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Yearley AG, Chalif JI, Zaidi HA. Utility of Expandable Interbody Cages in Open Transforaminal Interbody Fusions: A Comparison With Static Cages. Cureus 2023; 15:e40262. [PMID: 37440805 PMCID: PMC10335839 DOI: 10.7759/cureus.40262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/15/2023] Open
Abstract
Background Expandable interbody cages, while popular in minimally invasive fusions due to their slim profile and increased ease of insertion, have not been widely explored in open surgery. The benefits of expandable cages may also extend to open fusions through their potential to achieve a greater restoration of lumbar lordosis while minimizing intraoperative complications. To highlight these benefits, we present a case series of adult spinal deformity (ASD) patients treated with an open transforaminal lumbar interbody fusion (TLIF) using expandable cages and compare outcomes to those of patients treated with static cages from the literature. Methods A retrospective cohort study of patients who underwent a deformity correction procedure and TLIF with expandable interbody cages at Brigham and Women's Hospital between 2018 and 2022 was conducted. Patient demographics, complications, and pre- and postoperative radiographic parameters of spinopelvic alignment were collected. A literature search was completed to identify studies employing static cages. T-tests were performed to compare postoperative changes in radiographic parameters by cage type. Results Forty-five patients (mean age of 62.6 years) with an average of 2.1 cages placed met the inclusion criteria. Patients experienced five intraoperative complications and 23 neurologic deficits (from minor to major), while nine patients required a revision operation. Lumbar lordosis increased by 9.8° ± 14.5° (p < 0.0001), the sagittal vertical axis (SVA) decreased by 25.5 mm ± 56.7 mm (p = 0.0048), and pelvic incidence-lumbar lordosis mismatch decreased by 13.3° ± 17.5° (p < 0.0001) with the use of expandable cages. Expandable cages yielded similar changes in lumbar lordosis to 15° and 8° cages but improved the lumbar lordosis generated from rectangular and 4° cages. When compared to static cages, expandable cages mildly reduced intraoperative complications. Conclusions Expandable interbody cages are an effective means of restoring spinopelvic alignment in ASD that have the potential to improve patient outcomes in open fusions compared to standard static cages. Especially when compared to rectangular and 4° static cages, expandable cages provide a clear benefit in the correction of lumbar lordosis. The impact of open spinal fusions with expandable cages on outcomes should continue to be explored in other cohorts.
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Affiliation(s)
- Alexander G Yearley
- Department of Neurological Surgery, Harvard Medical School, Boston, USA
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, USA
| | - Joshua I Chalif
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, USA
| | - Hasan A Zaidi
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, USA
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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. JOURNAL OF SPINE SURGERY 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] [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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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
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Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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Oikonomidis S, Heck V, Bantle S, Scheyerer MJ, Hofstetter C, Budde S, Eysel P, Bredow J. Impact of lordotic cages in the restoration of spinopelvic parameters after dorsal lumbar interbody fusion: a retrospective case control study. INTERNATIONAL ORTHOPAEDICS 2020; 44:2665-2672. [PMID: 32661634 PMCID: PMC7679311 DOI: 10.1007/s00264-020-04719-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022]
Abstract
Purpose Aim of this study was to compare the reconstruction of radiological sagittal spinopelvic parameters between lordotic (10°) and normal cages (0°) after dorsal lumbar spondylodesis. Methods This retrospective monocentric study included patients who received dorsal lumbar spondylodesis between January 2014 and December 2018. Inclusion criteria were degenerative lumbar diseases and mono- or bi-segmental fusions in the middle and lower lumbar region. Exclusion criteria were long-distance fusions (3 segments and more) and infectious and tumour-related diseases. The sagittal spinopelvine parameters (lumbar lordosis, segmental lordosis, sacral slope, pelvic incidence, and pelvic tilt) were measured pre- and post-operatively by two examiners at two different times. The patients were divided into 2 groups (group 1: lordotic cage, group 2: normal cage). Results One hundred thirty-eight patients (77 female, 61 male) with an average age of 66.6 ± 11.2 years (min.: 26, max.: 90) were included in the study based on the inclusion criteria. Ninety-two patients (66.7%) received 0° cages and 46 (33.3%) lordotic cages (10°). Segmental lordosis was increased by 4.2° on average in group 1 and by 6.5° in group 2 (p = 0.074). Average lumbar lordosis was increased by 2.1° in group 1 and by 0.6° in group 2 (p = 0.378). There was no significant difference in the correction of sagittal spinopelvic parameters. Inter- and inter-class reliability was between 0.887 and 0.956. Conclusion According to the results of our study, no advantages regarding sagittal radiological parameters for the implantation of a lordotic cage could be demonstrated.
