Does Early Postoperative T1 Slope Change Affect Clinical Results of Patients With Single-level ACDF?

Abstract Background Lumbar interbody fusion is a standard technique for treating degenerative lumbar disorders involving instability. Due to its invasiveness, a minimally invasive technique, extraforaminal lumbar interbody fusion (ELIF), was introduced. On surgically approaching posterolaterally, the posterior muscles and spinal canal are barely invaded. Despite its theoretical advantage, ELIF is technically demanding and has not been popularised. Therefore, we developed a microendoscopy-assisted ELIF (mELIF) technique which was designed to be safe and less invasive. Here, we aimed to report on the surgical technique and clinical results. Methods Using a posterolateral approach similar to that of lateral disc herniation surgery, a tubular retractor, 16 or 18 mm in diameter, was placed at the lateral aspect of the facet joint. The facet joint was partially excised, and the disc space was cleaned. A cage and local bone graft were inserted into the disc space. All disc-related procedures were performed under microendoscopy. The spinal canal was not invaded. Bilateral percutaneous screw-rod constructs were inserted and fixed. Results Fifty-five patients underwent the procedure. The Oswestry Disability Index and visual analogue scale scores greatly improved. Over 90% of the patients obtained excellent or good results based on Macnab’s criteria. There were neither major adverse clinical effects nor the need for additional surgery. Conclusions mELIF is minimally invasive because the spinal canal and posterior muscles are barely invaded. It produces good clinical results with fewer complications. This technique can be applied in most single-level spondylodesis cases, including those involving L5/S1 disorders.

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MIS-TLIF versus O-TLIF for single-level degenerative stenosis: study protocol for randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-041134 ◽

2021 ◽

Vol 11 (3) ◽

pp. e041134

Author(s):

Olga N Leonova ◽

Evgeny A Cherepanov ◽

Aleksandr V Krutko

Keyword(s):

Minimally Invasive ◽

Study Protocol ◽

Controlled Trial ◽

Clinical Results ◽

Patient Reported Outcome Measures ◽

Neurogenic Claudication ◽

Low Grade ◽

Clinical Safety ◽

Single Level ◽

Patient Reported

IntroductionPatients with symptomatic single-level combination of degenerative stenosis and low-grade spondylolisthesis are often treated by nerve root decompression and spinal fusion. The gold standard is traditional open decompression and fusion, but minimally invasive method is more and more prevailing. However, there is lack of high-quality studies comparing these two techniques in order to obtain the advantages and certain indications to use one of these methods. The current study includes clinical, safety and radiological endpoints to determine the effectiveness of minimally invasive decompression and fusion (MIS-TLIF) over the traditional open one (O-TLIF).Methods and analysisAll patients aged 40–75 years with neurogenic claudication or bilateral radiculopathy caused by single-level combination of degenerative stenosis and low-grade spondylolisthesis, confirmed by MRI with these symptoms persisting for at least 3 months prior to surgery, are eligible. Patients will be randomised into MIS-TLIF or traditional O-TLIF. The primary outcome measure is Oswestry Disability Index at 3-month follow-up term. The secondary outcomes are patient-reported outcome measures by the number of clinical scales, radiological parameters including sagittal balance parameters, safety endpoints and cost-effectiveness of each method. All patients will be analysed preoperatively, as well as on the 14th day of hospital stay (or on the day of hospital discharge), 3 months, 6 months, 12 months and 24 months postoperatively. The study has the design of a parallel group to demonstrate the non-inferior clinical results of MIS-TLIF compared with the traditional O-TLIF.Ethics and disseminationThe study will be performed according to Helsinki Declaration. The study protocol was approved by the Local Ethical Committee of Priorov National Medical Research Center of Traumatology and Orthopedics in August 2020. Preliminary and final results will be presented in peer-reviewed journals, especially orthopaedic and spine surgery journals, at national and international congresses.Trial registration numberNCT04594980.

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Anterior Cervical Discectomy with or without Fusion in Non-traumatic Single level Cervical Disc Disorder: Study of 50 Cases

Journal of Dhaka Medical College ◽

10.3329/jdmc.v27i1.38893 ◽

2018 ◽

Vol 27 (1) ◽

pp. 29-35

Author(s):

Sukriti Das ◽

Md Mamunur Rashid ◽

Kanij Fatema Ishrat Zahan ◽

Samsul Islam Khan

Keyword(s):

