Extraforaminal Lumbar Interbody Fusion at the L5–S1 Level: Technical Considerations and Feasibility

Background Extraforaminal lumbar interbody fusion (ELIF) surgery is a muscle-sparing approach that allows the treatment of various degenerative spinal diseases. It is technical challenging to perform the ELIF approach at the L5–S1 level because the sacral ala obstructs the view of the intervertebral disk space. Methods We reported earlier on the ELIF technique in which the intervertebral disk is targeted at an angle of 45 degrees relative to the midline. In this article we describe the technical process we developed to overcome the anatomic relation between the sacral ala and the intervertebral disk space L5–S1 that hinders the ELIF approach at this level. We then report in a retrospective analysis on the short-term clinical and radiologic outcome of 100 consecutive patients with degenerative L5–S1 pathologies who underwent ELIF surgery. Results The L5–S1 ELIF approach could be realized in all patients. The short-term clinical outcome was evaluated 5 months after surgery: 92% of the patients were satisfied with their postoperative result; 8% had a poor result. Overall, 17% of the patients presented light radicular or low back pain not influencing their daily activity, and 82% of the patients working before surgery returned to work 3 to 7 months after surgery. The radiologic outcome was documented by computed tomography at 5 months after surgery and showed fusion in 99% of the patients. Lumbar magnetic resonance imaging performed in 5 patients at 6 months after surgery revealed the integrity of the paraspinal muscles. Conclusions ELIF surgery at the L5–S1 level is technically feasible for various degenerative spinal diseases. Analysis of the clinical and radiologic data in a consecutive retrospective cohort of patients who underwent this surgical procedure showed a good short-term clinical outcome and fusion rate.

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The Use of Bone Morphogenetic Protein in the Intervertebral Disk Space in Minimally Invasive Transforaminal Lumbar Interbody Fusion

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000800 ◽

2019 ◽

Vol 32 (6) ◽

pp. E272-E276 ◽

Cited By ~ 1

Author(s):

Ian K. White ◽

Megan Tuohy ◽

Jacob Archer ◽

Gregory D. Schroeder ◽

Alexander R. Vaccaro ◽

...

Keyword(s):

Minimally Invasive ◽

Bone Morphogenetic Protein ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Intervertebral Disk ◽

Lumbar Interbody Fusion ◽

Disk Space ◽

Morphogenetic Protein ◽

Intervertebral Disk Space

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Posterior lumbar interbody fusion with cages: an independent review of 71 cases

Journal of Neurosurgery Spine ◽

10.3171/spi.1999.91.2.0186 ◽

1999 ◽

Vol 91 (2) ◽

pp. 186-192 ◽

Cited By ~ 16

Author(s):

Siviero Agazzi ◽

Alain Reverdin ◽

Daniel May

Keyword(s):

Retrospective Study ◽

Clinical Outcome ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Content Type ◽

Fixation Techniques ◽

Independent Review ◽

Fine Print

Object. The authors conducted a retrospective study to provide an independent evaluation of posterior lumbar interbody fusion (PLIF) in which impacted carbon cages were used. Interbody cages have been developed to replace tricortical interbody grafts in anterior and PLIF procedures. Superior fusion rates and clinical outcomes have been claimed by the developers. Methods. In a retrospective study, the authors evaluated 71 consecutive patients in whom surgery was performed between 1995 and 1997. The median follow-up period was 28 months. Clinical outcome was assessed using the Prolo scale. Fusion results were interpreted by an independent radiologist. The fusion rate was 90%. Overall, 67% of the patients were satisfied with their outcome and would undergo the same operation again. Based on the results of the Prolo scale, however, in only 39% of the patients were excellent or good results achieved. Forty-six percent of the work-eligible patients resumed their working activity. Clinical outcome and return-to-work status were significantly associated with socioeconomic factors such as preoperative employment (p = 0.03), compensation issues (p = 0.001), and length of preoperative sick leave (p = 0.01). Radiographically demonstrated fusion was not statistically related to clinical outcome (p = 0.2). Conclusions. This is one of the largest independent series in which PLIF with cages has been evaluated. The results show that the procedure is safe and effective with a 90% fusion rate and a 66% overall satisfaction rate, which compare favorably with those of traditional fixation techniques but fail to match the higher results claimed by the innovators of the cage techniques. The authors' experience confirms the reports of others that many patients continue to experience incapacitating back pain despite successful fusion and neurological recovery.

