scholarly journals Additional lateral plate fixation has no effect to prevent cage subsidence in oblique lumbar interbody fusion

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tenghui Ge ◽  
Jintao Ao ◽  
Guanqing Li ◽  
Zhao Lang ◽  
Yuqing Sun
Keyword(s):  
Interbody Fusion ◽  
Plate Fixation ◽  
Lumbar Interbody Fusion ◽  
Degenerative Diseases ◽  
Lateral Plate ◽  
Subsidence Rate ◽  
Cage Subsidence ◽  
Indirect Decompression ◽  
Oblique Lumbar Interbody Fusion ◽  
Lumbar Degenerative Diseases

Abstract Background For lumbar degenerative diseases, cage subsidence is a serious complication and can result in the failure of indirect decompression in the oblique lumbar interbody fusion (OLIF) procedure. Whether additional lateral plate fixation was effective to improve clinical outcomes and prevent cage subsidence was still unknown. This study aimed to compare the incidence and degree of cage subsidence between stand-alone oblique lumbar interbody fusion (SA-OLIF) and OLIF combined with lateral plate fixation (OLIF + LP) for the treatment of lumbar degenerative diseases and to evaluate the effect of the lateral plate fixation. Methods This was a retrospective comparative study. 20 patients with 21 levels underwent SA-OLIF and 21 patients with 26 levels underwent OLIF + LP. We compared clinical and radiographic outcomes between two groups. Clinical evaluation included Visual Analog Scale (VAS) for back pain and leg pain, Japanese Orthopaedic Association (JOA) scores and Oswestry Disability Index (ODI). Radiographical evaluation included disc height (DH), segmental lordosis angle (SL), and subsidence rate on standing lateral radiographs. Cage subsidence was classified using Marchi’s criteria. Results The mean follow-up duration was 6.3 ± 2.4 months. There were no significant differences among perioperative data (operation time, estimated intraoperative blood loss, and complication), clinical outcome (VAS, ODI, and JOA) and radiological outcome (SH and SL). The subsidence rate was 19.0% (4/21) in SA-OLIF group and 19.2% (5/26) in OLIF + LP group. 81.0% in SA-OLIF group and 80.8% in OLIF + LP group had Grade 0 subsidence, 14.3% in SA-OLIF group and 15.4% in OLIF + LP group had Grade I subsidence, and 4.8% in SA-OLIF group and 3.8% in OLIF + LP group had Grade II subsidence (P = 0.984). One patient with severe cage subsidence and lateral plate migration underwent revision surgery. Conclusions The additional lateral plate fixation does not appear to be more effective to prevent cage subsidence in the oblique lumbar interbody fusion, compared with stand-alone technique. If severe cage subsidence occurs, it may result in lateral plate migration in OLIF combined with lateral plate fixation.

scholarly journals Biomechanical Evaluation of Oblique Lateral Locking Plate System for Oblique Lumbar Interbody Fusion: A Finite Element Analysis

2021 ◽  
Author(s):  
Yinge Wang ◽  
Jiajia Wang ◽  
Sha Tu ◽  
Shuang Li ◽  
Jiangpu Yi ◽  
...  
Keyword(s):  
Finite Element ◽  
Interbody Fusion ◽  
Locking Plate ◽  
Lumbar Interbody Fusion ◽  
Lateral Plate ◽  
Flexion Extension ◽  
Cage Subsidence ◽  
Oblique Lumbar Interbody Fusion ◽  
Locking Plate System ◽  
Plate System