Range Of Motion ◽

Clinical Results ◽

Small Degree ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Discectomy ◽

Single Level ◽

Medical College ◽

Anteroposterior Translation ◽

Mean Time

Objectives: The aim of this study is to compare patients undergoing single level anterior cervical discectomy without fusion (ACD) versus anterior cervical discectomy with fusion (ACDF). Methods: A retrospective analysis of 50 patients with degenerative cervical spondylosis of them 25 had undergone ACD without fusion and remaining 25 undergone ACDF at either C4-C5, C5- C6 level or at C6-C7 level. Results: The kinematic analysis included the range of motion, intervertebral angulations, anteroposterior translation and disc height assessed for the cervical functional spinal units at the operated level and adjacent levels. At the operated level of C4-C5, C5-C6 and C6-C7, the range of motion and the translation were minimal in the anterior cervical discectomy without fusion (ACD) group, but absent in the cervical discectomy with fusion (ACDF) group. The superior adjacent levels range of motion and the translation were greater in the ACDF group compared with the ACD group. But both groups had almost similar results in term of hospital stay, mean time for improvement and patient satisfaction. Conclusion: The clinical results of anterior cervical discectomy without fusion (ACD) and anterior cervical discectomy with fusion (ACDF) were comparable. In cervical discectomy without fusion, the elastic fibrous intradiscal scar at the operated level allows a small degree of mobility and the adjacent cervical levels are not overstressed. Fusion is not routinely required in single level cervical disc herniation until it is associated with instability, loss of cervical lordosis, hard disc, osteophytic bar and multi-segmental disease. So ACD is a better option in single level cervical disc disorder than ACDF. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 29-35

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Surgery in cervical disc herniation: anterior cervical discectomy without fusion or with fusion

Romanian Neurosurgery ◽

10.1515/romneu-2017-0008 ◽

2017 ◽

Vol 31 (1) ◽

pp. 54-58

Author(s):

Andrei Stefan Iencean

Keyword(s):

Range Of Motion ◽

Disc Herniation ◽

Clinical Results ◽

Small Degree ◽

Anterior Cervical Discectomy ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Discectomy ◽

Single Level ◽

Anteroposterior Translation

Abstract The study included a group of anterior cervical microdiscectomy without fusion performed at one level (either C5-C6 level or at the C6-C7 level) and a second group of patients with same single-level of anterior cervical discectomy with fusion. The kinematic analysis included the range of motion, anteroposterior translation and disc height assessed for the cervical functional spinal units at the operated level and adjacent levels. At the operated level the range of motion and the translation were minimal in the anterior cervical discectomy without fusion group, both for the C5-C6 and C6-C7 levels, and absent in the cervical discectomy with fusion group. The superior adjacent levels translations were greater in the ACDF group compared with the ACD group. The clinical results of both types of cervical discectomy were comparable. In cervical microdiscectomy without fusion the elastic fibrous intradiscal scar at the operated level allows a small degree of mobility and the adjacent cervical levels are not overstressed. No need for anterior cervical discectomy with fusion to trait a single level cervical disc herniation than in selected cases.

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Clinical Results of Single-Level Posterior Lumbar Interbody Fusion Using the Brantigan I/F Carbon Cage Filled With a Mixture of Local Morselized Bone and Bioactive Ceramic Granules

Spine ◽

10.1097/00007632-200202010-00011 ◽

2002 ◽

Vol 27 (3) ◽

pp. 258-262 ◽

Cited By ~ 64

Author(s):

Tomoyuki Hashimoto ◽

Keiichi Shigenobu ◽

Masahiro Kanayama ◽

Masahito Harada ◽

Fumihiro Oha ◽

...

Keyword(s):

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Clinical Results ◽

Lumbar Interbody Fusion ◽

Carbon Cage ◽

Single Level ◽

Bioactive Ceramic

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A Comparison of Fusion Rates and Clinical Results Between Single-Level Cervical Corpectomy and Two-Level Discectomies and Fusion with Plating

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2002.9.1.35 ◽

2002 ◽

Vol 9 (1) ◽

pp. 35

Author(s):

Kyung Won Song ◽

In Heon Park ◽

Sung Il Shin ◽

Jin Young Lee ◽

Sung Jin Park ◽

...

Keyword(s):

Clinical Results ◽

Cervical Corpectomy ◽

Single Level

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Hollow cylindrical polymethylmethacrylate strut for spinal reconstruction after single-level cervical corpectomy

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.5.4.287 ◽

2006 ◽

Vol 5 (4) ◽

pp. 287-293 ◽

Cited By ~ 8

Author(s):

Jyi-Feng Chen ◽

Chieh-Tsai Wu ◽

Sai-Cheung Lee ◽

Shih-Tseng Lee

Keyword(s):

