1
|
Kim JE, Son S, Park EJ. Technical Feasibility and Early Clinical Outcome of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Larger Cage. World Neurosurg 2023; 178:e666-e672. [PMID: 37543195 DOI: 10.1016/j.wneu.2023.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Transforaminal lumbar interbody fusion with biportal endoscopic guidance (BE-TLIF) has been previously reported with promising clinical results. However, complications such as delayed union or subsidence occurred as with open surgery. We assumed using larger cages would result in less occurrence of such complications. We aimed to analyze the clinical outcome and technical feasibility of BE-TLIF using larger cages, initially designed for oblique lumbar interbody fusion. METHODS We enrolled cases that underwent single-level BE-TLIF between January 2021 and January 2022. Polyetheretherketone cages that were larger than the conventional size were used. Diagnoses were degenerative spondylolisthesis or isthmic spondylolisthesis. Visual analog scale scores of the back and leg and Oswestry Disability Index were collected perioperatively. Modified Macnab criteria were used to evaluate the patients at the final follow-up. Radiologic outcome of interbody fusion rate and perioperative complications were analyzed. RESULTS A total of 35 cases were included in this study. The mean age was 67.5 ± 8.4 and consisted of 13 male patients, and the mean follow-up duration was 18.3 ± 3.7 months. The majority (32/35, 91.3%) of the index level was located within the lower lumbar region, L4-S1. Oswestry Disability Index scores improved from 65.4 ± 5.4 preoperatively to 15.4 ± 6.1 at the final follow-up (P < 0.001). Visual analog scale scores of the leg decreased from 7.9 ± 1.5 to 1.7 ± 1.5 at the final follow-up (P < 0.001). Per the modified Macnab criteria on the final follow-up, 94% of the patients reported good/excellent. Most (94.2%) of the patients showed fusion grade I and II at the 1-year follow-up. No patient showed subsidence or other postoperative complication. CONCLUSIONS BE-TLIF using a larger cage was safely performed without risk of subsidence during the 1-year follow-up. A cage with a larger footprint may be advantageous in BE-TLIF in the aspect of interbody fusion and subsidence.
Collapse
Affiliation(s)
- Ju-Eun Kim
- Department of Orthopedic Surgery, Baro Seomyeon Hospital, Busan, South Korea
| | - Sangwoo Son
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Eugene J Park
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea.
| |
Collapse
|
2
|
Lu W, Wu L, Chen Y, Hu X, Ruan C, Wang Y, Ma W, Jiang W. Effect of preoperative contralateral foramen stenosis on contralateral root symptoms after unilateral transforaminal lumbar interbody fusion: a ambispective cohort study. BMC Musculoskelet Disord 2023; 24:291. [PMID: 37060092 PMCID: PMC10103372 DOI: 10.1186/s12891-023-06381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/28/2023] [Indexed: 04/16/2023] Open
Abstract
PURPOSE To evaluate the correlation between the degree of preoperative contralateral foraminal stenosis(CFS) and the incidence of contralateral root symptoms after unilateral transforaminal lumbar interbody fusion(TLIF) and to evaluate the appropriate candidate of preventive decompression according to the degree of preoperative contralateral foraminal stenosis. METHODS An ambispective cohort study was conducted to investigate the incidence of contralateral root symptoms after unilateral transforaminal lumbar interbody fusion (TLIF) and the effectiveness of preventive decompression. A total of 411 patients were included in the study, all of whom met the inclusion and exclusion criteria and underwent surgery at the Department of Spinal Surgery, Ningbo Sixth Hospital, between January 2017 and February 2021. The study was divided into two groups: retrospective cohort study A and prospective cohort study B. The 187 patients included in study A from January 2017 to January 2019 did not receive preventive decompression. They were divided into four groups based on the degree of preoperative contralateral intervertebral foramen stenosis: no stenosis group A1, mild stenosis group A2, moderate stenosis group A3, and severe stenosis group A4. A Spearman rank correlation analysis was used to evaluate the correlation between the preoperative contralateral foramen stenosis degree and the incidence of contralateral root symptoms after unilateral TLIF. From February 2019 to February 2021, 224 patients were included in the prospective cohort group B. The decision to perform preventive decompression during the operation was based on the degree of preoperative contralateral foramen stenosis. Severe intervertebral foramen stenosis was treated with preventive decompression as group B1, while the rest were not treated with preventive decompression as group B2. The baseline data, surgical-related indicators, the incidence of contralateral root symptoms, clinical efficacy, imaging results, and other complications were compared between group A4 and group B1. RESULTS All 411 patients completed the operation and were followed up for an average of 13.5 ± 2.8 months. In the retrospective study, there was no significant difference in baseline data among the four groups (P > 0.05). The incidence of postoperative contralateral root symptoms increased gradually, and a weak positive correlation was found between the degree of preoperative intervertebral foramen stenosis and the incidence of postoperative root symptoms (rs = 0.304, P < 0.001). In the prospective study, there was no significant difference in baseline data between the two groups. The operation time and blood loss in group A4 were less than those in group B1 (P < 0.05). The incidence of contralateral root symptoms in group A4 was higher than that in group B1 (P = 0.003). However, there was no significant difference in leg VAS score and ODI index between the two groups at 3 months after the operation (P > 0.05). There was no significant difference in cage position, intervertebral fusion rate, and lumbar stability between the two groups (P > 0.05). No incisional infection occurred after the operation. No pedicle screw loosening, displacement, fracture, or interbody fusion cage displacement occurred during follow-up. CONCLUSION This study found a weak positive correlation between the degree of preoperative contralateral foramen stenosis and the incidence of contralateral root symptoms after unilateral TLIF. Intraoperative preventive decompression of the contralateral side may prolong the operation time and increase intraoperative blood loss to some extent. However, when the contralateral intervertebral foramen stenosis reaches the severe level, it is recommended to perform preventive decompression during the operation. This approach can reduce the incidence of postoperative contralateral root symptoms while ensuring clinical efficacy.
