scholarly journals A Comparison of Revision Rates and Patient-Reported Outcomes for a 2-Level Posterolateral Fusion Augmented With Single Versus 2-Level Transforaminal Lumbar Interbody Fusion

2019 ◽  
Vol 10 (8) ◽  
pp. 958-963
Author(s):  
I. David Kaye ◽  
Terry Fang ◽  
Scott C. Wagner ◽  
Joseph S. Butler ◽  
Arjun Sebastian ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment Disease ◽  
Posterolateral Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Control Series ◽  
Patient Reported ◽  
Reoperation Rates ◽  
Level Group

Study Design: Retrospective, single institution, multisurgeon case control series. Objective: To determine whether there are differences in reoperation rates or outcomes for patients undergoing 2-level posterolateral fusion (PLF) augmented by a transforaminal lumbar interbody fusion (TLIF) at only one of the levels or at both. Methods: A total of 416 patients were identified who underwent 2-level PLF with a TLIF at either one of those levels (n = 183) or at both (n = 233) with greater than 1-year follow-up. Demographic, surgical, radiographic, and clinical data was reviewed for each patient. These included age, sex, race, body mass index, smoking status, Charleston Comorbidity Index, operative time, estimated blood loss, length of stay, and patient-reported outcome measures. Results: Each cohort underwent 24 reoperations. Although the number of overall reoperations was not significantly different ( P > .05), among the reoperation types, there were significantly more reoperations for adjacent segment disease in the 2-level group compared to the 1-level group (19 vs 12, P = .04). There was no difference in reoperation for pseudarthrosis between the groups ( P > .05). Although both groups experienced significant improvements in Oswestry Disability Index ( P < .001) and Short Form–12 health questionnaire ( P < .001), there were no differences between improvements for 1- versus 2-level cohorts. Conclusions: For patients undergoing 2-level PLF in the setting of a TLIF, using a TLIF at one versus both levels does not seem to influence reoperation rates or outcomes. However, reoperation rates for adjacent segment disease are increased in the setting of a 2-level PLF augmented by a 2-level TLIF.

scholarly journals Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Wei Wang ◽  
Xiangyao Sun ◽  
Tongtong Zhang ◽  
Siyuan Sun ◽  
Chao Kong ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Reoperation Rates ◽  
Topping Off

The treatment effects of topping-off technique were still controversial. This study compared all available data on postoperative clinical and radiographic outcomes of topping-off technique and posterior lumbar interbody fusion (PLIF). PubMed, EMBASE, and Cochrane were systematically reviewed. Variations included radiographical adjacent segment disease (RASD), clinical adjacent segment disease (CASD), global lumbar lordosis (GLL), visual analogue scale (VAS) of back (VAS-B) and leg (VAS-L), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, duration of surgery, estimated blood loss (EBL), reoperation rates, and complication rates. Sixteen studies, including 1372 cases, were selected for the analysis. Rates of proximal RASD (P=0.0004), distal RASD (P=0.03), postoperative VAS-B (P=0.0001), postoperative VAS-L (P=0.02), EBL (P=0.007), and duration of surgery (P=0.02) were significantly lower in topping-off group than those in PLIF group. Postoperative ODI after 3 years (P=0.04) in the topping-off group was significantly less than that in the PLIF group. There was no significant difference in the rates of CASD (P=0.06), postoperative GLL (P=0.14), postoperative ODI within 3 years (P=0.24), and postoperative JOA (P=0.70) and in reoperation rates (P=0.32) and complication rates (P=0.27) between topping-off group and PLIF. The results confirmed that topping-off technique could effectively prevent ASDs after lumbar internal fixation. However, this effect is effective in preventing RASD. Topping-off technique is more effective in improving the subjective feelings of patients rather than objective motor functions compared with PLIF. With the development of surgical techniques, both topping-off technique and PLIF are safe.

scholarly journals Benefit of Transforaminal Lumbar Interbody Fusion vs Posterolateral Spinal Fusion in Lumbar Spine Disorders

Neurosurgery ◽  
2015 ◽  
Vol 79 (3) ◽  
pp. 397-405 ◽  
Author(s):  
Steven D. Glassman ◽  
Leah Y. Carreon ◽  
Zoher Ghogawala ◽  
Kevin T. Foley ◽  
Matthew J. McGirt ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Estimated Blood Loss ◽  
Posterolateral Spinal Fusion ◽  
Room Time ◽  
Operating Room Time