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Clinical and Radiological Evaluation of Cage Subsidence Following Oblique Lumbar Interbody Fusion

10.21203/rs.3.rs-853052/v1 ◽

2021 ◽

Author(s):

Long Zhao ◽

Tianhang XIE ◽

Xiandi Wang ◽

Zhiqiang Yang ◽

Xingxiao Pu ◽

...

Keyword(s):

Risk Factors ◽

Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Disk Space ◽

Related Risk ◽

Flat Disk ◽

Cage Subsidence ◽

Oblique Lumbar Interbody Fusion

Abstract Background Cage subsidence was previously reported as one of the most common complications following oblique lumbar interbody fusion (OLIF). We aimed to assess the impacts of CS on surgical results following OLIF, and determine its radiological characteristics and related risk factors. Methods Two hundred and forty-two patients underwent OLIF at L4-5 and with a minimum 12 months follow-up were reviewed. Patients were divided into three groups according to the extent disk height (DH) decrease during the follow-up: no CS (DH decrease ≤ 2 mm), mild CS (2mm < DH decrease ≤ 4 mm) and severe CS (DH decrease > 4mm). The clinical and radiological results were compared between groups to evaluate the radiological features, clinical effects and risk factors of CS. Results CS was identified in 79 (32.6%) patients, including 48 (19.8%) with mild CS and 31 (11.8%) with severe CS. CS mainly identified within 1 month postoperatively and did not progress after 3 months postoperatively, and more noted in the caudal endplate (44, 55.7%). In terms of clinical results, patients in the mild CS group were significantly worse than those in the no CS group, and patients in the severe CS group were significantly worse than those in the mild CS group. There was no significant difference in fusion rate between no CS (92.6%, 151/163) and mild CS (83.3%, 40/48) groups. However, significant lower fusion rate was observed in severe CS group (64.5%, 20/31) compared to no CS group. CS related risk factors included osteoporosis (OR = 5.976), DH overdistraction (OR = 1.175), flat disk space (OR = 3.309) and endplate injury (OR = 6.135). Conclusion CS following OLIF was an early postoperative complication. Higher magnitudes of CS were associated with worse clinical improvements and lower intervertebral fusion. Osteoporosis and endplate injury were significant risk factor for CS. Additionally, flat disk space and DH overdistraction were also correlated with the increased probability of CS.

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Differences in the interbody bone graft area and fusion rate between minimally invasive and traditional open transforaminal lumbar interbody fusion: a retrospective short-term image analysis

European Spine Journal ◽

10.1007/s00586-019-06002-4 ◽

2019 ◽

Vol 28 (9) ◽

pp. 2095-2102 ◽

Cited By ~ 3

Author(s):

Yu-Cheng Yao ◽

Hsi-Hsien Lin ◽

Po-Hsin Chou ◽

Shih-Tien Wang ◽

Ming-Chau Chang

Keyword(s):

Image Analysis ◽

Minimally Invasive ◽

Bone Graft ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Short Term ◽

Graft Area

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Augmenting posterolateral fusion with transforaminal lumbar interbody fusion cage improves clinical outcome, but not fusion rate, of posterior decompression

Journal of International Medical Research ◽

10.1177/0300060520910025 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006052091002

Author(s):

Teoman Atici ◽

Selcan Yerebakan ◽

Cenk Ermutlu ◽

Ali Özyalçın

Keyword(s):

Clinical Outcome ◽

Spinal Stenosis ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Posterior Decompression ◽

