scholarly journals Comparison of Single-Level Open and Minimally Invasive Transforaminal Lumbar Interbody Fusions Presenting a Learning Curve

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Viktor Zs. Kovari ◽  
Akos Kuti ◽  
Krisztina Konya ◽  
Istvan Szel ◽  
Anna K. Szekely ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Operative Time ◽  
Leg Pain ◽  
Low Back ◽  
Single Level

Background. Comparison of single-level open and minimally invasive transforaminal lumbar interbody fusions (O-TLIF and MI-TLIF) of a single surgeon and presentation of his MI-TLIF learning curve in a retrospective observational cohort study. Methods. 27 MI-TLIF and 31 O-TLIF patients, performed between 03/01/2013 and 03/31/2018, were compared regarding the operative time, blood loss, blood transfusion frequency, postoperative length of stay (LOS), and adverse events. An overall comparison of pre- and postoperative Oswestry Disability Index (ODI) results and Visual Analog Score (VAS) results of low back and leg pain was performed in the case of the two techniques. For a learning curve presentation, the MI-TLIF cases were compared and the optimal operative time was determined. Results. The gender ratio and age did not differ in the groups. Operative time showed no difference (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P≤0.001) in the MI-TLIF group (288.9 ± 339.8 mL) than in the O-TLIF group (682.3 ± 465.4 mL) while the incidence of blood transfusion was similar (P=0.64). The MI-TLIF group had shorter LOS (2.7 ± 1.1 days vs. 5 ± 2.7, P≤0.001). The frequencies of the surgical site infections (SSI), durotomy, new motor, and sensory deficit were not significantly different (P=0.17, 0.5, 0.29, 0.92). All the ODI, the VAS low back pain, and the VAS leg pain scores improved in both groups significantly (P≤0.001, P≤0.001, and P≤0.001 in the MI-TLIF group and P≤0.001, P≤0.001, and P≤0.001 in the O-TLIF group). The comparison of the pre- and postoperative results of the ODI and VAS questionnaires of the two techniques showed no significant difference regarding the improvement of these scores (MI-TLIF versus O-TLIF pre- and postoperative ODI difference p=0.64, VAS low back pain P=0.47, and VAS leg pain P=0.21). Assessing the MI-TLIF learning curve, operative time was shortened by 63 minutes (P=0.04). After the 14th MI-TLIF case, the surgical duration became relatively constant. Comparing the 14th and previous MI-TLIF cases to the later cases, LOS showed reduction by 1.03 days (P=0.01), while the other parameters did not show significant changes. Conclusions. Similar operative time and postoperative quality of life improvement can be achieved by MI-TLIF procedure as with O-TLIF, and additionally LOS and blood loss can be reduced. When comparing parameters, MI-TLIF can be an alternative option for O-TLIF with a similar complication profile. The learning curve of MI-TLIF can be steep, although it depends on the circumstances.

scholarly journals Lumbar degenerative disease after oblique lateral interbody fusion: sagittal spinopelvic alignment and its impact on low back pain

2020 ◽  
Author(s):  
Jia Li ◽  
Di Zhang ◽  
Yong Shen ◽  
Xiangbei Qi
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Degenerative Disease ◽  
Leg Pain ◽  
Low Back ◽  
Lumbar Degenerative Disease ◽  
Single Level ◽  
Vas Scores ◽  
Oblique Lateral Interbody Fusion

