scholarly journals Enhanced Recovery after an Innovative Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis: A Prospective Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Peng Yin ◽  
Haifeng Gao ◽  
Lijin Zhou ◽  
Daming Pang ◽  
Yong Hai ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Enhanced Recovery ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Clinical Effects ◽  
Lumbar Interbody Fusion ◽  
Multifidus Muscle ◽  
Cross Sectional ◽  
Significant Difference ◽  
Lumbar Spinal

Background. The objective of this study was to investigate the enhanced recovery clinical effects of an innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of patients with LSS and degenerative instability. Methods. From January 2019 to March 2020, 51 patients with single-segment LSS and degenerative instability were prospectively included in our study (ChiCTR1900020679). The Oswestry Disability Index (ODI), the visual analogue scale (VAS) on lumbar and leg pain (VAS-LBP and VAS-LP), serum creatine kinase (CK), the peak intensity of sulphur hexafluoride microbubble contrast agent (PI), and the maximal cross-sectional area of multifidus muscle (Max-CSA) around the surgical incision were assessed preoperatively, postoperatively, and at regular follow-up. Results. All patients were followed up. The mean postoperative bedridden time was 20.45 ± 2.66 hours. The ODI, VAS-LBP, and VAS-LP were improved significantly after operation compared to these data before operation in all the patients ( P < 0.05 ). The CK at 1 day after operation was higher compared to the data before the operation ( P < 0.05 ), and there was no significant difference on CK at 1 week after operation ( P > 0.05 ). The PI at 1 week after operation was higher compared to this item before operation ( P < 0.05 ), and there was no significant difference on PI at 1 month or 3 months after operation ( P > 0.05 ). The Max-CSA at 1 week after operation was higher compared to this item before the operation ( P < 0.05 ), and there was no significant difference in Max-CSA at 1 month or 3 months after operation compared with before the operation ( P > 0.05 ). Conclusions. Our results and systematic review presented the innovative PE-TLIF technique could obtain satisfactory and effective outcomes for the treatment of patients with LSS and degenerative instability. Our PE-TLIF technique also had the ability to decrease the MF injury and obtain an enhanced recovery.

scholarly journals An Innovative Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis with Degenerative Instability: a prospective cohort study

2021 ◽  
Author(s):  
Peng Yin ◽  
Yi Ding ◽  
Lijin Zhou ◽  
Chunyang Xu ◽  
Liming Zhang ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Controlled Study ◽  
Clinical Effects ◽  
Lumbar Interbody Fusion ◽  
Degenerative Diseases ◽  
Multifidus Muscle ◽  
Lumbar Spinal

Abstract Lumbar spinal stenosis (LSS) is most common lumbar degenerative diseases for people with low back pain. Endoscopic lumbar fusion technique was considered as a promising treatment for LSS with degenerative instability. The objective of this study was to compared the clinical effects for the treatment of Lumbar spinal stenosis (LSS) with degenerative instability between the innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) technique and posterior lumbar interbody fusion (PLIF) technique. Between April 2019 and December 2019, 40 patients with single-segment LSS were prospectively included in our study. Visual Analogue Scale (VAS) on lumbar and leg pain (VAS-LBP, VAS-LP), Oswestry Disability Index (ODI), serum Creatine Kinase (CK), the maximal cross-sectional area of multifidus muscle (Max-CSA) and the peak intensity of Sulphur hexafluoride microbubble contrast agent (PI) around the surgical incision by contrast-enhanced ultrasonography were evaluated preoperatively, post-operatively and at regular follow-up. All patients were followed up. The VAS-LBP, VAS-LP, ODI after operation were improved significantly compared to these data before operation in all the patients (P < 0.05). The VAS-LBP at 1 weeks, 3 months after operation in PE-TLIF group were significantly lower than these in PLIF group (P < 0.05). The injury degree of multifidus muscle evaluated by MAX-CSA and PI was significantly less in PE-TLIF group after operation(P < 0.05). There was no significant difference on the complication rate between these two groups (P > 0.05). Our results presented PE-TLIF technique could obtain comparable effective outcomes as conventional PLIF for the treatment of LSS with degenerative instability. The Patients with PE-TLIF had less muscle injury, less pain and quicker postoperative rehabilitation. (A multicenter non-randomized controlled study for percutaneous endoscope transforaminal lumbar interbody fusion (PE-TLIF) and traditional open surgery for the treatment of degenerative diseases of the lumbar spine;2019/4/13; http://www.chictr.org.cn/showproj.aspx?proj=38002; ChiCTR1900022492)

scholarly journals S-line as Predictor of Clinical Outcome for Patients Undergone Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis

