Prospective Study of Long-term Effect between Multifidus Muscle Bundle and Conventional Open Approach in One-level Posterior Lumbar Interbody Fusion

Object This randomized study was designed to elucidate the time course of the perioperative development of intramuscular multifidus muscle pressure after posterior lumbar interbody fusion (PLIF) and to investigate whether the route of pedicle screw insertion affects this pressure and resultant low-back pain. Although several studies have focused on intramuscular pressure associated with posterior lumbar surgery, those studies examined intramuscular pressure generated by the muscle retractors during surgery. No study has investigated the intramuscular pressure after PLIF. Methods Forty patients with L4–5 degenerative spondylolisthesis were randomly assigned to undergo either the mini-open PLIF procedure with pedicle screw insertion between the multifidus and longissimus muscles (n = 20) or the conventional PLIF procedure via a midline approach only (n = 20). Intramuscular pressure was measured 5 times (at 30 minutes and at 6, 12, 24, and 48 hours after surgery) with an intraoperatively installed sensor. Concurrently, the FACES Pain Rating Scale score for low-back pain and the total dose of postoperative analgesics were recorded. Results With the patients in the supine position, for both groups the mean pressure values were consistently 40–50 mm Hg, which exceeded the critical capillary pressure of the muscle. With the patients in the lateral decubitus position, the pressure decreased over time (from 14 to 9 mm Hg in the mini-open group and from 20 to 10 mm Hg in the conventional group). Among patients in the mini-open group, the pressure was lower, but the difference was not statistically significant. Postoperative pain and postoperative analgesic dosages were also lower . Conclusions To the authors' knowledge, this is the first study to evaluate postoperative intramuscular pressure after PLIF. Although the results did not demonstrate a significant difference in the intramuscular pressure between the 2 types of PLIF, mini-open PLIF was associated with less pain after surgery. Clinical trial registration no.: UMIN000010069 (www.umin.ac.jp/ctr/index.htm).

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Minimally Invasive Approach versus Traditional Open Approach for One Level Posterior Lumbar Interbody Fusion

min - Minimally Invasive Neurosurgery ◽

10.1055/s-0030-1247560 ◽

2010 ◽

Vol 53 (01) ◽

pp. 21-24 ◽

Cited By ~ 51

Author(s):

V. Ntoukas ◽

A. Müller

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Open Approach ◽

Lumbar Interbody Fusion ◽

Minimally Invasive Approach ◽

Invasive Approach

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Long-term Follow-up of Minimal-Access and Open Posterior Lumbar Interbody Fusion for Spondylolisthesis

Neurosurgery ◽

10.1227/neu.0b013e31827fce96 ◽

2012 ◽

Vol 72 (3) ◽

pp. 443-451 ◽

Cited By ~ 9

Author(s):

Nicholas K. Cheung ◽

Richard D. Ferch ◽

Ali Ghahreman ◽

Nikolai Bogduk

Keyword(s):

Back Pain ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Disc Height ◽

Leg Pain ◽

Lumbar Interbody Fusion ◽

Minimal Access ◽

Success Rates ◽

Long Term Outcome

Abstract BACKGROUND: Although posterior lumbar interbody fusion (PLIF) is regarded as an effective treatment for spondylolisthesis, few studies have reported comprehensive, long-term outcome data, and none has investigated the incidence of deterioration of outcomes. OBJECTIVE: To determine and compare the success rates and long-term stability of outcomes of open PLIF and minimal-access PLIF in the treatment of radicular pain and back pain in patients with spondylolisthesis. METHODS: Forty-three patients were followed for a minimum of 3 years. They completed a Short-Form Health Survey and visual analog scores for back pain and leg pain and underwent lumbar spine radiography. Outcomes were compared with baseline data and 12-month data. RESULTS: Surgery succeeded in reducing listhesis and increasing disc height, but had little effect on lumbar lordosis or the angulation of the segment treated. At 12 months after surgery, listhesis was reduced, disc height was increased, leg pain was reduced or eliminated, and physical functioning restored. Back pain was less often relieved. These outcomes were largely maintained over the ensuing 2 years. Only 5% to 10% of patients reported deterioration in their relief of pain. Depending on the definition adopted for success, the long-term success rate of PLIF may be as high as 70%. CONCLUSION: For the relief of leg pain, the success rates of open PLIF (70%) and minimal-access PLIF (67%) for spondylolisthesis are high and durable in the long-term. PLIF is less often successful in relieving back pain, but the outcomes are maintained. The outcomes of open PLIF and minimal-access PLIF were statistically indistinguishable.

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