Are the Benefits of Interbody Fusion Worth the Risks for Adult Deformity Correction?

2013 ◽  
Vol 13 (9) ◽  
pp. S25
Author(s):  
Michael S. Chang ◽  
Yu-Hui Chang ◽  
Jan Revella ◽  
Dennis G. Crandall
Keyword(s):  
Interbody Fusion ◽  
Deformity Correction ◽  
Adult Deformity

scholarly journals Treatment of Adult Scoliosis Fractional Curve With Minimally Invasive Surgery: Anterior Versus Posterior Approach?

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Robert Eastlack ◽  
Juan S Uribe ◽  
Richard G Fessler ◽  
Khoi D Than ◽  
Stacie Tran ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Posterior Approach ◽  
Interbody Fusion ◽  
Deformity Correction ◽  
Adult Scoliosis ◽  
Hybrid Technique ◽  
Complication Rates ◽  
Adult Deformity ◽  
Curve Magnitude

Abstract INTRODUCTION The fractional curve in adult scoliosis often causes radiculopathy and may be managed in varied manners with minimally invasive (MIS) deformity correction. There are inherent risks and benefits to anterior and posterior interbody reconstruction techniques, and the purpose of this study was to evaluate for differences in outcomes or complication rates by fractional curve treatment via MIS anterior vs. posterior interbody fusion METHODS Inclusion criteria were age = 18 yr, and one of the following: coronal cobb > 20°, SVA > 5 cm, PT > 20°, PI-LL > 10°. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery and had 2-yr minimum follow-up. Patient were divided into two groups: anterior or posterior interbody fusion at the lumbosacral junction (L4-S1). HRQOL measures included Oswestry Disability Index (ODI), visual analog score (VAS). RESULTS A total of 112 patients who underwent MIS adult deformity surgery with minimum 2-yr follow up. A total of 74 patients underwent anterior and 38 patients underwent posterior interbody reconstruction at L4-S1 utilizing MIS technique. Preoperative spinopelvic parameters, radiographic parameters, and VAS were not different, but ODI was higher in the anterior group (53 vs 48, P = .047). Complications and reoperation rates were not different (P = .089, P = .597), but posterior had more infections (15.8% vs 2.7%, P = .01). When subdivided for cMIS only surgery, 38 had anterior and 19 underwent posterior interbody fusions in the fractional curve. Pre- and postoperative VAS leg, ODI, and fractional curve magnitude were not different. In the anterior surgery cohorts, laminectomies at L4-S1 were performed in 22% of hybrid cases and in 8% of cMIS cases. CONCLUSION Treatment of the fractional curve of adult scoliosis appears to be similarly effective in reducing VAS, ODI, and fractional curve magnitude regardless of anterior vs posterior approach. However, posterior interbody reconstruction was associated with higher infection rate than anterior, regardless of application in cMIS or hybrid technique.

Mini-open posterior approach for adult deformity correction

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video14
Author(s):  
Cheerag Upadhyaya ◽  
John Ziewacs ◽  
Praveen Mummaneni
Keyword(s):  
Interbody Fusion ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Tubular Retractor ◽  
Adult Deformity ◽  
Minimally Invasive Surgical ◽  
Key Steps ◽  
Tissue Trauma ◽  
Mini Open

Minimally invasive surgical (MIS) approaches are gaining popularity in many surgical fields. Potential advantages include reduced blood loss, shorter length of stay, and less soft-tissue trauma. Potential disadvantages include inadequate deformity correction, increased fluoroscopy, longer operative times, and decreased posterolateral fusion surface area exposure.This video demonstrates the key steps in our mini-open transforaminal lumbar interbody fusion (TLIF) using an expandable tubular retractor, placement of cannulated pedicle instrumentation, and subsequent deformity correction. The video demonstrates positioning, surgical opening through a midline incision, a bilateral Wiltse plane tubular approach for the TLIF, placement of bilateral cannulated pedicle screws, and deformity correction.The video can be found here: http://youtu.be/9GH3qsCGX3E.

Saturday, September 29, 2018 9:00 am–10:00 am Impact of Adult Deformity Correction

2018 ◽  
Vol 18 (8) ◽  
pp. S129-S130
Author(s):  
Themistocles S. Protopsaltis ◽  
Nicholas Stekas ◽  
Renaud Lafage ◽  
Justin S. Smith ◽  
Alexandra Soroceanu ◽  
...  
Keyword(s):  
Deformity Correction ◽  
Adult Deformity

Strategies for prevention of rod fracture in adult spinal deformity: cobalt chrome rod, accessory rod technique, and lateral lumbar interbody fusion

2021 ◽  
pp. 1-10
Author(s):  
Ki Young Lee ◽  
Jung-Hee Lee ◽  
Kyung-Chung Kang ◽  
Sang-Kyu Im ◽  
Hae Seong Lim ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Lumbar Interbody Fusion ◽  
Patient Factors ◽  
Rod Fracture ◽  
Cobalt Chrome

