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Sheppard W, Reading L, Patel AA, Greenberg J, Spiessberger A. Different Concepts in Short Segment Reconstruction of Moderate to Severe PI-LL Mismatch Deformity with ALIF, Mini-PSO, and TLIF: A Video Case Series. Clin Spine Surg 2025:01933606-990000000-00472. [PMID: 40163631 DOI: 10.1097/bsd.0000000000001796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 02/17/2025] [Indexed: 04/02/2025]
Abstract
Sagittal plane deformities of the thoracolumbar spine, in which there is a significant mismatch between pelvic incidence (PI) and lumbar lordosis (LL) can negatively impact quality of life. Reconstructive surgery frequently involves long-segment spinal fusion. This video case series presents 3 patients with moderate to severe PI-LL mismatch spinal deformities, who underwent short construct corrections using varying strategies. Case 1 utilizes a combination of posterior column osteotomy (PCO) and anterior lumbar interbody fusion (ALIF) to achieve correction. Case 2 describes a combined transforaminal lumbar interbody fusion (TLIF) with a partial pedicle subtraction osteotomy (PSO). Lastly, case 3 details deformity correction with a multilevel TLIF, using extra-large footprint static banana cages, combined with posterior column osteotomy. The aim of this video case series is to outline these 3 techniques and illustrate that in select cases, a short-segment fusion limited to the lumbar spine can achieve significant deformity correction.
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Affiliation(s)
| | | | - Arpan A Patel
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH
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2
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Pereira Filho ARD, Baptista VS, Mussalem MGVB, Júnior FCFC, Uehara MK, Aguiar NRC, Baston AC, Desideri AV, de Meldau Benites V. Incidence of intraoperative morbidities in anterior lumbar interbody fusion (ALIF): a comprehensive study of 5,299 levels. Neurosurg Rev 2025; 48:327. [PMID: 40138083 DOI: 10.1007/s10143-025-03496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 03/06/2025] [Accepted: 03/22/2025] [Indexed: 03/29/2025]
Abstract
CONTEXT Anterior Lumbar Interbody Fusion (ALIF) is performed via an abdominal approach to remove the intervertebral disc. Although academic reports suggest low intraoperative complication rates, the available data show significant variability. There is a lack of large-scale, robust studies that consistently evaluate the morbidity rates associated with this procedure. OBJECTIVE This study evaluates the operative parameters of this procedure based on a substantial number of cases. STUDY DESIGN A retrospective case series. METHODS Patient data were retrospectively collected from the database of the Instituto de Acessos à coluna Aécio Dias (IAAD). All patients aged 18 years or older who underwent ALIF surgery were included in the study. Patients who underwent other surgical approaches were excluded. Data on intraoperative morbidity (vascular injuries, injuries to intra- and extraperitoneal organs, dural sac injuries, and nerve root injuries), operative time, and blood loss were collected and analyzed. RESULTS A total of 3,438 patients were evaluated. 1,671 (48.6%) were male, and 1,767 (51.4%) were female. The mean age was 47.87 ± 12.10 years, ranging from 18 to 88 years. The reported incidence of complications was as follows: vascular injuries (3.25%), nerve root injuries (0.09%), dural sac injuries (0.06%), and injuries to intra- and extraperitoneal organs (0.03%). CONCLUSIONS ALIF surgery demonstrated safety and low morbidity. A multidisciplinary team, including access surgeons, played a pivotal role in reducing vascular complications, optimizing surgical times, and minimizing blood loss, aligning with the standards reported in the literature.
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Affiliation(s)
| | - Vinicius Santos Baptista
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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3
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Su L, Liu W, Zhang Y, Li F, Liu Y, Wang Z. Lateral retroperitoneal approach for the treatment of a recumbent silkworm-like paravertebral schwannoma in the lumbar spine: a case report. Front Oncol 2025; 15:1544175. [PMID: 40171261 PMCID: PMC11958940 DOI: 10.3389/fonc.2025.1544175] [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: 12/12/2024] [Accepted: 02/27/2025] [Indexed: 04/03/2025] Open
Abstract
Objective This case report describes the surgical management of a recumbent silkworm-like paravertebral schwannoma in the lumbar spine resected via the lateral retroperitoneal approach. Methods A lumbar paravertebral schwannoma resembling a "recumbent silkworm" was excised using the lateral retroperitoneal approach. Intraoperative measures included electrophysiological monitoring and insertion of a ureteral D-J stent to protect critical surrounding anatomical structures. Complete tumor resection was achieved without intraoperative complications. Follow-up demonstrated no tumor recurrence or postoperative complications. Results The duration of surgery was 310 min, with an estimated blood loss of 50mL. The tumor resection rate was 100%. The patient was discharged 11 days after hospitalization. Postoperative histopathological examination confirmed the diagnosis of schwannoma. There were no postoperative complications. The patient ADL (Activities of Daily Living score did not decline compared with the preoperative levels. After one year of follow-up, no signs of tumor recurrence were observed. Conclusion Paravertebral tumors located in the anterior and lateral aspects of the lumbar spine pose significant surgical challenges because of their complex position and morphology. Complete excision of such tumors via the lateral retroperitoneal approach is an optimal treatment strategy.
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Affiliation(s)
- Lanming Su
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong First Medical University& Shandong Academy of Medical Sciences, Jinan, China
| | - Wei Liu
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong First Medical University& Shandong Academy of Medical Sciences, Jinan, China
| | - Yingying Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Feng Li
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yuanqin Liu
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ziyu Wang
- School of Pharmacy, Shandong Second Medical University, Weifang, China
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Zhang JK, Greenberg JK, Javeed S, Benedict B, Botterbush KS, Dibble CF, Khalifeh JM, Brehm S, Jain D, Dorward I, Santiago P, Molina C, Pennicooke BH, Ray WZ. Predictors of Postoperative Segmental and Overall Lumbar Lordosis in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Consecutive Case Series. Global Spine J 2025; 15:425-437. [PMID: 37522797 PMCID: PMC11877597 DOI: 10.1177/21925682231193610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
STUDY DESIGN Retrospective Case-Series. OBJECTIVES Due to heterogeneity in previous studies, the effect of MI-TLIF on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Therefore, we aim to identify radiographic factors associated with lordosis after surgery in a homogenous series of MI-TLIF patients. METHODS A single-center retrospective review identified consecutive patients who underwent single-level MI-TLIF for grade 1 degenerative spondylolisthesis from 2015-2020. All surgeries underwent unilateral facetectomies and a contralateral facet release with expandable interbody cages. PROs included the ODI and NRS-BP for low-back pain. Radiographic measures included SL, disc height, percent spondylolisthesis, cage positioning, LL, PI-LL mismatch, sacral-slope, and pelvic-tilt. Surgeries were considered "lordosing" if the change in postoperative SL was ≥ +4° and "kyphosing" if ≤ -4°. Predictors of change in SL/LL were evaluated using Pearson's correlation and multivariable regression. RESULTS A total of 73 patients with an average follow-up of 22.5 (range 12-61) months were included. Patients experienced significant improvements in ODI (29% ± 22% improvement, P < .001) and NRS-BP (3.3 ± 3 point improvement, P < .001). There was a significant increase in mean SL (Δ3.43° ± 4.37°, P < .001) while LL (Δ0.17° ± 6.98°, P > .05) remained stable. Thirty-eight (52%) patients experienced lordosing MI-TLIFs, compared to 4 (5%) kyphosing and 31 (43%) neutral MI-TLIFs. A lower preoperative SL and more anterior cage placement were associated with the greatest improvement in SL (β = -.45° P = .001, β = 15.06° P < .001, respectively). CONCLUSIONS In our series, the majority of patients experienced lordosing or neutral MI-TLIFs (n = 69, 95%). Preoperative radiographic alignment and anterior cage placement were significantly associated with target SL following MI-TLIF.
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Affiliation(s)
- Justin K. Zhang
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Saad Javeed
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Braeden Benedict
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | | | | | - Jawad M. Khalifeh
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, MD
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Deeptee Jain
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Ian Dorward
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Paul Santiago
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Camilo Molina
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
| | | | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA
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5
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Theologis AA, Collins AP, Parhar K, Gupta MC. Revisiting abdominal wall "morbidity" of the extensile anterolateral approach to the thoracolumbar spine. Spine Deform 2025; 13:251-260. [PMID: 39307890 PMCID: PMC11729118 DOI: 10.1007/s43390-024-00971-3] [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] [Received: 07/16/2023] [Accepted: 09/10/2024] [Indexed: 01/14/2025]
Abstract
PURPOSE To assess patients' perceptions of their abdominal wall following extensile anterolateral approaches to the thoracolumbar spine for adult spinal deformity (ASD) using validated questionnaires. METHODS Adults who underwent anterior-posterior thoracolumbar spinal operations to the pelvis for ASD in which the anterior fusion was performed through an extensile anterolateral approach were reviewed. Three questionnaires were administered at least 1 year following surgery and included The Abdominal Core Health Quality Collaborative Survey (AHS-QC), The Patient Scar Assessment Scale (PSAS), and The Anterior Abdominal Incision Questionnaire (AAIQ). RESULTS Fifty-one patients (80.4% female, median age 65 years) were included. Average follow-up was 2.8 ± 1.7 years. Average number of anterior fusion levels was 3.5 ± 1.4. Patients achieved high satisfaction rates from surgery (74.5%). AAIQ responses included postoperative pain (33.3%), bulging (41.7%), and limitations in daily activities (18.8%) with only 15.7% experienced moderate-severe pain related to their incisions and only 6.3% seeking treatment for their scars. Post-operatively, 63.2% had a neutral or improved self-image of their torso and trunk, while only 10.2% stating it was much worse. Patients' overall opinion of their scar compared to their normal skin was very positive [average 2.75 ± 2.93 (10 = worst possible scar)]. Favorable scores were also reported for color difference, stiffness, change in thickness, and irregularity in their abdominal scar compared to normal skin. CONCLUSIONS Following extensile anterolateral approaches to the thoracolumbar spine for ASD, the majority of patients reported mild pain, mild functional limitations, good cosmesis, and high satisfaction rates with their anterior incisions based on validated questionnaires.
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Affiliation(s)
- Alekos A Theologis
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA.
| | - Andrew P Collins
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Kanwar Parhar
- Elson S. Floyd College of Medicine, Washington State University, Pullman, WA, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
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Ragborg LC, Dragsted C, Hallager DW, Dahl B, Gehrchen M. Anterior Lumbar Interbody Fusion as a Supplement to Posterior Instrumentation in Adult Spinal Deformity Patients: A Pilot Randomized Study With a Median of Eight Years of Follow-Up. Cureus 2024; 16:e70020. [PMID: 39445241 PMCID: PMC11498895 DOI: 10.7759/cureus.70020] [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] [Accepted: 09/19/2024] [Indexed: 10/25/2024] Open
Abstract
Aim We aim to assess the long-term revision rates in patients with adult spinal deformity (ASD) undergoing posterior instrumentation with or without supplemental anterior lumbar interbody fusion (ALIF) with a median of eight years of follow-up. Materials and methods Based on a previous pilot randomized controlled trial (RCT) from 2012, all previous participants were invited to a clinical and radiographic follow-up. Full medical records from the total cohort were reviewed from the time of operation to the follow-up, and information on revision surgery due to mechanical failure was obtained and compared between the groups. Results Of the original 17 patients included in the RCT, 15 were available for follow-up and 10 attended the clinical and radiographic examination. A retrospective review was performed of the entire original cohort. The median age at follow-up was 67 (61-71) years, and the median follow-up time was 7.7 (5.1-8.8) years. Revision rates among ALIF patients were three out of seven (43%) and eight out of 10 (80%) among non-ALIF patients with pseudoarthrosis and rod breakage being the main cause. Time to failure was longer in ALIF patients with a median of 47 (28-53) months compared with non-ALIF patients with a median of 26 (9-31) months. Conclusion This study revealed a lower rate of revision surgery and a longer time to failure in patients undergoing ASD surgery with supplemental ALIF compared with posterior instrumentation alone. Further studies with a larger sample size are needed to make conclusions on the effect of a supplemental ALIF to posterior instrumentation on lowering the risk of mechanical failure in patients with adult spinal deformity.
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Affiliation(s)
- Lærke C Ragborg
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, DNK
| | - Casper Dragsted
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, DNK
| | - Dennis W Hallager
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, DNK
| | - Benny Dahl
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, DNK
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, DNK
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7
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Nagata K, Glassman SD, Brown ME, Daniels C, Merkel P, Djurasovic M, Gum J, Carreon L. Comparison of Complication Rates Between Transforaminal Interbody Fusion and Anteroposterior Fusion for One- or Two-Level Degenerative Lumbar Spine Surgery: A Propensity Score Matched Analysis. Cureus 2024; 16:e66455. [PMID: 39246880 PMCID: PMC11380527 DOI: 10.7759/cureus.66455] [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: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction Although transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) combined with posterior fusion (AP) have similar fusion rates, it is unclear if choice of approach has an impact on post-operative complications. Research question Is the incidence of residual leg and/or back pain requiring additional treatment after one- or two-level TLIF and AP similar? Material and methods Adult patients who underwent one- or two-level TLIF or AP for degenerative pathology were identified and matched using age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA), insurance status, smoking status, revision and number of levels fused. The incidence of radicular leg and back pain requiring emergency department visit/readmission or same level surgical intervention was compared between the two groups. Results Of the 319 TLIF and 288 AP cases, 119 cases in each cohort were matched. TLIF patients had shorter operative times (203 min vs 258 min, P<0.001) and hospital stays than the AP patients (3.76 days vs 4.98 days, P<0.001). The incidence of residual leg pain (7 vs 5, P=0.769) and back pain (13 vs 15, P=0.841) was similar between the two groups. Except for constipation, which was more common in the AP group, the incidence of complications was similar between the two groups. Conclusions Patients undergoing one- or two-level TLIF showed shorter operative time and hospital stay compared with those undergoing AP. The incidence of leg radiculopathy and back pain was similar between the two groups. Surgeons should consider these findings as part of the decision-making process regarding which approach to use in patients requiring a lumbar interbody fusion.