Collapse
Affiliation(s)
- Wenjie Lu
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Lingqiao Wu
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Yunlin Chen
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Xudong Hu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Chaoyue Ruan
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Yang Wang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Weihu Ma
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Weiyu Jiang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China.
| |
Collapse
|
3
|
Phani Kiran S, Sudhir G. Minimally invasive transforaminal lumbar interbody fusion - A narrative review on the present status. J Clin Orthop Trauma 2021; 22:101592. [PMID: 34603954 PMCID: PMC8463772 DOI: 10.1016/j.jcot.2021.101592] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/12/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023] Open
Abstract
Minimally invasive lumbar transforaminal interbody fusion (MIS TLIF) has become the most commonly performed lumbar fusion procedure. There are multiple variables such as bone graft properties, use of rhBMP (recombinant human bone morphogenic protein), interbody cage properties, image guidance techniques, etc., that may impact the outcomes and fusion rates. Radiation exposure to the patient as well as to the operating team is an important concern. The minimally invasive anterior approaches for lumbar fusion with ability to insert larger cages and achieve better sagittal correction have added another option in management of lumbar degenerative deformities. A literature review of recent studies and systematic reviews on different aspects impacting the outcomes of MIS TLIF has been done to define the present status of the procedure in this narrative review. Iliac crest bone graft can help achieve very good fusion rate without significantly increasing the morbidity. RhBMP is most potent enhancer of fusion and the adverse effects can be avoided by surgical technique and using lower dose. The use of navigation techniques has reduced the radiation exposure to patient and the surgeons but the benefit seems to be significant only in long segment fusions.
Collapse
Key Words
- ALIF, Anterior lumbar interbody fusion
- Bone graft substitutes
- DBM, Demineralised Bone Matrix
- JOABPEQ, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire
- LLIF, Lateral lumbar interbody fusion
- MIISA, Minimally Invasive Interbody Selection Algorithm
- MIS TLIF
- MIS TLIF, Minimally invasive transforaminal interbody fusion
- Minimally invasive lumbar interbody fusion
- Navigation assisted lumbar fusion
- OLIF, Oblique lumbar interbody fusion
- SiCaP, Silicate-substituted Calcium Phosphate
- Transforaminal interbody fusion
- XLIF, Extreme lateral lumbar interbody fusion
- rhBMP, recombinant human bone morphogenic protein
- β-TCP, β-Tricalcium Phosphate
Collapse
Affiliation(s)
- S. Phani Kiran
- Gleneagles Global Health City, Chennai, India,Corresponding author. Gleneagles Global Health City, 439 Cheran Nagar, Perumbakkam, Chennai, 600100, Tamilnadu, India.
| | - G. Sudhir
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| |
Collapse
|
4
|
Elgafy H, Wetzell B, Gillette M, Semaan H, Rowland A, Balboa CA, Mierzwa TA, McLean JB, Dorsch K, Moore MA. Lumbar spine fusion outcomes using a cellular bone allograft with lineage-committed bone-forming cells in 96 patients. BMC Musculoskelet Disord 2021; 22:699. [PMID: 34404368 PMCID: PMC8369686 DOI: 10.1186/s12891-021-04584-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Instrumented posterior lumbar fusion (IPLF) with and without transforaminal interbody fusion (TLIF) is a common treatment for low back pain when conservative interventions have failed. Certain patient comorbidities and lifestyle risk factors, such as obesity and smoking, are known to negatively affect these procedures. An advanced cellular bone allograft (CBA) with viable osteogenic cells (V-CBA) has demonstrated high fusion rates, but the rates for patients with severe and/or multiple comorbidities remain understudied. The purpose of this study was to assess fusion outcomes in patients undergoing IPLF/TLIF using V-CBA with baseline comorbidities and lifestyle risk factors known to negatively affect bone fusion. METHODS This was a retrospective study of de-identified data from consecutive patients at an academic medical center who underwent IPLF procedures with or without TLIF, and with V-CBA. Baseline patient and procedure characteristics were assessed. Radiological outcomes included fusion rates per the Lenke scale. Patient-reported clinical outcomes were evaluated via the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain. Operating room (OR) times and intraoperative blood loss rates were also assessed. RESULTS Data from 96 patients were assessed with a total of 222 levels treated overall (mean: 2.3 levels) and a median follow-up time of 16 months (range: 6 to 45 months). Successful fusion (Lenke A or B) was reported for 88 of 96 patients (91.7%) overall, including in all IPLF-only patients. Of 22 patients with diabetes in the IPLF+TLIF group, fusion was reported in 20 patients (90.9%). In IPLF+TLIF patients currently using tobacco (n = 19), fusion was reported in 16 patients (84.3%), while in those with a history of tobacco use (n = 53), fusion was observed in 48 patients (90.6%). Successful fusion was reported in all 6 patients overall with previous pseudarthrosis at the same level. Mean postoperative ODI and VAS scores were significantly reduced versus preoperative ratings. CONCLUSION The results of this study suggest that V-CBA consistently yields successful fusion and significant decreases in patient-reported ODI and VAS, despite patient comorbidities and lifestyle risk factors that are known to negatively affect such bony healing.