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Affiliation(s)
- Stavros Oikonomidis
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Vincent Heck
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sonja Bantle
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Max Joseph Scheyerer
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | | | - Stefan Budde
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hanover, Germany
| | - Peer Eysel
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan Bredow
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Wu WJ, Li Y, Hou TY, Cheng P, Zhang ZH, Xu JZ, Luo F. Application of New Allogeneic Lumbar Fusion Cage (Biocage) in Single-Segment Lumbar Degenerative Disease: A Prospective Controlled Study with Follow-Up for ≥2 Years. World Neurosurg 2019; 126:e1309-e1314. [PMID: 30898751 DOI: 10.1016/j.wneu.2019.03.084] [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: 01/10/2019] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We evaluated the clinical efficacy of the Biocage in lumbar fusion surgery and its safety and effectiveness. METHODS A total of 431 patients with single-segment lumbar degenerative disease diagnosed from January 2013 to December 2016 were considered for the present prospective, nonrandomized, and controlled study; 52 patient met the exclusion criteria and were excluded. The patients were divided into 2 groups according to their cage choice: Biocage (n = 206) and polyether ether ketone (PEEK) cage (n = 173). The patients were followed up for 24-48 months (average, 32). The operative time, blood loss, hospitalization duration, mean intervertebral fusion segment height, height of intervertebral foramen, fusion time, fusion rate, internal fixation failure rate, visual analog scale score, and Oswestry disability index were compared between the 2 groups. RESULTS All the patients underwent surgery successfully. No significant differences were found in gender, age, clinical diagnosis, lesion segment, operative time, blood loss, visual analog scale score, or Oswestry disability index between the 2 groups. No significant differences were found in the fusion rate; however, the Biocage group had a greater fusion rate and shorter fusion time than the PEEK group. During follow-up, the mean intervertebral height recovered significantly in the Biocage group compared with the PPEK group (P < 0.05). The height of the intervertebral foramen was significantly different between the 2 groups, and recovery was better in the Biocage group (P < 0.05). The Cobb angle of fusion segment in both groups improved significantly postoperatively compared with preoperatively (P < 0.05). The improvement in Cobb angle was significantly different between the 2 groups (P < 0.05). CONCLUSIONS The Biocage has excellent clinical efficacy in the treatment of lumbar degenerative disease. Although the Biocage achieved good therapeutic effects, it did not show obvious advantages compared with the PEEK cage. Therefore, the Biocage can only be used as a choice of bone graft materials for lumbar fusion surgery and should not completely replace the PEEK cage.
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Affiliation(s)
- Wen-Jie Wu
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Yang Li
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Tian-Yong Hou
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Peng Cheng
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Ze-Hua Zhang
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Jian-Zhong Xu
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Fei Luo
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China.
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Zhu K, Yan S, Guo S, Tong J, Li C, Tan J, Wan W. Morphological changes of contralateral intervertebral foramen induced by cage insertion orientation after unilateral transforaminal lumbar interbody fusion. J Orthop Surg Res 2019; 14:79. [PMID: 30866988 PMCID: PMC6416875 DOI: 10.1186/s13018-019-1121-1] [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: 11/29/2018] [Accepted: 03/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background This study was performed to investigate the morphological changes of contralateral intervertebral foramen (IVF) based on computed tomography images of patients with lumbar spinal stenosis after unilateral transforaminal lumbar interbody fusion (TLIF) and to compare the influence of different orientation of cage insertion on these changes. Methods This is a retrospective cohort study. Sixty-nine patients with lumbar spinal stenosis who had undergone single-level unilateral TLIF were retrospectively analyzed. The patients were divided into two groups according to the cage insertion orientation: the oblique group (o-group, 39 cases) and the transverse group (t-group, 30 cases). The morphological parameters of contralateral IVF were measured before and 6 months after the operation. Changes in these parameters were compared and analyzed between the two groups. The 6-month clinical outcomes of the two groups were also collected and analyzed. Results There was a significant difference in the rate of increase in the segmental angle (p < 0.01) between the two groups, the mean value of segmental angle increased by an average of 29.08% ± 14.93% in the o-group and 48.63% ± 12.01% in the t-group. Overall, the posterior disc height had a significant positive correlation with the foraminal height and area. In the o-group, however, an increase in the segmental angle resulted in a decrease in the foraminal area. No significant difference in clinical outcomes was found between the two groups. Conclusions Compared with oblique cage insertion, transverse cage insertion could achieve greater restoration of segmental lumbar lordosis without decreasing contralateral foraminal dimensions.
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Affiliation(s)
- Kai Zhu
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Shuaifeng Yan
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Song Guo
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Jinyu Tong
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Cong Li
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China
| | - Jun Tan
- Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai, 200120, China.
| | - Weiping Wan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, 200003, China.