Abstract Background: The objective of the retrospective study was to investigated the incidence and risk factors of low back pain (LBP) in patients with lumbar degenerative disease after single-level oblique lateral interbody fusion(OLIF).Methods: In this retrospective study, 120 patients who undergoing single-level OLIF to treat lumbar degenerative disease were recruited. Preoperative and postoperative radiographic parameters, including segmental lordosis(SL), lumbar lordosis(LL), disk height(DH), pelvic incidence(PI), pelvic tilt (PT), sacral slope(SS), thoracic kyphosis(TK), C7-sagittal vertical axis (SVA). Visual analog scale(VAS) for back and leg pain, and Oswestry Disability Index(ODI), were used to evaluate symptoms and quantify disability. All patients achieved at least two-year follow-up.Results: A total of 120 Patients who complained low back pain were apportioned to LBP group (n=38; VAS scores for back pain≥3) or Non-LBP group (n=82;VAS scores for back pain＜3). There was no difference in age(P=0.082), gender(P=0.425), body mass index(P=0.138), degenerative spondylolisthesis or lumbar spinal stenosis(P=0.529) surgical level(P=0.651), blood Loss (P=0.889) and operative time(P=0.731) between the groups. In both groups, the ODI and VAS scores for back pain and leg pain were significantly improved at the final follow-up compared to the preoperative scores (P=0.003). Furthermore, except for the LBP (P=0.000), there were no significant differences in these scores between the two groups at the final follow-up (P > 0.05). According to the radiographic parameters, in Non-LBP group, the LL, SL, DH, TK and SS had all significantly improved; PT and C7-SVA significantly decreased at the final follow-up compared to the preoperative values. The DH in both groups had significantly improved, no significant difference was found(P=0.325). In the final follow-up, LL, PI-LL, PT and C7-SVA in Non-LBP group had more improvements compared to the LBP group (P＜0.05) . Multivariate analysis showed that PT, PI-LL and C7-SVA were identified as significant risk factors for LBP after OLIF.Conclusion: The clinical outcomes of OLIF for single-level lumbar degenerative disease were satisfactory. Our findings showed that PT, PI-LL mismatch and C7-SVA had the greatest impact on the incidence of LBP. Therefore, patients with appropriate decreased PT, improved C7-SVA and PI-LL match experienced less low back pain.

scholarly journals Triangular Fixation to Prevent Proximal Screw Pullout in Adult Spinal Deformity Surgery: A Technical Note

2021 ◽  
Author(s):  
Masato Tanaka ◽  
Rahul Mehta ◽  
Taro Yamauchi ◽  
Shinya Arataki ◽  
Koji Uotani ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Adult Spinal Deformity ◽  
Operation Time ◽  
Low Back ◽  
Lower Back ◽  
Estimated Blood Loss ◽  
Proximal Screw

Abstract Background Adult spinal deformity (ASD) is caused by spinal malalignment and results in severe low back pain, neurological dysfunction, and severe deformity. Proximal screw back-out represents a difficult problem in minimally invasive ASD surgery. We describe a novel technique to prevent screw pullout in ASD. Methods A 71-year-old woman was referred to our hospital with severe low back pain and gait difficulty. Her daily life had been affected by severe lower back pain for more than 6 months. Standing radiograms indicated severe kyphoscoliosis. Two-stage minimally invasive corrective T10-to-pelvis fixation was performed. Results The first surgery was an L1–S1 C-arm-free oblique lumbar interbody fusion, with an operation time of 3 h 57 min and an estimated blood loss of 240 mL. After 1 week, the second percutaneous pedicle screw (PPS) fixation was performed and proximal screws were inserted under a transdiscal approach (T11) and with a lower angulation trajectory (T10) to enhance pullout strength. For this second surgery, operation time was 3 h 33 min, and estimated blood loss was 320 mL. No postoperative complications or neurological compromise was reported. In terms of clinical outcomes, Oswestry Disability Index improved from 56–24%, and visual analog scale score for lower back pain improved from 62 mm to 24 mm at the 1-year follow-up. Conclusions Minimally invasive circumferential surgery with triangular fixation is effective for preventing proximal screw back-out and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

Treatment of Refractory Low Back Pain Caused by Degenerative Spine Disease with Minimally Invasive Techniques