Collapse
Affiliation(s)
- Hossein Elgafy
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA.
| | - Bradley Wetzell
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Marshall Gillette
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Hassan Semaan
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Andrea Rowland
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Christopher A Balboa
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Thomas A Mierzwa
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Julie B McLean
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Kimberly Dorsch
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Mark A Moore
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| |
Collapse
|
5
|
Otsuki B, Fujibayashi S, Tanida S, Shimizu T, Murata K, Matsuda S. Possible Association of Pedicle Screw Diameter on Pseudoarthrosis Rate After Transforaminal Lumbar Interbody Fusion. World Neurosurg 2021; 150:e155-e161. [PMID: 33684576 DOI: 10.1016/j.wneu.2021.02.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although pedicle screw sizes may affect the rate of bone union after lumbar fusion surgery, there is currently no supportive clinical evidence. METHODS Eighty-five patients older than 50 years who underwent single-level L4/5 transforaminal lumbar interbody fusion with posterior pedicle screw (PS) fixation were analyzed. Patients with factors that potentially inhibit bone fusion, such as Parkinson disease, were excluded. Bone union was assessed using computed tomography and dynamic radiographs 1 year after surgery. Explanatory factors considered included sex, age, smoking, bone density, material of the cage, PS diameter (PSD), relative PS length, theoretical maximum PSD (PSDmax), which was defined as the maximum diameter of the screw that may be inserted without breaking cortical bone around the pedicle, and the filling index, which was defined as the difference between the cross-sectional area of maximum PS and actual PS (PSDmaxˆ 2 - PSD ˆ 2). Japanese Orthopaedic Association scores before and 1 year after surgery were evaluated as a clinical outcome. RESULTS Nineteen levels were diagnosed as pseudoarthrosis. A multivariate logistic regression analysis identified a larger filling index (P = 0.016) and older age (P = 0.047) as risk factors for pseudoarthrosis. The Japanese Orthopaedic Association score 1 year after surgery and its recovery rate were significantly worse in patients with pseudoarthrosis than in those with fusion. CONCLUSIONS The selection of an appropriately sized screw is important for achieving rigid fusion after transforaminal lumbar interbody fusion. Preoperative planning using multiplanar reconstruction computed tomography is an important approach for ensuring good clinical results.
Collapse
Affiliation(s)
- Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shimei Tanida
- Department of Orthopaedic Surgery, Shiga General Hospital, Moriyama, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
6
|
May AT, Farah K, Meyer M, Fuentes S. How I do it: mini invasive transforaminal lumbar interbody fusion. Acta Neurochir (Wien) 2021; 163:289-293. [PMID: 32410122 DOI: 10.1007/s00701-020-04388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive approaches for lumbar fusion are aimed at reducing soft tissue injury in order to minimize surgical morbidity and facilitate recovery. METHOD Applied to lumbar fusion, such an approach is described as a mini-open transforaminal lumbar interbody fusion (TLIF). Important anatomical landmarks are reviewed. Indications, advantages, and limitations are discussed, and a step-by-step description of the procedure is presented. RESULTS Decompression, fixation, and bone grafting can be achieved efficiently through this approach with lesser blood loss, shorter hospital stay, reduced rate of general complications, and infections as well as a lower readmission rate. CONCLUSION The mini-open TLIF technique, as presented here, is a safe and efficient procedure to achieve lumbar fusion with a reduced rate of complications related to surgery.