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Affiliation(s)
- Kosei Nagata
- Orthopedic Surgery, University of Tokyo Hospital, Tokyo, JPN
| | - Steven D Glassman
- Orthopedics, Norton Leatherman Spine Center, Norton Healthcare, Louisville, USA
| | - Morgan E Brown
- Research, Norton Leatherman Spine Center, Norton Healthcare, Louisville, USA
| | - Christy Daniels
- Research, Norton Leatherman Spine Center, Norton Healthcare, Louisville, USA
| | - Patrick Merkel
- Orthopedics, University of Louisville School of Medicine, Louisville, USA
| | - Mladen Djurasovic
- Orthopedics, Norton Leatherman Spine Center, Norton Healthcare, Louisville, USA
| | - Jeffrey Gum
- Orthopedics, Norton Leatherman Spine Center, Norton Healthcare, Louisville, USA
| | - Leah Carreon
- Research, Norton Leatherman Spine Center, Norton Healthcare, Louisville, USA
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8
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Chi J, Zhang Y, Fontaine A, Zhang Z, Wang J, Labaran L, Li X. Pedicle Subtraction Osteotomy Versus Multilevel Anterior Lumbar Interbody Fusion and Lateral Lumbar Interbody Fusion in the Treatment of Adult Spinal Deformity: Trends, Outcomes, and Cost. Clin Spine Surg 2024; 37:E192-E200. [PMID: 38158597 DOI: 10.1097/bsd.0000000000001566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to compare the outcomes of pedicle subtraction osteotomy (PSO) with multilevel anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) in posterior long-segment fusion. BACKGROUND PSO and ALIF/LLIF are 2 techniques used to restore lumbar lordosis and correct sagittal alignment, with each holding its unique advantages and disadvantages. As there are situations where both techniques can be employed, it is important to compare the risks and benefits of both. PATIENTS AND METHODS Patients aged 18 years or older who underwent PSO or multilevel ALIF/LLIF with posterior fusion of 7-12 levels and pelvic fixation were identified. 1:1 propensity score was used to match PSO and ALIF/LLIF cohorts for age, sex, and relevant comorbidities, including smoking status. Logistic regression was used to compare medical and surgical outcomes. Trends and costs were generated for both groups as well. RESULTS ALIF/LLIF utilization in posterior long fusion has been steadily increasing since 2010, whereas PSO utilization has significantly dropped since 2017. PSO was associated with an increased risk of durotomy ( P < 0.001) and neurological injury ( P = 0.018). ALIF/LLIF was associated with increased rates of postoperative radiculopathy ( P = 0.005). Patients who underwent PSO had higher rates of pseudarthrosis within 1 and 2 years ( P = 0.015; P = 0.010), 1-year hardware failure ( P = 0.028), and 2-year reinsertion of instrumentation ( P = 0.009). Reoperation rates for both approaches were not statistically different at any time point throughout the 5-year period. In addition, there were no significant differences in both procedural and 90-day postoperative costs. CONCLUSIONS PSO was associated with higher rates of surgical complications compared with anterior approaches. However, there was no significant difference in overall reoperation rates. Spine surgeons should select the optimal technique for a given patient and the type of lordotic correction required.
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Affiliation(s)
- Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Yi Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Andrew Fontaine
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Jesse Wang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Lawal Labaran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Xudong Li
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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Dias Pereira Filho AR, Baptista VS, Valadares Bertolini Mussalem MG, Frota Carneiro Júnior FC, de Meldau Benites V, Desideri AV, Uehara MK, Colaço Aguiar NR, Baston AC. Analysis of the Frequency of Intraoperative Complications in Anterior Lumbar Interbody Fusion: A Systematic Review. World Neurosurg 2024; 184:165-174. [PMID: 38266992 DOI: 10.1016/j.wneu.2024.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We assessed the frequency of intraoperative complication rates related to access surgery, operating time, and intraoperative bleeding rates described in the literature for patients undergoing anterior lumbar interbody fusion (ALIF) to evaluate the adverse effects and, thus, help in therapeutic decision making and contribute to future clinical trials. METHODS A systematic review was conducted of MEDLINE and Embase databases in March 2023. The main inclusion criteria were adult patients aged >18 years, with no maximum age limit; the use of ALIF; the presence of quantitative data on intraoperative complications; and randomized controlled trials and cohort studies. Vascular and peritoneal injuries were considered primary endpoints. The operative time and intraoperative bleeding rate were secondary endpoints. Reports and case series, case-control series, systematic reviews, and meta-analyses were excluded. RESULTS Eight studies were included with a total of 2395 patients. We found important quantitative data for future randomized clinical studies involving ALIF surgery, including the rate of vascular lesions (2.79%) and peritoneal lesions (0.37%). In addition to these factors, only 4 of the 8 studies addressed the average surgery time, with a total average of 145.61 minutes. Furthermore, 6 of the 8 articles reported the mean rate of intraoperative bleeding, with a total mean blood loss of 272.75 mL. CONCLUSIONS ALIF is a lumbar spine access technique with low intraoperative complications. Patients with contraindications have a higher risk of complications. Randomized clinical trials are needed to assess the efficacy and safety of the procedure.
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Affiliation(s)
| | - Vinicius Santos Baptista
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Vinicius de Meldau Benites
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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10
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Alhaug OK, Dolatowski FC, Thyrhaug AM, Mjønes S, Dos Reis JABPR, Austevoll I. Long-term comparison of anterior (ALIF) versus transforaminal (TLIF) lumbar interbody fusion: a propensity score-matched register-based study. 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 2024; 33:1109-1119. [PMID: 38078979 DOI: 10.1007/s00586-023-08060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/27/2023] [Accepted: 11/19/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE Anterior (ALIF) and transforaminal (TLIF) lumbar interbody fusion have shown similar clinical outcomes at short- and medium-term follow-ups. Possible advantages of ALIF in the long run could be better disc height and lumbar lordosis and reduced risk of adjacent segment disease. We aimed to study if ALIF could be associated with superior clinical outcomes than TLIF at long-term follow-up. METHODS We analysed 535 patients treated with ALIF or TLIF of the L5-S1 spinal segment between 2007 and 2017 who completed long-term follow-up in a national spine registry database (NORspine). We defined treatment success after surgery as at least 30% improvement in Oswestry Disability Index (ODI) at long-term follow-up. Patients treated with ALIF and TLIF and who responded at long term were balanced by propensity score matching. The proportions of successfully treated patients within each group were compared by numbers and percentages with corresponding relative risk. RESULTS The mean (95%CI) age of the total study population was 50 (49-51) years, and 264 (49%) were females. The mean (95%CI) preoperative ODI score was 40 (39-42), and 174 (33%) had previous spine surgery. Propensity score matching left 120 patients in each treatment group. At a median (95%CI) of 92 (88-97) months after surgery, we found no difference in proportions successfully treated patients with ALIF versus TLIF (68 (58%) versus 77 (65%), RR (95%CI) = 0.88 (0.72 to1.08); p = 0.237). CONCLUSIONS This propensity score-matched national spine register study of patients treated with ALIF versus TLIF of the lumbosacral junction found no differences in proportions of successfully treated patients at long-term follow-up. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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Affiliation(s)
- Ole Kristian Alhaug
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, PO Box 68, 2313, Ottestad, Norway.
- Norwegian University of Science and Technology, NTNU, PO Box 191, 7491, Trondheim, Norway.
- Orthopaedic Department, Akershus University Hospital, PO Box 1000, 1478, Loerenskog, Norway.
| | - Filip C Dolatowski
- Orthopaedic Department, Oslo University Hospital, PO Box 4956, 0424, Oslo, Norway
| | | | - Sverre Mjønes
- Orthopaedic Department, Akershus University Hospital, PO Box 1000, 1478, Loerenskog, Norway
| | | | - Ivar Austevoll
- Orthopaedic Department, Kysthospitalet in Hagavik, Haukeland University Hospital, 5217, Hagevik, Bergen, Norway
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11
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Daher M, Kreichati G, Aoun M, Riouallon G, Kharrat K, Sebaaly A. Approaches in Anterior Column Support in Adult Spinal Deformity Surgery: A Meta-Analysis of Clinical and Radiologic Outcomes. World Neurosurg 2024; 182:91-98. [PMID: 38008165 DOI: 10.1016/j.wneu.2023.11.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE This meta-analysis was conducted to compare anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) in terms of postoperative complications, improvement in radiographic parameters, and patient-reported outcomes. METHODS PubMed, Cochrane, and Google Scholar (pages 1-20) databases were searched up to June 2023. The studied outcomes were the rate of rod failures, rod failures requiring revision surgery, all complications, all revision surgeries, the change in pelvic tilt, sacral slope, Cobb angle, lumbar lordosis (LL), sagittal vertical axis, the postoperative pelvic incidence-LL, and LL, and the improvement in back pain and Oswestry Disability Index (ODI). RESULTS Six studies were included in this meta-analysis. ALIF showed higher postoperative lordosis (P = 0.003) and better improvement in ODI (P = 0.0001). No difference was seen in the remaining outcomes between ALIF and TLIF. CONCLUSIONS Although ALIF had better improvement in ODI, the mean difference was 6.5 points, which is below the minimal clinically important difference, stripping this result of any clinical value. Furthermore, even though ALIF had better postoperative lordosis, the change in LL postoperatively was not different between ALIF and TLIF. With no difference in complications, sagittal and coronal alignment, and patient-reported outcomes, TLIF was shown in this study to be favored instead of ALIF in adult spinal deformity surgery to avoid all the double approach-related comorbidity.
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Affiliation(s)
- Mohammad Daher
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Gaby Kreichati
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Marven Aoun
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Guillaume Riouallon
- Department of Orthopedic Surgery, Centre Hospitalier Paris Saint Joseph, Paris, France
| | - Khalil Kharrat
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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12
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Kotani Y, Ikeura A, Tanaka T, Saito T. Clinical and Radiologic Analysis of Minimally Invasive Anterior-Posterior Combined Surgery for Adult Spinal Deformity: Comparison of Oblique Lateral Interbody Fusion at L5/S1 (OLIF51) versus Transforaminal Interbody Fusion. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:107. [PMID: 38256368 PMCID: PMC10820572 DOI: 10.3390/medicina60010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Although adult spinal deformity (ASD) surgery brought about improvement in the quality of life of patients, it is accompanied by high invasiveness and several complications. Specifically, mechanical complications of rod fracture, instrumentation failures, and pseudarthrosis are still unsolved issues. To better improve these problems, oblique lateral interbody fusion at L5/S1 (OLIF51) was introduced in 2015 at my institution. The objective of this study was to compare the clinical and radiologic outcomes of anterior-posterior combined surgery for ASD between the use of OLIF51 and transforaminal interbody fusion (TLIF) at L5/S1. Materials and Methods: A total of 117 ASD patients received anterior-posterior correction surgeries either with the use of OLIF51 (35 patients) or L5/S1 TLIF (82 patients). In both groups, L1-5 OLIF and minimally invasive posterior procedures of hybrid or circumferential MIS were employed. The sagittal and coronal spinal alignment and spino-pelvic parameters were recorded preoperatively and at follow-up. The quality-of-life parameters and visual analogue scale were evaluated, as well as surgical complications at follow-up. Results: The average follow-up period was thirty months (13-84). The number of average fused segments was eight (4-12). The operation time and estimated blood loss were significantly lower in OLIF51 than in TLIF. The PI-LL mismatch, LLL, L5/S1 segmental lordosis, and L5 coronal tilt were significantly better in OLIF51 than TLIF. The complication rate was statistically equivalent between the two groups. Conclusions: The introduction of OLIF51 for adult spine deformity surgery led to a decrease in operation time and estimated blood loss, as well as improvement in sagittal and coronal correction compared to TLIF. The circumferential MIS correction and fusion with OLIF51 serve as an effective surgical modality which can be applied to many cases of adult spinal deformity.
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Affiliation(s)
- Yoshihisa Kotani
- Spine and Nerve Center, Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka 570-8507, Japan; (A.I.); (T.T.)
| | - Atsushi Ikeura
- Spine and Nerve Center, Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka 570-8507, Japan; (A.I.); (T.T.)
| | - Takahiro Tanaka
- Spine and Nerve Center, Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka 570-8507, Japan; (A.I.); (T.T.)
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka 573-1191, Japan;
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13
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Bakhsheshian J, Hassan FM, Greisberg G, Platt A, Zuckerman SL, Lenke LG. The "Sandwich" Extended Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Malalignment: Technical Description, Case Series, and Early Results With 2-Year Outcomes. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00987. [PMID: 38047642 DOI: 10.1227/ons.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Adult spinal deformity (ASD) with fixed sagittal malalignment (FSM) may require a pedicle subtraction osteotomy (PSO) for greater focal lordosis and restoration of global alignment. Despite growing trends in minimizing PSOs given their associated high risks, a considerable portion of patients with ASD still require a lumbar PSO most commonly because of iatrogenic flat back deformity. The purpose of this article is to describe a modified extended PSO technique with additional anterior column support coined the "sandwich" extended PSO (SE-PSO) to promote arthrodesis and report the outcomes in a consecutive case series. METHODS Patients with ASD treated with a lumbar SE-PSO at a single institution from 2015 to 2020 were analyzed. Complications, radiographic data, and patient-reported outcomes were compared preoperatively, at immediate postoperative follow-up, and at a 2-year postoperative follow-up (FU). RESULTS Fourteen patients who underwent revision operations for FSM were included. Improvements in segmental lordosis across the PSO site (14.8 ± 6.8 vs 39.9 ± 7.1, P < .0001), overall lumbar lordosis (14.6 ± 15.4 vs 44.6 ± 12.1, P < .0001), sacral slope (21.0 ± 10.5 31.1 ± 10.7, P = .0150), C7 sagittal vertical axis (140.1 ± 59.0 mm vs 35.9 ± 28.5, P < .0001), and spinopelvic mismatch (52.5 ± 21.3 vs 18.6 ± 14.1, P = .0001) were obtained in all patients. Eight patients experienced perioperative complications, with intraoperative durotomy being the most common (n = 7). Eight patients had a 2-year FU and demonstrated improvements in their segmental lordosis across the PSO site (14.3 ± 7.0 vs 41.3 ± 7.3, P = .0003), overall lumbar lordosis (8.7 ± 17.8 vs 46.1 ± 14.2, P = .0014), sacral slope (19.1 ± 12.8 vs 32.3 ± 12.5, P = .0479), C7 sagittal vertical axis (173.6 ± 54.4 mm vs 35.8 ± 30.0, P < .0001), and spinopelvic mismatch (63.0 ± 19.7 vs 21.1 ± 18.3, P < .0001), all of which were maintained at final FU (P > .05). At 2 years, a significant increase in Scoliosis Research Society-22r total score (2.5 ± 0.8 vs 3.6 ± 0.7, P = .0023 was reported. There were no reports of symptomatic pseudarthrosis or mechanical complications. CONCLUSION SE-PSO is an effective technique to correct FSM and is associated with low complications, improved patient-reported outcomes, and spinopelvic parameters that are maintained at 2 years.
