Posterior Lumbar Interbody Fusion Using an En-Bloc Resected Lamina as an Interbody Spacer in Combination with Spinal Instruments

1998 ◽  
Vol 02 (04) ◽  
pp. 325-332
Author(s):  
Shigeru Hirabayashi ◽  
Kiyoshi Kumano ◽  
Takeshi Uchida
Keyword(s):  
Interbody Fusion ◽  
Spinous Process ◽  
Degenerative Spondylolisthesis ◽  
Spinal Instrumentation ◽  
Posterior Lumbar Interbody Fusion ◽  
Bony Union ◽  
Lumbar Interbody Fusion ◽  
En Bloc ◽  
Time Of Operation

We developed a new method of posterior lumbar interbody fusion (PLIF) using an en-bloc resected lamina with or without a hydroxyapatite block as an interbody spacer instead of auto-iliac bone, in combination with rigid-type spinal instrumentation. The purpose of this study was to evaluate the effectiveness of our method. There were 23 patients (13 males, 10 females, age at the time of operation: 21–71 years, mean 50.5 years; follow-up: 1–4 years, mean 2 years and 3 months). In 10 patients with spondylolitic spondylolisthesis and 3 patients with spondylolysis, the floating lamina was resected enbloc by mid-line splitting. In 7 patients with degenerative spondylolisthesis and 3 patients with unstable spine, a cleavage was made at the isthmus and then the complex of lamina and inferior spinous process was resected en-bloc. Seventeen patients with olisthesis underwent reduction. PLIF was performed at the L4/L5 level in 10 patients and the L5/S1 level in 13 patients. Sixteen patients with preoperative low back pain recovered, except for one patient with instability at the adjacent vertebra. All of the seven patients with preoperative gait disturbance recovered. The ratio of olisthesis changed from preoperative 30% to postoperative 18% on average. Good bony union was obtained in both the patients with and those without a hydroxyapatite spacer. Posterior lumbar interbody fusion using an en-bloc resected lamina as an interbody spacer in combination with rigid-type spinal instrumentation was useful.

scholarly journals Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients

2018 ◽  
Vol 8 (7) ◽  
pp. 722-727 ◽  
Author(s):  
Shinya Okuda ◽  
Tomoya Yamashita ◽  
Tomiya Matsumoto ◽  
Yukitaka Nagamoto ◽  
Tsuyoshi Sugiura ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Interbody Fusion ◽  
Time Period ◽  
Time Periods

Study Design: Retrospective study. Objective: There have been few reports of adjacent segment disease (ASD) after posterior lumbar interbody fusion (PLIF) with large numbers and long follow-up. The purpose of this study was to investigate (1) ASD incidence and time periods after primary PLIF, (2) repeat ASD incidence and time periods, and (3) ASD incidence and time periods by fusion length, age, and preoperative pathologies. Methods: A total of 1000 patients (average age 67 years, average follow-up 8.3 years) who underwent PLIF for degenerative lumbar disorders were reviewed. ASD was defined as a symptomatic condition in which revision surgery was required. Results: The overall ASD rate was 9.0%, and the average ASD period was 4.7 years after primary surgery. With respect to clinical features of ASD, degenerative spondylolisthesis at the cranial fusion segment was the most frequent. In terms of repeat ASD, second and third ASD incidences were 1.1% and 0.4%, respectively. As for ASD by fusion length, age, and preoperative pathologies, ASD incidence was increased by fusion length, while the time period to ASD was significantly shorter in elderly patients and those with degenerative lumbar scoliosis. Conclusions: In the present study, the overall ASD incidence was 9.0%, and the average ASD period was 4.7 years after primary operation. Second and third ASD incidences were 1.1% and 0.4%, respectively. Fusion length affected the ASD incidence, while aging factor and preoperative pathology affected the ASD time period.

scholarly journals Functional and radiological analysis of posterior lumbar interbody fusion in spondylolisthesis

2015 ◽  
Vol 1 (1) ◽  
pp. 11
Author(s):  
Ramanujam Muthu Manickam ◽  
Ganesan G. Ram ◽  
S. Sundar ◽  
A. Prakash
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Surgical Intervention ◽  
Degenerative Spondylolisthesis ◽  
Posterior Lumbar Interbody Fusion ◽  
Low Grade ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis ◽  
The Mean

