scholarly journals Lateral Lumbar Interbody Fusion for Ossification of the Yellow Ligament in the Lumbar Spine: First Reported Case

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Kengo Fujii ◽  
Tetsuya Abe ◽  
Toru Funayama ◽  
Hiroshi Noguchi ◽  
Keita Nakayama ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Interbody Fusion ◽  
Pedicle Screws ◽  
Lateral Wall ◽  
Posterior Longitudinal Ligament ◽  
Posterior Fixation ◽  
Lumbar Interbody Fusion ◽  
Venous Plexus ◽  
Lateral Lumbar Interbody Fusion ◽  
Initial Surgery

When ossification of the yellow ligament (OYL) occurs in the lumbar spine and extends to the lateral wall of the spinal canal, facetectomy is required to remove all of the ossified lesion and achieve decompression. Subsequent posterior fixation with interbody fusion will then be necessary to prevent postoperative progression of the ossification and intervertebral instability. The technique of lateral lumbar interbody fusion (LLIF) has recently been introduced. Using this procedure, surgeons can avoid excess blood loss from the extradural venous plexus and detachment of the ossified lesion and the ventral dura mater is avoidable. We present a 55-year-old male patient with OYL at L3/4 and anterior spondylolisthesis of L4 vertebra, with concomitant ossification of the posterior longitudinal ligament, who presented with a severe gait disturbance. He underwent a 2-stage operation without complications: LLIF for L3/4 and L4/5 was performed at the initial surgery, and posterior decompression fixation using pedicle screws from L3 to L5 was performed at the second surgery. His postoperative progress was favorable, and his interbody fusion was deemed successful. Here, we present the first reported case of LLIF for OYL of the lumbar spine. This procedure can be a good option for OYL of the lumbar spine.

Intraoperative electromyography monitoring in minimally invasive transforaminal lumbar interbody fusion

2007 ◽  
Vol 6 (2) ◽  
pp. 126-132 ◽  
Author(s):  
Rajesh K. Bindal ◽  
Subrata Ghosh
Keyword(s):  
Minimally Invasive ◽  
Nerve Root ◽  
Interbody Fusion ◽  
Neurological Complication ◽  
Pedicle Screws ◽  
Ct Scanning ◽  
Lateral Wall ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Active Monitoring

Object Minimally invasive transforaminal lumbar interbody fusion (TLIF) is an increasingly popular method for achieving lumbar decompression and fusion. The procedure is technically more demanding than open fusion, with correspondingly more theoretical risk of complication. The authors describe the use of intraoperative electromyography (EMG) as an adjunct to surgery to reduce the risk of complications. Methods Between August 2005 and April 2006, 25 consecutive patients underwent minimally invasive TLIF in which a total of 105 pedicle screws were placed. Intraoperative EMG was performed and included passive recordings during decompression and interbody graft placement, as well as active recording during the placement of the pedicle access needle and testing of the pedicle tap. A uniform protocol for active monitoring was used, with the pedicle access needle set at 7 mA. To assess hardware placement, all patients underwent postoperative radiography and 20 underwent postoperative computed tomography (CT) scanning. In no patient did the authors observe significant EMG activation during decompression. In five cases, intermittent nerve root firing was noted after the interbody graft was placed, but this did not correlate with any postoperative deficits. Using the active stimulation protocol, 76.2% of screw placements required one or more changes to the trajectory of the pedicle access needle. With successful placement of the pedicle access needle, in all 105 screws, the pedicle tap nerve root stimulation threshold was greater than 15 mA. Postoperative radiography was performed in all patients and CT scanning was performed in 20 patients (with 85 screws being placed). Postoperative imaging revealed only three cases of pedicle breach. In all cases, the breach was at the lateral wall of the pedicle and not thought to be clinically relevant. Conclusions A continuous stimulation pedicle access needle alerts the surgeon to incorrect medial trajectories and may lead to safer pedicle cannulation. As a result of electrophysiological feedback, the pedicle access needle trajectory was altered in 76.2% of the reported cases. The use of the authors’ protocol resulted in a 0% incidence of clinically relevant malpositioned hardware and a low overall neurological complication rate. Intraoperative nerve root monitoring is a useful adjunct to minimally invasive TLIF.

Does Prone Repositioning Before Posterior Fixation Produce Greater Lordosis in Lateral Lumbar Interbody Fusion (LLIF)?