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Affiliation(s)
- Joshua Bakhsheshian
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Orthopaedic Surgery, The Och Spine Hospital at New York-Presbyterian, New York, New York, USA
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Fthimnir M Hassan
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Gabriella Greisberg
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Andrew Platt
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Orthopaedic Surgery, The Och Spine Hospital at New York-Presbyterian, New York, New York, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Orthopaedic Surgery, The Och Spine Hospital at New York-Presbyterian, New York, New York, USA
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14
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Tao X, Matur AV, Khalid S, Onyewadume L, Garner R, McGrath K, Owen B, Gibson J, Cass D, Mejia Munne JC, Vorster P, Shukla G, Gupta S, Wu A, Childress K, Palmisciano P, Duah HO, Motley B, Cheng J, Adogwa O. TLIF is Associated With Lower Rates of Adjacent Segment Disease and Complications Compared to ALIF: A Matched-Cohort Analysis. Spine (Phila Pa 1976) 2023; 48:1335-1341. [PMID: 37146059 DOI: 10.1097/brs.0000000000004694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/10/2023] [Indexed: 05/07/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare the rate of adjacent segment disease (ASD) in patients undergoing anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) for the treatment of degenerative stenosis and spondylolisthesis. SUMMARY OF BACKGROUND DATA ALIF and TLIF are frequently used to treat Lumbar stenosis and spondylolisthesis. While both approaches have distinct advantages, it is unclear whether there are any differences in rates of ASD and postoperative complications. METHODS A retrospective cohort study of patients who underwent index 1-3 levels ALIF or TLIF between 2010 and 2022, using the PearlDiver Mariner Database, an all-claims insurance database (120 million patients). Patients with a history of prior lumbar surgery and those undergoing surgery for cancer, trauma, or infection were excluded. Exact 1:1 matching was performed using demographic factors, medical comorbidities, and surgical factors found to be significantly associated with ASD in a linear regression model. The primary outcome was a new diagnosis of ASD within 36 months of index surgery, and secondary outcomes were all-cause medical and surgical complications. RESULTS Exact 1:1 matching resulted in 2 equal groups of 106,451 patients undergoing TLIF and ALIF. The TLIF approach was associated with a lower risk of ASD (RR 0.58, 95% CI 0.56-0.59, P < 0.001) and all-cause medical complications (RR 0.94, 95% CI 0.91-0.98, P =0.002). All-cause surgical complications were not significantly different between both groups. CONCLUSION After 1:1 exact matching to control for confounding variables, this study suggests that for patients with symptomatic degenerative stenosis and spondylolisthesis, a TLIF procedure (compared to ALIF) is associated with a decreased risk of developing ASD within 36 months of index surgery. Future prospective studies are needed to corroborate these findings. LEVEL OF EVIDENCE Level-3.
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Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois College of Medicine, Chicago, IL
| | - Louisa Onyewadume
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Rebecca Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kyle McGrath
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Bryce Owen
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Juan C Mejia Munne
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry O Duah
- Institute for Nursing Research & Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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15
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Liu J, Xie R, Chin CT, Rajagopalan P, Duan P, Li B, Burch S, Berven SH, Mummaneni PV, Chou D. Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2-Year Follow-Up. Orthop Surg 2023; 15:2334-2341. [PMID: 37526121 PMCID: PMC10475659 DOI: 10.1111/os.13812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE Generally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the realistic lumbosacral arthrodesis rates following ALIF and TLIF in patients with degenerative spondylolisthesis as measured by CT and radiology. METHODS Ninety-six patients who underwent single-level L5-S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan-Steffee-Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow-up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t-test or chi-square test. RESULTS The mean follow-up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow-up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow-up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p < 0.05). Overall complication rates were similar between the TLIF and ALIF groups (10.4% vs 8.33%; p > 0.999). CONCLUSIONS With a minimum 2-year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups.
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Affiliation(s)
- Jinping Liu
- Department of Neurosurgery, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Rong Xie
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
- Department of NeurosurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Cynthia T. Chin
- Department of RadiologyUniversity of California San FranciscoSan FranciscoCAUSA
| | - Priya Rajagopalan
- Department of RadiologyUniversity of California San FranciscoSan FranciscoCAUSA
| | - Ping‐Guo Duan
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Bo Li
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Shane Burch
- Department of Orthopaedic SurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Sigurd H. Berven
- Department of Orthopaedic SurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Praveen V. Mummaneni
- Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoCAUSA
| | - Dean Chou
- Department of NeurosurgeryColumbia UniversityNew YorkUSA
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16
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Gong K, Zhu Z, Wei J, Li F, Xiong W. The anatomical feasibility of anterior intra- and extra-bifurcation approaches to L5-S1: an anatomic study based on lumbar MRI. Spine J 2023; 23:1068-1078. [PMID: 36822511 DOI: 10.1016/j.spinee.2023.02.014] [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] [Received: 09/07/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND CONTEXT The anterior approach at L5-S1 has many advantages, however, vascular complications are challenging for spinal surgeons who may not be familiar with the variability of vascular anatomy. There are three different anterior approaches (intra-bifurcation approach and extra-bifurcation: left-, and right-sided prepsoas approaches) described in previous studies to respond to the variability of anterior vascular anatomy for reduction in vascular injury, while no guidance for the choice of approach preoperatively. PURPOSE To analyze the anatomical feasibility of three anterior approaches to access the L5-S1 disc space according to a practical framework. STUDY DESIGN Retrospective study. PATIENT SAMPLE Lumbar magnetic resonance imaging (MRI) from patients who visited our outpatient clinic were reviewed, with 150 cases meeting the inclusion criteria. OUTCOME MEASURES The following radiographic parameters were measured on axial T2-weighted MRI at the lower endplate of L5 and the upper endplate of S1: width of the vascular corridor, position of the left and right common iliac vein (CIV), and presence of perivascular adipose tissue (PAT). Moreover, we designed a safe line to evaluate the feasibility of left- and right-sided prepsoas approaches. Cases of lumbosacral transitional vertebrae were identified. METHODS The feasibility of the intra-bifurcation approach was determined by the width of the vascular corridor, presence of PAT, and the position of the CIV. The feasibility of the prepsoas approach was determined by the relative position of the CIV to the safe line, presence of PAT, and the intersection point of the CIV and vertebral body. RESULTS Sixty-eight percent, 64.7%, and 75.3% cases allowed the intra-bifurcation, left-, and right-sided prepsoas approach to L5-S1, respectively. The cases in this study had at least one of three anterior approaches to access L5-S1 disc space, and 74% of cases had more than one anatomical feasibility of anterior approach. The right-sided prepsoas approach was feasible in the majority of cases because of the vertical course of the right CIV with a significantly higher proportion of presence of PAT. Patients with lumbosacral transitional vertebrae (24 cases) may prefer the prepsoas approaches, and only six cases (25.0%) were determined to be feasible for the intra-bifurcation approach. CONCLUSIONS Our study proposes a practical framework to determine whether the three different anterior approaches are feasible access at L5-S1. According to the framework, all cases had the anatomical feasibility of using an anterior approach to access L5-S1, and three-fourths of cases had a replaceable anterior approach when encountering intraoperative difficulties.
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Affiliation(s)
- Ke Gong
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China
| | - Ziwei Zhu
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China
| | - Jiemao Wei
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China
| | - Feng Li
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China
| | - Wei Xiong
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China.
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17
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Siegel N, Lambrechts MJ, Brush PL, Karamian B, Lee Y, Depalma M, Delvadia B, Song S, Toci GR, Canseco JA, Woods BI, Kaye ID, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Do On-Table Radiographs Predict Postoperative Sagittal Alignment after Posterior Lumbar Fusion? World Neurosurg 2023; 174:e118-e125. [PMID: 36889640 DOI: 10.1016/j.wneu.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To determine if intraoperative on-table lumbar lordosis and segmental lordosis correlate with postoperative lordosis following single-level posterolateral decompression and fusion (PLDF) or transforaminal lumbar interbody fusion (TLIF). METHODS Electronic medical records were reviewed for patients ≥18 years old who underwent PLDF or TLIF between 2012 and 2020. Lumbar lordosis and segmental lordosis were compared between pre-, intra-, and postoperative radiographs using paired t tests. Significance was set at P < 0.05. RESULTS A total of 200 patients met inclusion criteria. No significant differences in preoperative, intraoperative, or postoperative measurements were found between groups. Patients who underwent PLDF experienced less disc height loss over 1 year postoperatively (PLDF: 0.45 ± 0.9 mm vs. TLIF: 1.2 ± 1.4 mm, P < 0.001). Lumbar lordosis significantly decreased between intraoperative to postoperative radiographs at 2-6 weeks for PLDF (Δ: -4.0°, P < 0.001) and TLIF (Δ: -5.6°, P < 0.001), but no change was identified between the intraoperative and >6 month postoperative radiographs for PLDF (Δ: -0.3°, P = 0.634) or TLIF (Δ: -1.6°, P = 0.087). Segmental lordosis significantly increased from the preoperative to post-instrumentation intraoperative radiographs for PLDF (Δ: 2.7°, P < 0.001) and TLIF (Δ: 1.8°, P < 0.001), but it subsequently decreased at the final follow up for PLDF (Δ: -1.9°, P < 0.001) and TLIF (Δ: -2.3°, P < 0.001). CONCLUSIONS Subtle decreases in lumbar lordosis may be noticed in early postoperative radiographs compared with intraoperative images on Jackson operative tables. However, these changes are not present at 1-year follow-up as lumbar lordosis increases to a similar level as intraoperative fixation.
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Affiliation(s)
- Nicholas Siegel
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Parker L Brush
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian Karamian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Yunsoo Lee
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Michael Depalma
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Bela Delvadia
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Steven Song
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory R Toci
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Barrett I Woods
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - I David Kaye
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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18
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Tanaka M, Sonawane S, Meena U, Lu Z, Fujiwara Y, Taoka T, Uotani K, Oda Y, Sakaguchi T, Arataki S. Comparison of C-Arm-Free Oblique Lumbar Interbody Fusion L5-S1 (OLIF51) with Transforaminal Lumbar Interbody Fusion L5-S1 (TLIF51) for Adult Spinal Deformity. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050838. [PMID: 37241070 DOI: 10.3390/medicina59050838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Adult spinal deformity (ASD) surgery, L5-S1 lordosis is very important factor. The main objective of the research is to retrospectively compare symptomatic presentation and radiological presentation in the sequelae of oblique lumbar inter-body spinal fusion at L5-S1 (OLIF51) and transforaminal lumbar interbody fusion (TLIF) for ASD. Materials and Methods: We retrospectively evaluated 54 patients who underwent corrective spinal fusion for ASD between October 2019 and January 2021. Thirteen patients underwent OLIF51 (average 74.6 years old, group O) and 41 patients underwent TLIF51 (average 70.5 years old, group T). Mean follow-up period was 23.9 months for group O and 28.9 months for group T, ranging from 12 to 43 months. Clinical and radiographic outcomes are assessed using values including visual analogue scale (VAS) for back pain and Oswestry disability index (ODI). Radiographic evaluation was also collected preoperatively and at 6, 12, and 24 months postoperatively. Results: Surgical time in group O was less than that in group T (356 min vs. 492 min, p = 0.003). However, intraoperative blood loss of both groups were not significantly different (1016 mL vs. 1252 mL, p = 0.274). Changes in VAS and ODI were similar in both groups. L5-S1 angle gain and L5-S1 height gain in group O were significantly better than those of group T (9.4° vs. 1.6°, p = 0.0001, 4.2 mm vs. 0.8 mm, p = 0.0002). Conclusions: Clinical outcomes were not significantly different in both groups, but surgical time in OLIF51 was significantly less than that in TLIF51. The radiographic outcomes showed that OLIF51 created more L5-S1 lordosis and L5-S1 disc height compared with TLIF 51.
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Affiliation(s)
- Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Sumeet Sonawane
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Umesh Meena
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Zhichao Lu
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Yoshihiro Fujiwara
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Takuya Taoka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Yoshiaki Oda
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Tomoyoshi Sakaguchi
- Department of Rehabilitation, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Shinya Arataki
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
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Mikula AL, Lakomkin N, Pennington Z, Nassr A, Freedman B, Sebastian AS, Bydon M, Elder BD, Fogelson JL. Lumbar Lordosis Correction With Transforaminal Lumbar Interbody Fusion in Adult Spinal Deformity Patients with Minimum 2-Year Follow-up. World Neurosurg 2022; 167:e295-e302. [PMID: 35953034 DOI: 10.1016/j.wneu.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the degree of lumbar lordosis (LL) correction possible via transforaminal lumbar interbody fusion (TLIF) in adult spinal deformity patients. METHODS A retrospective chart review identified patients ≥18 years of age with severe positive sagittal balance defined by the SRS-Schwab classification: pelvic incidence to LL mismatch >20°, sagittal vertical axis >9.5cm, and/or pelvic tilt >30°. All patients had surgery between 2013 to 2018 with a TLIF at L4-L5 and/or L5-S1 by the senior author (J.L.F.) with ≥2-years follow-up. RESULTS Sixty-one patients (18 men, 43 women) with 85 TLIFs were included with an average age of 66 years and average follow-up of 50 months. Average lumbar lordosis (L1-S1) improved from 27° preoperative to 48° postoperative and 45° at 2-year follow-up (P < 0.001). Average segmental lordosis at L4-L5 TLIF sites improved from 3° preoperative to 13° postoperative and persisted at 2-year follow-up (P < 0.001). Segmental lordosis at L5-S1 TLIF sites improved from 7° preoperative to 21° postoperative and 20° at 2-year follow-up (P < 0.001). Seventeen of the TLIFs (20%) had >20° of segmental lordosis improvement at long-term follow-up. The rate of revision surgery for pseudoarthrosis at the TLIF level was 5%. CONCLUSIONS Significant lordosis correction can be achieved through an open TLIF in patients with severe positive sagittal balance when utilizing meticulous deformity correction techniques, avoiding the added morbidity of an anterior approach or a 3-column osteotomy.
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Affiliation(s)
- Anthony L Mikula
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Nikita Lakomkin
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zach Pennington
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arjun S Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy L Fogelson
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Kieffer WKM, Don A, Field A, Robertson PA. Lordosis loss in degenerative spinal conditions. Spine Deform 2022; 10:1407-1414. [PMID: 35794423 DOI: 10.1007/s43390-022-00533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To establish whether common degenerative lumbar spine conditions have a predictable sagittal profile and associated range of lordosis. The spinopelvic balance of a normal population and normal ranges are well described in the literature. There is also evidence that certain degenerative conditions can lead to a preponderance of loss of lordosis at specific spinal levels. There is limited literature on the range and magnitude of loss of lordosis for known degenerative lumbar spine pathologies. METHODS A retrospective analysis of prospectively obtained radiographs from a dual surgeon database was performed and imaging analysed for spinopelvic parameters. Degenerative conditions studied were; Lumbar degenerative spondylolisthesis (L3/4 and L4/5 analysed separately), L5/S1 degenerative disc disease, L5/S1 isthmic spondylolisthesis. Pelvic incidence, sacral slope, pelvic tilt, segmental and global lumbar lordosis, vertebral lordosis and lumbar vertical axis were measured. RESULTS The range of change in segmental lordosis was normally distributed for all studied degenerative spinal conditions except L5/S1 isthmic spondylolisthesis. L5/S1 degenerative disc disease affected younger adults (mean age 37), whilst degenerative spondylolisthesis at L3/4 and L4/5 affected older adults (mean ages 69.5 and 68.9 respectively). Removing an outlying high-grade L5/S1 isthmic spondylolisthesis made the data distribution approach a normal distribution. CONCLUSION Most degenerative spinal pathologies cause a normally distributed spectrum of deformity which should be addressed and corrected with a tailored, individualised surgical plan for each patient. Universal treatment recommendations should be interpreted with caution.