Collapse
Affiliation(s)
- Adrien Thomas May
- Department of Neurosurgery, Hôpital de La Timone, Assistance Publique - Hôpitaux de Marseille, Rue Saint-Pierre 264, Marseille, France.
| | - Kaissar Farah
- Department of Neurosurgery, Hôpital de La Timone, Assistance Publique - Hôpitaux de Marseille, Rue Saint-Pierre 264, Marseille, France
| | - Mikael Meyer
- Department of Neurosurgery, Hôpital de La Timone, Assistance Publique - Hôpitaux de Marseille, Rue Saint-Pierre 264, Marseille, France
| | - Stéphane Fuentes
- Department of Neurosurgery, Hôpital de La Timone, Assistance Publique - Hôpitaux de Marseille, Rue Saint-Pierre 264, Marseille, France
| |
Collapse
|
7
|
Crawford CH, Owens RK, Djurasovic M, Gum JL, Dimar JR, Carreon LY. Minimally-Invasive midline posterior interbody fusion with cortical bone trajectory screws compares favorably to traditional open transforaminal interbody fusion. Heliyon 2019; 5:e02423. [PMID: 31535047 PMCID: PMC6744604 DOI: 10.1016/j.heliyon.2019.e02423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/05/2019] [Accepted: 09/02/2019] [Indexed: 12/14/2022] Open
Abstract
Objective Posterior interbody fusion is commonly performed for degenerative lumbar conditions. A minimally invasive technique of midline exposure limited only to the facets and fixation with laterally directed cortical bone trajectory (CBT) screws was introduced with the intent of decreasing surgical morbidity. The purpose of this study was to determine if posterior interbody fusion with this limited midline exposure will have less blood loss and shorter operative times (i.e., can be considered minimally invasive) compared to traditional open transforaminal interbody fusion. Methods A consecutive single-surgeon series of patients who underwent posterior interbody fusion with either a navigated, midline only exposure (MidLIF) or full, traditional open, exposure of the transverse processes with a posterolateral fusion (open TLIF) were identified. Demographic, peri-operative data, patient reported outcomes (PROs), and reoperation/readmission rates were collected and compared. Results There were 29 cases in the MidLIF and 27 in the open TLIF group. Both groups were similar with respect to surgical indications, age, BMI, gender, ASA grade and operative level. The MidLIF group had significantly lower estimated blood loss (266 vs. 446 cc, p = 0.003), shorter operative time (170 vs. 210 minutes, p = 0.003), and shorter length of hospital stay (2.9 vs. 3.7 days, p = 0.016) compared to the open TLIF group. A sub-analysis of single-level cases showed similar findings with significantly lower estimated blood loss (247 vs. 411 cc, p = 0.10), shorter operative time (159 vs. 199 min, p = 0.003), and shorter length of hospital stay (2.9 vs. 3.7 days, p = 0.023) in the MidLIF group. Patient reported outcomes at 6 weeks, 3 months, 6 months, 12 months and 24 months post-operative favored MidLIF with significantly greater ODI improvements at both 6 weeks and 12 months; and lower ODI and back pain at both 12 months and 24 months. Conclusions MidLIF had lower blood loss and shorter operative time compared to the traditional open TLIF technique. These differences compare well to reported values in the literature for tubular minimally-invasive TLIF. Patient reported outcomes from 6 weeks to 24 months post-operative, hospital length of stay, and reoperation/readmission rates all favored MidLIF compared to traditional open TLIF.
Collapse
Affiliation(s)
- Charles H Crawford
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, United States
| | - Roger K Owens
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, United States
| | - Mladen Djurasovic
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, United States
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, United States
| | - John R Dimar
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, United States
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, United States
| |
Collapse
|
8
|
Hlubek RJ, Godzik J, Newcomb AGUS, Lehrman JN, de Andrada B, Bohl MA, Farber SH, Kelly BP, Turner JD. Iliac screws may not be necessary in long-segment constructs with L5-S1 anterior lumbar interbody fusion: cadaveric study of stability and instrumentation strain. Spine J 2019; 19:942-950. [PMID: 30419290 DOI: 10.1016/j.spinee.2018.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbosacral pseudoarthrosis and instrumentation failure is common with long-segment constructs. Optimizing lumbosacral construct biomechanics may help to reduce failure rates. The influence of iliac screws and interbody type on range of motion (ROM), rod strain (RS), sacral screw strain (SS) is not well-established. PURPOSE Investigate the effects of transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and iliac screws on long-segment lumbosacral construct biomechanics. STUDY DESIGN Biomechanical study. PATIENT SAMPLE Fourteen human cadaveric spine specimens. OUTCOME MEASURES Lumbosacral ROM, RS, and SS. METHODS Specimens were potted at L1 and the ilium. Specimens were equally divided into either an L5-S1 ALIF or TLIF group and underwent testing in the following conditions: (1) intact (2) L2-S1 pedicle screw rod fixation (PSR-S) (3) L2-ilium (PSR-I) (4) PSR-S+ALIF (ALIF-S) or TLIF (TLIF-S) (5) PSR-I + ALIF (ALIF-I) or TLIF (TLIF-I). Pure moment bending (7.5 Nm) in flexion, extension, lateral bending, axial rotation, and compressive loads (400N) were applied and ROM, SS, and RS were measured. Comparisons were performed using a one-way ANOVA (p<.05). RESULTS ALIF-S and TLIF-S provided similar decreases in ROM as TLIF-I (p>.05). Compared to PSR-S, PSR-I significantly decreased SS during bending in all directions (p<.02) but increased RS in flexion and extension (p≤.02). Anterior lumbar interbody fusion-S provided similar decreases in SS as TLIF-I in all directions (p>.40) but had significantly less RS than TLIF-I in flexion, extension, compression (p<.01). TLIF-S had more SS than TLIF-I in flexion, extension, axial rotation (p<.02), while TLIF-S had less RS only in flexion (p=.03). Compared to PSR-I, ALIF-I decreased the RS (p<.02) but TLIF-I did not (p>.67). CONCLUSIONS Iliac screws were protective of SS but increased RS at the lumbosacral junction. Constructs with ALIF and no iliac screws result in comparable SS as constructs with TLIF and iliac screws with significantly reduced RS. If iliac screws are utilized, ALIF but not TLIF reduces the iliac screw-induced RS. CLINICAL SIGNIFICANCE There is a relatively high incidence of lumbosacral instrumentation failure in adult spinal deformity. Optimizing lumbosacral construct biomechanics may help to reduce failure rates. Iliac screws induce lumbosacral rod strain and may be responsible for instrumentation failure. Constructs with lumbosacral ALIF reduce iliac-screw induced rod strain and may obviate the need for fixation to the ilium.