Plate Fixation ◽

Neurological Status ◽

Clinical Results ◽

Radiographic Evaluation ◽

Complete Fusion ◽

Cervical Corpectomy ◽

Single Level ◽

Spinal Reconstruction ◽

Preliminary Study

Object This prospective study was conducted to assess the safety of using a cylindrical polymethylmethacrylate (PMMA) strut for fusion and reconstruction of the cervical spine after single-level cervical corpectomy. The authors describe the clinical results obtained in patients after surgery. Methods Fifty-four patients underwent single-level cervical corpectomy, fusion, and spinal reconstruction that involved the placement of hollow cylindrical PMMA struts. In each patient, the spine was reinforced with anterior cervical plates. The PMMA struts were filled with autologous bone obtained from the resected vertebral body. Follow-up radiographic evaluation involved plain lateral dynamic radiographs and computed tomography (CT) scans. Neurological status was assessed pre- and postoperatively using the Nurick Scale. A total of 46 patients (85.1%) attended follow-up visits for a minimum of 2 years. Spinal stability was documented in all patients on 12-month plain dynamic lateral radiographs; in 37 patients (80.4%), complete osseous fusion was demonstrated on the 12-month CT reconstructions. In the remaining nine patients, complete fusion had been achieved by 24 months. The overall mean preoperative Nurick grade was 2.94 ± 0.97, and this improved significantly to 1.71 ± 0.77 (p < 0.05) by 24 months. There were no complications related to the hollow cylindrical PMMA strut. Conclusions The findings of this preliminary study indicate that hollow cylindrical PMMA struts can be safely used in cervical fusion after single-level corpectomy and that the clinical results are satisfactory. The hollow cylindrical PMMA strut is a good substitute for spinal reconstruction and fusion when combined with plate fixation in patients who have undergone anterior cervical single-level corpectomy.

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CT-Guided Posterolateral Full-Endoscopic Ventral Decompression for Single-Level Cervical Spondylotic Myelopathy

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e203-e210 ◽

2021 ◽

pp. E203-E210

Keyword(s):

Endoscopic Surgery ◽

Cervical Spondylotic Myelopathy ◽

Japanese Orthopaedic Association ◽

Clinical Results ◽

Foraminal Stenosis ◽

Ct Guided ◽

Single Level ◽

Canal Diameter ◽

The Mean

BACKGROUND: Percutaneous full-endoscopic surgery was recently developed for the treatment of cervical foraminal stenosis and posterolateral disc herniation. However, there are no studies involving endoscopic surgery to treat cervical spondylotic myelopathy (CSM). OBJECTIVES: To observe the safety, feasibility, and efficacy of posterolateral full-endoscopic ventral decompression (PLEVD) via computed tomography (CT)-guided surgery in patients with single-level CSM. STUDY DESIGN: A prospective cohort study. SETTING: The First Affiliated Hospital of Gannan Medical College. METHODS: From May 2018 to August 2019, 21 patients with single-level CSM underwent CT-guided PLEVD. The posterolateral angle was measured during surgery. The neurologic condition was evaluated via the Japanese Orthopaedic Association (JOA) score and recovery rate, and a Visual Analog Scale (VAS) was used to measure pain relief. The maximum spinal canal diameter (MSCD) was measured on pre- and postoperative CT images. RESULTS: The mean length of follow-up was 11.3 ± 5.3 months. The average posterolateral angle was 36.0° ± 5.6°. The mean VAS score of limbs significantly decreased after surgery. The mean JOA score improved during the follow-up period. Nineteen of the 21 patients achieved good or excellent outcomes, and 2 patients had fair outcomes according to the JOA score 6 months after surgery. The average MSCD was enlarged from 0.55 ± 0.15 cm preoperatively to 1.02 ± 0.18 cm postoperatively. LIMITATIONS: This study was nonrandomized and provides only preliminary clinical results for single-level CSM. CONCLUSION: Under appropriate indications, PLEVD under CT guidance is an available and safe technique for treating single-level CSM. KEY WORDS: CT-guided, posterolateral, full-endoscopic, cervical spondylotic myelopathy

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Microendoscopy-assisted extraforaminal lumbar interbody fusion for treating single-level spondylodesis

10.21203/rs.3.rs-120579/v2 ◽

2021 ◽

Author(s):

Motohide Shibayama ◽

GuangHua Li ◽

LiGuo Zhu ◽

Zenya Ito ◽

Fujio Ito

Keyword(s):

Minimally Invasive ◽

Spinal Canal ◽

Interbody Fusion ◽

Facet Joint ◽

Clinical Results ◽

Invasive Technique ◽

Clinical Effects ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Single Level

Abstract Background: Lumbar interbody fusion is a standard technique for treating degenerative lumbar disorders involving instability. Due to its invasiveness, a minimally invasive technique, extraforaminal lumbar interbody fusion (ELIF), was introduced. On surgically approaching posterolaterally, the posterior muscles and spinal canal are barely invaded. Despite its theoretical advantage, ELIF is technically demanding and has not been popularised. Therefore, we developed a microendoscopy-assisted ELIF (mELIF) technique which was designed to be safe and less invasive. Here, we aimed to report on the surgical technique and clinical results.Methods: Using a posterolateral approach similar to that of lateral disc herniation surgery, a tubular retractor, 16 or 18 mm in diameter, was placed at the lateral aspect of the facet joint. The facet joint was partially excised, and the disc space was cleaned. A cage and local bone graft were inserted into the disc space. All disc-related procedures were performed under microendoscopy. The spinal canal was not invaded. Bilateral percutaneous screw-rod constructs were inserted and fixed. Results: Fifty-five patients underwent the procedure. The Oswestry Disability Index and visual analogue scale scores greatly improved. Over 90% of the patients obtained excellent or good results based on Macnab’s criteria. There were neither major adverse clinical effects nor the need for additional surgery.Conclusions: mELIF is minimally invasive because the spinal canal and posterior muscles are barely invaded. It produces good clinical results with fewer complications. This technique can be applied in most single-level spondylodesis cases, including those involving L5/S1 disorders.

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