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Georg Schmorl Prize of the German Spine Society (DWG) 2017: correction of spino-pelvic alignment with relordosing mono- and bisegmental TLIF spondylodesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:789-796. [DOI: 10.1007/s00586-018-5503-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/27/2018] [Indexed: 11/26/2022]
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Abstract
STUDY DESIGN Retrospective, radiological analysis. OBJECTIVE To determine that 15° lordotic angle cages create higher lumbar lordosis in open transforaminal lumbar interbody fusion (TLIF) than 4° and 8° cages. SUMMARY OF BACKGROUND DATA Restoration of lumbar lordosis is important to obtain good outcome after lumbar fusion surgery. Various shapes and angles of cages in interbody fusion have been used; however, it is not proved that lordotic angle of cages determine lumbar lordosis. METHODS Sixty-seven patients were evaluated after TLIF using 15° cages and screw instrumentation. For comparison, TLIF using 4° lordotic angle cages in 65 patients and 8° cages in 49 patients were analyzed. Lumbar lordosis angles, segmental lordosis angles, disc height, and bony union rate were measured on the radiographs. RESULTS The lumbar lordosis was 31.1° preoperatively, improved to 42.9° postoperatively, and decreased to 36.4° at the last follow-up in the 15° group. It was 35.8° before surgery, corrected to 41.5° after surgery, and changed to 33.6° at the last follow-up in the 4° group. In the 8° group, it was 32.7° preoperatively, improved to 39.1° postoperatively, and decreased to 34.5° at the last follow-up. These changes showed statistical significances (P < 0.001). The segmental lordosis at L4-5 was 6.6° before surgery, 13.1° after surgery, and 9.8° at the last follow-up in the 15° group. It was 6.9°, 9.5°, and 6.2° in the 4° group and 6.7°, 9.8°, and 8.1° in the 8° group, respectively (P < 0.001). The disc height restoration was better in the 15° group than in the 4° and 8° groups (P < 0.001). Bony union rate was not significant among the three groups (P = 0.087). CONCLUSION The lordotic angle of the cages determined restoration of lumbar lordosis after TLIF. Cages with sufficient lordotic angle showed better restoration of lumbar lordosis and prevention of loss of correction. LEVEL OF EVIDENCE 4.
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Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017. [DOI: 10.1007/s00586-017-5170-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Do Lordotic Cages Provide Better Segmental Lordosis Versus Nonlordotic Cages in Lateral Lumbar Interbody Fusion (LLIF)? Clin Spine Surg 2017; 30:E338-E343. [PMID: 28437335 DOI: 10.1097/bsd.0000000000000114] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective comparative radiographic review. OBJECTIVE To evaluate the radiographic changes brought about by lordotic and nonlordotic cages on segmental and regional lumbar sagittal alignment and disk height in lateral lumbar interbody fusion (LLIF). SUMMARY OF BACKGROUND DATA The effects of cage design on operative level segmental lordosis in posterior interbody fusion procedures have been reported. However, there are no studies comparing the effect of sagittal implant geometry in LLIF. METHODS This is a comparative radiographic analysis of consecutive LLIF procedures performed with use of lordotic and nonlordotic interbody cages. Forty patients (61 levels) underwent LLIF. Average age was 57 years (range, 30-83 y). Ten-degree lordotic PEEK cages were used at 31 lumbar interbody levels, and nonlordotic cages were used at 30 levels. The following parameters were measured on preoperative and postoperative radiographs: segmental lordosis; anterior and posterior disk heights at operative level; segmental lordosis at supra-level and subjacent level; and overall lumbar (L1-S1) lordosis. Measurement changes for each cage group were compared using paired t test analysis. RESULTS The use of lordotic cages in LLIF resulted in a significant increase in lordosis at operative levels (2.8 degrees; P=0.01), whereas nonlordotic cages did not (0.6 degrees; P=0.71) when compared with preoperative segmental lordosis. Anterior and posterior disk heights were significantly increased in both groups (P<0.01). Neither cage group showed significant change in overall lumbar lordosis (lordotic P=0.86 vs. nonlordotic P=0.25). CONCLUSIONS Lordotic cages provided significant increase in operative level segmental lordosis compared with nonlordotic cages although overall lumbar lordosis remained unchanged. Anterior and posterior disk heights were significantly increased by both cages, providing basis for indirect spinal decompression.
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Fujimori T, Le H, Schairer WW, Berven SH, Qamirani E, Hu SS. Does Transforaminal Lumbar Interbody Fusion Have Advantages over Posterolateral Lumbar Fusion for Degenerative Spondylolisthesis? Global Spine J 2015; 5:102-9. [PMID: 25844282 PMCID: PMC4369196 DOI: 10.1055/s-0034-1396432] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
Study Design Retrospective cohort study. Objective To compare the clinical and radiographic outcomes of transforaminal lumbar interbody fusion (TLIF) and posterolateral lumbar fusion (PLF) in the treatment of degenerative spondylolisthesis. Methods This study compared 24 patients undergoing TLIF and 32 patients undergoing PLF with instrumentation. The clinical outcomes were assessed by visual analog scale (VAS) for low back pain and leg pain, physical component summary (PCS) of the 12-item Short-Form Health Survey, and the Oswestry Disability Index (ODI). Radiographic parameters included slippage of the vertebra, local disk lordosis, the anterior and posterior disk height, lumbar lordosis, and pelvic parameters. Results The improvement of VAS of leg pain was significantly greater in TLIF than in PLF unilaterally (3.4 versus 1.0; p = 0.02). The improvement of VAS of low back pain was significantly greater in TLIF than in PLF (3.8 versus 2.2; p = 0.02). However, there was no significant difference in improvement of ODI or PCS between TLIF and PLF. Reduction of slippage and the postoperative disk height was significantly greater in TLIF than in PLF. There was no significant difference in local disk lordosis, lumbar lordosis, or pelvic parameters. The fusion rate was 96% in TLIF and 84% in PLF (p = 0.3). There was no significant difference in fusion rate, estimated blood loss, adjacent segmental degeneration, or complication rate. Conclusions TLIF was superior to PLF in reduction of slippage and restoring disk height and might provide better improvement of leg pain. However, the health-related outcomes were not significantly different between the two procedures.