2021 ◽  
Author(s):  
Yilin Lu ◽  
Jian Zhu ◽  
Xi Luo ◽  
Kaiqiang Sun ◽  
Jingchuan Sun ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Lumbar Spinal

Abstract Background: Some have speculated that LSTV has an impact on lumbar curve. A retrospective study was conducted to evaluate S-line as predictor of clinical outcome for patients undergone transforaminal lumbar interbody fusion for lumbar spinal stenosis.Methods: 126 patients undergoing transforaminal lumbar interbody fusion were enrolled. S-line stands for the connecting line between the highest points of the iliac crests on both sides. The patients were divided into two groups according to the position of S-line, S-line (-) group included patients whose S-line were between L4 and L5, and S-line (+) group included patients whose S-line is above or below this range, which were divided into two subgroups. Their pre-operative imaging data about sagittal alignment were collected, including lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI) and pelvic tilt (PT). Clinical outcomes were measured using Japanese Orthopaedic Association (JOA) scores, the Oswestry disability index (ODI), visual analog scale (VAS) before the surgery and postoperatively. The correlation of S-line and clinical outcomes, as well as sagittal alignment and clinical outcomes, were analyzed.Results: LL, SS, PI, PT and PI minus(-) LL of S-line (-) group were (45.39°±12.68°), (30.27°±10.55°), (43.32°±12.22°), (13.05°±6.52°), (-2.07°±8.20°), respectively, and those parameters of S-line (+) group were (40.29±14.92), (35.70°±14.09°), (52.59°±17.07°), (16.89°±8.24°), (12.30°±9.98°), respectively. Significant difference were seen in the above parameters between S-line (-) and S-line (+) group. For S-line (-) and S-line (+) group, post-operative JOA score were (22.39±2.12), (20.26±2.46), post-operative VAS were (2.07±0.88), (3.14±1.47), the post-operative ODI were (8.36±3.28), (11.82±3.32), the improvement rate is (0.61±0.13), (0.55±0.15), Significant differences of those parameters are seen between S-line (-) group and S-line (+) group.Conclusion: S-line is a reliable predictor of clinical outcome for patients undergone transforaminal lumbar interbody fusion for lumbar spinal stenosis.

scholarly journals Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery

2019 ◽  
Vol 46 (4) ◽  
pp. E18 ◽  
Author(s):  
Dong Hwa Heo ◽  
Choon Keun Park
Keyword(s):  
Interbody Fusion ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Clinical Results ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Mean

OBJECTIVEThe aims of enhanced recovery after surgery (ERAS) are to improve surgical outcomes, shorten hospital stays, and reduce complications. The objective of this study was to introduce ERAS with biportal endoscopic transforaminal lumbar interbody fusion (TLIF) and to investigate the clinical results.METHODSPatients were divided into two groups based on the fusion procedures. Patients who received microscopic TLIF without ERAS were classified as the non-ERAS group, whereas those who received percutaneous biportal endoscopic TLIF with ERAS were classified as the ERAS group. The mean Oswestry Disability Index (ODI) and visual analog scale (VAS) scores were compared between the two groups. In addition, demographic characteristics, diagnosis, mean operative time, estimated blood loss (EBL), fusion rate, readmissions, and complications were investigated and compared.RESULTSForty-six patients were grouped into the non-ERAS group (microscopic TLIF without ERAS) and 23 patients into the ERAS group (biportal endoscopic TLIF with ERAS). The VAS score for preoperative back pain on days 1 and 2 was significantly higher in the non-ERAS group than in the ERAS group (p < 0.05). The mean operative duration was significantly higher in the ERAS group than in the non-ERAS group, while the mean EBL was significantly lower in the ERAS group than in the non-ERAS group (p < 0.05). There was no significant difference in fusion rate between the two groups (p > 0.05). Readmission was required in 2 patients who were from the non-ERAS group. Postoperative complications occurred in 6 cases in the non-ERAS group and in 2 cases in the ERAS group.CONCLUSIONSPercutaneous biportal endoscopic TLIF with an ERAS pathway may have good aspects in reducing bleeding and postoperative pain. Endoscopic fusion surgery along with the ERAS concept may help to accelerate recovery after surgery.