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Affiliation(s)
- Will K M Kieffer
- Surrey and Sussex Healthcare NHS Trust, Canada Avenue, Redhill, RH1 5RH, Surrey, UK.
| | - Angus Don
- Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Antony Field
- Auckland City Hospital and Starship Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Peter A Robertson
- Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand
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21
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Failure in Adult Spinal Deformity Surgery: A Comprehensive Review of Current Rates, Mechanisms, and Prevention Strategies. Spine (Phila Pa 1976) 2022; 47:1337-1350. [PMID: 36094109 DOI: 10.1097/brs.0000000000004435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/22/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Literature review. OBJECTIVE The aim of this review is to summarize recent literature on adult spinal deformity (ASD) treatment failure as well as prevention strategies for these failure modes. SUMMARY OF BACKGROUND DATA There is substantial evidence that ASD surgery can provide significant clinical benefits to patients. The volume of ASD surgery is increasing, and significantly more complex procedures are being performed, especially in the aging population with multiple comorbidities. Although there is potential for significant improvements in pain and disability with ASD surgery, these procedures continue to be associated with major complications and even outright failure. METHODS A systematic search of the PubMed database was performed for articles relevant to failure after ASD surgery. Institutional review board approval was not needed. RESULTS Failure and the potential need for revision surgery generally fall into 1 of 4 well-defined phenotypes: clinical failure, radiographic failure, the need for reoperation, and lack of cost-effectiveness. Revision surgery rates remain relatively high, challenging the overall cost-effectiveness of these procedures. CONCLUSION By consolidating the key evidence regarding failure, further research and innovation may be stimulated with the goal of significantly improving the safety and cost-effectiveness of ASD surgery.
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22
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Tsutsui S, Yamamoto E, Kozaki T, Murata A, Yamada H. Biomechanical study of rod stress in lumbopelvic fixation with lateral interbody fusion: an in vitro experimental study using synthetic bone models. J Neurosurg Spine 2022; 37:73-79. [PMID: 35171839 DOI: 10.3171/2021.11.spine21807] [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: 06/10/2021] [Accepted: 11/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite improvements in surgical techniques and instruments, high rates of rod fracture following a long spinal fusion in the treatment of adult spinal deformity (ASD) remain a concern. Thus, an improved understanding of rod fracture may be valuable for better surgical planning. The authors aimed to investigate mechanical stress on posterior rods in lumbopelvic fixation for the treatment of ASD. METHODS Synthetic lumbopelvic bone models were instrumented with intervertebral cages, pedicle screws, S2-alar-iliac screws, and rods. The construct was then placed in a testing device, and compressive loads were applied. Subsequently, the strain on the rods was measured using strain gauges on the dorsal aspect of each rod. RESULTS When the models were instrumented using titanium alloy rods at 30° lumbar lordosis and with lateral interbody fusion cages, posterior rod strain was highest at the lowest segment (L5-S1) and significantly higher than that at the upper segment (L2-3) (p = 0.002). Changing the rod contour from 30° to 50° caused a 36% increase in strain at L5-S1 (p = 0.009). Changing the rod material from titanium alloy to cobalt-chromium caused a 140% increase in strain at L2-3 (p = 0.009) and a 28% decrease in strain at L5-S1 (p = 0.016). The rod strain at L5-S1 using a flat bender for contouring was 23% less than that obtained using a French bender (p = 0.016). CONCLUSIONS In lumbopelvic fixation in which currently available surgical techniques for ASD are used, the posterior rod strain was highest at the lumbosacral junction, and depended on the contour and material of the rods.
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Affiliation(s)
- Shunji Tsutsui
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
| | - Ei Yamamoto
- 2Department of Biomedical Engineering, Faculty of Biology-Oriented Science and Technology, Kindai University, Wakayama, Japan
| | - Takuhei Kozaki
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
| | - Akimasa Murata
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
| | - Hiroshi Yamada
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
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23
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Wu MH, Lee MH, Wu C, Tsai PI, Hsu WB, Huang SI, Lin TH, Yang KY, Chen CY, Chen SH, Lee CY, Huang TJ, Tsau FH, Li YY. In Vitro and In Vivo Comparison of Bone Growth Characteristics in Additive-Manufactured Porous Titanium, Nonporous Titanium, and Porous Tantalum Interbody Cages. MATERIALS 2022; 15:ma15103670. [PMID: 35629694 PMCID: PMC9147460 DOI: 10.3390/ma15103670] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023]
Abstract
Autogenous bone grafts are the gold standard for interbody fusion implant materials; however, they have several disadvantages. Tantalum (Ta) and titanium (Ti) are ideal materials for interbody cages because of their biocompatibility, particularly when they are incorporated into a three-dimensional (3D) porous structure. We conducted an in vitro investigation of the cell attachment and osteogenic markers of self-fabricated uniform porous Ti (20%, 40%, 60%, and 80%), nonporous Ti, and porous Ta cages (n = 6) in each group. Cell attachment, osteogenic markers, and alkaline phosphatase (ALP) were measured. An in vivo study was performed using a pig-posterior-instrumented anterior interbody fusion model to compare the porous Ti (60%), nonporous Ti, and porous Ta interbody cages in 12 pigs. Implant migration and subsidence, determined using plain radiographs, were recorded before surgery, immediately after surgery, and at 1, 3, and 6 months after surgery. Harvested implants were assessed for bone ingrowth and attachment. Relative to the 20% and 40% porous Ti cages, the 60% and 80% cages achieved superior cellular migration into cage pores. Among the cages, osteogenic marker and ALP activity levels were the highest in the 60% porous Ti cage, osteocalcin expression was the highest in the nonporous Ti cage, and the 60% porous Ti cage exhibited the lowest subsidence. In conclusion, the designed porous Ti cage is biocompatible and suitable for lumbar interbody fusion surgery and exhibits faster fusion with less subsidence compared with porous Ta and nonporous Ti cages.
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Affiliation(s)
- Meng-Huang Wu
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan; (M.-H.W.); (C.-Y.C.); (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110301, Taiwan
- TMU Biodesign Center, Taipei Medical University, Taipei 110301, Taiwan
| | - Ming-Hsueh Lee
- Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan;
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi 613016, Taiwan
| | - Christopher Wu
- College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Pei-I Tsai
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu County 310401, Taiwan; (P.-I.T.); (S.-I.H.); (K.-Y.Y.)
| | - Wei-Bin Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan;
| | - Shin-I Huang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu County 310401, Taiwan; (P.-I.T.); (S.-I.H.); (K.-Y.Y.)
| | - Tzu-Hung Lin
- Material and Chemical Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu County 310401, Taiwan;
| | - Kuo-Yi Yang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu County 310401, Taiwan; (P.-I.T.); (S.-I.H.); (K.-Y.Y.)
| | - Chih-Yu Chen
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan; (M.-H.W.); (C.-Y.C.); (C.-Y.L.); (T.-J.H.)
- TMU Biodesign Center, Taipei Medical University, Taipei 110301, Taiwan
- Department of Orthopedics, Shuang-Ho Hospital, Taipei Medical University, Taipei 235041, Taiwan
| | - Shih-Hao Chen
- Department of Orthopedic Surgery, Buddhist Tzu-Chi General Hospital, Taichung Branch, Taichung 427213, Taiwan;
- Department of Orthopedic Surgery, Tzu-Chi University, Hualien 970374, Taiwan
| | - Ching-Yu Lee
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan; (M.-H.W.); (C.-Y.C.); (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan; (M.-H.W.); (C.-Y.C.); (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Fang-Hei Tsau
- Laser and Additive Manufacturing Technology Center, Southern Region Campus, Industrial Technology Research Institute, Tainan 734045, Taiwan;
| | - Yen-Yao Li
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
- Correspondence: ; Tel.: +88653621000 (ext. 2855)
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Park SJ, Park JS, Lee CS, Lee KH. Metal failure and nonunion at L5-S1 after long instrumented fusion distal to pelvis for adult spinal deformity: Anterior versus transforaminal interbody fusion. J Orthop Surg (Hong Kong) 2022; 29:23094990211054223. [PMID: 34874195 DOI: 10.1177/23094990211054223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Pseudoarthrosis and metal failure at L5-S1 following long fusion surgery for adult spinal deformity (ASD) remain major issues. Few studies report on which anterior column support technique is better in terms of achieving fusion and avoiding metal failures. Our study aimed to evaluate the fusion status and metal failure rate at L5-S1 after anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF). METHODS The study population included patients aged >50 years who underwent surgery for ASD. Anterior column supports at L5-S1 using ALIF and TLIF were compared with ≥ 2-year follow-up. Fusion status on 2-year computed tomography (CT) scan, metal failure, visual analog scale (VAS), and Oswestry disability index (ODI) were evaluated. RESULTS 98 patients were included in this study (53 ALIF group and 45 TLIF group). We achieved solid fusion on 2-year CT scans in 88.9% and 69.8% patients in the TLIF and ALIF group, respectively. Metal failure developed in nine (17.0%) and six (13.3%) patients in the ALIF and TLIF group, respectively. The most common failure type was unilateral L5-S1 rod fracture (7 and five patients in the ALIF and TLIF group, respectively). Only one patient with bilateral rod fractures in the ALIF group required revision surgery. There were no differences in the VAS and ODI scores at the last follow-up. CONCLUSIONS TLIF showed a better fusion rate than ALIF at L5-S1 after long instrumented fusion for ASD. However, the capacity to restore sagittal parameters was greater in the ALIF group. There were no differences between the groups regarding metal failure rate, revision surgery, or clinical outcomes.
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Affiliation(s)
- Se-Jun Park
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, 36626Samsung Medical Center, Seoul, Republic of Korea
| | - Jin-Sung Park
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, 36626Samsung Medical Center, Seoul, Republic of Korea
| | - Chong-Suh Lee
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, 36626Samsung Medical Center, Seoul, Republic of Korea
| | - Keun-Ho Lee
- Department of Orthopedic Surgery, Hallym University, 37993Kangdong Sacred Heart Hospital, Seoul, Korea
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25
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Mills ES, Treloar J, Idowu O, Shelby T, Alluri RK, Hah RJ. Single position lumbar fusion: a systematic review and meta-analysis. Spine J 2022; 22:429-443. [PMID: 34699998 DOI: 10.1016/j.spinee.2021.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/19/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Recently, a single position lumbar fusion has been described in which both the anterior or lateral interbody fusion as well as posterior percutaneous pedicle screw fixation are performed in a single position. PURPOSE The purpose of this study was to present and analyze the current evidence for single position lumbar fusion. STUDY DESIGN/SETTING This is a systematic review and meta-analysis. PATIENT SAMPLE Prospective or retrospective studies published in English that assessed outcomes of single position lumbar fusion surgery for patients with lumbar degenerative disease, spondylolisthesis, or radiculopathy were included. OUTCOME MEASURES Outcome measures included operative time, estimated blood loss, hospital length of stay, X-Ray exposure time, and postoperative outcomes including leg numbness or pain, leg weakness, lumbar lordosis, and segmental lordosis. METHODS This systematic review was performed in accordance with PRISMA guidelines. Two separate meta-analyses were performed. The first compared single position (SP) surgery, both lateral and prone, to dual position or flipped (F) surgery. The second meta-analysis compared lateral single position (LSP) surgery to prone single position (PSP) surgery. Variables were included if (1) they were a mean with a reported standard deviation or (2) if they were a categorical variable. For calculating standard error of the mean, we used sample size, mean, and standard deviation. A random effects model was used. The heterogeneity among studies was assessed with a significance level of <0.05. RESULTS Twenty-one articles were included for analysis. Three studies were prospective nonrandomized studies, while 18 were retrospective. Seven articles studied lateral single position only, 10 articles compared lateral single position to traditional repositioning surgery, three articles studied prone single position surgery, and one article compared prone single position surgery to traditional repositioning surgery. A detailed review is provided for all 21 articles. Seventeen studies were included for meta-analysis comparing the SP versus F groups, for a total of 942 patients in the SP group and 254 in the F group. Mean operative time was significantly less for the SP group compared with the F group (SP: 127.5±7.9, F: 188.7±15.5, p<.001). Average hospital length of stay was 2.87±0.3 days in the SP group and 6.63±0.6 days in the F group (p<.001). Complication rates did not significantly differ between groups. Pedicle screws placed in the lateral position had a higher rate of complication as compared with those placed in a prone position (L: 10.2±2%, P: 1.6±1%, p=.015). Seventeen studies were included in the LSP versus PSP analysis, including 13 in the LSP group and four in the PSP group, with a total of 785 patients in the LSP group and 85 patients in the PSP group. Operative time and X-Ray exposure was significantly less in the LSP compared with the PSP group (117.1±5.5 minutes vs. 166.9±21.9 minutes, p<.001; 43.7±15.5 minutes vs. 171.0±25.8 minutes, p<.001). Postoperative segmental lordosis was greater in the prone single position group (p<.001). CONCLUSIONS Single position surgery decreases operative times and hospital length of stay, while maintaining similar complication rates and radiographic outcomes. PSP surgery was found to be longer in duration and have increased radiation exposure time compared with LSP, while increasing postoperative segmental lordosis.
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Affiliation(s)
- Emily S Mills
- Keck School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.
| | - Joshua Treloar
- Keck School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Olumuyiwa Idowu
- Keck School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Tara Shelby
- Keck School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ram K Alluri
- Keck School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Raymond J Hah
- Keck School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
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Revision Surgery for Adjacent Segment Degeneration After Fusion for Lumbar Spondylolisthesis: Is there a Correlation with Roussouly Type? Spine (Phila Pa 1976) 2022; 47:E10-E15. [PMID: 32991517 DOI: 10.1097/brs.0000000000003708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of this study was to investigate whether there is an association between revision surgery rates for adjacent segment degeneration (ASD) and Roussouly type after L4-5 transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis. SUMMARY OF BACKGROUND DATA Revision surgery for ASD is known to occur after spinal fusion; however, it is unclear whether rates of ASD are associated with certain Roussouly types. METHODS Patients who underwent L4-5 TLIF for spondylolisthesis at the University of California San Francisco from January 2006 to December 2016 with minimum 2-year follow-up were retrospectively analyzed by Roussouly type. Revision surgery for ASD was noted and correlated by Roussouly type. Spinopelvic parameters were also measured for correlation. A value of P < 0.05 was significant. RESULTS There were 174 patients who met inclusion criteria, (59 males and 115 females). The average age was 62.3 (25-80) years. A total of 132 patients had grade I spondylolisthesis, and 42 had grade II. Mean follow-up was 45.2 months (24-497). A total of 22 patients (12.6%) underwent revision surgery for ASD after L4-5 TLIF. When classified by Roussouly type, revision surgery rates for ASD were: 1, 14.3%; 2, 22.6%; 3, 4.9%; and 4, 15.6% (P = 0.013). Type 3 spines with normal PI-LL (8.85° ± 6.83°) had the lowest revision surgery rate (4.9%), and type 2 spines with PI-LL mismatch (11.06° ± 8.81°) had the highest revision surgery rate (22.6%), a four-fold difference (P = 0.013). The PI-LL mismatch did not change significantly in each type postoperatively (P > 0.05). CONCLUSION We found that there may be a correlation between Roussouly type and revision surgery for ASD after L4-5 TLIF for spondylolisthesis, with type 2 spines having the highest rate. Spinopelvic parameters may also correlate with revision surgery for ASD after L4-5 TLIF.Level of Evidence: 4.
