Effect of soft tissue thickness over the posterior border of the vertebral body and disc space on cage placement during posterior lumbar interbody fusion: A cadaveric study

Objective: To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF). Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level. Results: The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05). Conclusion: Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome.

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Biomechanical Comparison of Posterior and Transforaminal Interbody Fusion Constructs for the Degenerative Lumbar Spine

Advances in Bioengineering ◽

10.1115/imece2002-32633 ◽

2002 ◽

Author(s):

Stan Lee ◽

Alexander Ghanayem ◽

Scott Hodges ◽

Leonard Voronov ◽

Robert Havey ◽

...

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Facet Joint ◽

Posterior Lumbar Interbody Fusion ◽

Neural Element ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Fusion Procedure ◽

Flexion Extension ◽

Circumferential Fusion

Posterior lumbar interbody fusion (PLIF) is an established technique that allows circumferential fusion of lumbar spine through a single incision. A variation of PLIF called transforaminal lumbar interbody fusion (TLIF) uses a posterior approach to the spine but accesses the disc space via a path that runs through the far lateral portion of the vertebral foramen. TLIF provides the surgeon with a fusion procedure that reduces many of the risks and limitations associated with PLIF. Like PLIF, TLIF is easily enhanced when combined with posterolateral fusion (PLF) and instrumentation. TLIF offers an advantage in that it is usually done via a unilateral approach preserving the facet joint and the interlaminar surface on the contralateral side [1]. It minimizes soft tissue stripping and neural element retraction compared to PLIF, while providing a single-stage circumferential fusion. This study compared the biomechanical performance of these two constructs in flexion, extension, and lateral bending under physiologic compressive preloads.

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18F-FDG-PET/CT localizes intervertebral disc space infection following posterior lumbar interbody fusion surgery leading to successful retention of percutaneously inserted pedicle screws: a case report

Spinal Cord Series and Cases ◽

10.1038/s41394-018-0119-y ◽

2018 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Kentaro Haraya ◽

Katsuhisa Yamada ◽

Terufumi Kokabu ◽

Akira Iwata ◽

Tsutomu Endo ◽

...

Keyword(s):

Interbody Fusion ◽

Pedicle Screws ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Intervertebral Disc Space ◽

Disc Space ◽

Fusion Surgery ◽

Space Infection ◽

Pet Ct ◽

Fdg Pet Ct

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Induction of early degeneration of the adjacent segment after posterior lumbar interbody fusion by excessive distraction of lumbar disc space

Journal of Neurosurgery Spine ◽

10.3171/2009.12.spine08823 ◽

2010 ◽

Vol 12 (6) ◽

pp. 671-679 ◽

Cited By ~ 61

Author(s):

Takashi Kaito ◽

Noboru Hosono ◽

Yoshihiro Mukai ◽

Takahiro Makino ◽

Takeshi Fuji ◽

...

Keyword(s):

Risk Factor ◽

Interbody Fusion ◽

Lumbar Disc ◽

Japanese Orthopaedic Association ◽

Significant Risk ◽

Posterior Lumbar Interbody Fusion ◽

Disc Height ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Disc Space

Object Spinal fusion at the L4–5 disc space alters the normal biomechanics of the spine, and the loss of motion at the fused level is compensated by increased motion and load at the other unfused segments. This may lead to deterioration of the adjacent segments of the lumbar spine, called adjacent-segment disease (ASD). In this study, the authors investigate the distracted disc height of the fused segment, caused by cage or bone insertion during surgery, as a novel risk factor for ASD after posterior lumbar interbody fusion (PLIF). Methods Radiographic L3–4 ASD is defined by development of spondylolisthesis greater than 3 mm, a decrease in disc height of more than 3 mm, or intervertebral angle at flexion smaller than −5°. Symptomatic ASD is defined by a decrease of 4 points or more on the Japanese Orthopaedic Association scale. Eighty-five patients with L-4 spondylolisthesis treated by L4–5 PLIF underwent follow-up for more than 2 years (mean 38.8 ± 17.1 months). The patients were divided into 3 groups according to the final outcome. Group A comprised those patients without ASD (58), Group B patients had radiographic ASD (14), and Group C patients had symptomatic ASD (13). Results The L4–5 disc space distraction by cage insertion was 3.1 mm in the group without ASD, 4.4 mm in the group with radiographic ASD, and 6.2 mm in the group with symptomatic ASD, as measured using lateral spinal radiographs just after surgery. Multivariate analysis showed that distraction was the most significant risk factor. Conclusions The excessive distraction of the L4–5 disc space during PLIF surgery is a significant and potentially avoidable risk factor for the development of radiographic, symptomatic ASD.

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Evaluation of functional outcome of lumbar spondylolisthesis treated with posterior lumbar interbody fusion with instrumentation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182736 ◽

2018 ◽

Vol 4 (4) ◽

pp. 629

Author(s):

K. S. Raja ◽

M. Ravi

Keyword(s):

Functional Outcome ◽

Interbody Fusion ◽

Adult Population ◽

Three Dimensional ◽

Pedicle Screws ◽

Posterior Lumbar Interbody Fusion ◽

Lumbosacral Spine ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

College Hospital

Background: Spondylolisthesis with or without spondylolysis occurs in 5% to 8% of the adult population. It is commonly believed that spondylolysis does not exist at birth. The incidence is 4.4% to 5% at the age of 6 years, increasing to 6% at the age of 18 years, which is quite similar to that observed in adulthood.To analyze the functional outcome of posterior stabilization by pedicle screws with decompression and interbody fusion by PLIF (Posterior Lumbar Interbody Fusion) technique in adult single level spondylolisthesis. In this study our aim is to analyze the correlation between the degrees of fusion with functional outcomes.Methods: This is a prospective study of 20 patients carried out in the Department of Orthopaedics, Govt. Dharmapuri Medical College Hospital, Dharmapuri from January 2016 to December 2017. All patients were evaluated with anteroposterior, lateral and oblique radiographs of the lumbosacral spine. Dynamic plain radiographs of all our patients showed instability. CT/MRI evaluation of all patients was done.Results: In our study four patients (20%) had a complete reduction of the preoperative slip, fourteen patients (70%) showed a reduction of slip by one grade, while in two patients (10%) there was no change from the preoperative slip percentage.Conclusions: Further, three dimensional multislice thin section CT scans with multiplanar reconstruction are ideal to study the incorporation of the bone graft within the disc space.

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