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Affiliation(s)
- Takahito Fujimori
- Department of Orthopedic Surgery, University of California, San Francisco, California, United States,Department of Orthopedic Surgery, Sumitomo Hospital, Osaka, Japan,Address for correspondence Takahito Fujimori, MD, MSc Department of Orthopaedic Surgery, Sumitomo Hospital5-3-20 Kitaku Nakanoshima, Osaka 530-0005Japan
| | - Hai Le
- Department of Orthopedic Surgery, University of California, San Francisco, California, United States
| | - William W. Schairer
- Department of Orthopedic Surgery, University of California, San Francisco, California, United States
| | - Sigurd H. Berven
- Department of Orthopedic Surgery, University of California, San Francisco, California, United States
| | - Erion Qamirani
- Department of Orthopedic Surgery, University of California, San Francisco, California, United States
| | - Serena S. Hu
- Department of Orthopedic Surgery, University of California, San Francisco, California, United States
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Effects of lordotic angle of a cage on sagittal alignment and clinical outcome in one level posterior lumbar interbody fusion with pedicle screw fixation. BIOMED RESEARCH INTERNATIONAL 2015; 2015:523728. [PMID: 25685795 PMCID: PMC4317641 DOI: 10.1155/2015/523728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 11/18/2022]
Abstract
This study aims to assess the differences in the radiological and clinical results depending on the lordotic angles of the cage in posterior lumbar interbody fusion (PLIF). We reviewed 185 segments which underwent PLIF using two different lordotic angles of 4° and 8° of a polyetheretherketone (PEEK) cage. The segmental lordosis and total lumbar lordosis of the 4° and 8° cage groups were compared preoperatively, as well as on the first postoperative day, 6th and 12th months postoperatively. Clinical assessment was performed using the ODI and the VAS of low back pain. The pre- and immediate postoperative segmental lordosis angles were 12.9° and 12.6° in the 4° group and 12° and 12.0° in the 8° group. Both groups exhibited no significant different segmental lordosis angle and total lumbar lordosis over period and time. However, the total lumbar lordosis significantly increased from six months postoperatively compared with the immediate postoperative day in the 8° group. The ODI and the VAS in both groups had no differences. Cages with different lordotic angles of 4° and 8° showed insignificant results clinically and radiologically in short-level PLIF surgery. Clinical improvements and sagittal alignment recovery were significantly observed in both groups.
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Andrade NS, Flynn JP, Bartanusz V. Twenty-year perspective of randomized controlled trials for surgery of chronic nonspecific low back pain: citation bias and tangential knowledge. Spine J 2013; 13:1698-704. [PMID: 24012430 DOI: 10.1016/j.spinee.2013.06.071] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 05/27/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT After decades of clinical research, the role of surgery for chronic nonspecific low back pain (CNLBP) remains equivocal. Despite significant intellectual, human, and economic investments into randomized controlled trials (RCTs) in the past two decades, the role of surgery in the treatment for CNLBP has not been clarified. PURPOSE To delineate the historical research agenda of surgical RCTs for CNLBP performed between 1993 and 2012 investigating whether conclusions from earlier published trials influenced the choice of research questions of subsequent RCTs on elucidating the role of surgery in the management of CNLBP. STUDY DESIGN Literature review. METHODS We searched the literature for all RCTs involving surgery for CNLBP. We reviewed relevant studies to identify the study question, comparator arms, and sample size. Randomized controlled trials were classified as "indication" trials if they evaluated the effectiveness of surgical therapy versus nonoperative care or as "technical" if they compared different surgical techniques, adjuncts, or procedures. We used citation analysis to determine the impact of trials on subsequent research in the field. RESULTS Altogether 33 technical RCTs (3,790 patients) and 6 indication RCTs (981 patients) have been performed. Since 2007, despite the unclear benefits of surgery reported by the first four indication trials published in 2001 to 2006, technical trials have continued to predominate (16 vs. 2). Of the technical trials, types of instrumentation (13 trials, 1,332 patients), bone graft materials and substitutes (11 trials, 833 patients), and disc arthroplasty versus fusion (5 trials, 1,337 patients) were the most common comparisons made. Surgeon authors have predominantly cited one of the indication trials that reported more favorable results for surgery, despite a lack of superior methodology or sample size. Trials evaluating bone morphogenic protein, instrumentation, and disc arthroplasty were all cited more frequently than the largest trial of surgical versus nonsurgical therapy. CONCLUSIONS The research agenda of RCTs for surgery of CNLBP has not changed substantially in the last 20 years. Technical trials evaluating nuances of surgical techniques significantly predominate. Despite the publication of four RCTs reporting equivocal benefits of surgery for CNLBP between 2001 and 2006, there was no change in the research agenda of subsequent RCTs, and technical trials continued to outnumber indication trials. Rather than clarifying what, if any, indications for surgery exist, investigators in the field continue to analyze variations in surgical technique, which will probably have relatively little impact on patient outcomes. As a result, clinicians unfortunately have little evidence to advise patients regarding surgical intervention for CNLBP.
