Predicting spondylolisthesis correction with prone traction radiographs

2020 ◽  
Vol 102-B (8) ◽  
pp. 1062-1071 ◽  
Author(s):  
Jason P. Y. Cheung ◽  
Ho Ken Fong ◽  
Prudence W. H. Cheung
Keyword(s):  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Information Criterion ◽  
Disc Height ◽  
Posterolateral Fusion ◽  
Slip Angle ◽  
Level Of Evidence ◽  
Flexion Extension ◽  
Segmental Lordosis ◽  
Slip Distance

Aims To determine the effectiveness of prone traction radiographs in predicting postoperative slip distance, slip angle, changes in disc height, and lordosis after surgery for degenerative spondylolisthesis of the lumbar spine. Methods A total of 63 consecutive patients with a degenerative spondylolisthesis and preoperative prone traction radiographs obtained since 2010 were studied. Slip distance, slip angle, disc height, segmental lordosis, and global lordosis (L1 to S1) were measured on preoperative lateral standing radiographs, flexion-extension lateral radiographs, prone traction lateral radiographs, and postoperative lateral standing radiographs. Patients were divided into two groups: posterolateral fusion or posterolateral fusion with interbody fusion. Results The mean changes in segmental lordosis and global lordosis were 7.1° (SD 6.7°) and 2.9° (SD 9.9°) respectively for the interbody fusion group, and 0.8° (SD 5.1°) and -0.4° (SD 10.1°) respectively for the posterolateral fusion-only group. Segmental lordosis (ρ = 0.794, p < 0.001) corrected by interbody fusion correlated best with prone traction radiographs. Global lumbar lordosis (ρ = 0.788, p < 0.001) correlated best with the interbody fusion group and preoperative lateral standing radiographs. The least difference in slip distance (-0.3 mm (SD 1.7 mm), p < 0.001), slip angle (0.9° (SD 5.2°), p < 0.001), and disc height (0.02 mm (SD 2.4 mm), p < 0.001) was seen between prone traction and postoperative radiographs. Regression analyses suggested that prone traction parameters best predicted correction of slip distance (Corrected Akaike’s Information Criterion (AICc) = 37.336) and disc height (AICc = 58.096), while correction of slip angle (AICc = 26.453) was best predicted by extension radiographs. Receiver operating characteristic (ROC) cut-off showed, with 68.3% sensitivity and 64.5% specificity, that to achieve a 3.0° increase in segmental lordotic angle, patients with a prone traction disc height of 8.5 mm needed an interbody fusion. Conclusion Prone traction radiographs best predict the slip distance and disc height correction achieved by interbody fusion for lumbar degenerative spondylolisthesis. To achieve this maximum correction, interbody fusion should be undertaken if a disc height of more than 8.5 mm is attained on preoperative prone traction radiographs. Level of Evidence: Level II Prognostic Study Cite this article: Bone Joint J 2020;102-B(8):1062–1071.

scholarly journals Posterior fixation can further improve the segmental alignment of lumbar degenerative spondylolisthesis with oblique lumbar interbody fusion

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jingye Wu ◽  
Tenghui Ge ◽  
Ning Zhang ◽  
Jianing Li ◽  
Wei Tian ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Reduction Ratio ◽  
Posterior Fixation ◽  
Lumbar Interbody Fusion ◽  
Slip Ratio ◽  
Radiographic Parameters ◽  
Oblique Lumbar Interbody Fusion ◽  
Lumbar Degenerative Spondylolisthesis ◽  
Segmental Lordosis