OBJECTIVERestoring the proper sagittal alignment in adult spinal deformity (ASD) can improve radiological and clinical outcomes, but pseudarthrosis including rod fracture (RF) is a common problematic complication. The purpose of this study was to analyze the methods for reducing the incidence of RF in deformity correction of ASD.METHODSThe authors retrospectively selected 178 consecutive patients (mean age 70.8 years) with lumbar degenerative kyphosis (LDK) who underwent deformity correction with a minimum 2-year follow-up. Patients were classified into the non-RF group (n = 131) and the RF group (n = 47). For predicting the crucial factors of RF, patient factors, radiographic parameters, and surgical factors were analyzed.RESULTSThe overall incidence of RF was 26% (47/178 cases), occurring in 42% (42/100 cases) of pedicle subtraction osteotomy (PSO), 7% (5/67 cases) of lateral lumbar interbody fusion (LLIF) with posterior column osteotomy, 18% (23/129 cases) of cobalt chrome rods, 49% (24/49 cases) of titanium alloy rods, 6% (2/36 cases) placed with the accessory rod technique, and 32% (45/142 cases) placed with the 2-rod technique. There were no significant differences in the incidence of RF regarding patient factors between two groups. While both groups showed severe sagittal imbalance before operation, lumbar lordosis (LL) was more kyphotic and pelvic incidence (PI) minus LL (PI-LL) mismatch was greater in the RF group (p < 0.05). Postoperatively, while LL and PI-LL did not show significant differences between the two groups, LL and sagittal vertical axis correction were greater in the RF group (p < 0.05). Nonetheless, at the last follow-up, the two groups did not show significant differences in radiographic parameters except thoracolumbar junctional angles. As for surgical factors, use of the cobalt chrome rod and the accessory rod technique was significantly greater in the non-RF group (p < 0.05). As for the correction method, PSO was associated with more RFs than the other correction methods, including LLIF (p < 0.05). By logistic regression analysis, PSO, preoperative PI-LL mismatch, and the accessory rod technique were crucial factors for RF.CONCLUSIONSGreater preoperative sagittal spinopelvic malalignment including preoperative PI-LL mismatch was the crucial risk factor for RF in LDK patients 65 years or older. For restoring and maintaining sagittal alignment, use of the cobalt chrome rod, accessory rod technique, or LLIF was shown to be effective for reducing RF in ASD surgery.

scholarly journals THE USE OF NITINOL RODS IN SURGICAL TREATMENT OF DEGENERATIVE SCOLIOSIS. 2.5-YEAR FOLLOW-UP

2016 ◽  
Vol 15 (1) ◽  
pp. 22-25
Author(s):  
Natalia Sergeyevna Morozova ◽  
Dmitriy Aleksandrovich Kolbovsky ◽  
Arkadiy Ivanovich Kazmin ◽  
Sergey Vasilievich Kolesov
Keyword(s):  
Surgical Treatment ◽  
Interbody Fusion ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Control Group ◽  
Rigid Fixation ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbosacral Region ◽  
Pedicle Fixation

ABSTRACT Objectives: To compare the outcomes of surgical treatment with lumbar fixation using nitinol rods without fusion and with standard lumbar fixation with titanium rods and interbody fusion. Methods: Treatment results of 70 patients with degenerative lumbar scoliosis aged 40 to 82 were analyzed. In all cases pedicle screws and nitinol rods with a diameter of 5.5 mm were used. Thirty patients underwent fixation at L1-S1 and 40 patients underwent fixation at L1-L5. Spinal fusion was not performed. All patients had radiography, CT and MRI performed. The results were assessed according to the Oswestry scale, SRS 22, SF 36 and VAS. The minimum follow-up period for all patients was 2.5 years. For the control group, consisting of 72 patients, pedicle fixation with titanium rods and interbody fusion in the lumbosacral region were performed. Results: The average level of deformity correction equaled 25° (10° - 38°). The analysis of X-ray and CT-scans revealed a single patient with implant instability, two patients with bone resorption around the screws and one patient with rod fractures. Functional radiography 2.5 years after surgery showed an average mobility of the lumbar spine of 21° (15° - 30°). There were no problems at the adjacent levels. Conclusions: The use of nitinol rods in spinal deformity surgery is promising. This technology is an alternative to rigid fixation. Continued gathering of clinical data and its further evaluation is necessary.

scholarly journals Minimally invasive L5–S1 oblique lumbar interbody fusion with anterior plate

2016 ◽  
Vol 41 (videosuppl1) ◽  
pp. 1
Author(s):  
Martin H. Pham ◽  
Andre M. Jakoi ◽  
Patrick C. Hsieh
Keyword(s):  
Minimally Invasive ◽  
Degenerative Disc Disease ◽  
Interbody Fusion ◽  
Deformity Correction ◽  
Lumbar Interbody Fusion ◽  
Degenerative Scoliosis ◽  
Anterior Plate ◽  
Disc Disease ◽  
Case Presentation ◽  
Oblique Lumbar Interbody Fusion

Lumbar interbody fusion is an important technique for the treatment of degenerative disc disease and degenerative scoliosis. The oblique lumbar interbody fusion (OLIF) establishes a minimally invasive retroperitoneal exposure anterior to the psoas and lumbar plexus. In this video case presentation, the authors demonstrate the techniques of the OLIF at L5–S1 performed on a 69-year-old female with degenerative scoliosis as one component of an overall strategy for her deformity correction.The video can be found here: https://youtu.be/VMUYWKLAl0g.

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