6 Lateral transpsoas interbody lumbar fusionLumbar spinetranspsoas interbody fusion forMinimally Invasive Lateral Transpsoas Interbody Lumbar Fusion

2020 ◽  
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion

scholarly journals Best versus worst surgical outcomes after single-level posterior lumbar interbody fusion for degenerative spondylolisthesis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902098303
Author(s):  
Se-Jun Park ◽  
Keun-Ho Lee ◽  
Chong-Suh Lee ◽  
Ki-Tack Kim ◽  
Dong Hyeon Kim ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Degenerative Spondylolisthesis ◽  
Individual Treatment ◽  
Symptom Duration ◽  
Lumbar Interbody Fusion ◽  
Characteristic Analysis ◽  
Single Level ◽  
Patient Reported

Purpose: Previous studies have shown conflicting results regarding the factors affecting the clinical outcome after fusion for degenerative spondylolisthesis. However, no study has compared the best and worst clinical outcome groups using patient-reported outcome measures. We aimed to compare the characteristics of patients with best and worst outcomes following single-level lumbar fusion for degenerative spondylolisthesis. Methods: 200 patients underwent single-level interbody fusion with a minimum 2-years follow-up were included. We excluded patients with surgical complications already-known to be associated with poor postoperative outcomes, including pseudoarthrosis and postoperative infection. According to 2-year postoperative Oswestry disability index scores, patients were divided into two groups; Best and Worst. Demographic, clinical and radiographic variables were compared between the two groups. Results: Compared with patients in the Best group, those in the Worst group were older (59.5 and 67.0 years, respectively; p = 0.012; odds ratio [OR], 1.143; 95% confidence interval [CI], 1.030–1.269) and had a longer duration of pain from onset (2.6 and 7.2 years, respectively; p = 0.041; OR, 1.021; 95% CI, 1.001–1.041). The cutoff value of pain duration from onset was measured as ≥3.5 years on Receiver operating characteristic analysis. Patients in the Worst group had a lower preoperative angular motion compared to those in the Best group (12.7° and 8.3°, respectively; p = 0.016; OR, 0.816; 95% CI, 0.691–0.963). Conclusions: Degenerative spondylolisthesis patients of good clinical outcome after single-level lumbar interbody fusion were relatively young, had a short symptom duration before surgery, and a high preoperative instability compared with the patient having poor postoperative clinical outcome. Therefore, these findings should be considered preoperatively when deciding the appropriate individual treatment plan.

Retroperitoneal lateral lumbar interbody fusion with titanium threaded fusion cages

2002 ◽  
Vol 96 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Christopher E. Wolfla ◽  
Dennis J. Maiman ◽  
Frank J. Coufal ◽  
James R. Wallace
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Anterior Longitudinal Ligament ◽  
Content Type ◽  
Single Cage ◽  
Novel Technique ◽  
Methodological Problems ◽  
Fine Print

Object. Intertransverse arthrodesis in which instrumentation is placed is associated with an excellent fusion rate; however, treatment of patients with symptomatic nonunion presents a number of difficulties. Revision posterior and traditional anterior procedures are associated with methodological problems. For example, in the latter, manipulation of the major vessels from L-2 to L-4 may be undesirable. The authors describe a method for performing retroperitoneal lumbar interbody fusion (LIF) in which a threaded cage is placed from L-2 through L-5 via a lateral trajectory, and they also detail a novel technique for implanting a cage from L-5 to S-1 via an oblique trajectory. Although they present data obtained over a 2-year period in the study of 15 patients, the focus of this report is primarily on describing the surgical procedure. Methods. The lateral lumbar spine was exposed via a standard retroperitoneal approach. Using the anterior longitudinal ligament as a landmark, the L2–3 through L4–5 levels were fitted with instrumentation via a true lateral trajectory; the L5—S1 level was fitted with instrumentation via an oblique trajectory. A single cage was placed at each instrumented level. Fifteen symptomatic patients in whom previous lumbar fusion had failed underwent retroperitoneal LIF. Thirty-eight levels were fitted with instrumentation. There have been no instrumentation-related failures, and fusion has occurred at 37 levels during the 2-year postoperative period. Conclusions. The use of retroperitoneal LIF in which threaded fusion cages are used avoids the technical difficulties associated with repeated posterior procedures. In addition, it allows L2—S1 instrumentation to be placed anteriorly via a single surgical approach. This construct has been shown to be biomechanically sound in animal models, and it appears to be a useful alternative for the management of failed multilevel intertransverse arthrodesis.