2014 ◽  
Vol 4 (1_suppl) ◽  
pp. s-0034-1376724-s-0034-1376724
Author(s):  
K. Vladimirovich Tyulikov ◽  
K. Korostelev ◽  
V. Manukovsky ◽  
V. Litvinenko ◽  
V. Badalov
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Minimally Invasive ◽  
Low Back ◽  
Minimally Invasive Techniques ◽  
Degenerative Spine ◽  
Degenerative Spine Disease ◽  
Invasive Techniques ◽  
Spine Disease

Microendoscopic Decompression for Lumbar Spinal Stenosis Associated with Adjacent Segment Disease following Lumbar Fusion Surgery: 5-year Follow-up of a Retrospective Case Series

2021 ◽  
Author(s):  
Shizumasa Murata ◽  
Akihito Minamide ◽  
Yukihiro Nakagawa ◽  
Hiroshi Iwasaki ◽  
Hiroshi Taneichi ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Japanese Orthopaedic Association ◽  
Leg Pain ◽  
Adjacent Segment ◽  
Low Back ◽  
Spinal Decompression ◽  
Analog Scale ◽  
Clinically Important Difference ◽  
Lumbar Spinal

Abstract Background and Study Aims Surgical treatment options for lumbar spinal stenosis (LSS) based on adjacent segment disease (ASD) after spinal fusion typically involve decompression, with or without fusion, of the adjacent segment. The clinical benefits of microendoscopic decompression for LSS based on ASD have not yet been fully elucidated. We aimed to investigate the clinical results of microendoscopic spinal decompression surgery for LSS based on ASD. Patients and Methods From 2011 to 2014, consecutive patients who underwent microendoscopic spinal decompression without fusion for LSS based on ASD were enrolled. Data of 32 patients (17 men and 15 women, with a mean age of 70.5 years) were reviewed. Japanese Orthopaedic Association score and low back pain/leg pain visual analog scale score were utilized to measure neurologic and axial pain outcomes, respectively. Additionally, after the surgeries, we analyzed the magnetic resonance imaging (MRI), computed tomography (CT) scans, or radiographs to identify any new instabilities of the decompressed segments or progression of ASD adjacent to the decompressed segments. Results The Japanese Orthopaedic Association recovery rate at the 5-year postoperative visit was 49.2%. The visual analog scale scores for low back pain and leg pain were significantly improved. The minimum clinically important difference for leg pain (decrease by ≥24 mm) and clinically important difference for low back pain (decrease by ≥38 mm) were achieved in 84% (27/32) and 72% (23/32) of cases, respectively. Regarding new instability after microendoscopic decompression, no cases had apparent spinal instability at the decompression segment and adjacent segment to the decompressed segment. Conclusions Microendoscopic spinal decompression is an effective treatment alternative for patients with LSS caused by ASD. The ability to perform neural decompression while maintaining key stabilizing structures minimizes subsequent clinical instability. The substantial clinical and economic benefits of this approach may make it a favorable alternative to performing concurrent fusion in many patients.

The Treatment of Disabling Single-Level Lumbar Discogenic Low Back Pain With Total Disc Arthroplasty Utilizing the Prodisc Prosthesis

Spine ◽  
2005 ◽  
Vol 30 (19) ◽  
pp. 2230-2236 ◽  
Author(s):  
Rudolf Bertagnoli ◽  
James J. Yue ◽  
Rahul V. Shah ◽  
Regina Nanieva ◽  
Frank Pfeiffer ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Total Disc Arthroplasty ◽  
Disc Arthroplasty ◽  
Single Level ◽  
Discogenic Low Back Pain

Do minimally invasive procedures have a place in the treatment of chronic low back pain?

2004 ◽  
Vol 4 (3) ◽  
pp. 479-490 ◽  
Author(s):  
Alex Cahana ◽  
Philippe Mavrocordatos ◽  
Jos WM Geurts ◽  
Gerbrand J Groen
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Minimally Invasive ◽  
Chronic Low Back Pain ◽  
Minimally Invasive Procedures ◽  
Low Back ◽  
Invasive Procedures
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