Abstract Objective: Oblique lateral locking plate system (OLLPS) with the locking and reverse pedicle track screw configuration is a novel internal fixation designed for oblique lumbar interbody fusion(OLIF). It is placed in a single-position through the oblique lateral surgical corridor to reduce operative time and subsequent complications of prolonged anesthesia and prone positioning. The purpose of this study was to verify the biomechanical effect of OLLPS.Methods: The intact finite element model of L1–S1（Intact） was established based on CT images of a healthy male volunteer. The L4-L5 intervertebral space was selected as the surgical segment. The surgical models were established separately according to the OLIF surgical procedures and the different internal fixations: (1) stand-alone OLIF (SA); (2) OLIF with 2-screw lateral plate (LP-2); (3) OLIF with 4-screw lateral plate (LP-4); (4) OLIF with OLLPS (OLLPS); and (5) OLIF with bilateral pedicle screw fixation (BPS). After validating the intact model, the physiological loading was applied to the superior surface of L1 to simulate flexion, extension, left bending, right bending, left rotation, and right rotation motions. The evaluation indexes included the L4/5 range of motion (ROM), the L4 maximum displacement, and the maximum stress of the superior and inferior endplate, cage, and supplemental fixation.Results: In OLIF surgery, OLLPS provided multiplanar stability which was similar to that of BPS. Compared with LP-2 and LP-4, OLLPS had the better biomechanical properties in enhancing the instant stability of the surgical segment, reducing the stress of the superior and inferior endplates of the surgical segment, and reducing the risk of cage subsidence.Conclsions: With the minimally invasive background, OLLPS can be an alternative to BPS in OLIF and has a better prospect of clinical promotion and application.

scholarly journals Oblique Lateral Interbody Fusion Combined With Lateral Plate Fixation for the Treatment of Lumbar Degenerative Diseases: a Preliminary Clinical Study

2021 ◽  
Author(s):  
Hai-dong Li ◽  
Shi-Tong Xing ◽  
Ji-Kang Min ◽  
Xiang-Qian Fang ◽  
Shun-Wu Fan
Keyword(s):  
Blood Loss ◽  
Interbody Fusion ◽  
Plate Fixation ◽  
Operation Time ◽  
Degenerative Diseases ◽  
Lateral Plate ◽  
Lateral Interbody Fusion ◽  
Lumbar Degenerative Diseases ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Abstract Background The oblique lateral interbody fusion (OLIF) is a minimally invasive indirect decompression technique for the treatment of lumar spine disease. The OLIF has usually combined with supplemental posterior pedicle screw fixation for decreasing the perioperative complications. The purpose of this study was to evaluate clinical efficacy and complications of oblique lateral interbody fusion (OLIF) combined with lateral plate instrumentation for the treatment of lumbar degenerative diseases.Methods From May 2020 to August 2020, the clinical data of 20 patients who underwent OLIF combined with lateral plate instrumentation were retrospectively analyzed. The operation time, blood loss, and the complications were recorded. Also, the radiological parameters, Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI) were evaluated before and after surgery.Results The average operation time, blood loss, and length of hospital stay were 75.41±11.53 min, 39.57±9.22 ml, and 7.22±1.85 days, respectively. The VAS and ODI had both significantly improved after surgery (7.23±1.26 VS 2.15±0.87; 60.27±7.91 VS 21.80±6.32, P < 0.001). The postoperative disk height (DH) was 13.02±8.83 mm, which is much higher than before (P < 0.001); The postoperative foraminal height (FH) improved significantly (16.18±3.49 VS 21.54±2.12 mm, P < 0.01), and the cross-sectional area (CSA) had improved from 88.95±14.79 mm2 to 126.53±8.83 mm2 (P < 0.001). The radiological fusion rate was 95% at the last follow-up, while cage subsidence was found in one case. No major complications, such as ureteral injury, vascular injury and vertebral body fracture occurred.Conclusions OLIF combined with lateral plate fixation can avoid the lumbar posterior surgery, minimize the operation time, blood loss and the posterior ligament complex disruption. It can realize one-stage intervertebral fusion and instrumentation through a single small incision.

scholarly journals The radiological outcome in lumbar interbody fusion among rheumatoid arthritis patients: a 20-year retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kuan-Kai Tung ◽  
Yun-Che Wu ◽  
Kun-Hui Chen ◽  
Chien-Chou Pan ◽  
Wen-Xian Lu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interbody Fusion ◽  
Fusion Rate ◽  
Substantial Improvement ◽  
Lumbar Interbody Fusion ◽  
Subsidence Rate ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Cage Subsidence