Adjacent-segment effects of lumbar cortical screw–rod fixation versus pedicle screw–rod fixation with and without interbody support

2021 ◽  
pp. 1-7
Author(s):  
Piyanat Wangsawatwong ◽  
Anna G. U. Sawa ◽  
Bernardo de Andrada Pereira ◽  
Jennifer N. Lehrman ◽  
Luke K. O’Neill ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Statistical Significance ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Single Level ◽  
Cortical Screw ◽  
Flexion Extension

OBJECTIVE Cortical screw–rod (CSR) fixation has emerged as an alternative to the traditional pedicle screw–rod (PSR) fixation for posterior lumbar fixation. Previous studies have concluded that CSR provides the same stability in cadaveric specimens as PSR and is comparable in clinical outcomes. However, recent clinical studies reported a lower incidence of radiographic and symptomatic adjacent-segment degeneration with CSR. No biomechanical study to date has focused on how the adjacent-segment mobility of these two constructs compares. This study aimed to investigate adjacent-segment mobility of CSR and PSR fixation, with and without interbody support (lateral lumbar interbody fusion [LLIF] or transforaminal lumbar interbody fusion [TLIF]). METHODS A retroactive analysis was done using normalized range of motion (ROM) data at levels adjacent to single-level (L3–4) bilateral screw–rod fixation using pedicle or cortical screws, with and without LLIF or TLIF. Intact and instrumented specimens (n = 28, all L2–5) were tested using pure moment loads (7.5 Nm) in flexion, extension, lateral bending, and axial rotation. Adjacent-segment ROM data were normalized to intact ROM data. Statistical comparisons of adjacent-segment normalized ROM between two of the groups (PSR followed by PSR+TLIF [n = 7] and CSR followed by CSR+TLIF [n = 7]) were performed using 2-way ANOVA with replication. Statistical comparisons among four of the groups (PSR+TLIF [n = 7], PSR+LLIF [n = 7], CSR+TLIF [n = 7], and CSR+LLIF [n = 7]) were made using 2-way ANOVA without replication. Statistical significance was set at p < 0.05. RESULTS Proximal adjacent-segment normalized ROM was significantly larger with PSR than CSR during flexion-extension regardless of TLIF (p = 0.02), or with either TLIF or LLIF (p = 0.04). During lateral bending with TLIF, the distal adjacent-segment normalized ROM was significantly larger with PSR than CSR (p < 0.001). Moreover, regardless of the types of screw-rod fixations (CSR or PSR), TLIF had a significantly larger normalized ROM than LLIF in all directions at both proximal and distal adjacent segments (p ≤ 0.04). CONCLUSIONS The use of PSR versus CSR during single-level lumbar fusion can significantly affect mobility at the adjacent segment, regardless of the presence of TLIF or with either TLIF or LLIF. Moreover, the type of interbody support also had a significant effect on adjacent-segment mobility.

scholarly journals A comparative study of functional outcome between posterior lumbar fusion and posterior lumbar interbody fusion in spondylolisthesis

2021 ◽  
Vol 7 (3) ◽  
pp. 544
Author(s):  
Harpreet Singh ◽  
Dhruv Patel ◽  
Sangam Tyagi ◽  
Krushna Saoji ◽  
Tilak Patel ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Interbody Fusion ◽  
Operative Time ◽  
Lumbar Fusion ◽  
Tertiary Care ◽  
Posterior Lumbar Interbody Fusion ◽  
Invasive Technique ◽  
Lumbar Interbody Fusion ◽  
Tertiary Care Centre ◽  
Posterior Lumbar Fusion