Collapse
Affiliation(s)
- Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Anna G U S Newcomb
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Jennifer N Lehrman
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Bernardo de Andrada
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Samuel H Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Brian P Kelly
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA.
| |
Collapse
|
9
|
Champagne PO, Walsh C, Diabira J, Plante MÉ, Wang Z, Boubez G, Shedid D. Sagittal Balance Correction Following Lumbar Interbody Fusion: A Comparison of the Three Approaches. Asian Spine J 2019; 13:450-458. [PMID: 30909679 PMCID: PMC6547387 DOI: 10.31616/asj.2018.0128] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/20/2018] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE The objective of this study was to compare three widely used interbody fusion approaches in regard to their ability to correct sagittal balance, including pelvic parameters. OVERVIEW OF LITERATURE Restoration of sagittal balance in lumbar spine surgery is associated with better postoperative outcomes. Various interbody fusion techniques can help to correct sagittal balance, with no clear consensus on which technique offers the best correction. METHODS The charts and imaging of patients who have undergone surgery through either open transforaminal lumbar interbody fusion (TLIF), minimally invasive TLIF (MIS TLIF), or oblique lumbar interbody fusion (OLIF) were retrospectively reviewed. The following sagittal balance parameters were measured pre- and postoperatively: segmental lordosis, lumbar lordosis, disk height, pelvic tilt, and pelvic incidence. Data on postoperative complications were gathered. RESULTS Only OLIF managed to significantly improve segmental lordosis (4.4°, p <0.001) and lumbar lordosis (4.8°, p =0.049). All approaches significantly augmented disk height, with OLIF having the greatest effect (3.7°, p <0.001). No approaches were shown to significantly correct pelvic tilt. Pelvic incidence remained unchanged in all approaches. Open TLIF was the only approach with a higher rate of postoperative complications (33%, p =0.009). CONCLUSIONS The OLIF approach might offer greater correction of sagittal balance over open and MIS TLIF, mainly in regard to segmental lordosis, lumbar lordosis, and disk height. MIS TLIF, although offering more limited access than open TLIF, was not inferior to open TLIF in regard to sagittal balance correction. A higher rate of complications was shown for open TLIF than the other approaches, possibly due to its more invasive nature.
Collapse
Affiliation(s)
| | - Camille Walsh
- Division of Neurosurgery, University of Montreal Medical Center (CHUM), Montreal, Canada
| | - Jocelyne Diabira
- Division of Neurosurgery, University of Montreal Medical Center (CHUM), Montreal, Canada
| | - Marie-Élaine Plante
- Division of Neurosurgery, University of Montreal Medical Center (CHUM), Montreal, Canada
| | - Zhi Wang
- Division of Orthopaedic Surgery, University of Montreal Medical Center (CHUM), Montreal, Canada
| | - Ghassan Boubez
- Division of Orthopaedic Surgery, University of Montreal Medical Center (CHUM), Montreal, Canada
| | - Daniel Shedid
- Division of Neurosurgery, University of Montreal Medical Center (CHUM), Montreal, Canada
| |
Collapse
|
10
|
Seaman S, Kerezoudis P, Bydon M, Torner JC, Hitchon PW. Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature. J Clin Neurosci 2017; 44:23-29. [PMID: 28736113 DOI: 10.1016/j.jocn.2017.06.062] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/09/2017] [Indexed: 12/29/2022]
Abstract
Spinal interbody fusion is a standard and accepted method for spinal fusion. Interbody fusion devices include titanium (Ti) and polyetheretherketone (PEEK) cages with distinct biomechanical properties. Titanium and PEEK cages have been evaluated in the cervical and lumbar spine, with conflicting results in bony fusion and subsidence. Using Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, we reviewed the available literature evaluating Ti and PEEK cages to assess subsidence and fusion rates. Six studies were included in the analysis, 3 of which were class IV evidence, 2 were class III, and 1 was class II. A total of 410 patients (Ti-228, PEEK-182) and 587 levels (Ti-327, PEEK-260) were studied. Pooled mean age was 50.8years in the Ti group, and 53.1years in the PEEK group. Anterior cervical discectomy was performed in 4 studies (395 levels) and transforaminal interbody fusion in 2 studies (192 levels). No statistically significant difference was found between groups with fusion (OR 1.16, 95% C.I 0.59-2.89, p=0.686, I2=49.7%) but there was a statistically significant the rate of subsidence with titanium (OR 3.59, 95% C.I 1.28-10.07, p=0.015, I2=56.9%) at last follow-up. Titanium and PEEK cages are associated with a similar rate of fusion, but there is an increased rate of subsidence with titanium cage. Future prospective randomized controlled trials are needed to further evaluate these cages using surgical and patient-reported outcomes.