Abstract Background Clinical outcomes amongst Rheumatoid Arthritis (RA) patients have shown satisfactory results being reported after lumbar surgery. The increased adoption of the interbody fusion technique has been due to a high fusion rate and less invasive procedures. However, the radiographic outcome for RA patients after receiving interbody fusion has scarcely been addressed in the available literature. Methods Patients receiving interbody fusion including ALIF, OLIF, and TLIF were examined for implant cage motion and fusion status at two-year follow-up. Parameters for the index correction level including ADH, PDH, WI, SL, FW, and FH were measured and compared at pre-OP, post-OP, and two-year follow-up. Results We enrolled 64 RA patients at 104 levels (mean 64.0 years old, 85.9% female) received lumbar interbody fusion. There were substantial improvement in ADH, PDH, WI, SL, FW, and FH after surgery, with both ADH and PDH having significantly dropped at two-year follow up. The OLIF group suffered from a higher subsidence rate with no significant difference in fusion rate when compared to TLIF. The fusion rate and subsidence rate for all RA patients was 90.4 and 28.8%, respectively. Conclusions We revealed the radiographic outcomes of lumbar interbody fusions towards symptomatic lumbar disease in RA patients with good fusion outcome despite the relative high subsidence rate amongst the OLIF group. Those responsible for intra-operative endplate management should be more cautious to avoid post-OP cage subsidence.

scholarly journals The feasibility for a novel minimally invasive surgery–percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of lumbar degenerative diseases: a cadaveric experiment

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Peng Yin ◽  
Yaoshen Zhang ◽  
Aixing Pan ◽  
Yi Ding ◽  
Liming Zhang ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Nerve Root ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Degenerative Diseases ◽  
Articular Process ◽  
Lumbar Degenerative Diseases

Abstract Background The objective of the study was to evaluate our innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of lumbar degenerative diseases. Methods Two fresh-frozen human cadavers with soft tissues were donated for the experiment. Both cadavers had no history of previous spine surgery. The PE-TLIF surgery was performed on 3 levels (L4-5 of the first one, and L3-4, L4-5 of the second one) in October 2015. The PE-TLIF technique mainly included the following aspects: primary guide pins and a specially designed superior articular process (SAP) guide insertion, working channel setup, endoscopic decompression and fusion, and pedicle screw implantation and fixation. Under the surveillance of C-arm fluoroscope, four primary guide pins were inserted. The inferior primary guide in the hypothetically symptomatic side was confirmed as the first guide pin. At the end of the first guide pin, the specially designed SAP guide was installed. The secondary guide pin was inserted in the SAP via self-designed SAP guide. Under the protection cannula, part of the superior articular process was removed by oriented SAP resection device, so the working channel was smoothly put through the Kambin’s triangle. The endoscope was inserted close to the exiting nerve root. Rotation of the working channel kept the nerve root out of it. Results Three levels of PE-TLIF were successfully performed in two cadavers. Self-designed SAP guide made the secondary guide pin inserting the SAP accurately. Decompression was adequate and the traversing nerve root was relieved. Three aimed intervertebral levels are implanted with two 7-mm-high PEEK cages and one expandable cage. The expandable cage could be adjusted from 8 mm to 13 mm. Surgical incisions included four 15 mm incisions for percutaneous screw fixation and one 12 mm incision for working channel. There was no nerve injury during the operations. Conclusions Our present results showed that the novel minimally invasive surgery PE-TLIF was feasible for the treatment of lumbar degenerative diseases.

scholarly journals Biomechanical Evaluation of Anterolateral Screw Fixation for Oblique Lumbar Interbody Fusion Surgery – A Finite Element Analysis

2020 ◽  
Author(s):  
gufang Fang ◽  
SG Chen ◽  
wda zhuang ◽  
WH Huang ◽  
Hongxun Sang
Keyword(s):  
Finite Element ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Upper Body ◽  
Lumbar Interbody Fusion ◽  
Element Analysis ◽  
Flexion Extension ◽  
Cage Subsidence ◽  
Oblique Lumbar Interbody Fusion ◽  
Maximum Stresses

