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Kosterhon M, Müller A, Rockenfeller R, Aiyangar AK, Gruber K, Ringel F, Kantelhardt SR. Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis. Front Bioeng Biotechnol 2024; 11:1281119. [PMID: 38260753 PMCID: PMC10801739 DOI: 10.3389/fbioe.2023.1281119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction: The surgical treatment of degenerative spondylolisthesis with accompanying spinal stenosis focuses mainly on decompression of the spinal canal with or without additional fusion by means of a dorsal spondylodesis. Currently, one main decision criterion for additional fusion is the presence of instability in flexion and extension X-rays. In cases of mild and stable spondylolisthesis, the optimal treatment remains a subject of ongoing debate. There exist different opinions on whether performing a fusion directly together with decompression has a potential benefit for patients or constitutes overtreatment. As X-ray images do not provide any information about internal biomechanical forces, computer simulation of individual patients might be a tool to gain a set of new decision criteria for those cases. Methods: To evaluate the biomechanical effects resulting from different decompression techniques, we developed a lumbar spine model using forward dynamic-based multibody simulation (FD_MBS). Preoperative CT data of 15 patients with degenerative spondylolisthesis at the level L4/L5 who underwent spinal decompression were identified retrospectively. Based on the segmented vertebrae, 15 individualized models were built. To establish a reference for comparison, we simulated a standardized flexion movement (intact) for each model. Subsequently, we performed virtual unilateral and bilateral interlaminar fenestration (uILF, bILF) and laminectomy (LAM) by removing the respective ligaments in each model. Afterward, the standardized flexion movement was simulated again for each case and decompression method, allowing us to compare the outcomes with the reference. This comprehensive approach enables us to assess the biomechanical implications of different surgical approaches and gain valuable insights into their effects on lumbar spine functionality. Results: Our findings reveal significant changes in the biomechanics of vertebrae and intervertebral discs (IVDs) as a result of different decompression techniques. As the invasiveness of decompression increases, the moment transmitted on the vertebrae significantly rises, following the sequence intact ➝ uILF ➝ bILF ➝ LAM. Conversely, we observed a reduction in anterior-posterior shear forces within the IVDs at the levels L3/L4 and L4/L5 following LAM. Conclusion: Our findings showed that it was feasible to forecast lumbar spine kinematics after three distinct decompression methods, which might be helpful in future clinical applications.
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Affiliation(s)
- M. Kosterhon
- Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, Germany
| | - A. Müller
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, Germany
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dübendorf, Switzerland
- Department of Mathematics and Natural Science, Institute of Sports Science, University Koblenz, Koblenz, Germany
| | - R. Rockenfeller
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, Germany
- Department of Mathematics and Natural Science, Mathematical Institute, University Koblenz, Koblenz, Germany
| | - A. K. Aiyangar
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dübendorf, Switzerland
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- Faculty of Engineering and Sciences, University of Adolfo Ibanez, Vina del Mar, Chile
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - K. Gruber
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, Germany
| | - F. Ringel
- Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, Germany
| | - S. R. Kantelhardt
- Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, Germany
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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: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This meta-analysis aimed to compare the differences in postoperative efficacy between oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases. MATERIALS AND METHODS Strictly based on the search strategy, we searched the published papers on OLIF and TLIF for the treatment of lumbar degenerative diseases in PubMed, Embase, CINAHL, and Cochrane Library. A total of 607 related papers were retrieved, and 15 articles were finally included. The quality of the papers was evaluated according to the Cochrane systematic review methodology, and the data were extracted and meta-analyzed using Review manager 5.4 software. RESULTS Through comparison, it was found that in the treatment of lumbar degenerative diseases, the OLIF group had certain advantages over the TLIF group in terms of intraoperative blood loss, hospital stay, visual analog scale (VAS) for leg pain (VAS-LP), Oswestry disability index (ODI), disc height (DH), foraminal height (FH), fused segmental lordosis (FSL), and cage height, and the differences were statistically significant. The results were similar in terms of surgery time, complications, fusion rate, VAS for back pain (VAS-BP) and various sagittal imaging indicators, and there was no significant difference. CONCLUSIONS OLIF and TLIF can relieve low back pain symptoms in the treatment of lumbar degenerative diseases, but OLIF has certain advantages in terms of ODI and VAS-LP. In addition, OLIF has the advantages of minor intraoperative trauma and quick postoperative recovery.
