transforaminal lumbar interbody fusion (TLIF) and repeated laminotomy and discectomy for the improvement of pain and disability. MATERIAL AND METHODS Data analysis was performed on a complex diagnosis and treatment of 56 patients with recurrent lumbar disc herniation who had previously underwent 1-3 lumbar disc surgeries. An MRI investigation with paramagnetic contrast agent (gadolinium) was used for the diagnosis and differentiation of epidural fibrosis, and a dynamic lateral X-ray investigation was carried out for the identification of segmental instability. The evolution period after the previous surgery was between 1 and 3 years after the index surgery. Pain expression degree and dynamics were assessed with the pain visual analog scale (VAS) in early and late postoperative periods. Postoperative success was assessed by using a modified MacNab scale. The follow-up recording period after the last operation was of at least 1 year, ranging from 1 to 4 years. RESULTS The surgical treatment was effective in most cases, recording a reduction in pain expression level from 7.2-7.7 points on the VAS scale to 1.7-2.1 in the early period and 2.2-2.6 in the late period (1 year). Repeated surgery was effective in 21 of 30 (70%) cases who underwent decompression surgery without fusion and in 20 of 26 (76.9%) cases who underwent repeated surgery with transforaminal lumbar interbody fusion (TLIF). Overall, postoperative success was assessed by using a modified MacNab scale. CONCLUSION Repeated surgery is a viable option for patients who have clinical manifestations of recurrent disc herniation. Investigation with contrast agent by MRI allows differentiating disk herniation recurrences from epidural fibrosis. Supplementing repeated discectomies and decompression with intervertebral transforaminal fusion provide superior clinical outcomes, especially in patients with clinical and radiological signs of lumbar segment instability.
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Affiliation(s)
- A Bodiu
- Institute of Neurology and Neurosurgery, Chisinau, Republic of Moldova
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