scholarly journals Is Routine Use of Drain Really Necessary for Posterior Lumbar Interbody Fusion Surgery? A Retrospective Case Series with a Historical Control Group

2021 ◽  
pp. 219256822110018
Author(s):  
Hae-Dong Jang ◽  
Seong San Park ◽  
Kyungbum Kim ◽  
Eung-Ha Kim ◽  
Jae Chul Lee ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Case Series ◽  
Posterior Lumbar Interbody Fusion ◽  
Neurological Deficits ◽  
Control Group ◽  
Lumbar Interbody Fusion ◽  
Retrospective Case ◽  
Hematoma Evacuation ◽  
Additional Surgery ◽  
Drain Group

Study Design: A retrospective case-control study. Objectives: The usefulness of a drain in spinal surgery has always been controversial. The purposes of this study were to determine the incidence of hematoma-related complications after posterior lumbar interbody fusion (PLIF) without a drain and to evaluate its usefulness. Methods: We included 347 consecutive patients with degenerative lumbar disease who underwent single- or double-level PLIF. The participants were divided into 2 groups by the use of a drain or not; drain group and no-drain group. Results: In 165 cases of PLIF without drain, there was neither a newly developed neurological deficit due to hematoma nor reoperation for hematoma evacuation. In the no-drain group, there were 5 (3.0%) patients who suffered from surgical site infection (SSI), all superficial, and 17 (10.3%) patients who complained of postoperative transient recurred leg pain, all treated conservatively. Days from surgery to ambulation and length of hospital stay (LOS) of the no-drain group were faster than those of the drain group ( P < 0.001). In a multiple regression analysis, a drain insertion was found to have a significant effect on the delayed ambulation and increased LOS. No significant differences existed between the 2 groups in additional surgery for hematoma evacuation, or SSI. Conclusions: No hematoma-related neurological deficits or reoperations caused by epidural hematoma and SSI were observed in the no-drain group. The no-drain group did not show significantly more frequent postoperative complications than the drain use group, hence the routine insertion of a drain following PLIF should be reconsidered carefully.

scholarly journals Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion

2017 ◽  
Vol 26 (4) ◽  
pp. 435-440 ◽  
Author(s):  
Tomiya Matsumoto ◽  
Shinya Okuda ◽  
Takafumi Maeno ◽  
Tomoya Yamashita ◽  
Ryoji Yamasaki ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Control Group ◽  
Sagittal Imbalance ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
Radiographic Parameters ◽  
Whole Spine ◽  
The Relationship

OBJECTIVE The importance of spinopelvic balance and its implications for clinical outcomes after spinal arthrodesis has been reported in recent studies. However, little is known about the relationship between adjacent-segment disease (ASD) after lumbar arthrodesis and spinopelvic alignment. The purpose of this study was to clarify the relationship between spinopelvic radiographic parameters and symptomatic ASD after L4–5 single-level posterior lumbar interbody fusion (PLIF). METHODS This was a retrospective 1:5 matched case-control study. Twenty patients who had undergone revision surgery for symptomatic ASD after L4–5 PLIF and had standing radiographs of the whole spine before primary and revision surgeries were enrolled from 2005 to 2012. As a control group, 100 age-, sex-, and pathology-matched patients who had undergone L4–5 PLIF during the same period, had no signs of symptomatic ASD for more than 3 years, and had whole-spine radiographs at preoperation and last follow-up were selected. Mean age at the time of primary surgery was 68.9 years in the ASD group and 66.7 years in the control group. Several radiographic spinopelvic parameters were measured as follows: sagittal vertical axis (SVA), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), and segmental lordosis at L4–5 (SL) in the sagittal view, and C7–central sacral vertical line (C7-CSVL) in the coronal view. Radiological parameters were compared between the groups. RESULTS No significant change was found between pre- and postoperative radiographic parameters in each group. In terms of preoperative radiographic parameters, the ASD group had significantly lower LL (40.7° vs 47.2°, p < 0.01) and significantly higher PT (27° vs 22.9°, p < 0.05) than the control group. SVA ≥ 50 mm was observed in 10 of 20 patients (50%) in the ASD group and in 21 of 100 patients (21%, p < 0.01) in the control group. PI-LL ≥ 10° was noted in 15 of 20 patients (75%) in the ASD group and in 40 of 100 patients (40%, p < 0.01) in the control group on preoperative radiographs. Postoperatively, the ASD group had significantly lower TK (22.5° vs 30.9°, p < 0.01) and lower LL (39.3° vs 48.1°, p < 0.05) than the control group had. PI-LL ≥ 10° was seen in 15 of 20 patients (75%) in the ASD group and in 43 of 100 patients (43%, p < 0.01) in the control group. CONCLUSIONS Preoperative global sagittal imbalance (SVA > 50 mm and higher PT), pre- and postoperative lower LL, and PI-LL mismatch were significantly associated with ASD. Therefore, even with a single-level PLIF, appropriate SL and LL should be obtained at surgery to improve spinopelvic sagittal imbalance. The results also suggest that the achievement of the appropriate LL and PI-LL prevents ASD after L4–5 PLIF.

