Curve Characteristics and Response of Sciatic and Olisthesis Scoliosis Following L5/S1 Transforaminal Lumbar Interbody Fusion in Adolescent Lumbar Spondylolisthesis

Neurosurgery ◽  
2020 ◽  
Author(s):  
Chang-zhi Du ◽  
Ze-zhang Zhu ◽  
Yu Wang ◽  
Song Li ◽  
Liang Xu ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Patient Reported Outcomes ◽  
Interbody Fusion ◽  
Reduction Rate ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Coronal Imbalance ◽  
Patient Reported ◽  
Lumbosacral Spondylolisthesis ◽  
Lumbar Spondylolisthesis

Abstract BACKGROUND Lumbosacral spondylolisthesis-induced scoliosis is a rare clinical entity. Sagittal reconstruction and the coronal curve evolution after surgery for spondylolisthesis have not been investigated in depth. OBJECTIVE To compare the curve characteristics between sciatic scoliosis and olisthetic scoliosis and to further investigate the effects of lumbosacral transforaminal lumbar interbody fusion (TLIF) on scoliosis evolution. METHODS Adolescents with sciatic scoliosis group (SS group) or olisthetic scoliosis group (OS group) who underwent L5/S1 TLIF from 2010 to 2017 and were followed up for at least 2 yr were retrospectively reviewed. Radiographic parameters and patient-reported outcomes were evaluated. RESULTS There were 20 patients in the SS group (M/F: 8/12; age: 15.6 ± 2.2 yr) and 16 in the OS group (M/F: 6/10; age: 16.8 ± 2.5 yr). Both groups had similar preoperative Cobb angles, but more patients with coronal imbalance were observed in the SS group. Moreover, the OS group showed significantly larger L5 tilt and rotation. After surgery, the slip reduction rate of the SS group and OS group were 76.1% ± 12.4% and 79.4% ± 9.6%, respectively. Scoliosis resolution was observed in all patients in the SS group but only in 9 patients (56.2%) in the OS group. Patients with failed scoliosis resolution in the OS group were older and had a larger Cobb angle and L5 rotation compared with those with successful scoliosis resolution. CONCLUSION Lumbosacral TLIF can achieve satisfactory slip reduction and scoliosis resolution. Sciatic scoliosis often presents with coronal imbalance but also a preferable curve prognosis. A large Cobb angle and L5 rotation may hinder the resolution of olisthetic scoliosis.

Lumbar alignment and patient-reported outcomes after single-level transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with and without local coronal imbalance

2020 ◽  
pp. 1-7
Author(s):  
Wei Pan ◽  
Jia-li Zhao ◽  
Jin Xu ◽  
Ming Zhang ◽  
Tao Fang ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Coronal Alignment ◽  
Distinct Subgroup ◽  
Coronal Imbalance ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
Lumbar Alignment

OBJECTIVEThe purpose of this study was to compare the preoperative radiographic features of degenerative lumbar spondylolisthesis (DLS) with and without local coronal imbalance (LCI) and to investigate the surgical outcomes of transforaminal lumbar interbody fusion (TLIF) in the treatment of DLS with LCI at the spondylolisthesis level. DLS with scoliotic disc wedging and/or lateral listhesis at the same involved segment, as well as LCI, constitutes a distinct subgroup. However, previous studies concerning surgical outcomes focused mainly on sagittal profiles. There is a paucity of valid data regarding lumbar coronal alignment and patient-reported outcomes (PROs) after surgery in DLS with LCI.METHODSThe authors reviewed consecutive patients who received TLIF for L4/5 DLS between 2009 and 2018. Patients were assigned to the LCI and non-LCI groups based on preoperative radiographs. Demographics, radiographic parameters related to both sagittal and coronal alignment, and PROs were compared between the 2 groups.RESULTSThere were 21 patients in the LCI and 80 in the non-LCI group. Compared with the non-LCI group, the LCI group was characterized by lower preoperative lumbar lordosis on sagittal alignment (38.3° vs 43.7°, p < 0.05), higher lumbar Cobb angle on coronal alignment (12.4° vs 5.1°, p < 0.05), and worse lumbar coronal balance (18.5 mm vs 6.8 mm, p < 0.05). After surgery, lumbar alignment in the sagittal and coronal planes was significantly improved in the LCI group, whereas no significant changes occurred in the non-LCI group. Scores on the preoperative Oswestry Disability Index and the visual analog scale for back pain and leg pain scores were significantly higher in the LCI group, whereas no differences were found between the 2 groups in the postoperative evaluation (p > 0.05).CONCLUSIONSDLS with LCI constitutes a distinct subgroup characterized by coronal malalignment and loss of whole lumbar lordosis, which may result in worse PROs. The TLIF procedure allows the reconstruction of the coronal and sagittal lumbar profile and achievement of satisfactory PROs.

Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis

2021 ◽  
pp. 1-12
Author(s):  
Jonathan Huang ◽  
Erik E. Rabin ◽  
Geoffrey P. Stricsek ◽  
Kevin N. Swong
Keyword(s):  
Elderly Patients ◽  
Complication Rate ◽  
Functional Outcomes ◽  
Patient Reported Outcomes ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Minor Complication ◽  
Patient Reported

OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be used to treat degenerative spinal pathologies while reducing risks associated with open procedures. As an increasing number of lumbar fusions are performed in the aging United States population, MIS-TLIF has been widely adopted into clinical practice in recent years. However, its complication rate and functional outcomes in elderly patients remain poorly characterized. The objective of this study was to assess complication rates and functional outcomes in elderly patients (≥ 65 years old) undergoing MIS-TLIF. METHODS The PubMed, Embase, and Scopus databases were searched for relevant records in accordance with the PRISMA guidelines. Inclusion criteria were peer-reviewed original research; English language; full text available; use of MIS-TLIF; and an elderly cohort of at least 5 patients. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies—of Interventions) tool. Pooled complication rates were calculated for elderly patients, with subgroup analyses performed for single versus multiple-level fusions. Complication rates in elderly compared to nonelderly patients were also assessed. Postoperative changes in patient-reported outcomes, including Oswestry Disability Index (ODI) and visual analog scale (VAS) back pain (BP) and leg pain (LP) scores, were calculated. RESULTS Twelve studies were included in the final analysis. Compared to nonelderly patients, MIS-TLIF in elderly patients resulted in significantly higher rates of major (OR 2.15, 95% CI 1.07–4.34) and minor (OR 2.20, 95% CI 1.22–3.95) complications. The pooled major complication rate in elderly patients was 0.05 (95% CI 0.03–0.08) and the pooled minor complication rate was 0.20 (95% CI 0.13–0.30). Single-level MIS-TLIF had lower major and minor complication rates than multilevel MIS-TLIF, although not reaching significance. At a minimum follow-up of 6 months, the postoperative change in ODI (−30.70, 95% CI −41.84 to −19.55), VAS-BP (−3.87, 95% CI −4.97 to −2.77), and VAS-LP (−5.11, 95% CI −6.69 to −3.53) in elderly patients all exceeded the respective minimum clinically important difference. The pooled rate of fusion was 0.86 (95% CI 0.80–0.90). CONCLUSIONS MIS-TLIF in elderly patients results in a high rate of fusion and significant improvement of patient-reported outcomes, but has significantly higher complication rates than in nonelderly patients. Limitations of this study include heterogeneity in the definition of elderly and limited reporting of risk factors among included studies. Further study of the impact of complications and the factors predisposing elderly patients to poor outcomes is needed.

scholarly journals Endoscopic transforaminal lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis

2019 ◽  
Author(s):  
Denglu Yan ◽  
Zaiheng Zhang ◽  
Zhi Zhang
Keyword(s):  
Interbody Fusion ◽  
Reduction Rate ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Intervertebral Foramen ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis ◽  
Disk Height ◽  
Endoscopic Group

Abstract Background There were no studies in literature of lumbar spondylolisthesis treated by endoscopic surgery. The purpose of this study was to evaluate the efficacy of endoscopic transforaminal lumbar interbody fusion (ELIF) in the treatment of degenerative lumbar spondylolisthesis by compare to the standard transforaminal lumbar interbody fusion (TLIF).Methods A total of 93 patients with lumbar spondylolisthesis who had surgery from February 2017 to January 2018 were categorized into different groups depending on the procedure by ELIF or TLIF. The ELIF and TLIF procedures was performed, and the clinical outcomes of blood loss, operation times, hospital stay days, pain index, ODI score, the spondylolisthesis rate and reduction rate, and the disk height and intervertebral foramen height were recorded.Results There was no intraoperative death in this series. In ends 86 cases had follow-up at least one year and 7 cases lost, and the follow-up rate and followed time were no difference between two groups (P > 0.05). The operational time was longer in ELIF than TLIF (P < 0.01).The hospital days and blood loss were significant less in endoscopic group than TLIF (P < 0.01). The pain index and ODI score, the spondylolisthesis rate and reduction rate, and the disk height and intervertebral foramen height were better than preoperational (P < 0.01), and there were no difference between two groups (P > 0.05). All patients achieved spinal fusion with no cases of cage extrusion, and no infection, and no dural tear of cerebrospinal fluid leakage complication. There were one case of radiculitis (man) at endoscopic group. CT-myelogram revealed the radiculitis patients had normal radiologic findings, and the patient was recovered by neurotrophy drugs and functional exercises after 3 months.Conclusions Endoscopic lumbar decompression and interbody fusion procedures was effective and safe measure in the treatment of the lumbar spondylolisthesis. Compare to open interbody fusion techniques, endoscopic lumbar interbody fusion was minimally invasive surgery with less bold loss and earlier postoperative recovery.

scholarly journals A novel technique for awake, minimally invasive transforaminal lumbar interbody fusion: technical note

2019 ◽  
Vol 46 (4) ◽  
pp. E16 ◽  
Author(s):  
Andrew Kai-Hong Chan ◽  
Winward Choy ◽  
Catherine A. Miller ◽  
Leslie C. Robinson ◽  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive ◽  
Patient Reported Outcomes ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Technical Note ◽  
Lumbar Interbody Fusion ◽  
Spinal Anesthetic ◽  
Novel Technique ◽  
Patient Reported ◽  
Multimodal Methods

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is associated with improved patient-reported outcomes in well-selected patients. Recently, some neurosurgeons have aimed to further improve outcomes by utilizing multimodal methods to avoid the use of general anesthesia. Here, the authors report on the use of a novel awake technique for MI-TLIF in two patients. They describe the successful use of liposomal bupivacaine in combination with a spinal anesthetic to allow for operative analgesia.

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