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Comparison of Incidence of Adjacent Segment Pathology between Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion Treatments for Lumbosacral Junction. Tomography 2021; 7:855-865. [PMID: 34941644 PMCID: PMC8708785 DOI: 10.3390/tomography7040072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
This research compared the incidence of adjacent segment pathology (ASP) between anterior interbody lumbar fusion (ALIF) treatment and transforaminal lumbar interbody fusion (TLIF) treatment. Seventy patients were included in this retrospective study: 30 patients received ALIF treatment, and 40 patients received TLIF treatment at a single medical center between 2011 and 2020 with a follow-up of at least 12 months. The outcomes were radiographic adjacent segment pathology (RASP) and clinical adjacent segment pathology (CASP). The mean follow-up period was 42.10 ± 22.61 months in the ALIF group and 56.20 ± 29.91 months in the TLIF group. Following single-level lumbosacral fusion, ALIF is superior to TLIF in maintaining lumbar lordosis, whereas the risk of adjacent instability in the ALIF group is significantly higher. Regarding ASP, the incidence of overall RASP and CASP did not differ significantly between ALIF and TLIF groups.
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28
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Buell TJ, Shaffrey CI, Bess S, Kim HJ, Klineberg EO, Lafage V, Lafage R, Protopsaltis TS, Passias PG, Mundis GM, Eastlack RK, Deviren V, Kelly MP, Daniels AH, Gum JL, Soroceanu A, Hamilton DK, Gupta MC, Burton DC, Hostin RA, Kebaish KM, Hart RA, Schwab FJ, Ames CP, Smith JS. Multicenter assessment of outcomes and complications associated with transforaminal versus anterior lumbar interbody fusion for fractional curve correction. J Neurosurg Spine 2021; 35:729-742. [PMID: 34416723 DOI: 10.3171/2020.11.spine201915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few studies have compared fractional curve correction after long fusion between transforaminal lumbar interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) for adult symptomatic thoracolumbar/lumbar scoliosis (ASLS). The objective of this study was to compare fractional correction, health-related quality of life (HRQL), and complications associated with L4-S1 TLIF versus those of ALIF as an operative treatment of ASLS. METHODS The authors retrospectively analyzed a prospective multicenter adult spinal deformity database. Inclusion required a fractional curve ≥ 10°, a thoracolumbar/lumbar curve ≥ 30°, index TLIF or ALIF performed at L4-5 and/or L5-S1, and a minimum 2-year follow-up. TLIF and ALIF patients were propensity matched according to the number and type of interbody fusion at L4-S1. RESULTS Of 135 potentially eligible consecutive patients, 106 (78.5%) achieved the minimum 2-year follow-up (mean ± SD age 60.6 ± 9.3 years, 85% women, 44.3% underwent TLIF, and 55.7% underwent ALIF). Index operations had mean ± SD 12.2 ± 3.6 posterior levels, 86.6% of patients underwent iliac fixation, 67.0% underwent TLIF/ALIF at L4-5, and 84.0% underwent TLIF/ALIF at L5-S1. Compared with TLIF patients, ALIF patients had greater cage height (10.9 ± 2.1 mm for TLIF patients vs 14.5 ± 3.0 mm for ALIF patients, p = 0.001) and lordosis (6.3° ± 1.6° for TLIF patients vs 17.0° ± 9.9° for ALIF patients, p = 0.001) and longer operative duration (6.7 ± 1.5 hours for TLIF patients vs 8.9 ± 2.5 hours for ALIF patients, p < 0.001). In all patients, final alignment improved significantly in terms of the fractional curve (20.2° ± 7.0° to 6.9° ± 5.2°), maximum coronal Cobb angle (55.0° ± 14.8° to 23.9° ± 14.3°), C7 sagittal vertical axis (5.1 ± 6.2 cm to 2.3 ± 5.4 cm), pelvic tilt (24.6° ± 8.1° to 22.7° ± 9.5°), and lumbar lordosis (32.3° ± 18.8° to 51.4° ± 14.1°) (all p < 0.05). Matched analysis demonstrated comparable fractional correction (-13.6° ± 6.7° for TLIF patients vs -13.6° ± 8.1° for ALIF patients, p = 0.982). In all patients, final HRQL improved significantly in terms of Oswestry Disability Index (ODI) score (42.4 ± 16.3 to 24.2 ± 19.9), physical component summary (PCS) score of the 36-item Short-Form Health Survey (32.6 ± 9.3 to 41.3 ± 11.7), and Scoliosis Research Society-22r score (2.9 ± 0.6 to 3.7 ± 0.7) (all p < 0.05). Matched analysis demonstrated worse ODI (30.9 ± 21.1 for TLIF patients vs 17.9 ± 17.1 for ALIF patients, p = 0.017) and PCS (38.3 ± 12.0 for TLIF patients vs 45.3 ± 10.1 for ALIF patients, p = 0.020) scores for TLIF patients at the last follow-up (despite no differences in these parameters at baseline). The rates of total complications were similar (76.6% for TLIF patients vs 71.2% for ALIF patients, p = 0.530), but significantly more TLIF patients had rod fracture (28.6% of TLIF patients vs 7.1% of ALIF patients, p = 0.036). Multiple regression analysis demonstrated that a 1-mm increase in L4-5 TLIF cage height led to a 2.2° reduction in L4 coronal tilt (p = 0.011), and a 1° increase in L5-S1 ALIF cage lordosis led to a 0.4° increase in L5-S1 segmental lordosis (p = 0.045). CONCLUSIONS Operative treatment of ASLS with L4-S1 TLIF versus ALIF demonstrated comparable mean fractional curve correction (66.7% vs 64.8%), despite use of significantly larger, more lordotic ALIF cages. TLIF cage height had a significant impact on leveling L4 coronal tilt, whereas ALIF cage lordosis had a significant impact on restoration of lumbosacral lordosis. The advantages of TLIF may include reduced operative duration and hospitalization; however, associated HRQL was inferior and more rod fractures were detected in the TLIF patients included in this study.
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Affiliation(s)
- Thomas J Buell
- 1Department of Orthopaedic & Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Christopher I Shaffrey
- 1Department of Orthopaedic & Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Shay Bess
- 2Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado
| | - Han Jo Kim
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eric O Klineberg
- 4Department of Orthopaedic Surgery, University of California, Davis, California
| | - Virginie Lafage
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Peter G Passias
- 5Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Gregory M Mundis
- 6Scripps Clinic and San Diego Center for Spinal Disorders, La Jolla, California
| | - Robert K Eastlack
- 6Scripps Clinic and San Diego Center for Spinal Disorders, La Jolla, California
| | | | - Michael P Kelly
- 8Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Alan H Daniels
- 9Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island
| | - Jeffrey L Gum
- 10Department of Orthopaedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky
| | - Alex Soroceanu
- 11Department of Orthopaedic Surgery, University of Calgary, Alberta, Canada
| | - D Kojo Hamilton
- 12Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Munish C Gupta
- 8Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Douglas C Burton
- 13Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Richard A Hostin
- 14Department of Orthopaedic Surgery, Southwest Scoliosis Institute, Baylor Scott and White Medical Center, Plano, Texas
| | - Khaled M Kebaish
- 15Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Robert A Hart
- 16Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington; and
| | - Frank J Schwab
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Christopher P Ames
- 17Neurological Surgery, University of California, San Francisco, California
| | - Justin S Smith
- 18Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Liu J, Duan P, Mummaneni PV, Xie R, Li B, Dong Y, Berven S, Chou D. Does transforaminal lumbar interbody fusion induce lordosis or kyphosis? Radiographic evaluation with a minimum 2-year follow-up. J Neurosurg Spine 2021; 35:419-426. [PMID: 34243159 DOI: 10.3171/2020.12.spine201665] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Conflicting reports exist about whether transforaminal lumbar interbody fusion (TLIF) induces lordosis or kyphosis, ranging from decreasing lordosis by 3.71° to increasing it by 18.8°. In this study, the authors' aim was to identify factors that result in kyphosis or lordosis after TLIF. METHODS A single-center, retrospective study of open TLIF without osteotomy for spondylolisthesis with a minimum 2-year follow-up was undertaken. Preoperative and postoperative clinical and radiographic parameters and cage specifics were collected. TLIFs were considered to be "lordosing" if postoperative induction of lordosis was > 0° and "kyphosing" if postoperative induction of lordosis was ≤ 0°. RESULTS A total of 137 patients with an average follow-up of 52.5 months (range 24-130 months) were included. The overall postoperative disc angle (DA) and segmental lordosis (SL) increased by 1.96° and 1.88° (p = 0.003 and p = 0.038), respectively, whereas overall lumbar lordosis remained unchanged (p = 0.133). Seventy-nine patients had lordosing TLIFs with a mean SL increase of 5.72° ± 3.97°, and 58 patients had kyphosing TLIFs with a mean decrease of 3.02° ± 2.98°. Multivariate analysis showed that a lower preoperative DA, lower preoperative SL, and anterior cage placement were correlated with the greatest increase in postoperative SL (p = 0.040, p < 0.001, and p = 0.035, respectively). There was no difference in demographics, cage type or height, or spinopelvic parameters between the groups (p > 0.05). Linear regression showed that the preoperative DA and SL correlated with SL after TLIF (R2 = 0.198, p < 0.001; and R2 = 0.2931, p < 0.001, respectively). CONCLUSIONS Whether a TLIF induces kyphosis or lordosis depends on the preoperative DA, preoperative SL, and cage position. Less-lordotic segments became more lordotic postoperatively, and highly lordotic segments may lose lordosis after TLIF. Cages placed more anteriorly were associated with more lordosis.
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Affiliation(s)
- Jinping Liu
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
- 2Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Pingguo Duan
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Rong Xie
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Bo Li
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Yinhui Dong
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Sigurd Berven
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
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Dinizo M, Srisanguan K, Dolgalev I, Errico TJ, Raman T. Pseudarthrosis and Rod Fracture Rates After Transforaminal Lumbar Interbody Fusion at the Caudal Levels of Long Constructs for Adult Spinal Deformity Surgery. World Neurosurg 2021; 155:e605-e611. [PMID: 34474159 DOI: 10.1016/j.wneu.2021.08.099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Interbody fusion at the caudal levels of long constructs for adult spinal deformity (ASD) surgery is used to promote fusion and secure a solid foundation for maintenance of deformity correction. We sought to evaluate long-term pseudarthrosis, rod fracture, and revision rates for TLIF performed at the base of a long construct for ASD. METHODS We reviewed 316 patients who underwent TLIF as a component of ASD surgery for medical comorbidities, surgical characteristics, and rate of unplanned reoperation for pseudarthrosis or instrumentation failure at the TLIF level. Fusion grading was assessed after revision surgery for pseudarthrosis at the TLIF level. RESULTS Rate of pseudarthrosis at the TLIF level was 9.8% (31/316), and rate of rod fractures was 7.9% (25/316). The rate of revision surgery at the TLIF level was 8.9% (28/316), and surgery was performed at a mean of 20.4 ± 16 months from the index procedure. Current smoking status (odds ratio 3.34, P = 0.037) was predictive of pseudarthrosis at the TLIF site. At a mean follow-up of 43 ± 12 months after revision surgery, all patients had achieved bony union at the TLIF site. CONCLUSIONS At 3-year follow-up, the rate of pseudarthrosis after TLIF performed at the base of a long fusion for ASD was 9.8%, and the rate of revision surgery to address pseudarthrosis and/or rod fracture was 8.9%. All patients were successfully treated with revision interbody fusion or posterior augmentation of the fusion mass, without need for further revision procedures at the TLIF level.
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Affiliation(s)
- Michael Dinizo
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Karnmanee Srisanguan
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Igor Dolgalev
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Thomas J Errico
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Tina Raman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA.
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Improvement of coronal alignment in fractional low lumbar curves with the use of anterior interbody devices. Spine Deform 2021; 9:1443-1447. [PMID: 33740230 DOI: 10.1007/s43390-021-00328-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES To determine if the addition of an anterior lumbar interbody fusion (ALIF) improves the fractional curve in adult spinal deformity correction when compared to posterior surgery alone. ALIF is commonly advocated to improve lordosis and fusion in adult deformity surgery. Improved fractional curve correction may help level the pelvis and minimize proximal malalignment. METHODS Patients undergoing thoracolumbar fusion to the pelvis with S2AI screws for deformity were identified and stratified into patients who had an ALIF as part of their deformity correction procedure (ALIF + PSF), and those who had a posterior approach alone. The posterior approach (PSF) includes patients who had a posterolateral fusion with or without a transforaminal lumbar interbody fusion (TLIF). Radiographic parameters measured included pre-op and post-op fractional coronal curve Cobb angle, lumbar lordosis, pelvic tilt, pelvic incidence and sacral slope, major Cobb angle, coronal and sagittal SVA. RESULTS There were 31 cases in the ALIF + PSF group and 28 in the PSF group. Baseline demographic characteristics of the two groups were similar. Mean pre-op fractional coronal Cobb (18.3° vs 13.4°, p = 0.027) was larger in the ALIF + PSF group, whereas lumbar lordosis (31.0° vs 33.6°, p = 0.487) and pelvic parameters were similar between the two groups. Post-op lumbar lordosis was similar (48.2° vs 43.0°, p = 0.092). Greater fractional coronal curve correction was achieved in the ALIF + PSF group (67%) compared to the PSF group (36%) with a smaller post-op fractional coronal curve in the ALIF + PSF group (6.1°) compared to the PSF group (8.6°, p = 0.053). CONCLUSION There is a greater correction of the fractional curve in the ALIF + PSF group compared with the PSF group. While this may not be the primary indication for ALIF, it is a benefit which may facilitate overall deformity correction and leveling of the pelvis.
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Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To determine if the addition of L5-S1 interbody support in long fusion deformity constructs is associated with superior long-term clinical and radiographic outcomes. To compare the 5-year clinical and radiographic outcomes and complications between long fusion constructs with L5-S1 interbody support versus posterolateral fusion (PLF) alone. SUMMARY OF BACKGROUND DATA Cadaveric biomechanical studies have suggested that an interbody fusion at L5-S1 is beneficial in long fusion constructs with sacropelvic fixation. However, there is limited data reflecting the superiority of interbody support augmentation in optimizing arthrodesis and deformity correction relative to PLF alone. METHODS Eighty-eight consecutive adults with spinal deformity who underwent at minimum T11-pelvis posterior pedicle screw instrumentation with 5-year follow-up were included. Two cohorts were compared based on technique used at the lumbosacral junction (L5-S1): (A) no interbody (PLF; n = 23), or (B) interbody support at L5-S1 (IB; n = 65). Radiographic measurements and clinical outcome measures were compared at multiple time points. Complications were recorded and compared. RESULTS No differences in baseline patient characteristics between cohorts. One nonunion occurred at L5-S1 in the PLF group (P = 0.091). Initial postop sagittal alignment was better in the IB group (PLF: 6.46 cm, IB: 2.48 cm, P = 0.007); however, this was not maintained over long-term follow-up. No significant differences in proximal junctional kyphosis (PLF: 7/23, IB: 9/65, P = 0.076). Proximal junctional failure was more frequent in the PLF group (PLF: 6/23, IB: 6/65, P = 0.043). No significant differences in complications were found. Both cohorts had improvement from baseline pain and functional scores. CONCLUSION There is no absolute long-term advantage for lumbar interbody support in adult spinal deformity patients undergoing spinal arthrodesis to the pelvis.Level of Evidence: 3.
