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Ma X, Lin L, Wang J, Meng L, Zhang X, Miao J. Oblique lateral interbody fusion combined with unilateral versus bilateral posterior fixation in patients with osteoporosis. J Orthop Surg Res 2023; 18:776. [PMID: 37845750 PMCID: PMC10577918 DOI: 10.1186/s13018-023-04262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023] Open
Abstract
PURPOSE To compare the clinical efficacy of oblique lateral interbody fusion (OLIF) combined with unilateral (UPSF) and bilateral pedicle screw internal fixation (BPSF) in patients with osteoporosis. METHODS Clinical data of 57 patients who underwent single-segment OLIF surgery with a clear diagnosis of osteoporosis from December 2018 to May 2021 were retrospectively analyzed, of which 27 patients underwent OLIF + UPSF and 30 patients underwent OLIF + BPSF. Surgical technique-related indexes were recorded, including operative time, operative blood loss and postoperative hospital stay; clinical outcome-related indexes included postoperative complications, Visual analogue scale (VAS) and Oswestry disability index (ODI) at preoperative, 1 week, 1 month, 3 months, and 12 months postoperative follow-up; and imaging outcome-related indexes included the measurement of preoperative and postoperative segmental lordosis (SL), and observation of the degree of cage subsidence and bone graft fusion. RESULTS The surgery was successfully performed in 57 patients, and there was no statistical difference in operative blood loss and postoperative hospital stay between UPSF group and BPSF group (P > 0.05). In terms of operative time, there was a significant difference (UPSF group: 92.30 ± 11.03 min, BPSF group: 119.67 ± 16.41, P < 0.05). Postoperative VAS and ODI scores exhibited significant improvement (P < 0.05). At the 12 months postoperative follow-up, the VAS and ODI scores in the BPSF group were significantly better than those in the UPS group (P < 0.05). Compared with the preoperative images, the SL was significantly improved in both groups after surgery (P < 0.05). At 6 months postoperatively, the fusion rate in the UPSF group was significantly lower than that in the BPSF group (P < 0.05). At 1 year postoperatively, the fusion rate in the UPSF group was not significantly different from that in the BPSF group (P > 0.05). At 1 year postoperatively, the rate and degree of cage subsidence was higher in the UPSF group than in the BPSF group (P < 0.05). CONCLUSION In the long term, OLIF combined with bilateral posterior fixation applied to the osteoporosis patients is superior to OLIF surgery combined with unilateral posterior fixation in terms of clinical and imaging outcomes. It is effective in improving pain relief and functional improvement, accelerating bone graft fusion, and reducing cage subsidence compared with UPSF.
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Affiliation(s)
- Xiang Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, 300210, China
| | - Longwei Lin
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, 300210, China
- Tianjin Medical University, Tianjin, China
| | - Jian Wang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, 300210, China
- Tianjin Medical University, Tianjin, China
| | - Lin Meng
- Tianjin University, Tianjin, China
| | - Xingze Zhang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, 300210, China
- Tianjin Medical University, Tianjin, China
| | - Jun Miao
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, 300210, China.
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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] [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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Yu Y, Wang Y, Xie Y, Feng C, Chen Y, Xu J, Fan X. Comparison of the mid-term clinical efficacy of different fixtaion methods combined with oblique lumbar interbody fusion in treating lumbar degenerative diseases. J Orthop Surg (Hong Kong) 2023; 31:10225536231209552. [PMID: 37859589 DOI: 10.1177/10225536231209552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND To compare the mid-term follow-up clinical efficacy among three treatment approaches for lumbar degenerative diseases (LDD): standalone oblique lumbar interbody fusion (SF), oblique lumbar interbody fusion combined with lateral screw fixation (LF), and oblique lumbar interbody fusion combined with posterior screw fixation (PF). METHOD This retrospective study included a total of 71 cases of single level LDD that underwent OLIF in Hospital of Chengdu University of Traditional Chinese Medicine were retrospectively collected between March 2016 and September 2017. Patients were divided into three groups: 24 cases in the SF group, 24 cases in the LF group and 23 cases in the PF group. Various parameters, such as operation time, hospitalization time, and complications, were recorded. The fusion condition was assessed at last follow up. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) from pre-operation to 5 years post-surgery. RESULTS Significantly lower mean operation time and hospitalization time were observed in the SF and LF groups compared to the PF group (p < .05). However, no significant difference in fusion rate was found among the three groups. Regarding clinical outcomes, there was no statistically significant difference in VAS scores between the three groups during all follow-up periods. At the 6th month and 1st year after surgery, the SF and LF groups had significantly lower Oswestry Disability Index (ODI) scores compared to the PF group (p < .05). There was no significant difference in perioperative complication rates among the three groups (p > .05). In the LF group, one case of instrument displacement and urethra injury were reported, while in the SF, LF, and PF groups, 10, 9, and 3 cases of cage subsidence were reported, respectively. CONCLUSION The study findings suggest that oblique lumbar interbody fusion (OLIF) is a safe and effective treatment for mid-term management of lumbar degenerative diseases (LDD). Compared to the posterior screw fixation (PF) group, both the standalone OLIF (SF) and OLIF combined with lateral screw fixation (LF) groups showed advantages in terms of reduced operation time, shorter hospitalization, and faster symptom alleviation in the short-term. However, OLIF combined with PF demonstrated comparable symptom relief in the mid-term and had the additional benefit of lower cage subsidence rates while improving fusion rates as well.