Abstract Background For patients with degenerative spondylolisthesis, whether additional posterior fixation can further improve segmental alignment is unknown, compared with stand-alone cage insertion in oblique lumbar interbody fusion (OLIF) procedure. The aim of this study was to compare changes of the radiographical segmental alignment following stand-alone cage insertion and additional posterior fixation in the same procedure setting of OLIF for patients with degenerative spondylolisthesis. Methods A retrospective observational study. Selected consecutive patients with degenerative spondylolisthesis underwent OLIF procedure from July 2017 to August 2019. Five radiographic parameters of disc height (DH), DH-Anterior, DH-Posterior, slip ratio and segmental lordosis (SL) were measured on preoperative CT scans and intraoperative fluoroscopic images. Comparisons of those radiographic parameters prior to cage insertion, following cage insertion and following posterior fixation were performed. Results A total of thirty-three patients including six males and twenty-seven females, with an average age of 66.9 ± 8.7 years, were reviewed. Totally thirty-six slipped levels were assessed with thirty levels at L4/5, four at L3/4 and two at L2/3. Intraoperatively, with only anterior cage support, DH was increased from 8.2 ± 1.6 mm to 11.8 ± 1.7 mm (p < 0.001), DH-Anterior was increased from 9.6 ± 2.3 mm to 13.4 ± 2.1 mm (p < 0.001), DH-Posterior was increased from 6.1 ± 1.9 mm to 9.1 ± 2.1 mm (p < 0.001), the slip ratio was reduced from 11.1 ± 4.6% to 8.3 ± 4.4% (p = 0.020) with the slip reduction ratio 25.6 ± 32.3%, and SL was slightly changed from 8.7 ± 3.7° to 8.3 ± 3.0°(p = 1.000). Following posterior fixation, the DH was unchanged (from 11.8 ± 1.7 mm to 11.8 ± 2.3 mm, p = 1.000), DH-Anterior and DH-Posterior were slightly changed from 13.4 ± 2.1 mm and 9.1 ± 2.1 mm to 13.7 ± 2.3 mm and 8.4 ± 1.8 mm respectively (P = 0.861, P = 0.254), the slip ratio was reduced from 8.3 ± 4.4% to 2.1 ± 3.6% (p < 0.001) with the slip reduction ratio 57.9 ± 43.9%, and the SL was increased from 8.3 ± 3.0° to 10.7 ± 3.6° (p = 0.008). Conclusions Compared with stand-alone cage insertion, additional posterior fixation provides better segmental alignment improvement in terms of slip reduction and segmental lordosis in OLIF procedures in the treatment of lumbar degenerative spondylolisthesis.

scholarly journals Feasibility of Endoscopic Transforaminal Lumbar Interbody Fusion through the Posterior Paraspinal Approach: Technical Note and Preliminary Result

2020 ◽  
Author(s):  
Hyeun-Sung Kim ◽  
Harshavardhan Dilip Raorane ◽  
Pang Hung Wu ◽  
Dong Hwa Heo ◽  
Yeon Jin Yi ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Plain Radiograph ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Graft Material ◽  
Lumbar Interbody Fusion ◽  
Paraspinal Approach ◽  
Segmental Lordosis

Abstract Background: The implement of endoscopic spinal surgery into degenerative spinal disease has minimized the requirement of fusion procedures. However, it is still necessary to develop endoscopic spine surgery in certain patients requiring fusion such as instability. We performed a full-endoscopic transforaminal lumbar interbody fusion(eTLIF) through a conventional paraspinal approach. The feasibility of procedure and early outcome were evaluated.Materials and Methods: eighteen consecutive patients with degenerative lumbar disease underwent eTLIF through a conventional paraspinal approach. Their clinical outcomes were evaluated with visual analog scale(VAS) leg pain score, Oswestry Disability Index(ODI) and the MacNab's criteria; radiological outcome measured with segmental lordosis, global lumbar lordosis, disc height on plain radiograph and percentage of potential fusion mass on CT scan at pre-operative, post-operative and final follow up period. intra operative and post-operative complications noted.Results: Mean age was 63. 71 years and Mean follow-up periods was 7.78 months. According to the level, L2-3 (1 case), L3-4 (4 cases), L4-5 (13 cases) and L5-S1 (2 cases). In the X-ray result, mean segmental lordosis angle(SLA) improved in pre-operative/post-operative/follow-up period 9.87±2.74 degree/ 11.79±3.74 degree/ 10.56±3.69 degree (p > 0.01); mean lumbar lordosis angle(LLA) improved 37.1±7.04 degree/ 39.2±7.13 degree/ 35.7±7.25 degree(p > 0.01). Mean preoperative disc height(DH) improved from 8.97±1.49 mm/ 12.34±1.39 mm/ 11.44±1.98 mm (p < 0.01). In the CT result, Average percentage of fusion mass was 42.61%. VAS was improved significantly, 7.67 / 3.39 / 2.5 and ODI was improved significantly, 74.9 / 34.56 / 27.76 by each preoperative / postoperative / final follow-up. In the clinical result, excellent was 5 cases and good was 13 cases. Conclusion: According to the results of this study, eTLIF was competent enough to perform as open TLIF. and good results were obtained in the form of endplate preservation, disc height restoration, minimal blood loss and post-operative pain with early mobilization. In addition, the fusion volume including the cage and the bone graft material occupies 40% to 50% of disc space is expected to give sufficient fusion by using 3D printed cages which gives the high fusion rate. In conclusion, eTLIF is considered to be a viable surgical procedure.