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong>Spondylolisthesis is present in 5% of the adult population with clinical evidence of low back pain. These patients are treated initially by conservative measures, failing of which surgical intervention is mandatory. Majority of patients with varying degree of slip and disability ultimately require surgical intervention. In this study we are trying to analyse the functional outcome following posterior lumbar interbody fusion in spondylolisthesis.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> Posterior lumbar interbody fusion using pedicle screw and rods with cage was performed on 25 patients. 6 months follow-up was completed in 25 patients who were then reviewed at regular intervals. Out of the 25 patients, 17(68%) were females and 8(32%) were males. The mean age of the patients was 40.64 years. Out of 25 patients, 14 patients had listhesis at L4 – L5 level and another 11 at L5 – S1 level. 21(84%) were Isthmic variant and 4 (16%) were Degenerative spondylolisthesis.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong>The mean follow up period in this study of 25 patients is 19 months. Out of 25 patients, there was mean improvement of 18.96 in the Oswestry scoring index. The Visual analogue scale score showed a mean improvement of 6.48. Radiologically, the percentage of slip was decreased by a mean of 8.40%. One patient had a cage extrusion with no neurological deficit.</p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong>The pedicle screw with rod and cage system is easy to use and provides the anatomic restoration of the isthmus in isthmic spondylolisthesis or restoring the stability after laminectomy/discectomy in degenerative spondylolisthesis. From our study, we strongly believe that this technique is very useful in low grade degenerative and isthmic spondylolisthesis.</p>

Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis

2018 ◽  
Vol 28 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Hironobu Sakaura ◽  
Toshitada Miwa ◽  
Tomoya Yamashita ◽  
Yusuke Kuroda ◽  
Tetsuo Ohwada
Keyword(s):  
Interbody Fusion ◽  
Clinical Symptoms ◽  
Screw Fixation ◽  
Posterior Lumbar Interbody Fusion ◽  
Bony Union ◽  
Lumbar Interbody Fusion ◽  
Degenerative Lumbar Spondylolisthesis ◽  
The Mean ◽  
Lumbar Spondylolisthesis

OBJECTIVEThe cortical bone trajectory (CBT) screw technique is a new nontraditional pedicle screw (PS) insertion method. However, the biomechanical behavior of multilevel CBT screw/rod fixation remains unclear, and surgical outcomes in patients after 2-level posterior lumbar interbody fusion (PLIF) using CBT screw fixation have not been reported. Thus, the purposes of this study were to examine the clinical and radiological outcomes after 2-level PLIF using CBT screw fixation for 2-level degenerative lumbar spondylolisthesis (DS) and to compare these outcomes with those after 2-level PLIF using traditional PS fixation.METHODSThe study included 22 consecutively treated patients who underwent 2-level PLIF with CBT screw fixation for 2-level DS (CBT group, mean follow-up 39 months) and a historical control group of 20 consecutively treated patients who underwent 2-level PLIF using traditional PS fixation for 2-level DS (PS group, mean follow-up 35 months). Clinical symptoms were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Bony union was assessed by dynamic plain radiographs and CT images. Surgery-related complications, including symptomatic adjacent-segment disease (ASD), were examined.RESULTSThe mean operative duration and intraoperative blood loss were 192 minutes and 495 ml in the CBT group and 218 minutes and 612 ml in the PS group, respectively (p < 0.05 and p > 0.05, respectively). The mean JOA score improved significantly from 12.3 points before surgery to 21.1 points (mean recovery rate 54.4%) at the latest follow-up in the CBT group and from 12.8 points before surgery to 20.4 points (mean recovery rate 51.8%) at the latest follow-up in the PS group (p > 0.05). Solid bony union was achieved at 90.9% of segments in the CBT group and 95.0% of segments in the PS group (p > 0.05). Symptomatic ASD developed in 2 patients in the CBT group (9.1%) and 4 patients in the PS group (20.0%, p > 0.05).CONCLUSIONSTwo-level PLIF with CBT screw fixation for 2-level DS could be less invasive and result in improvement of clinical symptoms equal to those of 2-level PLIF using traditional PS fixation. The incidence of symptomatic ASD and the rate of bony union were lower in the CBT group than in the PS group, although these differences were not significant.

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.

Repeated adjacent-segment degeneration after posterior lumbar interbody fusion

2014 ◽  
Vol 20 (5) ◽  
pp. 538-541 ◽  
Author(s):  
Shinya Okuda ◽  
Takenori Oda ◽  
Ryoji Yamasaki ◽  
Takafumi Maeno ◽  
Motoki Iwasaki
Keyword(s):  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Long Term Results ◽  
Sacral Slope ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Primary Operation ◽  
The Third

One of the most important sequelae affecting long-term results is adjacent-segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF). Although several reports have described the incidence rate, there have been no reports of repeated ASD. The purpose of this report was to describe 1 case of repeated ASD after PLIF. A 62-year-old woman with L-4 degenerative spondylolisthesis underwent PLIF at L4–5. At the second operation, L3–4 PLIF was performed for L-3 degenerative spondylolisthesis 6 years after the primary operation. At the third operation, L2–3 PLIF was performed for L-2 degenerative spondylolisthesis 1.5 years after the primary operation. Vertebral collapse of L-1 was detected 1 year after the third operation, and the collapse had progressed. At the fourth operation, 3 years after the third operation, vertebral column resection of L-1 and replacement of titanium mesh cages with pedicle screw fixation between T-4 and L-5 was performed. Although the patient's symptoms resolved after each operation, the time between surgeries shortened. The sacral slope decreased gradually although each PLIF achieved local lordosis at the fused segment.

Sign in / Sign up

Export Citation Format

Share Document