Anterior Lumbar Interbody Fusion With Cage Retrieval for the Treatment of Pseudarthrosis After Transforaminal Lumbar Interbody Fusion: A Single-Institution Case Series

2020 ◽  
Author(s):  
Michael M Safaee ◽  
Alexander Tenorio ◽  
Alexander F Haddad ◽  
Bian Wu ◽  
Serena S Hu ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Medical Center ◽  
Perioperative Complications ◽  
Academic Medical Center ◽  
Case Series ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Additional Surgery ◽  
Tract Infections

Abstract BACKGROUND The treatment of pseudarthrosis after transforaminal lumbar interbody fusion (TLIF) can be challenging, particularly when anterior column reconstruction is required. There are limited data on TLIF cage removal through an anterior approach. OBJECTIVE To assess the safety and efficacy of anterior lumbar interbody fusion (ALIF) as a treatment for pseudarthrosis after TLIF. METHODS ALIFs performed at a single academic medical center were reviewed to identify cases performed for the treatment of pseudarthrosis after TLIF. Patient demographics, surgical characteristics, perioperative complications, and 1-yr radiographic data were collected. RESULTS A total of 84 patients were identified with mean age of 59 yr and 37 women (44.0%). A total of 16 patients (19.0%) underwent removal of 2 interbody cages for a total of 99 implants removed with distribution as follows: 1 L2/3 (0.9%), 6 L3/4 (5.7%), 37 L4/5 (41.5%), and 55 L5/S1 (51.9%). There were 2 intraoperative venous injuries (2.4%) and postoperative complications were as follows: 7 ileus (8.3%), 5 wound-related (6.0%), 1 rectus hematoma (1.1%), and 12 medical complications (14.3%), including 6 pulmonary (7.1%), 3 cardiac (3.6%), and 6 urinary tract infections (7.1%). Among 58 patients with at least 1-yr follow-up, 56 (96.6%) had solid fusion. There were 5 cases of subsidence (6.0%), none of which required surgical revision. Two patients (2.4%) required additional surgery at the level of ALIF for pseudarthrosis. CONCLUSION ALIF is a safe and effective technique for the treatment of TLIF cage pseudarthrosis with a favorable risk profile.

scholarly journals High-dose tranexamic acid reduces intraoperative and postoperative blood loss in posterior lumbar interbody fusion

2017 ◽  
Vol 26 (3) ◽  
pp. 363-367 ◽  
Author(s):  
Junichi Kushioka ◽  
Tomoya Yamashita ◽  
Shinya Okuda ◽  
Takafumi Maeno ◽  
Tomiya Matsumoto ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Interbody Fusion ◽  
Surgical Techniques ◽  
Posterior Lumbar Interbody Fusion ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
High Dose ◽  
Lumbar Interbody Fusion ◽  
Single Level