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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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Song Z, Zhu W, Zheng J, Wu G, Li T, Huang A, Bian J, Chen C, Li H. Comparison of short-term efficacy of MIS-TLIF and Endo-LIF in the treatment of single-segment degenerative lumbar diseases. Front Surg 2022; 9:922930. [PMID: 36211296 PMCID: PMC9545169 DOI: 10.3389/fsurg.2022.922930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/02/2022] [Indexed: 11/14/2022] Open
Abstract
Background A prospective controlled study was conducted to compare the short-term clinical results and postoperative complications of minimally invasive transforaminal lumbar decompression and fusion (minimally invasive surgery transforaminal lumbar interbody fusion, MIS-TLIF) and percutaneous endoscope-assisted transforaminal lumbar interbody fusion (endoscopic lumbar interbody fusion, Endo-LIF) in the treatment of single-segment degenerative lumbar diseases, to provide some scientific guidance for clinicians to select surgical treatment for patients with lumbar degeneration. Methods From October 2020 to October 2021, a total of 62 patients were enrolled, with 31 patients in the MIS-TLIF group and 31 patients in the Endo-LIF group. All patients were followed up for 6 months. The following information from the two groups of patients was recorded: (1) operation time, radiation exposure time, intraoperative blood loss, bed rest time, and hospital stay; (2) ODI score (The Oswestry Disability Index), low back pain VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores) 1 day before the operation; 1, 3, 6 days after operation; and 1, 3 and 6 months after operation. (3) X-ray evaluations of lumbar fusion at the last follow-up. Results There were significant differences in operation time, intraoperative fluoroscopy time, and hospitalization cost between the two groups. The MIS-TLIF group was significantly better than the Endo-LIF group, and the intraoperative bleeding volume of the Endo-LIF group was significantly better than that of the MIS-TLIF group, but there was no significant difference in postoperative bed rest time and postoperative hospital stay. There was no significant difference in the scores of ODI, VAS, and JOA between the two groups before and after the operation. At the last follow-up, the fusion rate was 100% in the MIS-TLIF group and 100% in the Endo-LIF group. Conclusions There was no significant difference in short-term clinical efficacy and safety between Endo-LIF and MIS-TLIF in the treatment of single-segment degenerative lumbar diseases, but MIS-TLIF was significantly better than Endo-LIF in terms of the operation time, hospitalization cost, and fluoroscopy time, and Endo-LIF was significantly better than MIS-TLIF in terms of intraoperative blood loss.
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Affiliation(s)
- Zhiwei Song
- Department of Orthopedics, Hospital Affiliated 5 to Nantong University, Taizhou People’s Hospital, Taizhou, China
- Medical School of Nantong University, Nantong, China
| | - Weihua Zhu
- Department of Orthopedics, Hospital Affiliated 5 to Nantong University, Taizhou People’s Hospital, Taizhou, China
- Department of Orthopedics, Taizhou People’s Hospital, Nanjing Medical University, Taizhou, China
| | - Junwen Zheng
- Postgraduate Training Base of Dalian Medical University, Taizhou People’s Hospital, Jiangsu, China
| | - Gang Wu
- Postgraduate Training Base of Dalian Medical University, Taizhou People’s Hospital, Jiangsu, China
| | - Tianqi Li
- Postgraduate Training Base of Dalian Medical University, Taizhou People’s Hospital, Jiangsu, China
| | - Aibing Huang
- Department of Orthopedics, Hospital Affiliated 5 to Nantong University, Taizhou People’s Hospital, Taizhou, China
- Postgraduate Training Base of Dalian Medical University, Taizhou People’s Hospital, Jiangsu, China
| | - Jian Bian
- Department of Orthopedics, Hospital Affiliated 5 to Nantong University, Taizhou People’s Hospital, Taizhou, China
- Department of Orthopedics, Taizhou People’s Hospital, Nanjing Medical University, Taizhou, China
| | - Chunmao Chen
- Department of Orthopedics, Hospital Affiliated 5 to Nantong University, Taizhou People’s Hospital, Taizhou, China
- Department of Orthopedics, Taizhou People’s Hospital, Nanjing Medical University, Taizhou, China
| | - Haijun Li
- Department of Orthopedics, Hospital Affiliated 5 to Nantong University, Taizhou People’s Hospital, Taizhou, China
- Department of Orthopedics, Taizhou People’s Hospital, Nanjing Medical University, Taizhou, China
- Correspondence: Haijun Li
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Effect of Discectomy on Dynesys Dynamic Fixation in the Treatment of Lumbar Degenerative Diseases. Pain Res Manag 2022; 2021:3043645. [PMID: 35003407 PMCID: PMC8736702 DOI: 10.1155/2021/3043645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022]
Abstract
Objective To compare the effect of decompression of the spinal canal with or without discectomy on the clinical efficacy of Dynesys dynamic fixation treatment in lumbar degenerative diseases. Methods A total of 62 patients treated for single-segment lumbar degenerative disease from October 2010 to November 2017 were retrospectively analyzed. All patients underwent decompression of the spinal canal with Dynesys dynamic fixation and were divided into two groups. Twenty-seven patients in group A did not undergo discectomy, and 35 patients in group B underwent discectomy. The intervertebral height, range of motion, Pfirrmann grade of the surgical segment and the upper adjacent segment, function scores, and operation information were compared. Results All patients were followed up for an average of 30.7 ± 11.5 months. At the final follow-up, the intervertebral height and range of motion of the surgical segment decreased significantly in both group A and B (p < 0.05), the range of motion of the upper adjacent segment increased significantly (p < 0.05), and the intervertebral height did not change significantly (p < 0.05). The retained percentages of surgical segment intervertebral height and ROM in group A were significantly better than those in group B (p < 0.05). The intervertebral height (p > 0.05) and range of motion (p < 0.05) of the surgical segment in group A were higher than those in group B. The surgical segment Pfirrmann grading of group A was better than that of group B (p < 0.05). Conclusion Dynesys in the treatment of lumbar degenerative diseases may lead to a good clinical effect. In selected cases without discectomy, the range of motion and intervertebral height may be better preserved, and disc degeneration may be reduced.
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