scholarly journals An in vitro study examining a novel suction curette device for lumbar discectomy compared with standard manual discectomy

2017 ◽  
Vol 26 (4) ◽  
pp. 454-458 ◽  
Author(s):  
William F. Lavelle ◽  
Nathaniel R. Ordway ◽  
Ali Araghi ◽  
Rudolph A. Buckley ◽  
Amir H. Fayyazi
Keyword(s):  
Intervertebral Disc ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Whole Body ◽  
Lumbar Interbody Fusion ◽  
Interface Area ◽  
Surgical Time ◽  
Cross Sectional ◽  
Significant Difference ◽  
Disc Material

OBJECTIVE This purpose of this study was to objectively evaluate and assess the efficacy and efficiency of discectomy and endplate preparation during transforaminal lumbar interbody fusion (TLIF) using traditional manual instrumentation versus a novel suction discectomy curette. Transforaminal lumbar interbody fusion is the most widely used approach for lumbar arthrodesis, and its success depends on the ability to achieve fusion. Complete preparation of intervertebral disc space (removal of the nucleus, endplate cartilage, and margin of inner annulus) is the surgical goal. Performing an adequate discectomy requires numerous instrument passes, increasing surgical time and the risk of complications. METHODS Four experienced spinal surgeons performed transforaminal discectomies from T-12 to S-1 on 5 whole-body cadavers. Each level (n = 26) was randomly assigned to either a control group using traditional instruments (12 levels) or to a suction curette group (14 levels). The time required to perform the discectomy and the number of passes through the annulus were recorded. Motion segments were dissected and analyzed by digital photogrammetric analysis. The intervertebral disc and the discectomy cross-sectional areas were measured on both superior and inferior images of each dissected surgical level. Areas were divided into 4 quadrants based on a midsagittal and midcoronal axis and analyzed for regional efficiency. In addition, a cross-sectional area of bony endplate (the area still covered with cartilage) and an area of endplate perforation were evaluated. RESULTS There was no significant difference in surgical time between the techniques (7:51 ± 2:43 minutes in the manual discectomy [MD] group and 7:06 ± 3:33 minutes in the suction curette discectomy [SD] group). There were significantly fewer (p < 0.01) instrument passes in the SD group (13 passes) compared with the MD group (43 passes). For both techniques, the amount of disc removed depended upon the anatomical region, with the posterior-contralateral side having the least amount of disc material removed. There was significantly less (p < 0.01) disc material removed in the MD group (38%) compared with the SD group (48%). The amount of disc material removed was significantly more (p < 0.05) in each quadrant when comparing the SD and MD groups, with the anterior regions showing the largest difference. For both techniques, the preparation of the endplate within the discectomy area resulted in a mostly cartilaginous interface (50% MD, 48% SD); a smaller amount of bony interface area (31% MD, 38% SD); and a smaller amount of perforation to the interface area (19% MD, 13% SD). There were no significant differences between the groups in terms of endplate preparation. CONCLUSIONS The improved discectomy observed with the suction curette device could potentially improve the clinical fusion rate.

Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive transforaminal lumbar interbody fusion: a single-center randomized prospective study

2013 ◽  
Vol 35 (2) ◽  
pp. E13 ◽  
Author(s):  
Nader S. Dahdaleh ◽  
Alexander T. Nixon ◽  
Cort D. Lawton ◽  
Albert P. Wong ◽  
Zachary A. Smith ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prospective Study ◽  
Interbody Fusion ◽  
Short Form ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Lost To Follow Up