2014 ◽  
Vol 27 (7) ◽  
pp. 364-369 ◽  
Author(s):  
Sharon C. Yson ◽  
Jonathan N. Sembrano ◽  
Edward R. G. Santos ◽  
Jeffrey T. P. Luna ◽  
David W. Polly
Keyword(s):  
Interbody Fusion ◽  
Posterior Fixation ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion

scholarly journals Effects of intradiscal vacuum phenomenon on surgical outcome of lateral interbody fusion for degenerative lumbar disease

2017 ◽  
Vol 26 (4) ◽  
pp. 419-425 ◽  
Author(s):  
Chun-Po Yen ◽  
Joshua M. Beckman ◽  
Andrew C. Vivas ◽  
Konrad Bach ◽  
Juan S. Uribe
Keyword(s):  
Interbody Fusion ◽  
Pedicle Screws ◽  
Retrospective Chart Review ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Vacuum Phenomenon ◽  
Lateral Lumbar Interbody Fusion ◽  
Cage Subsidence ◽  
Degenerative Lumbar Disease ◽  
The Mean

OBJECTIVE The authors investigated whether the presence of intradiscal vacuum phenomenon (IVP) results in greater correction of disc height and restoration of segmental lordosis (SL). METHODS A retrospective chart review was performed on every patient at the University of South Florida's Department of Neurosurgery treated with lateral lumbar interbody fusion between 2011 and 2015. From these charts, preoperative plain radiographs and CT images were reviewed for the presence of IVP. Preoperative and postoperative posterior disc height (PDH), anterior disc height (ADH), and SL were measured at disc levels with IVP and compared with those at disc levels without IVP using the t-test. Linear regression was used to evaluate the factors that predict changes in PDH, ADH, and SL. RESULTS One hundred forty patients with 247 disc levels between L-1 and L-5 were treated with lateral lumbar interbody fusion. Among all disc levels treated, the mean PDH increased from 3.69 to 6.66 mm (p = 0.011), the mean ADH increased from 5.45 to 11.53 mm (p < 0.001), and the mean SL increased from 9.59° to 14.55° (p < 0.001). Significantly increased PDH was associated with the presence of IVP, addition of pedicle screws, and lack of cage subsidence; significantly increased ADH was associated with the presence of IVP, anterior longitudinal ligament (ALL) release, addition of pedicle screws, and lack of subsidence; and significantly increased SL was associated with the presence of IVP and ALL release. CONCLUSIONS IVP in patients with degenerative spinal disease remains grossly underreported. The data from the present study suggest that the presence of IVP results in increased restoration of disc height and SL.

scholarly journals Interbody Spacer Material Properties and Design Conformity for Reducing Subsidence During Lumbar Interbody Fusion

2017 ◽  
Vol 139 (5) ◽  
Author(s):  
Lillian S. Chatham ◽  
Vikas V. Patel ◽  
Christopher M. Yakacki ◽  
R. Dana Carpenter
Keyword(s):  
Lumbar Spine ◽  
Interbody Fusion ◽  
Experimental Testing ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Stress And Strain ◽  
Fe Model ◽  
Lumbar Interbody Fusion ◽  
Cadaveric Specimen ◽  
Vertebral Endplates

There is a need to better understand the effects of intervertebral spacer material and design on the stress distribution in vertebral bodies and endplates to help reduce complications such as subsidence and improve outcomes following lumbar interbody fusion. The main objective of this study was to investigate the effects of spacer material on the stress and strain in the lumbar spine after interbody fusion with posterior instrumentation. A standard spacer was also compared with a custom-fit spacer, which conformed to the vertebral endplates, to determine if a custom fit would reduce stress on the endplates. A finite element (FE) model of the L4–L5 motion segment was developed from computed tomography (CT) images of a cadaveric lumbar spine. An interbody spacer, pedicle screws, and posterior rods were incorporated into the image-based model. The model was loaded in axial compression, and strain and stress were determined in the vertebra, spacer, and rods. Polyetheretherketone (PEEK), titanium, poly(para-phenylene) (PPP), and porous PPP (70% by volume) were used as the spacer material to quantify the effects on stress and strain in the system. Experimental testing of a cadaveric specimen was used to validate the model's results. There were no large differences in stress levels (<3%) at the bone–spacer interfaces and the rods when PEEK was used instead of titanium. Use of the porous PPP spacer produced an 8–15% decrease of stress at the bone–spacer interfaces and posterior rods. The custom-shaped spacer significantly decreased (>37%) the stress at the bone–spacer interfaces for all materials tested. A 28% decrease in stress was found in the posterior rods with the custom spacer. Of all the spacer materials tested with the custom spacer design, 70% porous PPP resulted in the lowest stress at the bone–spacer interfaces. The results show the potential for more compliant materials to reduce stress on the vertebral endplates postsurgery. The custom spacer provided a greater contact area between the spacer and bone, which distributed the stress more evenly, highlighting a possible strategy to decrease the risk of subsidence.

scholarly journals Lateral Lumbar Interbody Fusion and in Situ Screw Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine

2017 ◽  
Vol 60 (6) ◽  
pp. 755-762 ◽  
Author(s):  
Young Hoon Choi ◽  
Shin Won Kwon ◽  
Jung Hyeon Moon ◽  
Chi Heon Kim ◽  
Chun Kee Chung ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion

Stability of transforaminal lumbar interbody fusion in the setting of retained facets and posterior fixation using transfacet or standard pedicle screws

2015 ◽  
Vol 15 (5) ◽  
pp. 1077-1082 ◽  
Author(s):  
Kingsley R. Chin ◽  
Marco T. Reis ◽  
Phillip M. Reyes ◽  
Anna G.U. Newcomb ◽  
Anda Neagoe ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Posterior Fixation ◽  
Lumbar Interbody Fusion
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