Abstract Background: The most common complication of oblique lumbar interbody fusion (OLIF) is cage subsidence. OLIF combined with internal fixation could help decrease the cage subsidence and increase the fusion rate. The aim of this study was to evaluate the biomechanical feasibility and safety in the patients undergoing OLIF surgery with anterolateral screw fixation (ASF). Methods: Based on our previous validated model , L4-L5 functional surgical models corresponding to the ASF and Bilateral pedicle screw fixation(BPSF) methods were created. A 500 N compression force was applied to the superior surface of the model to represent the upper body weight, and a 7.5 Nm moment was applied to simulate the six movement directions of the lumbar spinal model: flexion/extension, right/left lateral bending and right/left axial rotation. Finite element (FE) models were developed to compare the biomechanics of the ASF and BPSF groups. Results: Compared to the range of motion (ROM) of the intact lumbar model, that of the ASF model was decreased by 82.0% in flexion, 60.0% in extension, and the BPSF model was decreased by 86.7% in flexion, 77.3% in extension. Compared to the BPSF model, the maximum stresses of the L4 inferior endplate (IEP) and L5 superior endplate (SEP) were greatly increased in the ASF model; The contact surface between vertebrae and screw (CSVS) in the ASF model produced nearly100% more stresses than the BPSF model in all moment .Conclusions: OLIF surgery with ASF could not reduce the maximum stresses on the endplate and CSVS, which may be a potential risk factor for cage subsidence and screw loosening.

scholarly journals Oblique Lateral Interbody Fusion Combined with Lateral Plate VS. Combined with Posterior Pedicle Screw Fixation in Lumbar Degenerative Diseases

2021 ◽  
Author(s):  
Hai-dong Li ◽  
Li Zhong ◽  
Xiang-Qian Fang ◽  
Lei-Sheng Jiang
Keyword(s):  
Blood Loss ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Fusion Rate ◽  
Degenerative Diseases ◽  
Lateral Plate ◽  
Lateral Interbody Fusion ◽  
Lumbar Degenerative Diseases ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Abstract Background The oblique lateral interbody fusion (OLIF) is a minimally invasive indirect decompression technique for the treatment of degenerative spinal disease. OLIF with posterior pedicle screws fixation frequently is performed, whereas it requires much more surgery time and blood loss. The purpose of this study was to compare the oblique lateral interbody fusion (OLIF) combined with lateral plate (LP) vs. OLIF combined with posterior pedicle screw (PS) fixation for the treatment of lumbar degenerative diseases.Methods The clinical data of 53 patients with lumbar degenerative diseases who underwent OLIF from January 2020 to September 2020 were retrospectively analyzed，24 in OLIF combined with lateral plate (OLIF+LP) group and 29 in OLIF combined with pedicle screw (OLIF+PS) group. All patients completed a minimum 1-year follow-up. The duration of operation, blood loss, fusion rate and complications were recorded. The visual analog scale (VAS) score, Oswestry Disability Index (ODI), disc height (DH), foraminal height (FH) and cross-sectional area (CSA) were also evaluated.Results The operation time was 75.41±11.53 min in the OLIF+LP group, which shorter than that in OLIF+PS group(127.05±5.62min, P<0.01). Also, the blood loss was significantly less in the OLIF+LP group (39.55±5.32 ml ) than in the OLIF+PS group (89.81±9.62, P<0.01). The VAS and ODI scores both significantly reduced after operation in OLIF+LP group. There was no difference either in VAS or ODI scores by 1 year after surgery between two groups (P>0.01). The DH, FH, and CSA parameters were all improved significantly after operation in both groups, however, there was no significant difference at the any follow-up point between the two groups. The total complication rate was 13.21% (7/53) in this study, and there was no siginificant difference between the two groups. The fusion rate was 91.67% in the OLIF+LP group and 93.10% in the OLIF+PS group (P =0.69).Conclusions OLIF+LP fixation seems to be a valuable surgical option for single-segmental lumbar degenerative disease, it can achieve much better clinical outcomes than OLIF+PS group.

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