Collapse
Affiliation(s)
- Scott Seaman
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Panagiotis Kerezoudis
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States; Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, United States
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States; Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, United States
| | - James C Torner
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, United States
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United States.
| |
Collapse
|
11
|
Lin GX, Quillo-Olvera J, Jo HJ, Lee HJ, Covarrubias-Rosas CA, Jin C, Kim JS. Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison Study Based on End Plate Subsidence and Cystic Change in Individuals Older and Younger than 65 Years. World Neurosurg 2017; 106:174-184. [PMID: 28669872 DOI: 10.1016/j.wneu.2017.06.136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/20/2017] [Accepted: 06/24/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the outcomes between patients older and younger than 65 years who underwent single-level minimally invasive transforaminal interbody fusion (MI-TLIF) surgery. METHODS This study is a retrospective analysis of 76 patients who underwent MI-TLIF between April 2012 and June 2016. Group A consisted of 35 patients (<65 years) and group B consisted of 41 patients (≥65 years). Intraoperative data were recorded. The evaluation of clinical outcomes was based on the visual analog scale for back and leg pain and the Oswestry Disability Index. Radiologic outcomes including cage subsidence, end plate cyst formation, and fusion rate were assessed. RESULTS The mean age of the study subjects was 65.3 years, and the mean duration of follow-up was 18.98 months. Group B had a higher rate of comorbidities compared with group A (90.24% vs. 57.14%, respectively; P < 0.05). There was no statistically significant difference in the rate of complications between the groups (group A, 14.29%; group B, 17.07%). Clinical outcomes significantly improved in both groups postoperatively (P < 0.05). Although bony fusion in group A was slightly higher than that in group B, the fusion rate was not statistically different according to age. There were no statistically significant differences in the rates of cage subsidence or positive cyst sign between the groups. CONCLUSIONS MI-TLIF presented similar safeness and acceptable outcomes and complication rate in both groups. Cyst formation may be aggravated by cage subsidence, because cage subsidence was a useful potential predictor of cyst formation.
Collapse
Affiliation(s)
- Guang-Xun Lin
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, Republic of Korea
| | - Javier Quillo-Olvera
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, Republic of Korea
| | - Hyun-Jin Jo
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, Republic of Korea
| | - Hyeong-Jin Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, Republic of Korea
| | - Claudia Angelica Covarrubias-Rosas
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, Republic of Korea
| | - Chengzhen Jin
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, Republic of Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, Republic of Korea.
| |
Collapse
|
12
|
Siddiqui MM, Sta Ana AR, Yeo W, Yue WM. Bone Morphogenic Protein Is a Viable Adjunct for Fusion in Minimally Invasive Transforaminal Lumbar Interbody Fusion. Asian Spine J 2016; 10:1091-9. [PMID: 27994786 DOI: 10.4184/asj.2016.10.6.1091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/20/2016] [Accepted: 05/07/2016] [Indexed: 11/21/2022] Open
Abstract
Study Design Comparison of prospectively collected data of patients undergoing minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) with and without recombinant human bone morphogenic protein 2 (BMP). Purpose To compare the clinical, radiological outcome and complications of patients undergoing MIS-TLIF with and without BMP. Overview of Literature BMP is an effective fusion enhancer with potential complications. Direct comparison of MIS-TLIF with and without BMP is limited to retrospective studies with short follow-up. Methods From June 2005 to February 2011, consecutive cases of MIS-TLIF performed by a single surgeon were included. North American Spine Society (NASS) score, Oswestry disability index (ODI), Short Form-36 (SF-36), and visual analogue score (VAS) were assessed preoperatively and at 6 and 24 months postoperatively. Fusion rates and complications were noted. Results The 252 cases comprised 104 non-BMP and 148 BMP cases. The BMP group was significantly older (mean age, 60.2 vs. 53.9; p<0.01). Preoperative scores were similar. Immediate postoperative morphine usage was significantly lower in the BMP group (12.4 mg vs. 20.1 mg, p<0.01). At 6 months, the BMP group had lower VAS back and leg pain scores (p<0.01). At 2 years, the BMP group had better leg pain scores (p<0.01), ODI (15.4 vs. 20.3, p=0.04) and NASS scores (8.8 vs. 15.8, p<0.01). Both groups showed significant clinical improvement compared to their preoperative levels. The BMP group attained a significantly higher rate of fusion at 6 months follow-up (88.4% vs. 76.8%, p=0.016) with no difference at 2 years. The non-BMP and BMP group had 12 (11.5%) and 9 (6.1%) complications and 5 (4.8%) and 2 (1.4%) reoperations, respectively. Conclusions The use of BMP to augment fusion in MIS-TLIF is an acceptable alternative that has potential benefits of less pain in early and intermediate postoperative follow-up.