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Affiliation(s)
- Yang Yu
- Doctor of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yongtao Wang
- Master of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yizhou Xie
- Doctor of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chengzhi Feng
- Master of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuzhou Chen
- Master of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiajia Xu
- Master of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaohong Fan
- Doctor of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Miscusi M, Trungu S, Ricciardi L, Forcato S, Piazza A, Ramieri A, Raco A. Stand-Alone Oblique Lumbar Interbody Fusion (OLIF) for the Treatment of Adjacent Segment Disease (ASD) after Previous Posterior Lumbar Fusion: Clinical and Radiological Outcomes and Comparison with Posterior Revision Surgery. J Clin Med 2023; 12:jcm12082985. [PMID: 37109321 PMCID: PMC10144531 DOI: 10.3390/jcm12082985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Background: Radiological evidence of adjacent segment disease (ASD) has been reported to have a prevalence of more than 30% and several risk factors have been reported. The aim of this study is to evaluate the clinical and radiological outcomes of patients with symptomatic ASD treated with stand-alone OLIF and compare results with a posterior revision surgery cohort. Methods: This is a retrospective case-control study. Clinical-patient-reported outcomes were obtained at preoperative, postoperative and final follow-up visits using the Short Form (SF-36) scale, the Oswestry Disability Index (ODI) and the visual analog scale (VAS). Radiological measures include lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence-lumbar lordosis (PI-LL) mismatch, segmental coronal Cobb angle and intervertebral disc height (DH). The data are compared with a retrospective series of patients that underwent a posterior revision surgery for ASD. Results: Twenty-eight patients in the OLIF group and 25 patients in the posterior group meet inclusion criteria. The mean ages at the time of the surgery are 65.1 years and 67.5, respectively. The mean follow-up time is 36.1 months (range of 14-56). The clinical outcomes significantly improve from preoperative values from the surgery in both groups. The radiological parameters are significantly improved postoperatively and were maintained at the last follow-up in both groups. A statistically significant difference is observed between the two groups for minor complication rate, length of surgery, blood loss and DH restoration. Conclusions: Stand-alone OLIF is an effective and safe technique with low morbidity and complication rates for the treatment of selected patients with symptomatic ASD following a previous lumbar fusion.
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Affiliation(s)
- Massimo Miscusi
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Sokol Trungu
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
- Neurosurgery Unit, Cardinale G. Panico Hospital, 73039 Tricase, Italy
| | - Luca Ricciardi
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Forcato
- Neurosurgery Unit, Cardinale G. Panico Hospital, 73039 Tricase, Italy
| | - Amedeo Piazza
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandro Ramieri
- Department of Orthopedics, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Antonino Raco
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
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Lee HJ, Lee SJ, Jung JM, Lee TH, Jeong C, Lee TJ, Jang JE, Lee JW. Biomechanical Evaluation of Lateral Lumbar Interbody Fusion with Various Fixation Options for Adjacent Segment Degeneration: A Finite Element Analysis. World Neurosurg 2023; 173:e156-e167. [PMID: 36775239 DOI: 10.1016/j.wneu.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Adjacent segment degeneration (ASD) is a common phenomenon after lumbar fusion. Lateral lumbar interbody fusion (LLIF) may provide an alternative treatment method for ASD. This study used finite element analysis to evaluate the biomechanical effects of LLIF with various fixation options and identify an optimal surgical strategy for ASD. METHODS A validated L1-S1 finite element model was modified for simulation. Six finite element models of the lumbar spine were created and were divided into group 1 (L4-5 posterior lumbar interbody fusion [PLIF] + L3-4 LLIF) and group 2 (L5-S1 PLIF + L4-5 LLIF). Each group consisted of 1) cage-alone, 2) cage + lateral screw fixation (LSF), and 3) cage + bilateral pedicle screw fixation (BPSF) models. The range of motion, intradiscal pressure, and facet loads of adjacent segments as well as interbody cage stress were analyzed. RESULTS The stress on the LLIF cage-superior endplate interface was highest in the cage-alone model followed by the cage + LSF model and cage + BPSF model. The increase in range of motion, intradiscal pressure, and facet loads at the adjacent segment was highest in the cage + BPSF model followed by the cage + LSF model and cage-alone model. However, the biomechanical effect on the adjacent segment seemed similar in the cage-alone and cage + LSF models. CONCLUSIONS LLIF with BPSF is recommended when performing LLIF surgery for ASD after L4-5 and L5-S1 PLIF. Considering cage subsidence and biomechanical effects on the adjacent segment, LLIF with LSF may be a suboptimal option for ASD surgery.