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Affiliation(s)
- Nicholas S Andrade
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900, USA
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Li FC, Chen QX, Chen WS, Xu K, Wu QH, Chen G. Posterolateral lumbar fusion versus transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis. J Clin Neurosci 2013; 20:1241-5. [PMID: 23827174 DOI: 10.1016/j.jocn.2012.10.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 11/16/2022]
Abstract
This study compares the safety and efficacy of posterolateral lumbar fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS). Forty DLS patients with Cobb angles of 20-60 degrees were randomized into either the PLF or TLIF treatment group, and were followed up for 2-5 years. Operating time, intraoperative blood loss, clinical outcomes, complications and imaging were compared between the two groups. There were significant differences between the PLF and TLIF treatment groups in operative time (187.8±63.5 minutes and 253.2±57.6 minutes, respectively; p=0.002) and intraoperative blood loss (1166.7±554.1 mL and 1673.7±922.4 mL, respectively; p=0.048). The occurrence rates of early complications in the two groups were 11.1% and 26.3%. The recovery rates of the lumbar lordotic angle and spinal sagittal balance were significantly different (36.7% versus 62.5% and 44.8% versus 64.1%, respectively). In various domains of the Scoliosis Research Society-22 (SRS-22) questionnaire, the scores for pain and satisfaction with the treatment showed significant differences between PLF and TLIF group (p=0.033 and p=0.006, for pain and satisfaction respectively), and the TLIF group showed better outcomes than the PLF group. There were no significant differences in the recovery rates in the Cobb angle and the spinal coronal balance, function, self-image, or mental health scores. Although TLIF increases the surgical trauma and occurrence of complications, it helps to improve lumbar lordosis and sagittal balance and shows better clinical outcomes. For patients without significant loss of lumbar lordosis and with good spinal sagittal balance preoperatively, PLF is still an option.
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Affiliation(s)
- Fang-cai Li
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jie Fang Road, Hangzhou 310009, Zhejiang, China
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Kanemura T, Ishikawa Y, Matsumoto A, Yoshida G, Sakai Y, Itoh Z, Imagama S, Kawakami N. The maturation of grafted bone after posterior lumbar interbody fusion with an interbody carbon cage: a prospective five-year study. ACTA ACUST UNITED AC 2012; 93:1638-45. [PMID: 22161927 DOI: 10.1302/0301-620x.93b12.26063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated the maturation of grafted bone in cases of successful fusion after a one- or two-level posterior lumbar interbody fusion (PLIF) using interbody carbon cages. We carried out a five-year prospective longitudinal radiological evaluation of patients using plain radiographs and CT scans. One year after surgery, 117 patients with an early successful fusion were selected for inclusion in the study. Radiological evaluation of interbody bone fusion was graded on a 4-point scale. The mean grades of all radiological and CT assessments increased in the five years after surgery, and differences compared to the previous time interval were statistically significant for three or four years after surgery. Because the grafted bone continues to mature for three years after surgery, the success of a fusion should not be assessed until at least three years have elapsed. There were no significant differences in the longitudinal patterns of grafted bone maturity between iliac bone and local bone. However, iliac bone grafting may remodel faster than local bone.
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Affiliation(s)
- T Kanemura
- Konan Kosei Hospital, Konan Kosei Spine Center, 137 Oomatsubara, Takaya-cho, Konan, Aichi 483-8704, Japan.