Collapse
|
13
|
Tian Y, Liu X. Clinical outcomes of two minimally invasive transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases. Eur J Orthop Surg Traumatol 2016; 26:745-51. [PMID: 26943871 DOI: 10.1007/s00590-016-1755-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/17/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are two modified TLIF, including MIS-TLIF and TLIF through Wiltse approach (W-TLIF). Although both of the two minimally invasive surgical procedures can be effective in the treatment for lumbar degenerative diseases, no comparative analysis has been made so far regarding their clinical outcomes. OBJECTIVE To compare the clinical outcomes of MIS-TLIF and W-TLIF for the treatment for single-segment degenerative lumbar diseases. METHODS Ninety-seven patients with single-segment degenerative lumbar disorders were included in this study. Forty-seven underwent MIS-TLIF surgery (group A). For group B, fifty patients underwent W-TLIF. The Japanese Orthopedic Association (JOA) score, the visual analog scale (VAS) of low back pain (LBP) and leg pain, MRI score and atrophy rate of CSA, interbody fusion rate were assessed during the postoperative follow-up. RESULTS Incision length, blood loss, operative time, CPK, and postoperative incision pain VAS were better in group A (P < 0.05). The seconds of intraoperative fluoroscopy in groups A and B were 76 ± 9 and 7 ± 2, respectively (P < 0.05). In group B, The blood loss and CPK at L5-S1 were significantly higher than those at L4-5. Postoperative JOA scores, VAS of leg pain, and fusion rate were statistically the same between the two groups. VAS of LBP, MRI score, and atrophy rate of CSA was better in group A than in group B (P < 0.05). CONCLUSION Both methods are effective in the treatment for lumbar degenerative disease. MIS-TLIF has less blood loss, shorter surgical incision, and less lower postoperative back pain, while W-TLIF is less expensive for hospital stay with lower exposure to X-rays.
Collapse
Affiliation(s)
- Yonghao Tian
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, 107# Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Xinyu Liu
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, 107# Wenhua Road, Jinan, 250012, Shandong Province, China.
| |
Collapse
|
14
|
Shetty AP, Aiyer SN, Kanna RM, Maheswaran A, Rajasekaran S. Pyogenic lumbar spondylodiscitis treated with transforaminal lumbar interbody fusion: safety and outcomes. Int Orthop. 2016;40:1163-1170. [PMID: 26711446 DOI: 10.1007/s00264-015-3063-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/27/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE Our aim was to study the safety and outcomes of posterior instrumentation and transforaminal lumbar interbody fusion (TLIF) for treating pyogenic lumbar spondylodiscitis. METHODS Retrospective analysis was performed on prospectively collected data of 27 consecutive cases of lumbar pyogenic spondylodiscitis treated with posterior instrumentation and TLIF between January 2009 and December 2012. Cases were analysed for safety, radiological and clinical outcomes of transforaminal interbody fusion using bone graft ± titanium cages. Interbody metallic cages with bone graft were used in 17 cases and ten cases used only bone graft. Indications for surgical treatment were failed conservative management in 17, neurodeficit in six and significant bony destruction in four. RESULTS There were no cases reporting cage migration, loosening, pseudoarthrosis or recurrence of infection at a mean follow-up of 30 months. Clinical outcomes were assessed using Kirkaldy-Willis criteria, which showed 14 excellent, nine good, three fair and one poor result. Mean focal deformity improved with the use of bone graft ± interbody cages, and the deformity correction was maintained at final follow-up. Mean pre-operative focal lordosis for the graft group was 8.5° (2-16.5°), which improved to 10.9 °(3.3-16°); mean pre-operative focal lordosis in the group treated with cages was 6.7 °(0-15°), which improved to 7°(0-15°) . CONCLUSION TLIFs with cages in patients with pyogenic lumbar spondylodiscitis allows for acceptable clearance of infection, satisfactory deformity correction with low incidence of cage migration, loosening and infection recurrence.
