Traumatic Lumbosacral Dislocation Treated with Posterior Lumbar Interbody Fusion Using Intersomatic Cages

A 35-year-old man was struck by a car on his right side and presented with paraparesis of both lower extremities. Radiographic examination revealed multiple transverse process fractures and anterior displacement of L5 on S1. Computed tomography revealed a bilateral anterior facet dislocation of the fifth lumbar vertebra on the sacrum. MRI showed rupture of the posterior ligamentous complex. A posterior lumbar interbody fusion using two intersomatic cages and pedicle screw instrumentation and posterior fusion were performed. Although no major disc lesion was found at the level of L5-S1 on preoperative MRI, a severely collapsed L5-S1 disc was found intraoperatively. Two years after surgery, the patient was asymptomatic with normal neurological findings, and has resumed normal activity. We believe that lumbosacral dislocation can be considered a three-column injury with an L5-S1 disc lesion, and, therefore, requires a solid circumferential segmental arthrodesis to improve fusion rate.

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Cortical Bone Trajectory Screws in Posterior Lumbar Interbody Fusion: Minimally Invasive Surgery for Maximal Muscle Sparing—A Prospective Comparative Study with the Traditional Open Technique

BioMed Research International ◽

10.1155/2018/7424568 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 14

Author(s):

Nicola Marengo ◽

Marco Ajello ◽

Michele Federico Pecoraro ◽

Giulia Pilloni ◽

Giovanni Vercelli ◽

...

Keyword(s):

Comparative Study ◽

Interbody Fusion ◽

Pedicle Screws ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Significant Difference ◽

Prospective Comparative Study ◽

One Year ◽

Muscular Damage

Introduction. A prospective comparative study between classical posterior interbody fusion with peduncular screws and the new technique with divergent cortical screws was conducted. Material and Methods. Only patients with monosegmental degenerative disease were recruited into this study. We analyzed a cohort of 40 patients treated from January 2015 to March 2016 divided into 2 groups (20 patients went to traditional open surgery and 20 patients under mini-invasive strategy). Primary endpoints of this study are fusion rate and muscular damage; secondary endpoints analyzed were three different clinical scores (ODI, VAS, and EQ) and the morbidity rate of both techniques. Results. There was no significant difference in fusion rate between the two techniques. In addition, a significant difference in muscular damage was found according to the MRI evaluation. Clinical outcomes, based on pain intensity, Oswestry Disability Index status, and Euroquality-5D score, were found to be also statistically different, even one year after surgery. This study also demonstrated a correlation between patients’ muscular damage and their clinical outcome. Conclusions. Cortical bone trajectory screws would provide similar outcomes compared to pedicle screws in posterior lumbar interbody fusion at one year after surgery, and this technique represents a reasonable alternative to pedicle screws.

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Microendoscope-Assisted Versus Open Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Multicenter Retrospective Cohort Study

Medicina ◽

10.3390/medicina57020150 ◽

2021 ◽

Vol 57 (2) ◽

pp. 150

Author(s):

Masayoshi Fukushima ◽

Nozomu Ohtomo ◽

Michita Noma ◽

Yudai Kumanomido ◽

Hiroyuki Nakarai ◽

...

Keyword(s):

Interbody Fusion ◽

Intraoperative Complications ◽

Operating Time ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Open Group ◽

Lumbar Interbody Fusion ◽

Lumbar Degenerative Disease ◽

Radiographic Findings ◽

One Year

Background and objectives: Minimally invasive surgery has become popular for posterior lumbar interbody fusion (PLIF). Microendoscope-assisted PLIF (ME-PLIF) utilizes a microendoscope within a tubular retractor for PLIF procedures; however, there are no published reports that compare Microendoscope-assisted to open PLIF. Here we compare the surgical and clinical outcomes of ME-PLIF with those of open PLIF. Materials and Methods: A total of 155 consecutive patients who underwent single-level PLIF were registered prospectively. Of the 149 patients with a complete set of preoperative data, 72 patients underwent ME-PLIF (ME-group), and 77 underwent open PLIF (open-group). Clinical and radiographic findings collected one year after surgery were compared. Results: Of the 149 patients, 57 patients in ME-group and 58 patients in the open-group were available. The ME-PLIF procedure required a significantly shorter operating time and involved less intraoperative blood loss. Three patients in both groups reported dural tears as intraoperative complications. Three patients in ME-group experienced postoperative complications, compared to two patients in the open-group. The fusion rate in ME-group at one year was lower than that in the open group (p = 0.06). The proportion of patients who were satisfied was significantly higher in the ME-group (p = 0.02). Conclusions: ME-PLIF was associated with equivalent post-surgical outcomes and significantly higher rates of patient satisfaction than the traditional open PLIF procedure. However, the fusion rate after ME-PLIF tended to be lower than that after the traditional open method.