Abstract BACKGROUND: Despite increasing use and potential benefits of transforaminal lumbar interbody fusion (TLIF) compared with posterolateral spinal fusion (PSF), previous studies have not documented improved clinical outcomes with TLIF vs PSF. OBJECTIVE: To compare the outcomes of TLIF with PSF in patients with spondylolisthesis, spinal stenosis, and adjacent level disease. METHODS: The National Neurosurgical Quality and Outcomes Database was queried for patients who had a lumbar fusion. Eighty-five percent (1722) of enrolled cases had 12-month follow-up data. There were 306 PSF patients and 1230 TLIF patients. PSF cases within each diagnostic subgroup were propensity-matched to patients who had TLIF. Sufficient propensity-matched controls were available for patients with spondylolisthesis (109), spinal stenosis (63), and adjacent segment disease (47). RESULTS: Operating room time, estimated blood loss, and length of stay were similar between PSF and TLIF in all 3 propensity-matched groups. In the spondylolisthesis group, there was a greater improvement in Oswestry Disability Index (ODI) with TLIF vs PSF at 3 months (19.4 vs 26.0, P =.009), 12 months (20.8 vs 29.3, P =.001), and in percentage reaching minimal clinically important difference at 12 months (80% vs 62%, P =.007). There were no differences in ODI improvement between PSF and TLIF in the stenosis or adjacent segment disease groups. CONCLUSION: TLIF generated more favorable ODI outcomes than PSF for patients with spondylolisthesis, but not for patients with spinal stenosis or adjacent segment disease. There was also equivalence in operating room time and estimated blood loss between TLIF and PSF, potentially altering the long-standing assumption that PSF is a simpler procedure.

Topping-off technique for stabilization of lumbar degenerative instabilities in 322 patients

2020 ◽  
Vol 32 (3) ◽  
pp. 366-372
Author(s):  
Sandro M. Krieg ◽  
Nele Balser ◽  
Haiko Pape ◽  
Nico Sollmann ◽  
Lucia Albers ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Interbody Fusion ◽  
Smooth Transition ◽  
Lumbar Pain ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Rod System ◽  
Reoperation Rates ◽  
Topping Off

OBJECTIVESemi-rigid instrumentation (SRI) was introduced to take advantage of the concept of load sharing in surgery for spinal stabilization. The authors investigated a topping-off technique in which interbody fusion is not performed in the uppermost motion segment, thus creating a smooth transition from stabilized to free motion segments. SRI using the topping-off technique also reduces the motion of the adjacent segments, which may reduce the risk of adjacent segment disease (ASD), a frequently observed sequela of instrumentation and fusion, but this technique may also increase the possibility of screw loosening (SL). In the present study the authors aimed to systematically evaluate reoperation rates, clinical outcomes, and potential risk factors and incidences of ASD and SL for this novel approach.METHODSThe authors collected data for the first 322 patients enrolled at their institution from 2009 to 2015 who underwent surgery performed using the topping-off technique. Reoperation rates, patient satisfaction, and other outcome measures were evaluated. All patients underwent pedicle screw–based semi-rigid stabilization of the lumbar spine with a polyetheretherketone (PEEK) rod system.RESULTSImplantation of PEEK rods during revision surgery was performed in 59.9% of patients. A median of 3 motion segments (range 1–5 segments) were included and a median of 2 motion segments (range 0–4 segments) were fused. A total of 89.4% of patients underwent fusion, 73.3% by transforaminal lumbar interbody fusion (TLIF), 18.4% by anterior lumbar interbody fusion (ALIF), 3.1% by extreme lateral interbody fusion (XLIF), 0.3% by oblique lumbar interbody fusion (OLIF), and 4.9% by combined approaches in the same surgery. Combined radicular and lumbar pain according to a visual analog scale was reduced from 7.9 ± 1.0 to 4.0 ± 3.1, with 56.2% of patients indicating benefit from surgery. After maximum follow-up (4.3 ± 1.8 years), the reoperation rate was 16.4%.CONCLUSIONSThe PEEK rod concept including the topping-off principle seems safe, with at least average patient satisfaction in this patient group. Considering the low rate of first-tier surgeries, the presented results seem at least comparable to those of most other series. Follow-up studies are needed to determine long-term outcomes, particularly with respect to ASD, which might be reduced by the presented approach.

Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up

2021 ◽  
Vol 34 (1) ◽  
pp. 83-88
Author(s):  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Minghao Wang ◽  
Andrew K. Chan ◽  
Bo Li ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Inclusion Criteria ◽  
Single Level ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Surgery Rates

OBJECTIVEIn this study, the authors’ aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.METHODSPatients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters.RESULTSA total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24–135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49–0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05).CONCLUSIONSIn patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.

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