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Dimar JR, Glassman SD, Vemuri VM, Esterberg JL, Howard JM, Carreon LY. Lumbar lordosis restoration following single-level instrumented fusion comparing 4 commonly used techniques. Orthopedics 2011; 34:e760-4. [PMID: 22049959 DOI: 10.3928/01477447-20110922-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A major sequelae of lumbar fusion is acceleration of adjacent-level degeneration due to decreased lumbar lordosis. We evaluated the effectiveness of 4 common fusion techniques in restoring lordosis: instrumented posterolateral fusion, translumbar interbody fusion, anteroposterior fusion with posterior instrumentation, and anterior interbody fusion with lordotic threaded (LT) cages (Medtronic Sofamor Danek, Memphis, Tennessee). Radiographs were measured preoperatively, immediately postoperatively, and a minimum of 6 months postoperatively. Parameters measured included anterior and posterior disk space height, lumbar lordosis from L3 to S1, and surgical level lordosis.No significant difference in demographics existed among the 4 groups. All preoperative parameters were similar among the 4 groups. Lumbar lordosis at final follow-up showed no difference between the anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cage groups, although the posterolateral fusion group showed a significant loss of lordosis (-10°) (P<.001). Immediately postoperatively and at follow-up, the LT cage group had a significantly greater amount of lordosis and showed maintenance of anterior and posterior disk space height postoperatively compared with the other groups. Instrumented posterolateral fusion produces a greater loss of lordosis compared with anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cages. Maintenance of lordosis and anterior and posterior disk space height is significantly better with anterior interbody fusion with LT cages.
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Affiliation(s)
- John R Dimar
- Norton Leatherman Spine Center, Louisville, Kentucky, USA
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Kim DH, Jeong ST, Lee SS. Posterior lumbar interbody fusion using a unilateral single cage and a local morselized bone graft in the degenerative lumbar spine. Clin Orthop Surg 2009; 1:214-21. [PMID: 19956479 PMCID: PMC2784962 DOI: 10.4055/cios.2009.1.4.214] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 02/16/2009] [Indexed: 12/15/2022] Open
Abstract
Background We retrospectively evaluated the clinical and radiological outcomes of posterior lumbar interbody fusion (PLIF) with using a unilateral single cage and a local morselized bone graft. Methods Fifty three patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft were enrolled in this study. The average follow-up duration was 31.1 months. The clinical outcomes were evaluated with using the visual analogue scale (VAS) at the pre-operative period, at 1 year post-operation and at the last follow-up, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria at the last follow-up; the radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instablity and the disc height. Results For the clinical evaluation, the VAS pain index, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria showed excellent outcomes. For the the radiological evaluation, 52 cases showed complete bone union at the last follow-up. Regarding the complications, only 1 patient had cage breakage during follow-up. Conclusions PLIF using a unilateral single cage filled with a local morselized bone graft has the advantages of a shorter operation time, less blood loss and a shorter hospital stay, as compared with the PLIF using bilateral cages, for treating degenerative lumbar spine disease. This technique also provides excellent outcomes according to the clinical and radiological evaluation.
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Affiliation(s)
- Dong-Hee Kim
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
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Kim SB, Jeon TS, Heo YM, Lee WS, Yi JW, Kim TK, Hwang CM. Radiographic results of single level transforaminal lumbar interbody fusion in degenerative lumbar spine disease: focusing on changes of segmental lordosis in fusion segment. Clin Orthop Surg 2009; 1:207-13. [PMID: 19956478 PMCID: PMC2784961 DOI: 10.4055/cios.2009.1.4.207] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 11/26/2008] [Indexed: 02/01/2023] Open
Abstract
Background To assess the radiographic results in patients who underwent transforaminal lumbar interbody fusion (TLIF), particularly the changes in segmental lordosis in the fusion segment, whole lumbar lordosis and disc height. Methods Twenty six cases of single-level TLIF in degenerative lumbar diseases were analyzed. The changes in segmental lordosis, whole lumbar lordosis, and disc height were evaluated before surgery, after surgery and at the final follow-up. Results The segmental lordosis increased significantly after surgery but decreased at the final follow-up. Compared to the preoperative values, the segmental lordosis did not change significantly at the final follow-up. Whole lumbar lordosis at the final follow-up was significantly higher than the preoperative values. The disc height was significantly higher in after surgery than before surgery (p = 0.000) and the disc height alter surgery and at the final follow-up was similar. Conclusions When performing TLIF, careful surgical techniques and attention are needed to restore and maintain the segmental lordosis at the fusion level.
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Affiliation(s)
- Sang-Bum Kim
- Department of Orthopaedic Surgery, Konyang Universitiy College of Medicine, Daejeon, Korea
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Jagannathan J, Sansur CA, Oskouian RJ, Fu KM, Shaffrey CI. RADIOGRAPHIC RESTORATION OF LUMBAR ALIGNMENT AFTER TRANSFORAMINAL LUMBAR INTERBODY FUSION. Neurosurgery 2009; 64:955-63; discussion 963-4. [DOI: 10.1227/01.neu.0000343544.77456.46] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE
Restoration of lumbar lordosis is a critical factor in long-term success after lumbar fusions. Transforaminal lumbar interbody fusion (TLIF) is a popular surgical technique in the lumbar spine, but few data exist on change in spinal alignment after the procedure.
METHODS
Eighty patients who underwent TLIF surgery were retrospectively reviewed (minimum follow-up period, 2 years). Standing x-rays were assessed for changes in focal and segmental kyphosis, and restoration of lumbar lordosis. Improvement in spondylolisthesis, sagittal balance, and scoliosis were also assessed. Fusion was assessed as well.