<p class="abstract"><strong>Background:</strong> Spondylolisthesis is condition in which one vertebra slips over other vertebra. This study has been done to compare the functional outcome and complications of two techniques: posterior lumbar fusion (intertransverse fusion) and posterior lumbar interbody fusion.</p><p class="abstract"><strong>Methods:</strong> Total 20 patients with spondylolisthesis admitted in a tertiary care centre in Rajasthan were allotted alternatively in posterior lumbar fusion (PLF) group and posterior lumbar interbody fusion (PLIF) group. In PLF, fusion was done by placing bone graft between transverse processes and around facets. In PLIF, fusion was bone by placing cage in between vertebral bodies.</p><p class="abstract"><strong>Results:</strong> 20 patients were included in our study with female predominance (65%). Mean age was 54.2 years (PLF=58.4 and PLIF=50.2). 70% patients have L4-L5 level spondylolisthesis. Average operative time was less in PLF group, which is statistically significant. Functional outcome was measured by using visual analogue scale (VAS) score and Japanese orthopedics association score (JOAS) at 3 weeks, 3 months and 6 months. There is a significant decrease between preoperative VAS and at 6 months, in both PLF and PLIF group. JOAS was significantly increased at 6 months in both PLF and PLIF group as compared to preoperative score. But difference in JOAS at 6 months is not significant between PLF and PLIF.</p><p class="abstract"><strong>Conclusions:</strong> Both PLF and PLIF are equally effective for spondylolisthesis. Both techniques have same satisfactory results. As PLIF is more invasive technique, more operative time and more complications are seen.</p>

Radiographic and Clinical Outcomes of Anteroposterior Lumbar Fusion vs Transforaminal Lumbar Interbody Fusion in Patients with Mechanical Disc Collapse

2017 ◽  
Vol 17 (10) ◽  
pp. S250-S251
Author(s):  
Michael V. Mills ◽  
Steven D. Glassman ◽  
John R. Dimar ◽  
Valeri Wolf ◽  
Morgan Brown ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion

scholarly journals Novel spinal instrumentation to enhance osteogenesis and fusion: a preliminary study

2016 ◽  
Vol 25 (3) ◽  
pp. 318-327 ◽  
Author(s):  
Matthew R. MacEwan ◽  
Michael R. Talcott ◽  
Daniel W. Moran ◽  
Eric C. Leuthardt
Keyword(s):  
Electrical Stimulation ◽  
Quantitative Analysis ◽  
High Resolution ◽  
Bone Density ◽  
Spinal Fusion ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Spinal Instrumentation ◽  
Ct Scanner ◽  
Vertebral Bodies

OBJECTIVE Instrumented spinal fusion continues to exhibit high failure rates in patients undergoing multilevel lumbar fusion or pseudarthrosis revision; with Grade II or higher spondylolisthesis; or in those possessing risk factors such as obesity, tobacco use, or metabolic disorders. Direct current (DC) electrical stimulation of bone growth represents a unique surgical adjunct in vertebral fusion procedures, yet existing spinal fusion stimulators are not optimized to enhance interbody fusion. To develop an advanced method of applying DC electrical stimulation to promote interbody fusion, a novel osteogenic spinal system capable of routing DC through rigid instrumentation and into the vertebral bodies was fabricated. A pilot study was designed to assess the feasibility of osteogenic instrumentation and compare the ability of osteogenic instrumentation to promote successful interbody fusion in vivo to standard spinal instrumentation with autograft. METHODS Instrumented, single-level, posterior lumbar interbody fusion (PLIF) with autologous graft was performed at L4–5 in adult Toggenburg/Alpine goats, using both osteogenic spinal instrumentation (plus electrical stimulation) and standard spinal instrumentation (no electrical stimulation). At terminal time points (3 months, 6 months), animals were killed and lumbar spines were explanted for radiographic analysis using a SOMATOM Dual Source Definition CT Scanner and high-resolution Microcat II CT Scanner. Trabecular continuity, radiodensity within the fusion mass, and regional bone formation were examined to determine successful spinal fusion. RESULTS Quantitative analysis of average bone density in pedicle screw beds confirmed that electroactive pedicle screws used in the osteogenic spinal system focally enhanced bone density in instrumented vertebral bodies. Qualitative and quantitative analysis of high-resolution CT scans of explanted lumbar spines further demonstrated that the osteogenic spinal system induced solid bony fusion across the L4–5 disc space as early as 6 weeks postoperatively. In comparison, inactive spinal instrumentation with autograft was unable to promote successful interbody fusion by 6 months postoperatively. CONCLUSIONS Results of this study demonstrate that novel osteogenic spinal instrumentation supports interbody fusion through the focal delivery of DC electrical stimulation. With further technical development and scientific/clinical validation, osteogenic spinal instrumentation may offer a unique alternative to biological scaffolds and pharmaceutical adjuncts used in spinal fusion procedures.

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