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Le H, Anderson R, Phan E, Wick J, Barber J, Roberto R, Klineberg E, Javidan Y. Clinical and Radiographic Comparison Between Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion With Bilateral Facetectomies. Global Spine J 2021; 11:903-910. [PMID: 32677520 PMCID: PMC8258811 DOI: 10.1177/2192568220932879] [Citation(s) in RCA: 12] [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] [Indexed: 12/27/2022] Open
Abstract
STUDY DESIGN Age- and sex-matched cohort study. OBJECTIVES To compare outcomes after open versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with bilateral facetectomies. METHODS We retrospectively compared patients who underwent single- or 2-level MIS-TLIF with an age- and sex-matched open-TLIF cohort. Surgical data was collected for operative time, estimated blood loss (EBL), and drain use. Clinical outcomes included the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), length of stay (LOS), complications, and reoperations. Lumbar radiographs were measured for changes in global lumbar lordosis (LL) and segmental lordosis (SL). RESULTS Between 2016 and 2020, 38 MIS-TLIF patients were compared with 38 open-TLIF patients. No subfascial drain was used in the MIS-TLIF group (P < .001). The MIS-TLIF group had longer operative time (310.8 vs 276.5 minutes; P = .046) but less EBL (282.4 vs 420.8 mL; P = .007). LOS (P = .15), complication rates (P = .50), and revision rates (P = .17) were equivalent. VAS and ODI improved but did not differ between groups. In the open-TLIF group, LL and SL were restored or improved in 81.6% and 86.9% of cases, respectively. In the MIS-TLIF group, LL and SL were restored or improved in 86.8% and 97.4% of cases, respectively. There were no differences in changes in LL and SL between groups. CONCLUSIONS Compared with the age- and sex-matched open-TLIF cohort, patients undergoing MIS-TLIF had reduced EBL and subfascial drain use but increased operative time. There were no differences in complications, reoperations, or LOS. Both groups demonstrated improvement in VAS and ODI. MIS-TLIF with bilateral facetectomies provided equivalent improvements in global and segmental LL.
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Affiliation(s)
- Hai Le
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ryan Anderson
- University of California Davis School of Medicine, Sacramento, CA, USA,Yashar Javidan, Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y St #1700, Sacramento, CA 95817, USA.
| | - Eileen Phan
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Joseph Wick
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Joshua Barber
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Rolando Roberto
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Eric Klineberg
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Yashar Javidan
- University of California Davis School of Medicine, Sacramento, CA, USA
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Moses ZB, Razvi S, Oh SY, Platt A, Keegan KC, Hamati F, Witiw C, David BT, Fontes RBV, Deutsch H, O'Toole JE, Fessler RG. A retrospective comparison of radiographic and clinical outcomes in single-level degenerative lumbar disease undergoing anterior versus transforaminal lumbar interbody fusion. JOURNAL OF SPINE SURGERY 2021; 7:170-180. [PMID: 34296029 DOI: 10.21037/jss-20-673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/29/2021] [Indexed: 11/06/2022]
Abstract
Background Single-level lumbar degenerative disc disease (DDD) remains a significant cause of morbidity in adulthood. Anterior lumbar interbody fusion (ALIF) and Transforaminal lumbar interbody fusion (TLIF) are surgical techniques developed to treat this condition. With limited studies on intermediate term outcomes in a single cohort, we compare radiographic and clinical outcomes in patients undergoing ALIF and TLIF. Methods A retrospective chart review was performed on 164 patients (111 TLIF; 53 ALIF) over a 60-month period. X-ray radiographs obtained pre-operatively, prior to discharge, and at one year were utilized for radiographic assessment. Segmental lordosis, lumbar lordosis and HRQOL scores were measured preoperatively and at one-year timepoints. Results Changes in lumbar lordosis and segmental lordosis were significantly greater after ALIF (4.6° vs. -0.6°, P=0.05; 4.7° vs. -0.7°, P<0.05) at one year (mean time, 366±20 days). At one year or greater, there was a greater reduction in mean VAS-leg score in TLIF patients (3.4 vs. 0.6, P<0.05) and ODI score (16.2 vs. 5.4, P<0.05). Similar outcomes were seen for VAS-back, SF-12 Physical Health, and SRS-30 Function/Activity. SF-12 Mental Health scores were found to be lower in patients undergoing TLIF (-3.5 vs. 2.7, P<0.05). Conclusions ALIF demonstrated a superior method of increasing lumbar and segmental lordosis. TLIF was utilized more in patients with higher pre-operative VAS-leg pain scores and therefore, showed a greater magnitude of VAS-leg pain improvement. TLIF also demonstrated a greater improvement in ODI scores despite similar baseline scores, suggesting a possible enhanced functional outcome.
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Affiliation(s)
- Ziev B Moses
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Sharmeen Razvi
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Seok Yoon Oh
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew Platt
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C Keegan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Fadi Hamati
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher Witiw
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian T David
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Ricardo B V Fontes
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Harel Deutsch
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Mummaneni PV, Hussain I, Shaffrey CI, Eastlack RK, Mundis GM, Uribe JS, Fessler RG, Park P, Robinson L, Rivera J, Chou D, Kanter AS, Okonkwo DO, Nunley PD, Wang MY, Marca FL, Than KD, Fu KM. The minimally invasive interbody selection algorithm for spinal deformity. J Neurosurg Spine 2021; 34:741-748. [PMID: 33711811 DOI: 10.3171/2020.9.spine20230] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive surgery (MIS) for spinal deformity uses interbody techniques for correction, indirect decompression, and arthrodesis. Selection criteria for choosing a particular interbody approach are lacking. The authors created the minimally invasive interbody selection algorithm (MIISA) to provide a framework for rational decision-making in MIS for deformity. METHODS A retrospective data set of circumferential MIS (cMIS) for adult spinal deformity (ASD) collected over a 5-year period was analyzed by level in the lumbar spine to identify surgeon preferences and evaluate segmental lordosis outcomes. These data were used to inform a Delphi session of minimally invasive deformity surgeons from which the algorithm was created. The algorithm leads to 1 of 4 interbody approaches: anterior lumbar interbody fusion (ALIF), anterior column release (ACR), lateral lumbar interbody fusion (LLIF), and transforaminal lumbar interbody fusion (TLIF). Preoperative and 2-year postoperative radiographic parameters and clinical outcomes were compared. RESULTS Eleven surgeons completed 100 cMISs for ASD with 338 interbody devices, with a minimum 2-year follow-up. The type of interbody approach used at each level from L1 to S1 was recorded. The MIISA was then created with substantial agreement. The surgeons generally preferred LLIF for L1-2 (91.7%), L2-3 (85.2%), and L3-4 (80.7%). ACR was most commonly performed at L3-4 (8.4%) and L2-3 (6.2%). At L4-5, LLIF (69.5%), TLIF (15.9%), and ALIF (9.8%) were most commonly utilized. TLIF and ALIF were the most selected approaches at L5-S1 (61.4% and 38.6%, respectively). Segmental lordosis at each level varied based on the approach, with greater increases reported using ALIF, especially at L4-5 (9.2°) and L5-S1 (5.3°). A substantial increase in lordosis was achieved with ACR at L2-3 (10.9°) and L3-4 (10.4°). Lateral interbody arthrodesis without the use of an ACR did not generally result in significant lordosis restoration. There were statistically significant improvements in lumbar lordosis (LL), pelvic incidence-LL mismatch, coronal Cobb angle, and Oswestry Disability Index at the 2-year follow-up. CONCLUSIONS The use of the MIISA provides consistent guidance for surgeons who plan to perform MIS for deformity. For L1-4, the surgeons preferred lateral approaches to TLIF and reserved ACR for patients who needed the greatest increase in segmental lordosis. For L4-5, the surgeons' order of preference was LLIF, TLIF, and ALIF, but TLIF failed to demonstrate any significant lordosis restoration. At L5-S1, the surgical team typically preferred an ALIF when segmental lordosis was desired and preferred a TLIF if preoperative segmental lordosis was adequate.
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Affiliation(s)
- Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Ibrahim Hussain
- 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher I Shaffrey
- 3Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Robert K Eastlack
- 4Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California
| | - Gregory M Mundis
- 4Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California
| | - Juan S Uribe
- 5Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Paul Park
- 7Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Adam S Kanter
- 10Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David O Okonkwo
- 10Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pierce D Nunley
- 11Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, Louisiana
| | - Michael Y Wang
- 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Frank La Marca
- 12Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan; and
| | - Khoi D Than
- 3Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Kai-Ming Fu
- 13Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
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Patel VV, Billys J, Okonkwo DO, He DY, Ryaby JT, Radcliff K. Three- and 4-Level Lumbar Arthrodesis Using Adjunctive Pulsed Electromagnetic Field Stimulation: A Multicenter Retrospective Evaluation of Fusion Rates and a Review of the Literature. Int J Spine Surg 2021; 15:228-233. [PMID: 33900979 DOI: 10.14444/8031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The incidence of 3- and 4-level lumbar arthrodesis is rising due to an aging population, and fusion rates affect clinical success in this population. Pulsed electromagnetic field (PEMF) stimulation is used as an adjunct to increase fusion rates following multilevel arthrodesis. The purpose of the study was to evaluate the fusion rates for subjects who underwent 3- and 4-level lumbar interbody arthrodesis following PEMF treatment. METHODS In this retrospective, multicenter study, patient charts that listed 3- or 4-level lumbar arthrodesis with adjunctive use of a PEMF device were evaluated. Inclusion criteria included patients who were diagnosed with lumbar degenerative disease, spinal stenosis, and/or spondylolisthesis (grade 1 or 2). A radiographic evaluation of fusion status was performed at 12 months by the treating physicians. Fusion rates were stratified by graft material, surgical interbody approach, and certain clinical risk factors for pseudoarthrosis. RESULTS A total of 55 patients were identified who had a 12-month follow-up. The radiographic fusion rate was 92.7% (51 patients) at 12 months. There were no significant differences in fusion rates for patients treated with allograft or autograft, for patients with different interbody approaches, or for those with or without certain clinical risk factors. CONCLUSIONS With modern fusion techniques and PEMF, the overall fusion rate was high following 3- and 4-level lumbar arthrodesis. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE PEMF may be a useful adjunct for treatment of patients with surgical risk factors, such as multilevel arthrodesis, and clinical risk factors.
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Affiliation(s)
- Vikas V Patel
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - David Y He
- Analytical Solutions Group, Inc, North Potomac, Maryland
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Amara D, Mummaneni PV, Burch S, Deviren V, Ames CP, Tay B, Berven SH, Chou D. The impact of increasing interbody fusion levels at the fractional curve on lordosis, curve correction, and complications in adult patients with scoliosis. J Neurosurg Spine 2021; 34:430-439. [PMID: 33186901 DOI: 10.3171/2020.6.spine20256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Radiculopathy from the fractional curve, usually from L3 to S1, can create severe disability. However, treatment methods of the curve vary. The authors evaluated the effect of adding more levels of interbody fusion during treatment of the fractional curve. METHODS A single-institution retrospective review of adult patients treated for scoliosis between 2006 and 2016 was performed. Inclusion criteria were as follows: fractional curves from L3 to S1 > 10°, ipsilateral radicular symptoms concordant on the fractional curve concavity side, patients who underwent at least 1 interbody fusion at the level of the fractional curve, and a minimum 1-year follow-up. Primary outcomes included changes in fractional curve correction, lumbar lordosis change, pelvic incidence - lumbar lordosis mismatch change, scoliosis major curve correction, and rates of revision surgery and postoperative complications. Secondary analysis compared the same outcomes among patients undergoing posterior, anterior, and lateral approaches for their interbody fusion. RESULTS A total of 78 patients were included. There were no significant differences in age, sex, BMI, prior surgery, fractional curve degree, pelvic tilt, pelvic incidence, pelvic incidence - lumbar lordosis mismatch, sagittal vertical axis, coronal balance, scoliotic curve magnitude, proportion of patients undergoing an osteotomy, or average number of levels fused among the groups. The mean follow-up was 35.8 months (range 12-150 months). Patients undergoing more levels of interbody fusion had more fractional curve correction (7.4° vs 12.3° vs 12.1° for 1, 2, and 3 levels; p = 0.009); greater increase in lumbar lordosis (-1.8° vs 6.2° vs 13.7°, p = 0.003); and more scoliosis major curve correction (13.0° vs 13.7° vs 24.4°, p = 0.01). There were no statistically significant differences among the groups with regard to postoperative complications (overall rate 47.4%, p = 0.85) or need for revision surgery (overall rate 30.7%, p = 0.25). In the secondary analysis, patients undergoing anterior lumbar interbody fusion (ALIF) had a greater increase in lumbar lordosis (9.1° vs -0.87° for ALIF vs transforaminal lumbar interbody fusion [TLIF], p = 0.028), but also higher revision surgery rates unrelated to adjacent-segment pathology (25% vs 4.3%, p = 0.046). Higher ALIF revision surgery rates were driven by rod fracture in the majority (55%) of cases. CONCLUSIONS More levels of interbody fusion resulted in increased lordosis, scoliosis curve correction, and fractional curve correction. However, additional levels of interbody fusion up to 3 levels did not result in more postoperative complications or morbidity. ALIF resulted in a greater lumbar lordosis increase than TLIF, but ALIF had higher revision surgery rates.
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Affiliation(s)
| | | | - Shane Burch
- 2Orthopedic Surgery, UCSF Spine Center, University of California, San Francisco, California
| | - Vedat Deviren
- 2Orthopedic Surgery, UCSF Spine Center, University of California, San Francisco, California
| | | | - Bobby Tay
- 2Orthopedic Surgery, UCSF Spine Center, University of California, San Francisco, California
| | - Sigurd H Berven
- 2Orthopedic Surgery, UCSF Spine Center, University of California, San Francisco, California
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Preoperative lordosis in L4/5 predicts segmental lordosis correction achievable by transforaminal lumbar interbody fusion. 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 2021; 30:1277-1284. [PMID: 33409727 DOI: 10.1007/s00586-020-06710-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/23/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The mean potential of lordosis restoration by transforaminal lumbar interbody fusion (TLIF) is supposed to be low in general. In contrast, clinical experience shows a wide range of segmental lordosis correction. In this study, the predictability of lordosis correction should be investigated. METHODS Prospectively collected register data were analyzed retrospectively. One hundred twenty-one consecutive patients (2014-2016) operated with single-level TLIF L4/5 (10°-lordotic cage). Segmental lordosis (L4/5) and overall lordosis (L1-S1) were measured on lumbar X-rays: preoperatively (pre), after 3-5 days (post), at least 24 months postoperatively (2yFU). Outcome and satisfaction of patients were assessed. Parameters were statistically compared by students t-tests (a = 0.05). In addition, predictors of correction were analyzed. RESULTS Age was 60.7 years, rate of 2yFU 41.3% (n = 50). Lordosis correction L4/5 was statistically significant with (post-pre) 4.9 ± 5.7° (p < 0.01), but not significant for L1-S1 (post-pre) 1.6 ± 8.0° (p = 0.3). A strong-moderate correlation of lordosis L4/5 (pre) and lordosis correction L4/5 (post-pre) was shown (r = - 0.6, p < 0,01). In a rising range of preoperative lordosis L4/5 from 15-30° the likelihood of lordosis loss increased. In 2yFU correction, L4/5 was significant with (post-pre) 5.4 ± 5.4° (p < 0.01), no significant long-term change (2yFU-postop) - 1.5 ± 4.9° (p = 0.2). No correlation (r = - 0.1) of correction and ODI. VAS-B improved by means of 2.9, VAS-L by 2.5, ODI by 19.1% (pre vs. 2yFU), each statistically significant (p < 0.01). CONCLUSION Significant segmental relordosation can be performed by TLIF L4/5. The potential of correction strongly correlates with preoperative lordosis. Therefore, TLIF technique should be considered carefully in cases with a preoperative segmental lordosis of more than 15° and additional need of lordosation.