Group A ◽

Group B ◽

Lumbar Spinal

Objective This study was performed to compare fusion rates and clinical outcomes of posterior decompression by posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for treatment of lumbar spinal stenosis. Methods This retrospective cohort study involved 157 patients with lumbar spinal stenosis treated with instrumented PLF alone or instrumented PLF combined with TLIF from 2010 to 2018. The patients were divided into two groups: the PLF group (Group A), in which posterior decompression with instrumented PLF was performed, and the cage-augmented group (Group B), in which TLIF was added to the procedures described for the PLF group. Patient outcomes (Oswestry Disability Index, visual analog scale score, and 36-Item Short-Form Health Survey scores) and fusion rates were compared. Results The fusion rate was similar between the two groups. Among patients with two- and three-level fusion, improvements in the clinical outcome scores were significantly greater in Group B than Group A. Conclusion Combining TLIF with PLF provides better clinical outcomes than PLF alone when multilevel fusion is indicated. TLIF augmentation does not improve the fusion rates in either single- or multi-level surgery.

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Minimally invasive transforaminal lumbar interbody fusion: Technical tips, learning curve, short-term clinical outcome, and brief review

Journal of Craniovertebral Junction and Spine ◽

10.4103/jcvjs.jcvjs_112_21 ◽

2021 ◽

Vol 12 (4) ◽

pp. 387

Author(s):

VamsiKrishna Yerramneni ◽

ReddyRamanadha Kanala ◽

Thirumal Yerragunta ◽

Swapnil Kolpakawar ◽

KS Vishwa Kumar ◽

...

Keyword(s):

Clinical Outcome ◽

Minimally Invasive ◽

Learning Curve ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Short Term

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Posterior Lumbar Interbody Fusion with Interspinous Fastener Provides Comparable Clinical Outcome and Fusion Rate to Pedicle Screws

Orthopaedic Surgery ◽

10.1111/os.12328 ◽

2017 ◽

Vol 9 (2) ◽

pp. 198-205

Author(s):

Wei-min Huang ◽

Xing-ming Yu ◽

Xiao-duo Xu ◽

Ruo-xian Song ◽

Li-li Yu ◽

...

Keyword(s):

Clinical Outcome ◽

Interbody Fusion ◽

Pedicle Screws ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion

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The radiological outcome in lumbar interbody fusion among rheumatoid arthritis patients: a 20-year retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04531-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kuan-Kai Tung ◽

Yun-Che Wu ◽

Kun-Hui Chen ◽

Chien-Chou Pan ◽

Wen-Xian Lu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Interbody Fusion ◽

Fusion Rate ◽

Substantial Improvement ◽

Lumbar Interbody Fusion ◽

Subsidence Rate ◽

Radiographic Outcomes ◽

Significant Difference ◽

Cage Subsidence

Abstract Background Clinical outcomes amongst Rheumatoid Arthritis (RA) patients have shown satisfactory results being reported after lumbar surgery. The increased adoption of the interbody fusion technique has been due to a high fusion rate and less invasive procedures. However, the radiographic outcome for RA patients after receiving interbody fusion has scarcely been addressed in the available literature. Methods Patients receiving interbody fusion including ALIF, OLIF, and TLIF were examined for implant cage motion and fusion status at two-year follow-up. Parameters for the index correction level including ADH, PDH, WI, SL, FW, and FH were measured and compared at pre-OP, post-OP, and two-year follow-up. Results We enrolled 64 RA patients at 104 levels (mean 64.0 years old, 85.9% female) received lumbar interbody fusion. There were substantial improvement in ADH, PDH, WI, SL, FW, and FH after surgery, with both ADH and PDH having significantly dropped at two-year follow up. The OLIF group suffered from a higher subsidence rate with no significant difference in fusion rate when compared to TLIF. The fusion rate and subsidence rate for all RA patients was 90.4 and 28.8%, respectively. Conclusions We revealed the radiographic outcomes of lumbar interbody fusions towards symptomatic lumbar disease in RA patients with good fusion outcome despite the relative high subsidence rate amongst the OLIF group. Those responsible for intra-operative endplate management should be more cautious to avoid post-OP cage subsidence.

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499020983038 ◽

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.

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