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Affiliation(s)
- Hyun Ji Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Jong-Myung Jung
- Department of Neurosurgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea.
| | - Tae Hoon Lee
- Department of Orthopedic Surgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea
| | - Chandong Jeong
- Department of Orthopedic Surgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea
| | - Tae Jin Lee
- Department of Orthopedic Surgery, 9988 Joint & Spine Hospital, Seoul, Republic of Korea
| | - Ji-Eun Jang
- R&D Center, GS Medical Co., Ltd., Cheongju, Republic of Korea
| | - Jae-Won Lee
- R&D Center, GS Medical Co., Ltd., Cheongju, Republic of Korea
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Deng C, Feng H, Ma X, Chen C, Mei J, Sun L. Comparing oblique lumbar interbody fusion with lateral screw fixation and percutaneous endoscopic transforaminal discectomy (OLIF-PETD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar disc herniation complicated with lumbar instability. BMC Musculoskelet Disord 2022; 23:1104. [PMID: 36529717 PMCID: PMC9761955 DOI: 10.1186/s12891-022-06075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate the early clinical effect of oblique lumbar interbody fusion with lateral screw fixation and percutaneous endoscopic transforaminal discectomy (OLIF-PETD) in the treatment of lumbar disc herniation with lumbar instability. METHODS A total of 22 patients with lumbar disc herniation and lumbar instability from August 2017 to August 2019 were enrolled in this retrospective study. The general information, perioperative indicators and complications were recorded. The clinical outcomes and radiological outcomes were evaluated before the operation, seven days after the operation, and at the last follow-up. Vertebral fusion and degree of multifidus muscle injury were evaluated at the last follow-up. RESULTS In this study, OLIF + PETD showed shorter incision length compared to the MIS-TLIF (P < 0.001). In the two groups, the clinical outcomes and radiological outcomes were significantly improved compared with the preoperative (P < 0.001). At the seven days after the operation and the last follow-up, the VAS of OLIF + PETD group was lower than that of MIS-TLIF group (P < 0.05). OLIF + PETD could give superior outcome in restoring disc height (P < 0.001), but the fusion segment angle of OLIF + PETD group was larger compared to the MIS-TLIF group seven days after the operation and at the last follow-up (P < 0.05). In addition, the fusion rate was not significantly different between the two groups (P > 0.05), but OLIF + PETD could avoid the multifidus injury (P < 0.001). CONCLUSION Compared to MIS-TLIF, OLIF-PETD can achieve satisfactory decompression effects and fusion rates with less multifidus injury and postoperative low back pain, which may be an alternative choice for the treatment of lumbar disc herniation combined with lumbar instability.
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Affiliation(s)
- Chen Deng
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China
| | - Haoyu Feng
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Xun Ma
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Chen Chen
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Jun Mei
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Lin Sun
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
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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] [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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Huang S, Min S, Wang S, Jin A. Biomechanical effects of an oblique lumbar interbody fusion combined with posterior augmentation: a finite element analysis. BMC Musculoskelet Disord 2022; 23:611. [PMID: 35761228 PMCID: PMC9235194 DOI: 10.1186/s12891-022-05553-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Oblique lateral interbody fusion (OLIF) is widely used to treat lumbar degenerative disc disease. This study aimed to evaluate the biomechanical stability of OLIF, OLIF including posterior pedicle screw and rod (PSR), and OLIF including cortical screw and rod (CSR) instrumentation through finite element analysis. Methods A complete L2-L5 finite element model of the lumbar spine was constructed. Surgical models of OLIF, such as stand-alone, OLIF combined with PSR, and OLIF combined with CSR were created in the L3-L4 surgical segments. Range of motion (ROM), end plate stress, and internal fixation peak stress were compared between different models under the same loading conditions. Results Compared to the intact model, ROM was reduced in the OLIF model under all loading conditions. The surgical models in order of increasing ROM were PSR, CSR, and stand-alone; however, the difference in ROM between BPS and CSR was less than 0.4° and was not significant under any loading conditions. The stand-alone model had the highest stress on the superior L4 vertebral body endplate under all loading conditions, whereas the end plate stress was relatively low in the BPS and CSR models. The CSR model had the highest internal fixation stress, concentrated primarily at the end of the screw. Conclusions OLIF alone significantly reduces ROM but does not provide sufficient stability. Addition of posterior PSR or CSR internal fixation instrumentation to OLIF surgery can significantly improve biomechanical stability of the segment undergoing surgery.