OBJECTIVE Tranexamic acid (TXA), a synthetic antifibrinolytic drug, has been reported to reduce blood loss in orthopedic surgery, but there have been few reports of its use in spine surgery. Previous studies included limitations in terms of different TXA dose regimens, different levels and numbers of fused segments, and different surgical techniques. Therefore, the authors decided to strictly limit TXA dose regimens, surgical techniques, and fused segments in this study. There have been no reports of using TXA for prevention of intraoperative and postoperative blood loss in posterior lumbar interbody fusion (PLIF). The purpose of the study was to evaluate the efficacy of high-dose TXA in reducing blood loss and its safety during single-level PLIF. METHODS The study was a nonrandomized, case-controlled trial. Sixty consecutive patients underwent single-level PLIF at a single institution. The first 30 patients did not receive TXA. The next 30 patients received 2000 mg of intravenous TXA 15 minutes before the skin incision was performed and received the same dose again 16 hours after the surgery. Intra- and postoperative blood loss was compared between the groups. RESULTS There were no statistically significant differences in preoperative parameters of age, sex, body mass index, preoperative diagnosis, or operating time. The TXA group experienced significantly less intraoperative blood loss (mean 253 ml) compared with the control group (mean 415 ml; p < 0.01). The TXA group also had significantly less postoperative blood loss over 40 hours (mean 321 ml) compared with the control group (mean 668 ml; p < 0.01). Total blood loss in the TXA group (mean 574 ml) was significantly lower than in the control group (mean 1080 ml; p < 0.01). From 2 hours to 40 hours, postoperative blood loss in the TXA group was consistently significantly lower. There were no perioperative complications, including thromboembolic events. CONCLUSIONS High-dose TXA significantly reduced both intra- and postoperative blood loss without causing any complications during or after single-level PLIF.

scholarly journals Compression Therapy Following Posterior Lumbar Interbody Fusion: A Prospective, Randomized, Clinical Study

2019 ◽  
Author(s):  
Wu Sun ◽  
Jing-hua Gao ◽  
ZHU Li-guo ◽  
Wei Xiao ◽  
Zhen-zhong Wang ◽  
...  
Keyword(s):  
Treatment Group ◽  
Blood Cell ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Compression Therapy ◽  
Controlled Study ◽  
Control Group ◽  
Lumbar Interbody Fusion ◽  
Drainage Volume ◽  
Rbc Count

Abstract Background: Wound-related complications are an inevitable issue faced by spinal surgeons. Negative pressure drainage remains the most commonly used method to prevent postoperative hematoma and related complications. This prospective, randomized, controlled study was conducted to evaluate the efficacy of compression therapy following posterior lumbar interbody fusion, with emphasis on pain, anemia, and inflammation. Methods: Sixty consecutive patients who have undergone posterior lumbar interbody fusion in the age range 43–78 years, with an average age of 59 years, were selected and randomly assigned into two groups. Factors, such as drainage volume, visual analog scale (VAS) pain score for back pain, white blood cell (WBC) count , red blood cell (RBC) count, hemoglobin (Hb) levels, erythrocyte sedimentation rate(ESR), and C-reactive protein (CRP) levels assessed on the 1st, 3rd, and 10th days postoperatively, were compared between the two groups. Results: The average follow-up was 6 months, ranging from 3 to 11 months. Drainage volume, VAS score, and CRP levels on the 10th day after the surgery were found to be significantly lower in the treatment group than in the control group. RBC count and Hb levels on the 3rd and 10th postoperative days were observed to be significantly higher in the treatment group than in the control group ( P <0.05). During discharge, the wounds of the patients of the both groups had healed and neither showed any symptoms of infection, hematoma, or necrosis. Conclusion: Compression therapy relieves pain, alleviates anemia, and the inflammatory response following posterior lumbar interbody fusion.

scholarly journals Risk Factors for Posterior Cage Migration after Lumbar Interbody Fusion Surgery