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Posterior lumbar interbody fusion with cages: an independent review of 71 cases

Journal of Neurosurgery Spine ◽

10.3171/spi.1999.91.2.0186 ◽

1999 ◽

Vol 91 (2) ◽

pp. 186-192 ◽

Cited By ~ 16

Author(s):

Siviero Agazzi ◽

Alain Reverdin ◽

Daniel May

Keyword(s):

Retrospective Study ◽

Clinical Outcome ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Content Type ◽

Fixation Techniques ◽

Independent Review ◽

Fine Print

Object. The authors conducted a retrospective study to provide an independent evaluation of posterior lumbar interbody fusion (PLIF) in which impacted carbon cages were used. Interbody cages have been developed to replace tricortical interbody grafts in anterior and PLIF procedures. Superior fusion rates and clinical outcomes have been claimed by the developers. Methods. In a retrospective study, the authors evaluated 71 consecutive patients in whom surgery was performed between 1995 and 1997. The median follow-up period was 28 months. Clinical outcome was assessed using the Prolo scale. Fusion results were interpreted by an independent radiologist. The fusion rate was 90%. Overall, 67% of the patients were satisfied with their outcome and would undergo the same operation again. Based on the results of the Prolo scale, however, in only 39% of the patients were excellent or good results achieved. Forty-six percent of the work-eligible patients resumed their working activity. Clinical outcome and return-to-work status were significantly associated with socioeconomic factors such as preoperative employment (p = 0.03), compensation issues (p = 0.001), and length of preoperative sick leave (p = 0.01). Radiographically demonstrated fusion was not statistically related to clinical outcome (p = 0.2). Conclusions. This is one of the largest independent series in which PLIF with cages has been evaluated. The results show that the procedure is safe and effective with a 90% fusion rate and a 66% overall satisfaction rate, which compare favorably with those of traditional fixation techniques but fail to match the higher results claimed by the innovators of the cage techniques. The authors' experience confirms the reports of others that many patients continue to experience incapacitating back pain despite successful fusion and neurological recovery.

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

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000424 ◽

2017 ◽

Vol 30 (6) ◽

pp. E798-E803 ◽

Cited By ~ 4

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

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Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion?

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.99.2.0143 ◽

2003 ◽

Vol 99 (2) ◽

pp. 143-150 ◽

Cited By ~ 12

Author(s):

Giovanni La Rosa ◽

Alfredo Conti ◽

Fabio Cacciola ◽

Salvatore Cardali ◽

Domenico La Torre ◽

...

Keyword(s):

Interbody Fusion ◽

Lumbar Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Pedicle Screw Fixation ◽

Posterolateral Fusion ◽

Lumbar Interbody Fusion ◽

Isthmic Spondylolisthesis ◽

Content Type ◽

Fine Print

Object. Posterolateral fusion involving instrumentation-assisted segmental fixation represents a valid procedure in the treatment of lumbar instability. In cases of anterior column failure, such as in isthmic spondylolisthesis, supplemental posterior lumbar interbody fusion (PLIF) may improve the fusion rate and endurance of the construct. Posterior lumbar interbody fusion is, however, a more demanding procedure and increases costs and risks of the intervention. The advantages of this technique must, therefore, be weighed against those of a simple posterior lumbar fusion. Methods. Thirty-five consecutive patients underwent pedicle screw fixation for isthmic spondylolisthesis. In 18 patients posterior lumbar fusion was performed, and in 17 patients PLIF was added. Clinical, economic, functional, and radiographic data were assessed to determine differences in clinical and functional results and biomechanical properties. At 2-year follow-up examination, the correction of subluxation, disc height, and foraminal area were maintained in the group in which a PLIF procedure was performed, but not in the posterolateral fusion—only group (p < 0.05). Nevertheless, no statistical intergroup differences were demonstrated in terms of neurological improvement (p = 1), economic (p = 0.43), or functional (p = 0.95) outcome, nor in terms of fusion rate (p = 0.49). Conclusions. The authors' findings support the view that an interbody fusion confers superior mechanical strength to the spinal construct; when posterolateral fusion is the sole intervention, progressive loss of the extreme correction can be expected. Such mechanical insufficiency, however, did not influence clinical outcome.

