scholarly journals Roles of multimodal intra-operative neurophysiological monitoring (IONM) in percutaneous endoscopic transforaminal lumbar interbody fusion: a case series of 113 patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yu Chen ◽  
Chunmei Luo ◽  
Juan Wang ◽  
Libangxi Liu ◽  
Bo Huang ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Root Function ◽  
False Negative ◽  
Case Series ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Neurological Complications ◽  
Neurological Deficits ◽  
Neurophysiological Monitoring ◽  
Lumbar Interbody Fusion ◽  
Negative Findings

Abstract Background Despite the wide use of intraoperative neurophysiological monitoring (IONM) in spinal surgeries, the efficacy of IONM during percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) surgery in detecting postoperative neurological deficits has not been well characterized. Methods MIONM data from 113 consecutive patients who underwent PE-TLIF surgeries between June 2018 and April 2020 were retrospectively reviewed. Postoperative neurological deficits were documented and analyzed, and the efficacy and specificity of various IONM techniques were compared. Results Of the 113 consecutive patients, 12 (10.6%) with IONM alerts were identified. The MIONM sensitivity and specificity were 100 and 96.2%, respectively. The frequency of neurological complications, including minor deficits, was 6.2% (n = 7); all of the neurological complications were temporary. The ability of single IONM modalities to detect neurological complications varied between 25.0 and 66.6%, whereas that of all modalities was 100%. Conclusions MIONM is more effective and accurate than unimodal monitoring in assessing nerve root function during PE-TLIF surgeries, reducing both neurological complications and false-negative findings. We recommend MIONM in PE-TLIF surgeries.

scholarly journals The Efficacy of Intraoperative Neurophysiological Monitoring to Detect Postoperative Neurological Deficits in Transforaminal Lumbar Interbody Fusion Surgery

2018 ◽  
Vol 16 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Joung Heon Kim ◽  
Svetlana Lenina ◽  
Grace Mosley ◽  
Joshua Meaike ◽  
Benjamin Tran ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Sensitivity And Specificity ◽  
Interbody Fusion ◽  
High Sensitivity ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Neurological Deficits ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Motor Deficits ◽  
Lumbar Interbody Fusion

Abstract BACKGROUND Despite the extensive use of intraoperative neurophysiological monitoring (IONM) in spinal procedures, there is no standard guideline for what types of IONM tests should be monitored during lumbar procedures with instrumentation. Moreover, the efficacy of IONM during transforaminal lumbar interbody fusion (TLIF) surgery in detecting postoperative neurological deficits has not been well described. OBJECTIVE To analyze waveform changes from individual IONM tests (somatosensory evoked potentials [SSEP], motor evoked potentials [MEP], and electromyography [EMG]) during TLIF and compare the sensitivity and specificity of these tests in order to determine the best combination to detect postoperative neurological deficits. METHODS Two hundred seventy-five consecutive TLIF cases with IONM between 2010 and 2014 were reviewed, and new postoperative sensory and motor deficits were documented. Sensitivity and specificity for each IONM test in detecting postoperative sensory and/or motor deficits were analyzed. RESULTS SSEP and EMG tests were performed on all 275 patients with 66 patients undergoing additional MEP tests. A total of 7 postoperative deficits have been reported: 2 sensory and 5 motor deficits. MEP test had high sensitivity (80.0%) and specificity (100%) in detecting motor deficits. However, SSEP changes failed to detect sensory deficits and EMG test had high false-positive rates for detecting both sensory (100%) and motor deficits (97.3%). CONCLUSION MEP test should be incorporated in monitoring protocols during spinal procedures that involve instrumentations below vertebral level L1 such as TLIF, as it provides high sensitivity and specificity in detecting postoperative motor deficits. In addition, we propose modifying the standard lower extremity SSEP monitoring protocol to correspond to the vertebral levels being operated on.

scholarly journals Computerized tomography evaluation of a resorbable implant after transforaminal lumbar interbody fusion

2004 ◽  
Vol 16 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Timothy R. Kuklo ◽  
Michael K. Rosner ◽  
David W. Polly
Keyword(s):  
Computerized Tomography ◽  
Interbody Fusion ◽  
Case Series ◽  
Ct Scanning ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Delayed Union ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Screw Breakage

Object Synthetic bioabsorbable implants have recently been introduced in spinal surgery; consequently, the indications, applications, and results are still evolving. The authors used absorbable interbody spacers (Medtronic Sofamor Danek, Memphis, TN) packed with recombinant bone morphogenetic protein (Infuse; Medtronic Sofamor Danek) for single- and multiple-level transforaminal lumbar interbody fusion (TLIF) procedures over a period of 18 months. This is a consecutive case series in which postoperative computerized tomography (CT) scanning was used to assess fusion status. Methods There were 22 patients (17 men, five women; 39 fusion levels) whose mean age was 41.6 years (range 23–70 years) and in whom the mean follow-up duration was 12.4 months (range 6–18 months). Bridging bone was noted as early as the 3-month postoperative CT scan when obtained; solid arthrodesis was routinely noted between 6 and 12 months in 38 (97.4%) of 39 fusion levels. In patients who underwent repeated CT scanning, the fusion mass appeared to increase with time, whereas the disc space height remained stable. Although the results are early (mean 12-month follow-up duration), there was only one noted asymptomatic delayed union/nonunion at L5–S1 in a two-level TLIF with associated screw breakage. There were no infections or complications related to the cages. Conclusions The bioabsorbable cages appear to be a viable alternative to metal interbody spacers, and may be ideally suited to spinal interbody applications because of their progressive load-bearing properties.