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Lenz M, Mohamud K, Bredow J, Oikonomidis S, Eysel P, Scheyerer MJ. Comparison of Different Approaches in Lumbosacral Spinal Fusion Surgery: A Systematic Review and Meta-Analysis. Asian Spine J 2021; 16:141-149. [PMID: 33389967 PMCID: PMC8873994 DOI: 10.31616/asj.2020.0405] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
We aimed to systematically review the literature to analyze the differences in posterior lumbar interbody fusion (PLIF), anterior lumbar interbody fusion (ALIF), and transforaminal lumbar interbody fusion (TLIF), focusing on the complications, risk factors, and fusion rate of each approach. Spinal fusion surgery is a well-established surgical procedure for a variety of indications, and different approaches developed. The various approaches and their advantages, as well as approach-related pathology and complications, are well investigated in spinal surgery. Focusing only on lumbosacral fusion, the comparative studies of different approaches remain fewer in numbers. We systematically reviewed the literature on the complications associated with lumbosacral interbody fusion. Only the PLIF, ALIF, or TLIF approaches and studies published within the last decade (2007–2017) were included. The exclusion criteria in this study were oblique lumbar interbody fusion, extreme lateral interbody fusion, more than one procedure per patient, and reported patient numbers less than 10. The outcome variables were indications, fusion rates, operation time, perioperative complications, and clinical outcome by means of Visual Analog Scale, Oswestry Disability Index, and Japanese Orthopaedic Association score. Five prospective, 17 retrospective, and two comparative studies that investigated the lumbosacral region were included. Mean fusion rates were 91,4%. ALIF showed a higher operation time, while PLIF resulted in greater blood loss. In all approaches, significant improvements in the clinical outcome were achieved, with ALIF showing slightly better results. Regarding complications, the ALIF technique showed the highest complication rates. Lumbosacral fusion surgery is a treatment to provide good results either through an approach for various indications as causes of lower back pain. For each surgical approach, advantages can be depicted. However, perioperative complications and risk factors are numerous and vary with ALIF, PLIF, and TLIF procedures, as well as with fusion rates.
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Affiliation(s)
- Maximilian Lenz
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Kaliye Mohamud
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Stavros Oikonomidis
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Max Joseph Scheyerer
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
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Deng S, Zhao Q, Yang C, Peng R, Zhao J, Zhong E, Luo B, Luo J, Liu Z, Li Q. The lumbar autonomic nerves in males: a few anatomical insights into anterior lumbar interbody fusion. Spine J 2020; 20:2006-2013. [PMID: 32721586 DOI: 10.1016/j.spinee.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar autonomic nerve injury is an underappreciated complication of anterior lumbar spinal surgery. A detailed description of lumbar autonomic nerve anatomy would be helpful for surgeons to minimize the risk of this complication. PURPOSE This study was designed to investigate the anatomical characteristics of lumbar autonomic nerves and provide a better understanding of these nerves for anterior lumbar spinal surgery. STUDY DESIGN A dissection-based study of 10 embalmed male cadavers. METHODS The lumbar autonomic nerves from 10 embalmed male cadavers were dissected in this study. The position of the lumbar sympathetic trunks was recorded. Distance between the initial sites of the lumbar splanchnic nerves (LSNs) and the corresponding lumbar vertebral inferior endplate, distance between the ipsilateral and adjacent LSNs, angles formed by the LSNs and the vertical axis were measured. This study has been supported by grants from Science and Technology Planning Project of Guangdong Province (CN) (Grant No. 2017B020210010) without potential conflict of interest-associated biases in the text of the paper. RESULTS In this study, a total of 72 LSNs were identified in the 10 human cadavers. On average, the investigation found that the initial sites of the first, second, third, and fourth LSNs were 9 mm distal, 5 mm distal, 9 mm proximal, and 9 mm distal to the inferior endplates of the L1, L2, L3, and L4 vertebrae, respectively, with variations from 6 to 11 mm for each nerve among specimens. There was no significant difference in the angle between each lumbar splanchnic nerve and the vertical axis (H=2.461, p=.482), with an angle of approximately 50°±6°. The distance between the first and the second LSNs, the second and the third LSNs, or the third and the fourth LSNs were 24±6 mm, 22±8 mm, and 55±11 mm, respectively. The bilateral lumbar sympathetic trunks (N=57, 95%) were more likely to be located in the first third of the sagittal plane at the level of the L2/3, L3/4, and L4/5 intervertebral discs. CONCLUSIONS The study found the same number and parallel courses of LSNs on each side, and on both the left and right side, the distance between the third and the fourth LSNs was much larger than the distance between the other two adjacent LSNs. The initial sites of 80.6% (n=58) of LSNs were superior to the inferior endplate of the L3 vertebra. Improved knowledge of lumbar autonomic nerve anatomy may be of great significance in reducing complications and improving surgical safety.
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Affiliation(s)
- Shangxi Deng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou 510630, China
| | - Qinghao Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou 510630, China
| | - Changsheng Yang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou 510630, China
| | - Rui Peng
- College of Traditional Chinese Medicine, Southern Medical University, No.1838, Guang Zhou Ave North, Guangzhou 510515, China
| | - Jianjun Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou 510630, China
| | - Enyi Zhong
- The Medical Center of Guangzhou Woman and Children's Hospital
| | - Baohua Luo
- Basic Medical College, Southern Medical University, No.1838, Guang Zhou Ave North, Guangzhou 510515, China
| | - Jianheng Luo
- Basic Medical College, Southern Medical University, No.1838, Guang Zhou Ave North, Guangzhou 510515, China
| | - Zezheng Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou 510630, China.
| | - Qingchu Li
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou 510630, China.
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Chou D. Commentary: Retrospective Review of Immediate Restoration of Lordosis in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison of Static and Expandable Interbody Cages. Oper Neurosurg (Hagerstown) 2020; 18:E153-E154. [PMID: 31914173 DOI: 10.1093/ons/opz272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/02/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dean Chou
- University of California San Francisco, San Francisco, California
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Xi Z, Burch S, Mummaneni PV, Chang CC, Ruan H, Eichler C, Chou D. Supine anterior lumbar interbody fusion versus lateral position oblique lumbar interbody fusion at L5-S1: A comparison of two approaches to the lumbosacral junction. J Clin Neurosci 2020; 82:134-140. [PMID: 33317722 DOI: 10.1016/j.jocn.2020.10.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/10/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION At L5-S1, anterior access can be performed with a supine anterior lumbar interbody fusion (ALIF) or lateral position oblique lumbar interbody fusion (LOLIF). We compared clinical and radiographic features of both approaches. METHODS A retrospective study of L5-S1 ALIF and LOLIF patients (2013-2018) by 3 spine surgeons and a vascular surgeon at our hospital was performed. Inclusion criteria were patients undergoing L5-S1 anterior surgery only without other anterior or lateral fusion levels, and data collected were patient demographics, cage parameters, perioperative variables, and radiographic parameters. 58 patients were included (33 ALIF and 25 LOLIF). RESULTS The average surgical time was 211.94 min for ALIF and 154.86 min for LOLIF (p < 0.001). The average blood loss was 214 ml for ALIF and 74 ml for LOLIF (p < 0.001). The average number of days to solid food was 2.55 for ALIF and 0.8 for LOLIF (p < 0.001). The average anterior L5-S1 disc height increase was 8.52 mm for ALIF and 5.02 mm LOLIF (p = 0.018), and the average posterior L5-S1 disc height increase was 3.34 mm for ALIF and 1.30 mm for LOLIF (p = 0.034). The average L5-S1 segmental lordosis increase was 6.82 degrees for ALIF and 7.63 degrees for LOLIF (p = 0.638). CONCLUSION The LOLIF is a feasible option for L5-S1 anterior access compared to ALIF. However, supine ALIF afforded larger cages to be placed, resulting in greater postoperative disc height. There did not appear to be a significant difference in postoperative L5-S1 segmental lordosis between the two approaches.
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Affiliation(s)
- Zhuo Xi
- Department of Neurosurgery, University of California San Francisco, USA; Department of Neurosurgery, Shengjing Hospital of China Medical University, 36 Sanhao St, Heping Qu, Shenyang Shi, Liaoning Sheng, China.
| | - Shane Burch
- Department of Orthopedic Surgery, University of California San Francisco, USA
| | | | - Chih-Chang Chang
- Department of Neurosurgery, University of California San Francisco, USA
| | - Huibing Ruan
- Department of Neurosurgery, University of California San Francisco, USA
| | - Charles Eichler
- Division of Vascular Surgery, University of California San Francisco, USA
| | - Dean Chou
- Department of Neurosurgery, University of California San Francisco, USA
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Tan LA, Rivera J, Tan XA, Le VP, Khoo LT, Berven SH. Clinical and Radiographic Outcomes After Minimally Invasive Transforaminal Lumbar Interbody Fusion-Early Experience Using a Biplanar Expandable Cage for Lumbar Spondylolisthesis. Int J Spine Surg 2020; 14:S39-S44. [PMID: 33122185 DOI: 10.14444/7125] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is a surgical technique frequently used to treat symptomatic lumbar spondylolisthesis. We aim to investigate the safety and efficacy of using a biplanar expandable cage in the treatment of symptomatic lumbar spondylolisthesis using a MIS TLIF approach. METHODS A retrospective review of patient records was performed on patients who underwent MIS TLIF for symptomatic lumbar spondylolisthesis using the FlareHawk cage over a 12-month period. Patient demographics, as well as preoperative and postoperative clinical and radiographic outcome measures were recorded and analyzed. RESULTS A total of 13 consecutive patients underwent MIS TLIF for symptomatic spondylolisthesis during the study period. The mean age was 60.2 ± 13.9 years, and 61.5% were female. The mean preoperative and postoperative slippage was 7.0 ± 3.0 mm and 1.0 ± 1.9 mm, respectively. The preoperative mean segmental lordosis was 5.1° ± 6.0°, mean anterior, posterior disc, and foraminal height were 9.1 ± 3.9 mm, 5.7 ± 1.5 mm, and 11.0 ± 2.0 mm, respectively. The postoperative mean segmental lordosis was 6.8° ± 4.7°, and mean anterior, posterior disc, and foraminal height were 11.4 ± 2.2 mm, 7.8 ± 1.0 mm, and 12.3 ± 1.3 mm. There was improvement in all radiographic parameters postoperatively. The mean Visual Analog Scale (VAS) back pain, VAS leg pain improved from 7.0 ± 2.9 and 5.1 ± 3.0 preoperatively to 3.1 ± 2.9 and 1.1 ± 1.7 at the latest clinic follow-up visit, respectively (P = .0081). The mean EuroQol-Five Dimensions (EQ5D) score improved from 0.37 ± 1.7 to 0.66 ± 0.23 after surgery. There was no subsidence, endplate violation, cage migration, or other implant-related complications. No patient required reoperation. CONCLUSIONS The biplanar expandable cage is both safe and efficacious in treating symptomatic lumbar spondylolisthesis using the MIS TLIF approach. Spine surgeons should be familiar with the biplanar expandable cage technology and keep it in their armamentarium in surgical treatment of lumbar spondylolisthesis. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
| | - Joshua Rivera
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
| | - Xiao A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
| | - Vivian P Le
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
| | - Larry T Khoo
- The Spine Clinic of Los Angeles, Good Samaritan Hospital, University of Southern California, Los Angeles, California
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, UCSF Medical Center, San Francisco, California
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Xi Z, Chou D, Mummaneni PV, Ruan H, Eichler C, Chang CC, Burch S. Anterior lumbar compared to oblique lumbar interbody approaches for multilevel fusions to the sacrum in adults with spinal deformity and degeneration. J Neurosurg Spine 2020; 33:461-470. [PMID: 32534496 DOI: 10.3171/2020.4.spine20198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In adult spinal deformity and degenerative conditions of the spine, interbody fusion to the sacrum often is performed to enhance arthrodesis, induce lordosis, and alleviate stenosis. Anterior lumbar interbody fusion (ALIF) has traditionally been performed, but minimally invasive oblique lumbar interbody fusion (OLIF) may or may not cause less morbidity because less retraction of the abdominal viscera is required. The authors evaluated whether there was a difference between the results of ALIF and OLIF in multilevel anterior or lateral interbody fusion to the sacrum. METHODS Patients from 2013 to 2018 who underwent multilevel ALIF or OLIF to the sacrum were retrospectively studied. Inclusion criteria were adult spinal deformity or degenerative pathology and multilevel ALIF or OLIF to the sacrum. Demographic, implant, perioperative, and radiographic variables were collected. Statistical calculations were performed for significant differences. RESULTS Data from a total of 127 patients were analyzed (66 OLIF patients and 61 ALIF patients). The mean follow-up times were 27.21 (ALIF) and 24.11 (OLIF) months. The mean surgical time was 251.48 minutes for ALIF patients and 234.48 minutes for OLIF patients (p = 0.154). The mean hospital stay was 7.79 days for ALIF patients and 7.02 days for OLIF patients (p = 0.159). The mean time to being able to eat solid food was 4.03 days for ALIF patients and 1.30 days for OLIF patients (p < 0.001). After excluding patients who had undergone L5-S1 posterior column osteotomy, 54 ALIF patients and 41 OLIF patients were analyzed for L5-S1 radiographic changes. The mean cage height was 14.94 mm for ALIF patients and 13.56 mm for OLIF patients (p = 0.001), and the mean cage lordosis was 15.87° in the ALIF group and 16.81° in the OLIF group (p = 0.278). The mean increases in anterior disc height were 7.34 mm and 4.72 mm for the ALIF and OLIF groups, respectively (p = 0.001), and the mean increases in posterior disc height were 3.35 mm and 1.24 mm (p < 0.001), respectively. The mean change in L5-S1 lordosis was 4.33° for ALIF patients and 4.59° for OLIF patients (p = 0.829). CONCLUSIONS Patients who underwent multilevel OLIF and ALIF to the sacrum had comparable operative times. OLIF was associated with a quicker ileus recovery and less blood loss. At L5-S1, ALIF allowed larger cages to be placed, resulting in a greater disc height change, but there was no significant difference in L5-S1 segmental lordosis.
