Biomechanical Comparison of Posterior and Transforaminal Interbody Fusion Constructs for the Degenerative Lumbar Spine

2002 ◽  
Author(s):  
Stan Lee ◽  
Alexander Ghanayem ◽  
Scott Hodges ◽  
Leonard Voronov ◽  
Robert Havey ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Posterior Lumbar Interbody Fusion ◽  
Neural Element ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Fusion Procedure ◽  
Flexion Extension ◽  
Circumferential Fusion

Posterior lumbar interbody fusion (PLIF) is an established technique that allows circumferential fusion of lumbar spine through a single incision. A variation of PLIF called transforaminal lumbar interbody fusion (TLIF) uses a posterior approach to the spine but accesses the disc space via a path that runs through the far lateral portion of the vertebral foramen. TLIF provides the surgeon with a fusion procedure that reduces many of the risks and limitations associated with PLIF. Like PLIF, TLIF is easily enhanced when combined with posterolateral fusion (PLF) and instrumentation. TLIF offers an advantage in that it is usually done via a unilateral approach preserving the facet joint and the interlaminar surface on the contralateral side [1]. It minimizes soft tissue stripping and neural element retraction compared to PLIF, while providing a single-stage circumferential fusion. This study compared the biomechanical performance of these two constructs in flexion, extension, and lateral bending under physiologic compressive preloads.

Unilateral Transforaminal Lumbar Interbody Fusion: A Review of the Technique, Indications and Graft Materials

2009 ◽  
Vol 37 (3) ◽  
pp. 908-917 ◽  
Author(s):  
Y-X Xiao ◽  
Q-X Chen ◽  
F-C Li
Keyword(s):  
Interbody Fusion ◽  
Lumbar Disc ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Disc Disease ◽  
Discogenic Pain ◽  
Fusion Procedure ◽  
Local Bone ◽  
Circumferential Fusion

Transforaminal lumbar interbody fusion (TLIF) is an alternative interbody fusion procedure in which interbody space is accessed via a path that runs through the far lateral portion of the vertebral foramen. TLIF reduces the potential complications of other approaches, including the transabdominal approach or posterior lumbar interbody fusion (PLIF), but still achieves clinical outcomes and circumferential fusion results comparable with PLIF. Operative indications for TLIF are contested among many spine experts. The optimal indications for using this technique are spondylolisthesis, degenerative disc disease with a specific discogenic pain pattern, lumbar stenosis with instability and recurrent lumbar disc herniation with radiculopathy. Various instrumentation techniques and graft materials are available to use in TLIF, and each option has benefits and disadvantages. Further research is needed, however, TLIF with one cage and excised local bone and augmented with a bilateral pedicle screw seems to be an effective and affordable treatment.

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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Motohide Shibayama ◽  
Guang Hua Li ◽  
Li Guo 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.

Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis

2013 ◽  
Vol 19 (1) ◽  
pp. 90-94 ◽  
Author(s):  
Hironobu Sakaura ◽  
Tomoya Yamashita ◽  
Toshitada Miwa ◽  
Kenji Ohzono ◽  
Tetsuo Ohwada
Keyword(s):  
Lumbar Spine ◽  
Clinical Outcome ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
The Mean

Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

scholarly journals Does Atherosclerosis Have Negative Impacts on Early Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion?

2020 ◽  
pp. 219256822091937
Author(s):  
Hironobu Sakaura ◽  
Daisuke Ikegami ◽  
Takahito Fujimori ◽  
Tsuyoshi Sugiura ◽  
Yoshihiro Mukai ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Interbody Fusion ◽  
Surrogate Marker ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Negative Impacts