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Zhu G, Wu Z, Fang Z, Zhang P, He J, Yu X, Ge Z, Tang K, Liang D, Jiang X, Liang Z, Cui J. Effect of the In Situ Screw Implantation Region and Angle on the Stability of Lateral Lumbar Interbody Fusion: A Finite Element Study. Orthop Surg 2022; 14:1506-1517. [PMID: 35656700 PMCID: PMC9251290 DOI: 10.1111/os.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate the effect of the in situ screw implantation region and angle on the stability of lateral lumbar interbody fusion (LLIF) from a biomechanical perspective. Methods A validated L2‐4 finite element (FE) model was modified for simulation. The L3‐4 fused segment undergoing LLIF surgery was modeled. The area between the superior and inferior edges and the anterior and posterior edges of the vertebral body (VB) is divided into four zones by three parallel lines in coronal and horizontal planes. In situ screw implantation methods with different angles based on the three parallel lines in coronal plane were applied in Models A, B, and C (A: parallel to inferior line; B: from inferior line to midline; C: from inferior line to superior line). In addition, four implantation methods with different regions based on the three parallel lines in horizontal plane were simulated as types 1–2, 1–3, 2–2, and 2–3 (1–2: from anterior line to midline; 1–3: from anterior line to posterior line; 2–2: parallel to midline; 2–3: from midline to posterior line). L3‐4 ROM, interbody cage stress, screw‐bone interface stress, and L4 superior endplate stress were tracked and calculated for comparisons among these models. Results The L3‐4 ROM of Models A, B, and C decreased with the extent ranging from 47.9% (flexion‐extension) to 62.4% (lateral bending) with no significant differences under any loading condition. Types 2–2 and 2–3 had 45% restriction, while types 1–2 and 1–3 had 51% restriction in ROM under flexion‐extension conditions. Under lateral bending, types 2–2 and 2–3 had 70.6% restriction, while types 1–2 and 1–3 had 61.2% restriction in ROM. Under axial rotation, types 2–2 and 2–3 had 65.2% restriction, while types 1–2 and 1–3 had 59.3% restriction in ROM. The stress of the cage in types 2–2 and 2–3 was approximately 20% lower than that in types 1–2 and 1–3 under all loading conditions in all models. The peak stresses at the screw‐bone interface in types 2–2 and 2–3 were much lower (approximately 35%) than those in types 1–2 and 1–3 under lateral bending, while no significant differences were observed under flexion‐extension and axial rotation. The peak stress on the L4 superior endplate was approximately 30 MPa and was not significantly different in all models under any loading condition. Conclusions Different regions of entry‐exit screws induced multiple screw trajectories and influenced the stability and mechanical responses. However, different implantation angles did not. Considering the difficulty of implantation, the ipsilateral‐contralateral trajectory in the lateral middle region of the VB can be optimal for in situ screw implantation in LLIF surgery.
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Affiliation(s)
- Guangye Zhu
- 1st Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhihua Wu
- 1st Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhichao Fang
- 1st Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Zhang
- 1st Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahui He
- 1st Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiang Yu
- Department of Spinal Surgery, 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhilin Ge
- 1st Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kai Tang
- 1st Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Department of Spinal Surgery, 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziyang Liang
- 1st Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jianchao Cui
- Department of Spinal Surgery, 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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10
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Oblique lateral interbody fusion combined with different internal fixations for the treatment of degenerative lumbar spine disease: a finite element analysis. BMC Musculoskelet Disord 2022; 23:206. [PMID: 35246101 PMCID: PMC8897936 DOI: 10.1186/s12891-022-05150-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background Little is known about the biomechanical performance of different internal fixations in oblique lumbar interbody fusion (OLIF). Here, finite element (FE) analysis was used to describe the biomechanics of various internal fixations and compare and explore the stability of each fixation. Methods CT scans of a patient with lumbar degenerative disease were performed, and the l3-S1 model was constructed using relevant software. The other five FE models were constructed by simulating the model operation and adding different related implants, including (1) an intact model, (2) a stand-alone (SA) model with no instrument, (3) a unilateral pedicle screw model (UPS), (4) a unilateral pedicle screw contralateral translaminar facet screw model (UPS-CTFS), (5) a bilateral pedicle screw (BPS) model, and (6) a cortical bone trajectory screw model (CBT). Various motion loads were set by FE software to simulate lumbar vertebral activity. The software was also used to extract the range of motion (ROM) of the surgical segment, CAGE and fixation stress in the different models. Results The SA group had the greatest ROM and CAGE stress. The ROM of the BPS and UPS-CTFS was not significantly different among motion loadings. Compared with the other three models, the BPS model had lower internal fixation stress among loading conditions, and the CBT screw internal fixation had the highest stress among loads. Conclusions The BPS model provided the best biomechanical stability for OLIF. The SA model was relatively less stable. The UPS-CTFS group had reduced ROM in the fusion segments, but the stresses on the internal fixation and CAGE were relatively higher in the than in the BPS group; the CBT group had a lower flexion and extension ROM and higher rotation and lateral flexion ROM than the BPS group. The stability of the CBT group was poorer than that of the BPS and LPS-CTFS groups. The CAGE and internal fixation stress was greater in the CBT group.