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 Mimickers in Spine: Migrated Cages Causing Radiculopathy

2019 ◽  
Vol 2 (1-3) ◽  
pp. 21-27
Author(s):  
Saurav Narayan Nanda ◽  
Mantu Jain ◽  
Sudarsan Behera ◽  
Manisha Gaikwad
Keyword(s):  
Bone Grafting ◽  
Interbody Fusion ◽  
Promising Result ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Neurological Complications ◽  
Lumbar Interbody Fusion ◽  
Fusion Cage ◽  
Cage Migration ◽  
Spine Disorders

The procedure of interbody fusion has become an established treatment for many spine disorders. This arthrodesis can be achieved by hardware (fusion cage) through many approaches. Initially, posterior lumbar interbody fusion was popularized but had some serious neurological complications related to insertion as well as the migration of the cage. Gradually, transforaminal lumbar interbody fusion (TLIF) was introduced, which proved safer as it involves minimal cord handling, and also migration, if any, remains asymptomatic. We had two patients who were operated for interbody fusion using TLIF technique with subsequent posterior migration of the banana-shaped fusion cage 4–6 month after the index surgery. Both patients presented with radiculopathy mimicking a prolapsed intervertebral disc. These were evaluated and operated with the removal of the migrated cages and revision with bigger-size cages with adequate bone grafting. At the 1-year follow-up, both had remission of symptoms, and radiographs showed no subsequent migration. TLIF procedure is an established procedure to achieve arthrodesis in varying spine disorders with promising result. However, there are only a few reports describing cage migration after the procedure and these have been asymptomatic. Revision surgery is contemplated in the setting of neurological compression or instability. A bigger fusion cage in a compressive mode with adequate bone grafting is used to achieve arthrodesis. The principles of interbody fusion must be followed, and utmost precautions must be taken to prevent this unfortunate complication.

Transfacet Minimally Invasive Transforaminal Lumbar Interbody Fusion With an Expandable Interbody Device—Part II: Consecutive Case Series

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S151-S151
Author(s):  
Jawad M Khalifeh ◽  
Christopher F Dibble ◽  
Priscilla Stecher ◽  
Ian Dorward ◽  
Ammar H Hawasli ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Case Series ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Consecutive Case

scholarly journals Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature

2015 ◽  
Vol 39 (4) ◽  
pp. E4 ◽  
Author(s):  
Jacob R. Joseph ◽  
Brandon W. Smith ◽  
Frank La Marca ◽  
Paul Park
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Neurological Deficit ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Neurological Deficits ◽  
Wound Complications ◽  
Medical Complications ◽  
Lumbar Interbody Fusion ◽  
Sensory Deficits

OBJECT Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and lateral lumbar interbody fusion (LLIF) are 2 currently popular techniques for lumbar arthrodesis. The authors compare the total risk of each procedure, along with other important complication outcomes. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies (up to May 2015) that reported complications of either MI-TLIF or LLIF were identified from a search in the PubMed database. The primary outcome was overall risk of complication per patient. Secondary outcomes included risks of sensory deficits, temporary neurological deficit, permanent neurological deficit, intraoperative complications, medical complications, wound complications, hardware failure, subsidence, and reoperation. RESULTS Fifty-four studies were included for analysis of MI-TLIF, and 42 studies were included for analysis of LLIF. Overall, there were 9714 patients (5454 in the MI-TLIF group and 4260 in the LLIF group) with 13,230 levels fused (6040 in the MI-TLIF group and 7190 in the LLIF group). A total of 1045 complications in the MI-TLIF group and 1339 complications in the LLIF group were reported. The total complication rate per patient was 19.2% in the MI-TLIF group and 31.4% in the LLIF group (p < 0.0001). The rate of sensory deficits and temporary neurological deficits, and permanent neurological deficits was 20.16%, 2.22%, and 1.01% for MI-TLIF versus 27.08%, 9.40%, and 2.46% for LLIF, respectively (p < 0.0001, p < 0.0001, p = 0.002, respectively). Rates of intraoperative and wound complications were 3.57% and 1.63% for MI-TLIF compared with 1.93% and 0.80% for LLIF, respectively (p = 0.0003 and p = 0.034, respectively). No significant differences were noted for medical complications or reoperation. CONCLUSIONS While there was a higher overall complication rate with LLIF, MI-TLIF and LLIF both have acceptable complication profiles. LLIF had higher rates of sensory as well as temporary and permanent neurological symptoms, although rates of intraoperative and wound complications were less than MI-TLIF. Larger, prospective comparative studies are needed to confirm these findings as the current literature is of relative poor quality.

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.

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