RESULTS
Eighty operations were performed at 107 levels. Mean presenting lumbar Cobb angle measurement (L1–S1) was 36.3 ± 4.5 degrees (range, 12–77 degrees). Forty patients (50%) had sagittal imbalance. Mean postoperative Cobb angle (L1–S1) was 55.1 ± 6.6. Thirty-three of 36 patients with segmental kyphosis (92%) had restoration of lordosis. Improvement in alignment was most prominent at the surgical level (mean increase in lordosis, 20.2 ± 4.2 degrees). The improvement in lumbar lordosis among patients undergoing multilevel TLIFs (27.3 ± 3.4 degrees) was significantly higher compared with patients undergoing single-level operations (17.4 ± 4.4) (Student's t test, P = 0.0004). Thirty of the 40 patients with sagittal imbalance (75%) achieved immediate restoration of normal sagittal balance. The ability to restore normal sagittal balance was correlated with a sagittal imbalance of less than 10 cm (P = 0.0001). Spondylolisthesis was completely corrected at the TLIF site in 90 of 99 levels (91%). Three patients (4%) required reoperation, 2 for implant disengagement and 1 for worsening kyphoscoliosis above the original surgical levels. Two of the 80 patients had pseudoarthrosis; hence, the rate of pseudoarthrosis was 2.5%.
CONCLUSION
The TLIF operation is highly effective in improving spinal alignment in patients with degenerative spinal disorders when the appropriate surgical technique is implemented.
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Affiliation(s)
- Jay Jagannathan
- Department of Neurological Surgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Charles A. Sansur
- Department of Neurological Surgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Rod J. Oskouian
- Department of Neurological Surgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Kai-Ming Fu
- Department of Neurological Surgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Christopher I. Shaffrey
- Department of Neurological Surgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
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Truumees E, Majid K, Brkaric M. Anterior Lumbar Interbody Fusion in the Treatment of Mechanical Low Back Pain. ACTA ACUST UNITED AC 2008. [DOI: 10.1053/j.semss.2008.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kim JW, Park HC, Yoon SH, Oh SH, Roh SW, Rim DC, Kim TS. A Multi-center Clinical Study of Posterior Lumbar Interbody Fusion with the Expandable Stand-alone Cage (Tyche(R) Cage) for Degenerative Lumbar Spinal Disorders. J Korean Neurosurg Soc 2007; 42:251-7. [PMID: 19096552 DOI: 10.3340/jkns.2007.42.4.251] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 08/29/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This multi-center clinical study was designed to determine the long-term results of patients who received a one-level posterior lumbar interbody fusion with expandable cage (Tyche(R) cage) for degenerative spinal diseases during the same period in each hospital. METHODS Fifty-seven patients with low back pain who had a one-level posterior lumbar interbody fusion using a newly designed expandable cage were enrolled in this study at five centers from June 2003 to December 2004 and followed up for 24 months. Pain improvement was checked with a Visual Analogue Scale (VAS) and their disability was evaluated with the Oswestry Disability Index. Radiographs were obtained before and after surgery. At the final follow-up, dynamic stability, quality of bone fusion, interveretebral disc height, and lumbar lordosis were assessed. In some cases, a lumbar computed tomography scan was also obtained. RESULTS The mean VAS score of back pain was improved from 6.44 points preoperatively to 0.44 at the final visit and the score of sciatica was reduced from 4.84 to 0.26. Also, the Oswestry Disability Index was improved from 32.62 points preoperatively to 18.25 at the final visit. The fusion rate was 92.5%. Intervertebral disc height, recorded as 9.94+/-2.69 mm before surgery was increased to 12.23+/-3.31 mm at postoperative 1 month and was stabilized at 11.43+/-2.23 mm on final visit. The segmental angle of lordosis was changed significantly from 3.54+/-3.70 degrees before surgery to 6.37+/-3.97 degrees by 24 months postoperative, and total lumbar lordosis was 20.37+/-11.30 degrees preoperatively and 24.71+/-11.70 degrees at 24 months postoperative. CONCLUSION There have been no special complications regarding the expandable cage during the follow-up period and the results of this study demonstrates a high fusion rate and clinical success.