2018 ◽  
Vol 12 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Dong-Yeong Lee ◽  
Young-Jin Park ◽  
Sang-Youn Song ◽  
Soon-Taek Jeong ◽  
Dong-Hee Kim
Keyword(s):  
Risk Factors ◽  
Interbody Fusion ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Posterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Related Factors ◽  
Low Bmi

<sec><title>Study Design</title><p>A retrospective clinical case series.</p></sec><sec><title>Purpose</title><p>To determine the strength of association between cage retropulsion and its related factors.</p></sec><sec><title>Overview of Literature</title><p>Lumbar interbody fusion with cage can obtain a firm union and can restore the disc height with normal sagittal and coronal alignment. Although lumbar interbody fusion procedures have satisfactory clinical outcomes, peri- and postoperative complications regarding the cage remain challenging.</p></sec><sec><title>Methods</title><p>From January 2006 to June 2016, 1,047 patients with lumbar degenerative disc disease who underwent posterior lumbar interbody fusion or transforaminal interbody fusion at Gyeongsang National University Hospital were enrolled. Medical records and pre- and postoperative radiographs were reviewed to identify significant cage retropulsion-related factors. The associations between cage retropulsion with various risk factors were evaluated by calculating odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression analysis.</p></sec><sec><title>Results</title><p>Of 1,229 disc levels, 16 cases (1.3%, 10 men and 6 women) had cage retropulsion. Univariate analysis revealed no significant differences between the cage retropulsion group and the no cage retropulsion group with regard to demographic data such as age, sex, weight, height, body mass index (BMI), smoking habits, presence of osteoporosis, and duration of follow-up. Multivariate analysis revealed that low BMI (OR, 0.875; 95% CI, 0.771–0.994; <italic>p</italic>=0.040), presence of screw loosening (OR, 27.400; 95% CI, 7.818–96.033; <italic>p</italic>&lt;0.001), and pear-shaped disc (OR, 9.158; 95% CI, 2.455–34.160; <italic>p</italic>=0.001) were significantly associated with cage retropulsion.</p></sec><sec><title>Conclusions</title><p>This study demonstrated that low BMI, loosening of posterior instrumentation, and pear-shaped disc were associated with cage retropulsion after lumbar interbody fusion. Therefore, when performing lumbar interbody fusion with a cage, surgeons should have skillful surgical techniques for firm fixation to prevent cage retropulsion, particularly in non-obese patients.</p></sec>

scholarly journals Complex Spinal Dorso-Ventral Stabilization in the Elderly – Is Age a Limiting Factor? Retrospective Case Series of 53 patients

2020 ◽  
pp. 1-9
Author(s):  
Christian Ewelt ◽  
Murat Yavuz ◽  
Nils Warneke ◽  
Michael Schwake ◽  
Juliane Schröteler ◽  
...  
Keyword(s):  
Case Series ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Control Group ◽  
Limiting Factor ◽  
Retrospective Case ◽  
Medical Progress ◽  
Duration Of Surgery

Objective: Medical progress is increasingly confronting us with the question of whether complex surgical spinal care can be performed safely, even in older patients. This study is intended to contribute to the clarification of this question. Methods: 53 patients with a minimum age of 70 years at time of surgery were retrospectively enrolled in a single center setting. All patients were treated with complex dorsoventral instrumentation and corpectomy due to different pathologies. Because of neurological deficits and untreatable pain, no control group of patients could be defined in advanced age by withholding necessary surgery. The ethical committee would not accept this. Results: Most patients benefited from the procedure with regard to pain (97%), sensori-motor deficit (89%), and finally, immobility (82%). The duration of surgery, the amount of transfused red blood cell concentrates, and the length of hospital stay were not predictors of a poor overall outcome. It was shown that the risk of postoperative complications increased due to the number of preoperative secondary diagnoses. Conclusion: Therefore, not the patients’ age alone is of prime importance for individual surgical treatment decisions, but the number of secondary diagnoses plays a more important role. Especially in that older population, patients benefit from surgical therapy; regardless, it could be complex.

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