A radiographic analysis of degenerative spondylolisthesis at the L4–5 level

2012 ◽  
Vol 16 (2) ◽  
pp. 130-134 ◽  
Author(s):  
D. Greg Anderson ◽  
Worawat Limthongkul ◽  
Amirali Sayadipour ◽  
Christopher K. Kepler ◽  
James S. Harrop ◽  
...  
Keyword(s):  
Degenerative Spondylolisthesis ◽  
Lateral View ◽  
Disc Height ◽  
Data Set ◽  
Osteophyte Formation ◽  
Radiographic Parameters ◽  
Wide Range ◽  
Flexion Extension ◽  
The Mean ◽  
Flexion And Extension

Object Lumbar degenerative spondylolisthesis (LDS) is common and has generally been characterized as a homogeneous disease entity in the literature and in clinical practice. Because disease variability has not been carefully characterized, stratification of treatment recommendations based on scientific evidence is currently lacking. In this study, the authors analyzed radiographic parameters of patients with LDS at the L4–5 level to better characterize this entity. Methods Demographic data were collected from 304 patients (200 women and 104 men) with LDS at the L4–5 level. Plain radiographs including anteroposterior, lateral, and flexion-extension lateral radiographs were analyzed for disc height, segmental angulation, segmental translation, and osteophyte formation. Correlations were sought between the variables of age, sex, disc height, segmental angulation, segmental translation, and osteophyte formation. Results The mean patient age was 63.8 years (range 40–86 years). The mean mid-disc height was 7 mm (range 0–14 mm) on the neutral lateral view. The mean angulation between the superior endplate of L-5 and the inferior endplate of L-4 was 6° of lordosis (range 13° of kyphosis to 23° lordosis) on the neutral lateral view. The mean angular change between flexion and extension lateral radiographs was 5° (range 0°–17°). The mean translation on the neutral lateral view was 6 mm (range 0–15 mm). The mean change in translational between flexion and extension was 2 mm (range 0–11 mm). Twenty patients (7%) exhibited spondylolisthesis only on the flexion view. A significant positive correlation was found between the change in angulation and the change in translation on flexion and extension views (ρ = 0.18, p = 0.001). No significant correlation was found between anterior osteophyte size and mobility with flexion-extension radiographs. Conclusions The wide range in all radiographic parameters for LDS confirms the heterogeneous nature of this condition and suggests that a grading system to subclassify LDS may be clinically useful. On flexion and extension radiographs, increased translational motion correlated with increased angular motion. Anterior osteophyte size was not found to be predictive of segmental stability. This data set should prove beneficial to those seeking to subcategorize LDS in the future.

scholarly journals Anterior lumbar compared to oblique lumbar interbody approaches for multilevel fusions to the sacrum in adults with spinal deformity and degeneration

2020 ◽  
Vol 33 (4) ◽  
pp. 461-470
Author(s):  
Zhuo Xi ◽  
Dean Chou ◽  
Praveen V. Mummaneni ◽  
Huibing Ruan ◽  
Charles Eichler ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Height Change ◽  
The Mean ◽  
Segmental Lordosis ◽  
Lateral Interbody

OBJECTIVEIn adult spinal deformity and degenerative conditions of the spine, interbody fusion to the sacrum often is performed to enhance arthrodesis, induce lordosis, and alleviate stenosis. Anterior lumbar interbody fusion (ALIF) has traditionally been performed, but minimally invasive oblique lumbar interbody fusion (OLIF) may or may not cause less morbidity because less retraction of the abdominal viscera is required. The authors evaluated whether there was a difference between the results of ALIF and OLIF in multilevel anterior or lateral interbody fusion to the sacrum.METHODSPatients from 2013 to 2018 who underwent multilevel ALIF or OLIF to the sacrum were retrospectively studied. Inclusion criteria were adult spinal deformity or degenerative pathology and multilevel ALIF or OLIF to the sacrum. Demographic, implant, perioperative, and radiographic variables were collected. Statistical calculations were performed for significant differences.RESULTSData from a total of 127 patients were analyzed (66 OLIF patients and 61 ALIF patients). The mean follow-up times were 27.21 (ALIF) and 24.11 (OLIF) months. The mean surgical time was 251.48 minutes for ALIF patients and 234.48 minutes for OLIF patients (p = 0.154). The mean hospital stay was 7.79 days for ALIF patients and 7.02 days for OLIF patients (p = 0.159). The mean time to being able to eat solid food was 4.03 days for ALIF patients and 1.30 days for OLIF patients (p < 0.001). After excluding patients who had undergone L5–S1 posterior column osteotomy, 54 ALIF patients and 41 OLIF patients were analyzed for L5–S1 radiographic changes. The mean cage height was 14.94 mm for ALIF patients and 13.56 mm for OLIF patients (p = 0.001), and the mean cage lordosis was 15.87° in the ALIF group and 16.81° in the OLIF group (p = 0.278). The mean increases in anterior disc height were 7.34 mm and 4.72 mm for the ALIF and OLIF groups, respectively (p = 0.001), and the mean increases in posterior disc height were 3.35 mm and 1.24 mm (p < 0.001), respectively. The mean change in L5–S1 lordosis was 4.33° for ALIF patients and 4.59° for OLIF patients (p = 0.829).CONCLUSIONSPatients who underwent multilevel OLIF and ALIF to the sacrum had comparable operative times. OLIF was associated with a quicker ileus recovery and less blood loss. At L5–S1, ALIF allowed larger cages to be placed, resulting in a greater disc height change, but there was no significant difference in L5–S1 segmental lordosis.