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Affiliation(s)
- Jin Wook Kim
- Department of Neurosurgery , Inha University, College of Medicine, Incheon, Korea
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Kakkar R, Sirigiri PBR, Howieson A, Siva Raman A, Crawford RJ. Posterior lumbar interbody fusion and segmental lumbar lordosis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2006. [DOI: 10.1007/s00590-006-0137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rao RD, David KS, Wang M. Biomechanical changes at adjacent segments following anterior lumbar interbody fusion using tapered cages. Spine (Phila Pa 1976) 2005; 30:2772-6. [PMID: 16371901 DOI: 10.1097/01.brs.0000190813.27468.2d] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical evaluation of anterior cages in a calf lumbar spine model. OBJECTIVES To determine changes in spinal motion and intradiscal pressures at immediately adjacent lumbar motion segments following anterior insertion of tapered cages. SUMMARY OF BACKGROUND DATA Stand-alone anterior lumbar interbody fusion (ALIF) is an effective approach in the treatment of discogenic low back pain. A tapered lumbar (LT) cage design attempts to restore physiologic lordosis and sagittal balance. We are not aware of any previous biomechanical evaluation of the effects of LT cages on adjacent motion segments. METHODS Nine fresh calf spines (L2-L5) were procured for the study. Pure moments (up to 8.5 Nm) in flexion, extension, and lateral bending were applied to the L2 vertebra in five steps through a nonconstrained loading system. With each step of loading, three-dimensional rotation at three intervertebral disc levels was obtained through a three-camera motion analysis system, and intradiscal pressures within the nucleus pulposus of the two nonoperated discs were measured with miniature transducers. The spines were tested initially intact and following paired anterior LT cage insertion. RESULTS Following ALIF, small to moderate increase in motion was found at both adjacent segments in flexion (superior: 12.5%, P < 0.05; inferior: 11.3%, P < 0.02) and lateral bending (superior: 7.8%, P < 0.02; inferior: 6.6%, P < 0.02). An increase in intradiscal pressure was noted at the superior adjacent segment under flexion (21%, P < 0.01) and lateral bending (16%, P < 0.03). Intradiscal pressure changes at the inferior adjacent level were not significant. CONCLUSIONS Statistically significant changes in intradiscal pressures and motion were found at the adjacent levels following a single-level stand-alone ALIF procedure using paired LT cages.
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Affiliation(s)
- Raj D Rao
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Groth AT, Kuklo TR, Klemme WR, Polly DW, Schroeder TM. Comparison of Sagittal Contour and Posterior Disc Height Following Interbody Fusion. ACTA ACUST UNITED AC 2005; 18:332-6. [PMID: 16021014 DOI: 10.1097/01.bsd.0000163037.17634.89] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Segmental restoration of sagittal contour is recognized as critical for improved long-term success following instrumented lumbar fusions. As such, the use of wedged implants has become more popular. Few studies exist to assess the postoperative lordotic and disc height changes following these varied techniques in spinal fusion. An observational radiographic study examining lumbar sagittal contour and posterior intervertebral disc space height following posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) was conducted using vertical cages (VCs), wedged structural allograft (WSA), and threaded cylindrical cages (TCCs). METHODS Forty-nine consecutive patients (59 spinal segments) were evaluated following single- or two-level interbody fusion with either stand-alone TCCs (n = 18 levels), WSA with posterior transpedicular compression instrumentation (n = 25 levels), or VCs with posterior transpedicular compression instrumentation (n = 16 levels). Standing lumbar radiographs were measured by two independent observers preoperatively, immediately postoperatively (within 1 week), at 6-week follow-up (range 4-8 weeks), and postoperatively (at 1-year follow-up) for segmental lordosis at each level undergoing posterior interbody arthrodesis and posterior intervertebral disc space height to assess indirect nerve root decompression. RESULTS At the 1-year follow-up, postoperative lordosis was improved in the VC group (+5.3 degrees ; P < 0.005), whereas it decreased in the WSA group (-0.9 degrees ; P = 0.407) and TCC group (-3.5 degrees ; P < 0.005). The posterior disc space height decreased in the VC group (-0.5 mm; P = 0.109), whereas it increased for both the WSA group (+1.2 mm; P = 0.05) and the TCC group (+0.8 mm; P = 0.219). CONCLUSIONS PLIF with stand-alone TCC and PLIF (or TLIF) with WSA and posterior transpedicular instrumentation results in an increased posterior disc height and thus improved indirect nerve root decompression. PLIF (or TLIF) with VC and posterior transpedicular instrumentation results in an overall decrease in posterior disc height. However, TCC and WSA resulted in a loss of lumbar lordosis, whereas VC resulted in an increase in lumbar lordosis.
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Affiliation(s)
- Adam T Groth
- Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, DC 20007, USA.
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Factors Affecting Segmental Lordotic Angle After Posterior Lumbar Interbody Fusion Using Metal Cage. ACTA ACUST UNITED AC 2005. [DOI: 10.4184/jkss.2005.12.4.316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
There are many options for the surgical treatment of lumbar spondylolisthesis, including anterior and posterior techniques. Among the most versatile is a 360° fusion. In consideration of the added risk of morbidity of two procedures, circumferential fusion leads to the highest fusion rates. This is particularly useful for patients at high risk for pseudarthrosis, such as patients with diabetes, posttransplant recipients, and those in whom fusion procedures have failed. Likewise, a 360° fusion may also be useful in achieving fusion in biomechanically disadvantageous situations, such as at the L5–S1 level or with high-grade subluxation. The options for 360° fusion are many and are determined, among other factors, by surgical pathology and surgeon preference. Standard open techniques are still considered the gold standard, although newer less invasive methods of circumferential fusion are being used more frequently. The operating surgeon must have a thorough knowledge of all available maneuvers for critical and effective decision making.
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