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CORRELATION OF FUSION RATE ON LUMBAR SPINAL STENOSIS POST PLIF WITH FUNCTIONAL OUTCOME

Biomedika ◽

10.23917/biomedika.v11i2.7613 ◽

2019 ◽

Vol 11 (2) ◽

pp. 61-67

Author(s):

Adi Surya Dharma ◽

Rieva Ermawan ◽

Pamudji Utomo ◽

Handry Tri Handojo

Keyword(s):

Ct Scan ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Oswestry Disability Index ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Functional Scores ◽

Lumbar Spinal

Lumbar spinal stenosis dengan instabilitas, salah satu pilihan pengobatannya dengan laminektomi dekompresi, stabilisasi posterior dan PLIF (Posterior Lumbar Interbody Fusion). Derajat fusi dapat ditentukan dengan pemeriksaan CT-scan post operatif. Sedangkan untuk menilai disabilitas dan skor fungsional pada pasien LSS menggunakan skor Oswestry Disability Index (ODI). Penelitian ini merupakan penelitian analisis observasional pada 18 pasien LSS yang telah dilakukan operasi instrumentasi PLIF. Pasien diminta mengisi kuesioner ODI dan dilakukan evaluasi CT Scan, kemudian dilakukan uji korelasi data yang didapat. Penelitian ini menunjukkan adanya korelasi yang signifikan antara derajat fusi dengan ODI. Koefisien korelasi antara derajat fusi dengan ODI didapatkan 0,904 dengan nilai signifikansi 0,00 (p<0,05). Derajat fusi post operasi dari gambaran CT Scan memiliki korelasi yang signifikan terhadap derajat disabilitas menggunakan skor ODI.Kata Kunci: Lumbar spinal stenosis, Fusion rate, PLIF, ODI Lumbar spinal stenosis with instability one of the treatment options is decompression laminectomy, posterior stabilization and PLIF (Posterior Lumbar Interbody Fusion). The degree of fusion can be determined by CT scan post -operatively. To assess disability and functional scores in LSS patients can use the Oswestry Disability Index (ODI). This study was an observational analysis study in 18 LSS patients who had PLIF instrumentation surgery. Patients were asked to fill in the ODI questionnaire and were evaluated for CT Scan, then the correlation data were obtained. This study shows a significant correlation between the degree of fusion and ODI. The correlation coefficient between the degree of fusion and ODI is 0.904 with a significance value of 0.00 (p <0.05). The degree of postoperative fusion of CT scans has a significant correlation to the degree of disability using the ODI score.Keywords: Lumbar spinal stenosis, Fusion rate, PLIF, ODI

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Transforaminal and Posterior Lumbar Interbody Fusion for Llumbar Degenerative Diseases, which one is better: A meta-analysis Through a Ggrade Analysis of Evidence

10.21203/rs.3.rs-910433/v1 ◽

2021 ◽

Author(s):

aixian tian ◽

xinlong ma ◽

jianxiong Ma

Keyword(s):

Blood Loss ◽

Interbody Fusion ◽

Meta Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Length Of Hospital Stay ◽

Operation Time ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Significant Difference

Abstract BackgroundTo explore the efficacy and safety between posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases.MethodsWe searched the literature in Pubmed, Embase, Cochrane Library and Web of Science. The index words were posterior lumbar interbody fusion, PLIF, transforaminal lumbar interbody fusion, TLIF, lumbar interbody fusion, spinal fusion, degenerative disc disease and lumbar degenerative diseases. Primary outcomes were fusion rate and complications. Secondary outcomes were visual analog scale (ΔVAS), Oswestry Disability Index (ΔODI), total blood loss, operation time and length of hospital stay. Review Manager 5.3 and Stata13.1 was used for the analysis of forest plots, heterogeneity, sensitivity and publication bias.Results17 studies were included (N=1562; PLIF, n=835; TLIF, n=727). The pooled data showed PLIF had a higher complications (P= 0.000), especially in nerve injury (p = 0.003) and dural tear (p = 0.005). PLIF required longer operation time (p = 0.004), more blood loss (p = 0.000) and hospital stays (p = 0.006). Surprisingly subgroup analysis showed there was significant difference in complications in patients under 55 (p = 0.000) and Asian countries (p = 0.000). No statistical difference was found between the two groups with regard to fusion rate (p = 0.593),ΔVAS (p = 0.364) andΔODI (p = 0.237).ConclusionsThis meta-analysis showed there were no significant difference in fusion rate, ΔVAS and ΔODI. However TLIF could reduce complications, especially nerve injury and dural tear. Besides, TLIF was associated with statistically significant less blood loss, shorter operation time and shorter length of hospital stay.

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