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11
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Li XH, She LJ, Zhang W, Cheng XD, Fan JP. Biomechanics of extreme lateral interbody fusion with different internal fixation methods: a finite element analysis. BMC Musculoskelet Disord 2022; 23:134. [PMID: 35139843 PMCID: PMC8829978 DOI: 10.1186/s12891-022-05049-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/20/2022] [Indexed: 01/03/2023] Open
Abstract
Background Establishing a normal L3–5 model and using finite element analysis to explore the biomechanical characteristics of extreme lateral interbody fusion (XLIF) with different internal fixation methods. Method The L3–5 CT image data of a healthy adult male volunteer were selected to establish a normal lumbar finite element model (M0). The range of motion (ROM) of L3–4 and L4–5, under flexion, extension, left bending, right bending, left rotation, and right rotation, together with L3–4 disc pressure was analyzed. Then the L4–5 intervertebral disc was excised and implanted with a cage, supplemented by different types of internal fixation, including lateral two-hole plate model (M1), lateral four-hole plate model (M2), VerteBRIDGE plating model (M3), lateral pedicle model (M4), posterior unilateral pedicle screw model (M5) and posterior bilateral pedicle screw model (M6). The ROM,the maximum stress value of the cage, and the maximum stress value of the intervertebral disc of L3–4 were analyzed and studied . Results The ROM of L3–4 and L4-L5 segments in the validation model under various motion states was basically consistent with previous reports. The lumbar finite element model was validated effectively. After XLIF-assisted internal fixation, the range of activity in L3–4 segments of each internal fixation model was greater than that of the normal model under various working conditions, among which the M5、M6 model had the larger range of activity in flexion and extension. After the internal fixation of L4–5 segments, the mobility in M1-M6 was significantly reduced under various motion patterns. In terms of flexion and extension, the posterior pedicle fixation model (M5、M6) showed a significant reduction,followed by M2. The maximal von mises cage stress of M1 was obviously greater than that of other models (except the left bending). Compared with M0, the intervertebral disc stress of M1-M6 at L3–4 segments was increased. Conclusions It is recommended that the posterior bilateral pedicle screw model is the first choice, followed by the lateral four-hole plate model for fixation during XLIF surgery. However, it is still necessary to be aware of the occurrence of adjacent segment degeneration (ASD) in the later stage.
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Affiliation(s)
- Xiao-Hua Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Li-Jun She
- Department of Tuberculosis, The Fifth Hospital of Shijiazhuang, No.42 Tanan Road, Shijiazhuang, 050000, China
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China.
| | - Xiao-Dong Cheng
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Jin-Peng Fan
- Department of Orthopedic Surgery, Shijiazhuang First Hospital, No. 365 Jianhua South Street, Shijiazhuang, 050000, China
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12
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Adl Amini D, Moser M, Oezel L, Zhu J, Okano I, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Early Outcomes of 3D-printed Porous Titanium versus Polyetheretherketone (PEEK) Cage Implantation for Standalone Lateral Lumbar Interbody Fusion in the Treatment of Symptomatic Adjacent Segment Degeneration. World Neurosurg 2021; 162:e14-e20. [PMID: 34863938 DOI: 10.1016/j.wneu.2021.11.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study compared outcomes of 3D-printed porous titanium (Ti) versus polyetheretherketone (PEEK) cage implantation for standalone lateral lumbar interbody fusion (SA-LLIF) in the treatment of symptomatic adjacent segment degeneration (ASD). METHODS 44 patients (59 levels) underwent SA-LLIF with Ti or PEEK cages between 10/2016 and 07/2020. The primary outcome was cage subsidence according to Marchi et al. Secondary outcomes included revision/recommendations for revision surgery, back/leg pain severity, changes in disc/foraminal height and global/segmental lumbar lordosis. RESULTS 44 patients (21 female) were included with a mean age at surgery of 61.8±11.5 years, average radiological follow-up of 12.5±8.2 and clinical follow-up of 11.0±7.1 months. The overall subsidence rate was significantly less in the Ti versus PEEK group (20% vs. 58.8%; p=0.004). Revision was recommended to none of the patients in the Ti and 3 in the PEEK group (p=0.239). Furthermore, patients in the Ti group showed significantly better improvement in back pain NRS score (p=0.001). Disc height (p<0.001) and foraminal height restoration (p=0.011) were statistically significant in the Ti group, whereas only disc height restoration was significant in the PEEK group (p=0.003). CONCLUSION In patients undergoing SA-LLIF for ASD treatment, 3D-printed Ti cages had significantly lower overall subsidence rate compared to PEEK cages. Furthermore, Ti cages resulted in fewer recommendations for revision surgery. Whether greater pain reduction in the Ti group is associated with earlier or higher fusion rates needs to be further elucidated.
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Affiliation(s)
- Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA; Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA; Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Jiaqi Zhu
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA.