Collapse
|
15
|
Giorgi H, Prébet R, Delhaye M, Aurouer N, Mangione P, Blondel B, Tropiano P, Fuentes S, Parent HF. Minimally invasive posterior transforaminal lumbar interbody fusion: One-year postoperative morbidity, clinical and radiological results of a prospective multicenter study of 182 cases. Orthop Traumatol Surg Res 2015; 101:S241-5. [PMID: 26372185 DOI: 10.1016/j.otsr.2015.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 06/24/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Interbody fusion is the gold standard treatment for the management of numerous diseases of the spine. Minimally invasive techniques may be more beneficial than conventional techniques. The main goal of this study was to report the one-year postoperative results of a series of posterior lumbar interbody fusions by a minimally invasive technique in relation to improvement in functional outcome, interbody fusion and morbidity. MATERIALS AND METHODS Between January 2012 and May 2013, 182 patients treated by minimally invasive posterior transforaminal lumbar interbody fusion (TLIF) were included in this prospective multicenter study. Clinical assessment was based on a comparison of the preoperative and one-year postoperative Oswestry (ODI), SF-12 and Quebec Scores and the Visual Analog Scale (VAS). Surgical and postoperative follow-up data were evaluated. Radiological assessment was based preoperative and one-year postoperative full spine teleradiographs. Interbody fusion at one-year was systematically evaluated by CT scan. RESULTS One hundred and eighty-two patients were included, mean age 58.9 years old. Surgery lasted a mean 101 minutes, mean preoperative bleeding was 143 mL, and mean radiation exposure was 247.4 cGy/cm(2). The rate of postoperative complications was 7.7%. The ODI, the Quebec Score, the SF-12 and the VAS were all significantly improved at one-year (P<0.0001). The rate of fusion was 72.6% at the final follow-up. There was no significant difference in functional outcome between patients with and without fusion. DISCUSSION The one-year postoperative radiological results and functional outcome of minimally invasive posterior lumbar fusion are satisfactory. The benefits of this minimally invasive approach are mainly found in the first 6 postoperative months. Successful radiological interbody fusion was not correlated to functional outcome at the final follow-up.
Collapse
Affiliation(s)
- H Giorgi
- Service de chirurgie orthopédique, université Aix-Marseille, CHU La Timone, 13005 Marseille, France
| | - R Prébet
- Centre du rachis, clinique Saint-Léonard, Angers, France
| | - M Delhaye
- Centre du rachis, clinique Saint-Léonard, Angers, France
| | - N Aurouer
- Centre Aquitain-du-Dos, Mérignac, France
| | - P Mangione
- Centre Aquitain-du-Dos, Mérignac, France
| | - B Blondel
- Service de chirurgie orthopédique, université Aix-Marseille, CHU La Timone, 13005 Marseille, France
| | - P Tropiano
- Service de chirurgie orthopédique, université Aix-Marseille, CHU La Timone, 13005 Marseille, France
| | - S Fuentes
- Service de neurochirurgie, université Aix-Marseille, CHU La Timone, Marseille, France
| | - H-F Parent
- Centre du rachis, clinique Saint-Léonard, Angers, France
| | | |
Collapse
|
16
|
Affiliation(s)
- Khoi D Than
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, USA.
| |
Collapse
|
17
|
Barami K, Lincoln T, Bains R. Experience with transforaminal interbody fusion in corrective surgery for adolescent idiopathic scoliosis. J Clin Neurosci 2013; 20:1256-8. [PMID: 23702374 DOI: 10.1016/j.jocn.2012.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/18/2012] [Accepted: 12/01/2012] [Indexed: 10/26/2022]
Abstract
One of the surgical goals during the treatment of adolescent idiopathic scoliosis (AIS) is to preserve segments and thus mobility while achieving a well-balanced spine on all planes. The transforaminal interbody fusion (TLIF) technique allows for a significant degree of rotational correction and thus may allow for preservation of more mobile segments. This retrospective study analyzed the use of TLIF in AIS patients who underwent surgery between 2006 and 2009 at a single center, and discusses the degree of curve correction, complications and outcomes. All curves were classified using the Lenke classification system. Standing posterior-anterior Cobb angle, sagittal and coronal balance, percent correction, and end/stable/neutral/apical vertebra were determined on preoperative, postoperative and follow-up radiographs. Nine patients were identified (eight women and one man) ranging in age from 11.6-18 years. All TLIF procedures were performed at the L2/3 level. Lenke curves included 5CN (n=5), 5BN (n=2), and 6CN (n=2). Average follow-up was 27.4 months (range, 12-57 months). Average postoperative curve correction was 79%. One patient underwent revision surgery. All patients remained stable from a clinical and radiographic standpoint on their last follow-up visit. TLIF is an important adjunct in the surgical management of select AIS patients. By allowing for greater rotational correction, it may be possible to preserve one more mobile segment without decompensation or overcorrection. To our knowledge, this is the first report on the role of TLIF in AIS. Future studies are warranted in determining those who will maximally benefit from this technique.
Collapse
Affiliation(s)
- Kaveh Barami
- Regional Spinal Surgery, Kaiser Permanente, Oakland Medical Center, 280 W. MacArthur Boulevard, Oakland, CA 94611, USA.
| | | | | |
Collapse
|