Object Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is used to treat a wide variety of lumbar degenerative disorders. Although there are some reports showing efficacy of unilateral instrumentation during MIS-TLIF, a controlled randomized prospective study has not been done. Methods Forty-one patients were randomly assigned to receive either bilateral or unilateral instrumentation following 1-level unilateral MIS-TLIF. Four patients were lost to follow-up in the unilateral group and 1 patient was lost to follow-up in the bilateral group. Preoperative and postoperative scores on a visual analog scale (VAS) for back pain and leg pain (VAS-BP and VAS-LP, respectively), Oswestry Disability Index (ODI), and 36-Item Short Form Healthy Survey version 2 (SF-36v2) were collected. Additionally, preoperative and postoperative segmental Cobb angles and radiographic evidence of fusion were analyzed. Results There was no statistically significant difference in baseline demographic characteristics between the 2 groups. The VAS-BP, VAS-LP, ODI, and SF-36v2 physical component scores improved significantly after surgery in both groups (p < 0.05); there was no statistically significant between-groups difference in the degree of improvement. Blood loss was significantly higher in the bilateral instrumentation group and hospital stay was longer in the unilateral instrumentation group. There was no statistically significant between-groups difference with respect to change in segmental lordosis or fusion rate. The average duration of follow-up was 12.4 months for the bilateral instrumentation group and 11.4 months for the unilateral instrumentation group. Conclusions Clinical and radiographic outcomes of unilateral and bilateral instrumentation for unilateral MISTLIF are similar 1 year after surgery.

scholarly journals Clinical outcomes of minimally invasive transforaminal lumbar interbody fusion via a novel tubular retractor

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092009
Author(s):  
Yan Wang ◽  
Yaqing Zhang ◽  
Fanli Chong ◽  
Yue Zhou ◽  
Bo Huang
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Fatty Infiltration ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Cerebrospinal Fluid Leakage ◽  
Lumbar Interbody Fusion ◽  
Multifidus Muscle ◽  
Tubular Retractor ◽  
Estimated Blood Loss

Objective To assess the feasibility and clinical results of microscopic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using a novel tapered tubular retractor that preserves the multifidus. Method A total of 122 patients underwent MIS-TLIF using a tapered tubular retractor system from March 2016 to August 2017. Perioperative parameters and follow-up outcomes were reviewed. Results The follow-up period was 23.95 ± 1.43 months. The operative time averaged 130.48 ± 34.44 minutes. The estimated blood loss was 114.10 ± 96.70 mL. The mean time until ambulation was 16.33 ± 6.29 hours. The average visual analogue scale (leg/waist) and Oswestry Disability Index scores (preoperative to last follow-up) improved from 4.93 ± 2.68/3.74 ± 2.28 to 0.34 ± 0.77/0.64 ± 0.74 and from 59.09% ± 22.34 to 17.04% ± 8.49, respectively. At the last follow-up, 98.36% of the patients achieved solid fusion. Cerebrospinal fluid leakage occurred in two cases. The asymptote of the surgeon’s learning curve occurred at the 25th case. There were no significant differences between the preoperative qualitative and quantitative analyses of multifidus muscle fatty infiltration and those at the final follow-up. Conclusion MIS-TLIF can be performed safely and effectively using this tapered tubular retractor system, which helps preserve the multifidus.

scholarly journals Clinical Outcomes of Posterior Lumbar Interbody Fusion versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in Three-Level Degenerative Lumbar Spinal Stenosis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Guoxin Fan ◽  
Xinbo Wu ◽  
Shunzhi Yu ◽  
Qi Sun ◽  
Xiaofei Guan ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Sf 36 ◽  
Lumbar Spinal

The aim of this study was to directly compare the clinical outcomes of posterior lumbar interbody fusion (PLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in three-level lumbar spinal stenosis. This retrospective study involved a total of 60 patients with three-level degenerative lumbar spinal stenosis who underwent MIS-TLIF or PLIF from January 2010 to February 2012. Back and leg visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) scale were used to assess the pain, disability, and health status before surgery and postoperatively. In addition, the operating time, estimated blood loss, and hospital stay were also recorded. There were no significant differences in back VAS, leg VAS, ODI, SF-36, fusion condition, and complications at 12-month follow-up between the two groups (P>0.05). However, significantly less blood loss and shorter hospital stay were observed in MIS-TLIF group (P<0.05). Moreover, patients undergoing MIS-TLIF had significantly lower back VAS than those in PLIF group at 6-month follow-up (P<0.05). Compared with PLIF, MIS-TLIF might be a prior option because of noninferior efficacy as well as merits of less blood loss and quicker recovery in treating three-level lumbar spinal stenosis.

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