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Yang H, Liu J, Hai Y. Is instrumented lateral lumbar interbody fusion superior to stand-alone lateral lumbar interbody fusion for the treatment of lumbar degenerative disease? A meta-analysis. J Clin Neurosci 2021; 92:136-146. [PMID: 34509241 DOI: 10.1016/j.jocn.2021.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/23/2021] [Accepted: 08/01/2021] [Indexed: 12/16/2022]
Abstract
The purpose of this meta-analysis was to compare the fusion rate and outcomes directly between patients who underwent stand-alone lateral lumbar interbody fusion (LLIF) and LLIF with supplemental posterior instrumentation. A comprehensive literature search was performed for relevant studies using PubMed, EMBASE, Web of Science, and Cochrane Library. The stand-alone and instrumented LLIF were compared by the fusion rate, the radiographic parameters, the cage subsidence rate, the clinical outcomes, the complication rate, and the reoperation rate. A total of 13 studies comprising 1090 patients with lumbar degenerative disease (LDD) were included. There was no significant statistical difference in the complication rate, and there was no significant clinical difference in the improvement of clinical outcomes at the last follow-up between patients who underwent stand-alone and instrumented LLIF. Nevertheless, lower fusion rate (RR, 0.92; 95% CI 0.87 to 0.98, P = 0.006), inferior restoration of disk height (WMD, -0.68; 95% CI -1.04 to -0.32, P < 0.001) and segmental lordosis (WMD, -1.28; 95% CI -2.30 to -0.27, P = 0.013), higher cage subsidence rate (RR, 1.68; 95% CI 1.36 to 2.07, P < 0.001), and higher reoperation rate (RR, 2.12; 95% CI 1.02 to 4.43, P = 0.045) were observed in the stand-alone group. Both stand-alone and instrumented LLIF were effective in improving the clinical outcomes of patients with LDD. However, the stand-alone LLIF was associated with lower fusion rate, inferior maintenance of indirect decompression, and higher reoperation rate due to high-grade cage subsidence. For patients with risk factors of high-grade cage subsidence, the LLIF with posterior instrumentation may be the better choice.
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Affiliation(s)
- Honghao Yang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jingwei Liu
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Li H, Li J, Tao Y, Li F, Chen Q, Chen G. Is stand-alone lateral lumbar interbody fusion superior to instrumented lateral lumbar interbody fusion for the treatment of single-level, low-grade, lumbar spondylolisthesis? J Clin Neurosci 2021; 85:84-91. [PMID: 33581796 DOI: 10.1016/j.jocn.2020.11.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/26/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to compare surgical trauma and radiographic and clinical outcomes of stand-alone and instrumented lateral lumbar interbody fusion (LLIF) in the treatment of single-level low-grade lumbar spondylolisthesis. METHODS Ninety-five patients with single-level low-grade lumbar spondylolisthesis, who underwent stand-alone LLIF (stand-alone group, [n = 54]) or LLIF plus percutaneous posterior fixation (instrumented group, [n = 41]) were enrolled in this study. Operative time, intraoperative blood loss, serum C-reactive protein (CRP) and creatine kinase (CK) levels, the length of postoperative bed rest time, and hospital stay were compared between the 2 groups. Disc height, the percent of slip, segment lordosis, lumbar lordosis, the visual analog scale score, the Oswestry Disability Index and complications were also compared. RESULTS Operative and bed rest time were shorter, intraoperative blood loss was less, and postoperative CRP and CK levels were lower in the stand-alone group. During follow-up, 6 patients in stand-alone group underwent posterior fixation due to cage subsidence. Although satisfactory radiographic results were achieved in both groups, the maintenance of increased disc heights and segment lordosis was inferior in the stand-alone group at the final follow-up. Greater improvement in postoperative VAS scores and ODI were observed in the stand-alone group, although the rates of cage subsidence and revision were higher. CONCLUSION Stand-alone LLIF was superior to instrumented LLIF in terms of tissue trauma for the treatment of single-level low-grade lumbar spondylolisthesis. However, stand-alone LLIF was inferior in the maintenance of disc height and segment lordosis, and the occurrence of cage subsidence and revision.
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Affiliation(s)
- Hao Li
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou 310009, People's Republic of China
| | - Jun Li
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou 310009, People's Republic of China
| | - Yiqing Tao
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou 310009, People's Republic of China
| | - Fangcai Li
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou 310009, People's Republic of China
| | - Qixin Chen
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou 310009, People's Republic of China.
| | - Gang Chen
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou 310009, People's Republic of China.
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15
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Manzur MK, Steinhaus ME, Virk SS, Jivanelli B, Vaishnav AS, McAnany SJ, Albert TJ, Iyer S, Gang CH, Qureshi SA. Fusion rate for stand-alone lateral lumbar interbody fusion: a systematic review. Spine J 2020; 20:1816-1825. [PMID: 32535072 DOI: 10.1016/j.spinee.2020.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/05/2020] [Accepted: 06/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lateral lumbar interbody fusion (LLIF) is used to treat multiple conditions, including spondylolisthesis, degenerative disc disorders, adjacent segment disease, and degenerative scoliosis. Although many advocate for posterior fixation with LLIF, stand-alone LLIF is increasingly being performed. Yet the fusion rate for stand-alone LLIF is unknown. PURPOSE Determine the fusion rate for stand-alone LLIF. STUDY DESIGN Systematic review. METHODS We queried Cochrane, EMBASE, and MEDLINE for literature on stand-alone LLIF fusion rate with a publication cutoff of April 2020. LLIF surgery was considered stand-alone when not paired with supplemental posterior fixation. Cohort fusion rate differences were calculated and tested for significance (p<0.05). All reported means were pooled. RESULTS A total of 2,735 publications were assessed. Twenty-two studies met inclusion criteria, including 736 patients and 1,103 vertebral levels. Mean age was 61.7 years with BMI 26.5 kg/m2. Mean fusion rate was 85.6% (range, 53.0%-100.0%), which did not differ significantly by number of levels fused (1-level, 2-level, and ≥3-level). Use of rhBMP-2 was reported in 39.3% of subjects, with no difference in fusion rates between studies using rhBMP-2 (87.7%) and those in which rhBMP-2 was not used (83.9%, odds ratio=1.37, p=0.448). Fusion rate did not differ with the addition of a lateral plate, or by underlying diagnosis. All-complication rate was 42.2% and mean reoperation rate was 11.1%, with 2.3% reoperation due to pseudarthrosis. Of the studies comparing stand-alone to circumferential fusion, pooled fusion rate was found to be 80.4% versus 91.0% (p=0.637). CONCLUSIONS Stand-alone LLIF yields high fusion rates overall. The wide range of reported fusion rates and lower fusion rates in studies involving subsequent surgical reoperation highlights the importance of proper training in this technique and employing a rigorous algorithm when indicating patients for stand-alone LLIF. Future research should focus on examining risk factors and patient-reported outcomes in stand-alone LLIF.