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Affiliation(s)
- Zhuo Xi
- 1Department of Neurological Surgery
- 4Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | | | | | | | | | | | - Shane Burch
- 3Department of Orthopedic Surgery, University of California, San Francisco, California; and
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Formica M, Quarto E, Zanirato A, Mosconi L, Lontaro-Baracchini M, Alessio-Mazzola M, Felli L. ALIF in the correction of spinal sagittal misalignment. A systematic review of literature. 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 2020; 30:50-62. [PMID: 32930843 DOI: 10.1007/s00586-020-06598-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/20/2020] [Accepted: 09/05/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE We aim at analysing the impact of anterior lumbar interbody fusion (ALIF) in restoring the main spinopelvic parameters, along with its potentials and limitations in correcting sagittal imbalance. MATERIALS AND METHODS The 2009 PRISMA flow chart was used to systematically review the literature; 27 papers were eventually selected. The following spinopelvic parameters were observed: pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), segmental lumbar lordosis (LLseg) and sagittal vertical axis (SVA). Papers reporting on hyperlordotic cages (HLC) were analysed separately. The indirect decompression potential of ALIF was also assessed. The clinical outcome was obtained by collecting visual analogue scale (VAS) for back and leg pain and Oswestry Disability Index (ODI) scores. Global fusion rate and main complications were collected. RESULTS PT, SS, LL, LLseg and SVA spinopelvic parameters all improved postoperatively by - 4.3 ± 5.2°, 3.9 ± 4.5°, 10.6 ± 12.5°, 6.7 ± 3.5° and 51.1 ± 44.8 mm, respectively. HLC were statistically more effective in restoring LL and LLseg (p < 0.05). Postoperative disc height, anterior disc height, posterior disc height and foraminal height, respectively, increased by 58.5%, 87.2%, 80.9% and 18.1%. Postoperative improvements were observed in VAS back and leg and ODI scores (p < 0.05). The global fusion rate was 94.5 ± 5.5%; the overall complication rate was 13%. CONCLUSION When managing sagittal imbalance, ALIF can be considered as a valid technique to achieve the correct spinopelvic parameters based on preoperative planning. This technique permits to obtain an optimal LL distribution and a solid anterior column support, with lower complications and higher fusion rates when compared to posterior osteotomies.
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Affiliation(s)
- M Formica
- IRCCS Policlinico San Martino, Genova - Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy.
| | - E Quarto
- IRCCS Policlinico San Martino, Genova - Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
| | - A Zanirato
- IRCCS Policlinico San Martino, Genova - Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
| | - L Mosconi
- IRCCS Policlinico San Martino, Genova - Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
| | - M Lontaro-Baracchini
- IRCCS Policlinico San Martino, Genova - Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
| | - M Alessio-Mazzola
- IRCCS Policlinico San Martino, Genova - Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
| | - L Felli
- IRCCS Policlinico San Martino, Genova - Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
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Safaee MM, Tenorio A, Osorio JA, Choy W, Amara D, Lai L, Molinaro AM, Zhang Y, Hu SS, Tay B, Burch S, Berven SH, Deviren V, Dhall SS, Chou D, Mummaneni PV, Eichler CM, Ames CP, Clark AJ. The impact of obesity on perioperative complications in patients undergoing anterior lumbar interbody fusion. J Neurosurg Spine 2020; 33:332-341. [PMID: 32330881 DOI: 10.3171/2020.2.spine191418] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior approaches to the lumbar spine provide wide exposure that facilitates placement of large grafts with high fusion rates. There are limited data on the effects of obesity on perioperative complications. METHODS Data from consecutive patients undergoing anterior lumbar interbody fusion (ALIF) from 2007 to 2016 at a single academic center were analyzed. The primary outcome was any perioperative complication. Complications were divided into those occurring intraoperatively and those occurring postoperatively. Multivariate logistic regression was used to assess the association of obesity and other variables with these complications. An estimation table was used to identify a body mass index (BMI) threshold associated with increased risk of postoperative complication. RESULTS A total of 938 patients were identified, and the mean age was 57 years; 511 were females (54.5%). The mean BMI was 28.7 kg/m2, with 354 (37.7%) patients classified as obese (BMI ≥ 30 kg/m2). Forty patients (4.3%) underwent a lateral transthoracic approach, while the remaining 898 (95.7%) underwent a transabdominal retroperitoneal approach. Among patients undergoing transabdominal retroperitoneal ALIF, complication rates were higher for obese patients than for nonobese patients (37.0% vs 28.7%, p = 0.010), a difference that was driven primarily by postoperative complications (36.1% vs 26.0%, p = 0.001) rather than intraoperative complications (3.2% vs 4.3%, p = 0.416). Obese patients had higher rates of ileus (11.7% vs 7.2%, p = 0.020), wound complications (11.4% vs 3.4%, p < 0.001), and urinary tract infections (UTI) (5.0% vs 2.5%, p = 0.049). In a multivariate model, age, obesity, and number of ALIF levels fused were associated with an increased risk of postoperative complication. An estimation table including 19 candidate cut-points, odds ratios, and adjusted p values found a BMI ≥ 31 kg/m2 to have the highest association with postoperative complication (p = 0.012). CONCLUSIONS Obesity is associated with increased postoperative complications in ALIF, including ileus, wound complications, and UTI. ALIF is a safe and effective procedure. However, patients with a BMI ≥ 31 kg/m2 should be counseled on their increased risks and warrant careful preoperative medical optimization and close monitoring in the postoperative setting.
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Affiliation(s)
- Michael M Safaee
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Alexander Tenorio
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Joseph A Osorio
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Winward Choy
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Dominic Amara
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Lillian Lai
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Annette M Molinaro
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Yalan Zhang
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Serena S Hu
- 2Department of Orthopedic Surgery, Stanford University, Palo Alto; and
| | - Bobby Tay
- Departments of3Orthopedic Surgery and
| | | | | | | | - Sanjay S Dhall
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Charles M Eichler
- 4Vascular Surgery, University of California, San Francisco, California
| | - Christopher P Ames
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Aaron J Clark
- 1Department of Neurological Surgery, University of California, San Francisco
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Choi J, Rhee I, Ruparel S. Assessment of Great Vessels for Anterior Access of L5/S1 Using Patient Positioning. Asian Spine J 2020; 14:438-444. [PMID: 32791768 PMCID: PMC7435306 DOI: 10.31616/asj.2020.0078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/20/2020] [Indexed: 01/06/2023] Open
Abstract
STUDY DESIGN This was a prospective cross-sectional study. PURPOSE The aim was to describe the effect of patient positioning, from supine to lateral decubitus position, on the width of the L5/S1 anterior disk space defined by the great vessels. OVERVIEW OF LITERATURE The application of the lateral decubitus position interbody fusion has been rapidly increasing; however, there are concerns regarding the access to the lumbosacral region due to the great vessels, which necessitates further morphometric data. METHODS A total of 20 consecutive live patients awaiting lumbar surgery were subjected to two magnetic resonance imaging scans on the same day in both supine and lateral decubitus positions at a single center to investigate the anterior L5/S1 disk space. RESULTS The bare anterior L5/S1 disk window was present in all patients of this study population, and the mean width was 27 mm in the supine and 22 mm in the lateral decubitus position, with a mean reduction of 5.2 mm between the positions. The oblique corridor angle was measured at a mean of 33°. CONCLUSIONS The bare window of L5/S1 disk space was present within this population group, and it was found to be mobile and changed significantly with patient positioning. Therefore, the spine surgeon or the access surgeon must consider the increased potential vascular risk during disk access in lateral decubitus anterior lumbar interbody spinal fusion surgery.
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Affiliation(s)
- John Choi
- Spine Ortho Clinic, The Bays Hospital, Mornington, Australia
| | - Isaac Rhee
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Sameer Ruparel
- Department of Orthopaedic-Spine Surgery, Global Hospital, Mumbai, India
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Iwamae M, Matsumura A, Namikawa T, Kato M, Hori Y, Yabu A, Sawada Y, Hidaka N, Nakamura H. Surgical Outcomes of Multilevel Posterior Lumbar Interbody Fusion versus Lateral Lumbar Interbody Fusion for the Correction of Adult Spinal Deformity: A Comparative Clinical Study. Asian Spine J 2020; 14:421-429. [PMID: 32693444 PMCID: PMC7435311 DOI: 10.31616/asj.2019.0357] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/23/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design A retrospective case control study. Purpose The purpose of this study was to compare the surgical outcomes of multilevel lateral lumbar interbody fusion (LIF) and multilevel posterior lumbar interbody fusion (PLIF) in the surgical treatment of adult spinal deformity (ASD) and to evaluate the sagittal plane correction by combining LIF with posterior-column osteotomy (PCO). Overview of Literature The surgical outcomes between multilevel LIF and multilevel PLIF in ASD patients remain unclear. Methods We retrospectively reviewed 31 ASD patients who underwent multilevel LIF combined with PCO (LIF group, n=14) or multilevel PLIF (PLIF group, n=17) and with a minimum 2-year follow-up. In the comparison between LIF and PLIF groups, their mean age at surgery was 69.4 vs. 61.8 years while the mean follow-up period was 29.2 vs. 59.3 months. We evaluated the transition of pelvic incidence–lumbar lordosis (PI–LL) and disc angle (DA) in the LIF group, in fulcrum backward bending (FBB), after LIF and after posterior spinal fusion (PSF) with PCO. The spinopelvic radiographic parameters were compared between LIF and PLIF groups. Results Compared with the PLIF group, the LIF group had less blood loss and comparable surgical outcomes with respect to radiographic data, health-related quality of life scores and surgical time. In the LIF group, the mean DA and PI–LL were unchanged after LIF (DA, 5.8°; PI–LL, 15°) compared with the values using FBB (DA, 4.3°; PI–LL, 15°) and improved significantly after PSF with PCO (DA, 8.1°; PI–LL, 0°). Conclusions In the surgical treatment of ASD, multilevel LIF is less invasive than multilevel PLIF and combination of LIF and PCO would be necessary for optimal sagittal correction in patients with rigid deformity.
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Affiliation(s)
- Masayoshi Iwamae
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akira Matsumura
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takashi Namikawa
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuta Sawada
- Department of Orthopaedic Surgery, Eniwa Hospital, Eniwa, Japan
| | - Noriaki Hidaka
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Verma R, Virk S, Qureshi S. Interbody Fusions in the Lumbar Spine: A Review. HSS J 2020; 16:162-167. [PMID: 32523484 PMCID: PMC7253570 DOI: 10.1007/s11420-019-09737-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbar interbody fusion is among the most common types of spinal surgery performed. Over time, the term has evolved to encompass a number of different approaches to the intervertebral space, as well as differing implant materials. Questions remain over which approaches and materials are best for achieving fusion and restoring disc height. QUESTIONS/PURPOSES We reviewed the literature on the advantages and disadvantages of various methods and devices used to achieve and augment fusion between the disc spaces in the lumbar spine. METHODS Using search terms specific to lumbar interbody fusion, we searched PubMed and Google Scholar and identified 4993 articles. We excluded those that did not report clinical outcomes, involved cervical interbody devices, were animal studies, or were not in English. After exclusions, 68 articles were included for review. RESULTS Posterior approaches have advantages, such as providing 360° support through a single incision, but can result in retraction injury and do not always restore lordosis or correct deformity. Anterior approaches allow for the largest implants and good correction of deformities but can result in vascular, urinary, psoas muscle, or lumbar plexus injury and may require a second posterior procedure to supplement fixation. Titanium cages produce improved osteointegration and fusion rates but also increase subsidence caused by the stiffness of titanium relative to bone. Polyetheretherketone (PEEK) has an elasticity closer to that of bone and shows less subsidence than titanium cages, but as an inert compound PEEK results in lower fusion rates and greater osteolysis. Combination PEEK-titanium coating has not yet achieved better results. Expandable cages were developed to increase disc height and restore lumbar lordosis, but the data on their effectiveness have been inconclusive. Three-dimensionally (3D)-printed cages have shown promise in biomechanical and animal studies at increasing fusion rates and reducing subsidence, but additive manufacturing options are still in their infancy and require more investigation. CONCLUSIONS All of the approaches to spinal fusion have plusses and minuses that must be considered when determining which to use, and newer-technology implants, such as PEEK with titanium coating, expandable, and 3D-printed cages, have tried to improve upon the limitations of existing grafts but require further study.
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Affiliation(s)
- Ravi Verma
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Sohrab Virk
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
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50
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Yi HL, Faloon M, Changoor S, Ross T, Boachie-Adjei O. Transsacral interbody fixation versus transforaminal lumbar interbody fusion at the lumbosacral junction for long fusions in primary adult scoliosis. J Neurosurg Spine 2020; 32:824-831. [PMID: 32059186 DOI: 10.3171/2019.12.spine19397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/03/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Achieving fusion at the lumbosacral junction poses many technical challenges. No data exist in the literature comparing radiographic or clinical outcomes between the different surgical techniques of transsacral fixation (TSF) with rods and transforaminal lumbar interbody fusion (TLIF) in conjunction with iliac fixation. The purpose of this study was to compare the clinical outcomes and radiographic fusions of TSF to TLIF in patients with adult spinal deformity undergoing long fusions across the lumbosacral junction. METHODS Patients with primary adult spinal deformity who underwent long fusions from the thoracic spine across the lumbosacral junction with different approaches of interbody fusion at the L5-S1 level were reviewed. Patients were subdivided by approach (TSF vs TLIF). Fusion status at L5-S1 was evaluated by multiple radiographs and/or CT scans. Scoliotic curve changes were also evaluated preoperatively and at final follow-up. Clinical outcomes were assessed by Scoliosis Research Society Outcome Instrument 22 and Oswestry Disability Index scores. RESULTS A total of 36 patients were included in the analysis. There were 18 patients in the TSF group and 18 patients in the TLIF group. A mean of 14.00 levels were fused in the TSF group and 10.94 in the TLIF group (p = 0.01). Both groups demonstrated significant postoperative radiographic improvement in coronal parameters. The fusion rates for TSF and TLIF groups were 100% and 88.9%, respectively (p < 0.05). Eight patients in the TSF group had pelvic fixation with unilateral iliac screws, compared to 15 patients in the TLIF group (p = 0.015). No statistical differences in patients' reported outcomes were seen between groups. CONCLUSIONS Despite similar clinical and radiographic outcomes between both groups, TSF required fewer iliac screws to augment stability of the lumbosacral junction while achieving a higher rate of fusion. This study suggests that TSF may decrease potential instrument-related complications requiring revision while decreasing operating room time and implant-related costs.
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Affiliation(s)
- Hong-Lei Yi
- 1Department of Orthopaedic Surgery, General Hospital of Southern Theatre Command of People's Liberation Army, Guangzhou, China
| | - Michael Faloon
- 2Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
| | - Stuart Changoor
- 2Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
| | - Thomas Ross
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Oheneba Boachie-Adjei
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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