scholarly journals Anterior Lumbar Interbody Fusion (ALIF) versus Oblique Lateral Interbody Fusion (OLIF) at L5-S1: A Comparison of Two Approaches to the Lumbosacral Junction

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Zhuo Xi ◽  
Shane Burch ◽  
Chih-Chang Chang ◽  
Hui-bing Ruan ◽  
Charles M Eichler ◽  
...  
Keyword(s):  
Blood Loss ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Lateral Interbody Fusion ◽  
Height Increase ◽  
Segmental Lordosis ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Abstract INTRODUCTION The oblique lateral interbody fusion OLIF is an alternative anterior approach to the lumbar spine at L5-S1, and it is unknown how it compares to anterior lumbar interbody fusion ALIF. This abstract is to compare the radiographic and clinical factors of ALIF and OLIF at L5-S1 only. METHODS A retrospective review of patients who underwent ALIF or OLIF at L5-S1 only at the University of California San Francisco (2013-2018) was performed. Data collected were demographics, cage parameters, perioperative factors, and radiographic parameters. RESULTS A total of 58 patients were included (33 ALIF and 25 OLIF). The average surgical time was 211.94 min for ALIF and 154.86 min for OLIF (P < .001). The average blood loss was 214 ml for ALIF and 74 ml for OLIF (P < .001). The average day to solid food was 2.55 for ALIF and 0.8 for OLIF (P < .001). The average cage height was 14.78 mm for ALIF and 12.9 mm (P < .001) for OLIF. The average cage lordosis was 15.45° for ALIF and 12.68° (P = .76) for OLIF. Average anterior L5-S1 disc height increase was 8.52 mm (ALIF) and 5.02 mm (OLIF) (P = .018), and average posterior L5-S1 disc height increase was 3.34 mm (ALIF) and 1.30 mm (OLIF) (P = .034). The average L5-S1 segmental lordosis increase was 6.82° for ALIF and 7.63° for OLIF (P = .638). CONCLUSION Patients who underwent OLIF at L5-S1 had shorter ileus duration compared to ALIF and comparable operative times and blood loss. ALIF afforded larger cages to be placed, resulting in greater disc height, but there was no significant difference in L5-S1 segmental lordosis.

BIOMECHANICAL ANALYSIS OF INTERBODY AND POSTEROLATERAL FUSION WITH TRANSPEDICULAR SCREW FIXATION FOR SPONDYLOLISTHESIS: A FINITE ELEMENT STUDY

2008 ◽  
Vol 20 (03) ◽  
pp. 145-151 ◽  
Author(s):  
Heng-Liang Liu ◽  
Ming-Tsung Sun ◽  
Chun-Li Lin ◽  
Hsin-Yi Cheng ◽  
Kou-Chen Wei ◽  
...  
Keyword(s):  
Finite Element ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Posterolateral Fusion ◽  
Fe Model ◽  
Functional Spinal Unit ◽  
Transpedicular Screw ◽  
Flexion Extension ◽  
Computer Aided ◽  
Transpedicular Screw Fixation

This study investigates and compares the mechanical response of interbody and posterolateral fusion along with the transpedicular screw fixation for the degenerative spondylolisthesis under different load conditions using finite element (FE) analysis. Image processing, computer aided design (CAD), and computer aided engineering techniques were applied to build a three-dimensional model of a functional spinal unit (L4–L5) with transpedicular screw fixation for the posterolateral fusion FE model. Additionally, the intervertebral disc was replaced by two cages to represent the interbody fusion FE model. A unit moment of 1 Nm was applied on the top of L4 in different directions to simulate the flexion, extension, lateral bending, and axial rotation, respectively. The lower of L5 was fixed in all directions for constraint. The simulated results revealed that using cages obviously decreased (13%–58%) the stress imposed upon the instrumentations. The stress concentration occurred at the locking nut on the transpedicular screw head, the middle part of the bone plate, and the thread of transpedicular screw near the head. These findings were comparable to clinical observations. With the limited data, our results suggested interbody fusion in combination with transpedicular screw fixation demonstrated less stress on the instrumentations than the posterolateral fusion with only transpedicular screw fixation.

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