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Affiliation(s)
- Mustfa K Manzur
- Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut St, Philadelphia, PA 19107, USA
| | | | - Sohrab S Virk
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Bridget Jivanelli
- The Kim Barrett Memorial Library, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Avani S Vaishnav
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Steven J McAnany
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Todd J Albert
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
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16
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Guo HZ, Tang YC, Guo DQ, Luo PJ, Li YX, Mo GY, Ma YH, Peng JC, Liang D, Zhang SC. Stability Evaluation of Oblique Lumbar Interbody Fusion Constructs with Various Fixation Options: A Finite Element Analysis Based on Three-Dimensional Scanning Models. World Neurosurg 2020; 138:e530-e538. [PMID: 32156592 DOI: 10.1016/j.wneu.2020.02.180] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the biomechanical performance of various fixation constructs after oblique lumbar interbody fusion (OLIF). This study aimed to explore the stability of various fixation options for OLIF by using finite element analysis based on three-dimensional scanning models. METHODS Six validated finite element models of the L3-L5 segment were reconstructed via computed tomography images, including (1) intact model, (2) stand-alone model with no instrument, (3) lateral rod-screw model, (4) lateral rod-screw plus contralateral translaminar facet screw (LRS-CTLFS) model, (5) unilateral pedicle screw model, and (6) bilateral pedicle screw (BPS) model. Models of the OLIF cage and pedicle screw were created with three-dimensional scanning to improve the accuracy of finite element analysis. Range of motion, stress of the cage, and stress of fixation were evaluated in the different models. RESULTS Range of motion increased from least to greatest as follows: BPS, LRS-CTLFS, unilateral pedicle screw, lateral rod-screw, stand-alone. Differences in range of motion between BPS and LRS-CTLFS were not significant for all loading cases. Compared with the other 3 models, the stress of the cage was found to be lower in BPS and LRS-CTLFS under all loading conditions, especially in BPS. Stress exerted on the fixation was the greatest in LRS-CTLFS, and the stress experienced by the translaminar facet screw was concentrated in part of the facet joint. CONCLUSIONS The BPS model provided the best biomechanical stability for OLIF; the stand-alone model could not provide sufficient stability. The LRS-CTLFS procedure increases the approximate stability and reduces stress at the cage-endplate interface; however, it causes an increase in screw stress.
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Affiliation(s)
- Hui-Zhi Guo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China; Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Chao Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dan-Qing Guo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Pei-Jie Luo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yong-Xian Li
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Guo-Ye Mo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yan-Huai Ma
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Jian-Cheng Peng
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shun-Cong Zhang
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China; Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Liang Z, Cui J, Zhang J, He J, Tang J, Ren H, Ye L, Liang D, Jiang X. Biomechanical evaluation of strategies for adjacent segment disease after lateral lumbar interbody fusion: is the extension of pedicle screws necessary? BMC Musculoskelet Disord 2020; 21:117. [PMID: 32085708 PMCID: PMC7035718 DOI: 10.1186/s12891-020-3103-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/30/2020] [Indexed: 12/26/2022] Open
Abstract
Background Adjacent segment disease (ASD) is a well-known complication after interbody fusion. Pedicle screw-rod revision possesses sufficient strength and rigidity. However, is a surgical segment with rigid fixation necessary for ASD reoperation? This study aimed to investigate the biomechanical effect of different instrumentation on lateral lumbar interbody fusion (LLIF) for ASD treatment. Methods A validated L2~5 finite element (FE) model was modified for simulation. ASD was considered the level cranial to the upper-instrumented segment (L3/4). Bone graft fusion in LLIF with bilateral pedicle screw (BPS) fixation occurred at L4/5. The ASD segment for each group underwent a) LLIF + posterior extension of BPS, b) PLIF + posterior extension of BPS, c) LLIF + lateral screw, and d) stand-alone LLIF. The L3/4 range of motion (ROM), interbody cage stress and strain, screw-bone interface stress, cage-endplate interface stress, and L2/3 nucleus pulposus of intradiscal pressure (NP-IDP) analysis were calculated for comparisons among the four models. Results All reconstructive models displayed decreased motion at L3/4. Under each loading condition, the difference was not significant between models a and b, which provided the maximum ROM reduction (73.8 to 97.7% and 68.3 to 98.4%, respectively). Model c also provided a significant ROM reduction (64.9 to 77.5%). Model d provided a minimal restriction of the ROM (18.3 to 90.1%), which exceeded that of model a by 13.1 times for flexion-extension, 10.3 times for lateral bending and 4.8 times for rotation. Model b generated greater cage stress than other models, particularly for flexion. The maximum displacement of the cage and the peak stress of the cage-endplate interface were found to be the highest in model d under all loading conditions. For the screw-bone interface, the stress was much greater with lateral instrumentation than with posterior instrumentation. Conclusions Stand-alone LLIF is likely to have limited stability, particularly for lateral bending and axial rotation. Posterior extension of BPS can provide reliable stability and excellent protective effects on instrumentation and endplates. However, LLIF with the use of an in situ screw may be an alternative for ASD reoperation.