Study Design: Retrospective study. Objective: To examine whether atherosclerosis has negative impacts on early adjacent segment degeneration (ASD) after posterior lumbar interbody fusion using traditional trajectory pedicle screw fixation (TT-PLIF). Methods: The subjects were 77 patients who underwent single-level TT-PLIF for degenerative lumbar spondylolisthesis. Using dynamic lateral radiographs of the lumbar spine before surgery and at 3 years postoperatively, early radiological ASD (R-ASD) was examined. Early symptomatic ASD (S-ASD) was diagnosed when neurologic symptoms deteriorated during postoperative 3-year follow-up and the responsible lesions adjacent to the fused segment were also confirmed on magnetic resonance imaging. According to the scoring system by Kauppila et al, the abdominal aortic calcification score (AAC score: a surrogate marker of systemic atherosclerosis) was assessed using preoperative lateral radiographs of the lumbar spine. Results: The incidence of early R-ASD was 41.6% at the suprajacent segment and 8.3% at the subjacent segment, respectively. Patients with R-ASD had significantly higher AAC score than those without R-ASD. The incidence of early S-ASD was 3.9% at the suprajacent segment and 1.4% at the subjacent segment, respectively. Patients with S-ASD had higher AAC score than those without S-ASD, although there was no significant difference. Conclusions: At 3 years after surgery, the advanced AAC had significantly negative impacts on early R-ASD after TT-PLIF. This result indicates that impaired blood flow due to atherosclerosis can aggravate degenerative changes at the adjacent segments of the lumbar spine after PLIF.

scholarly journals A minimally invasive posterior lumbar interbody fusion for degenerative lumbar spine instabilities

2011 ◽  
Vol 20 (S1) ◽  
pp. 41-45 ◽  
Author(s):  
C. A. Logroscino ◽  
L. Proietti ◽  
E. Pola ◽  
L. Scaramuzzo ◽  
F. C. Tamburrelli
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Degenerative Lumbar Spine

Cross-Sectional Area of the Lumbar Spine Trunk Muscle and Posterior Lumbar Interbody Fusion Rate

2017 ◽  
Vol 30 (6) ◽  
pp. E798-E803 ◽  
Author(s):  
Man Kyu Choi ◽  
Sung Bum Kim ◽  
Chang Kyu Park ◽  
Hridayesh P. Malla ◽  
Sung Min Kim
Keyword(s):  
Lumbar Spine ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Trunk Muscle ◽  
Cross Sectional Area ◽  
Lumbar Interbody Fusion ◽  
Sectional Area ◽  
Cross Sectional

Stabilizing effect of posterior lumbar interbody fusion cages before and after cyclic loading

2000 ◽  
Vol 92 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Annette Kettler ◽  
Hans-Joachim Wilke ◽  
Rupert Dietl ◽  
Matthias Krammer ◽  
Christianto Lumenta ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Axial Rotation ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Content Type ◽  
Flexion Extension ◽  
Stabilizing Effect ◽  
Fine Print

Object. The function of interbody fusion cages is to stabilize spinal segments primarily by distracting them as well as by allowing bone ingrowth and fusion. An important condition for efficient formation of bone tissue is achieving adequate spinal stability. However, the initial stability may be reduced due to repeated movements of the spine during everyday activity. Therefore, in addition to immediate stability, stability after cyclic loading is of remarkable relevance; however, this has not yet been investigated. The object of this study was to investigate the immediate stabilizing effect of three different posterior lumbar interbody fusion cages and to clarify the effect of cyclic loading on the stabilization. Methods. Before and directly after implantation of a Zientek, Stryker, or Ray posterior lumbar interbody fusion cage, 24 lumbar spine segment specimens were each evaluated in a spine tester. Pure lateral bending, flexion—extension, and axial rotation moments (± 7.5 Nm) were applied continuously. The motion in each specimen was measured simultaneously. The specimens were then loaded cyclically (40,000 cycles, 5 Hz) with an axial compression force ranging from 200 to 1000 N. Finally, they were tested once again in the spine tester. Conclusions. In general, a decrease of movement in all loading directions was noted after insertion of the Zientek and Ray cages and an increase of movement after implantation of a Stryker cage. In all three cage groups greater stability was demonstrated in lateral bending and flexion than in extension and axial rotation. Reduced stability during cyclic loading was observed in all three cage groups; however, loss of stability was most pronounced when the Ray cage was used.

Sign in / Sign up

Export Citation Format

Share Document