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Affiliation(s)
- Ziyang Liang
- First Clinical Medical College, Guangzhou University of Chinese medicine, Guangzhou, 510405, China
| | - Jianchao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou City, 510405, Guangdong Province, China
| | - Jiarui Zhang
- First Clinical Medical College, Guangzhou University of Chinese medicine, Guangzhou, 510405, China
| | - Jiahui He
- First Clinical Medical College, Guangzhou University of Chinese medicine, Guangzhou, 510405, China
| | - Jingjing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou City, 510405, Guangdong Province, China
| | - Hui Ren
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou City, 510405, Guangdong Province, China
| | - Linqiang Ye
- Department of Spinal Surgery, The Dongguan hospital of Chinese Medicine, Dongguan, 523000, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou City, 510405, Guangdong Province, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou City, 510405, Guangdong Province, China.
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Wei JL, Zhu YB, Zhao DW, Chen W, Wang J, Wang H, Lv JL, Zhang T, Cheng L, Zhang YZ. Dynamic Change of Lumbar Structure and Associated Factors: A Retrospective Study. Orthop Surg 2019; 11:1072-1081. [PMID: 31679187 PMCID: PMC6904611 DOI: 10.1111/os.12557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/07/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To determine whether lumbar anatomy parameters are in dynamic change and related factors. Methods This is a retrospective study. Participants who did lumbar computed tomography (CT) scanning in Shandong University Qilu Hospital from October 2017 to March 2019 were selected. The 476 participants were randomly selected as male or female, with the age ranging from 17 to 87 years (mean, 55.19; standard deviation, 14.28 years). All the measurements were taken based on the CT scanning image and the measurement of lumbar morphology was conducted using picture archiving and communication systems (PACS). The angle between the horizontal alignment and pedicle center on median sagittal view, the angle between upper endplate and lower endplate on median sagittal view as well as transverse section angle (TSA) using Magerl point in the axial view was determined by reconstructive CT analysis. Results In the overall participants, the angle between the horizontal alignment and pedicle center on median sagittal view of lumbar one to three was significantly decreased with aging, from 3.90° ± 2.81° to −4.18° ± 6.86° (P = 0.002), 5.60° ± 2.89° to −4.14° ± 5.90° (P = 0.030), and 4.75° ± 2.95° to −2.87° ± 4.68° (P < 0.001), respectively. Additionally, the angle between the horizontal alignment and pedicle center on median sagittal view in male participants of lumbar two was dramatically decreased, from 4.83° ± 2.79° to −4.45° ± 5.97° (P = 0.30). And that of lumbar three in female participants was significantly decreased, from 4.56° ± 2.52° to −2.88° ± 5.03° (P = 0.029). Furthermore, of the overall participants, the angle between upper endplate and lower endplate on median sagittal view of lumbar one to four was associated with aging (P < 0.001, P < 0.001, P = 0.015, P < 0.001, respectively). The angle of lumbar one, two and four in male participants and lumbar one to four in female participants were all significantly related to aging (all P < 0.05). Moreover, in the participants overall, the TSA of lumbar one to three was significantly associated with aging (P = 0.015, P = 0.006 and P = 0.007, respectively). In addition, this angle in lumbar one to lumbar four in male participants were all negatively associated with aging (P = 0.017, P = 0.001, P = 0.005 and P = 0.036, respectively). Conclusion Lumbar anatomy parameters are in dynamic change in an age and gender dependent manner. During spine surgery in elderly patients, more attention should be paid to these anatomic changes.
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Affiliation(s)
- Jian-Lu Wei
- Department of Orthopaedic Surgery, Qilu Hospital, Shandong University, Jinan, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Yan-Bin Zhu
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China.,Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Da-Wang Zhao
- Department of Orthopaedic Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Wei Chen
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China.,Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Juan Wang
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China.,Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong Wang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Jia-Li Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Jinan, China
| | - Tao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jinan, China
| | - Lei Cheng
- Department of Orthopaedic Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Ying-Ze Zhang
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China.,Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, China
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