scholarly journals Post-Operative Radiculitis Following One or Two Level Anterior Lumbar Surgery with or without Posterior Instrumentation

2020 ◽  
Author(s):  
Matthew S. Griffith ◽  
Kenneth A Shaw ◽  
Brian Burke ◽  
Keith Lynn Jackson ◽  
David Gloystein
Keyword(s):  
Statistical Analysis ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Anterior Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Lumbar Surgery ◽  
Number Of Patients ◽  
Height Change

Abstract Background: Anterior lumbar interbody fusion (ALIF) has evolved as a treatment strategy for a multitude of lumbar spine conditions. To date, two studies have identified radiculitis as a complication associated with ALIF procedures, but they do not outline a time to resolution. There have been no reports, of postoperative traction radiculitis in patients following anterior lumbar procedures.Materials and Methods: We retrospectively reviewed seventy patients who underwent anterior lumbar procedures by two surgeons. Using the Farfan ratio we calculated preoperative to postoperative change in disc height. We determined post-operative radiculitis symptoms from review of follow up notes. We also determined the type of graft used in fusion patients.Results: 70 patients were initially identified with 12 being excluded. This left 58 to be included in the study. Twenty-one patients (36.2%) developed postoperative radiculitis. There was a moderate to strong correlation with height change and radiculitis (p=0.044). Patients treated with rhBMP-2 had a rate of 36.5% post-operative radiculitis when compared to a rate of 17% for patients fused without rhBMP-2. The number of patients treated without rhBMP-2 were too few to perform statistical analysis, however. All radiculitis resolved by the 3 month follow up appointment.Conclusion: This study shows that there is a 36.2% rate of radiculitis following anterior lumbar procedures. There is a correlation between disc height change and postoperative radiculitis following anterior lumbar procedures. There also appears to be a relationship to the use of rhBMP-2. All radiculitis resolved by 3 months.

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.

Reasons for revision following stand-alone anterior lumbar interbody fusion and lateral lumbar interbody fusion

2021 ◽  
pp. 1-7
Author(s):  
Austin Q. Nguyen ◽  
Jackson P. Harvey ◽  
Krishn Khanna ◽  
Bryce A. Basques ◽  
Garrett K. Harada ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Preoperative Imaging ◽  
Lumbar Interbody Fusion ◽  
Adjacent Level ◽  
Posterior Decompression ◽  
Less Invasive ◽  
Lateral Lumbar Interbody Fusion ◽  
Reoperation Rates

OBJECTIVE Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are alternative and less invasive techniques to stabilize the spine and indirectly decompress the neural elements compared with open posterior approaches. While reoperation rates have been described for open posterior lumbar surgery, there are sparse data on reoperation rates following these less invasive procedures without direct posterior decompression. This study aimed to evaluate the overall rate, cause, and timing of reoperation procedures following anterior or lateral lumbar interbody fusions without direct posterior decompression. METHODS This was a retrospective cohort study of all consecutive patients indicated for an ALIF or LLIF for lumbar spine at a single academic institution. Patients who underwent concomitant posterior fusion or direct decompression surgeries were excluded. Rates, causes, and timing of reoperations were analyzed. Patients who underwent a revision decompression were matched with patients who did not require a reoperation, and preoperative imaging characteristics were analyzed to assess for risk factors for the reoperation. RESULTS The study cohort consisted of 529 patients with an average follow-up of 2.37 years; 40.3% (213/529) and 67.3% (356/529) of patients had a minimum of 2 years and 1 year of follow-up, respectively. The total revision rate was 5.7% (30/529), with same-level revision in 3.8% (20/529) and adjacent-level revision in 1.9% (10/529) of patients. Same-level revision patients had significantly shorter time to revision (7.14 months) than adjacent-level revision patients (31.91 months) (p < 0.0001). Fifty percent of same-level revisions were for a posterior decompression. After further analysis of decompression revisions, an increased preoperative canal area was significantly associated with a lower risk of further decompression revision compared to the control group (p = 0.015; OR 0.977, 95% CI 0.959–0.995). CONCLUSIONS There was a low reoperation rate after anterior or lateral lumbar interbody fusions without direct posterior decompression. The majority of same-level reoperations were due to a need for further decompression. Smaller preoperative canal diameters were associated with the need for revision decompression.

Guide device for percutaneous placement of translaminar facet screws after anterior lumbar interbody fusion

2003 ◽  
Vol 98 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Jee Soo Jang ◽  
Sang Ho Lee ◽  
Sang Rak Lim
Keyword(s):  
Interbody Fusion ◽  
Screw Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Posterior Fixation ◽  
Foraminal Stenosis ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Guide Device ◽  
Fine Print

Because the degree of immediate stabilization provided by cage-assisted anterior lumbar interbody fusion (ALIF) has been shown by several studies to be inadequate, supplementary posterior fixation, such as that created by translaminar or transpedicle screw fixation, is necessary. In this study, the authors studied the ALIF-augmentation procedure in which a special guide device is used to place percutaneously translaminar facet screws in 18 patients with degenerative lumbar disease. The minimum follow-up period was 1 month (mean 6 months, range 1–13 months). Degenerative spondylolisthesis with foraminal stenosis was diagnosed in nine patients, associated degenerative disc disease alone or combined with foraminal stenosis in eight, and recurrent disc herniation in one. Following screw placement, computerized tomography scanning was conducted to evaluate the accuracy of the facet screw positioning. All screws were properly placed. No screw penetrated the spinal canal or injured the neural structures. Excellent or good clinical outcomes were demonstrated in all patients at the last follow up. The use of this guide device for post—ALIF percutaneous translaminar facet screw fixation represents a safe, accurate, and minimally invasive modality with which to achieve immediate solid fixation in the lumbar spine.

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.

scholarly journals A Radiological Comparison of Anterior Fusion Rates in Anterior Lumbar Interbody Fusion

2012 ◽  
Vol 2 (4) ◽  
pp. 195-206 ◽  
Author(s):  
M. J. H. McCarthy ◽  
L. Ng ◽  
G. Vermeersch ◽  
D. Chan
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Anterior Lumbar Interbody Fusion ◽  
Posterior Fusion ◽  
Posterior Fixation ◽  
Anterior Fusion ◽  
Lumbar Interbody Fusion ◽  
Anterior Surgery ◽  
Single Level

Aim To compare anterior fusion in standalone anterior lumbar interbody fusion (ALIF) using cage and screw constructs and anterior cage–alone constructs with posterior pedicle screw supplementation but without posterior fusion. Methods Eighty-five patients underwent single- or two-level ALIF procedure for degenerative disk disease or lytic spondylolisthesis (SPL). Posterior instrumentation was performed without posterior fusion in all cases of lytic SPL and when the anterior cage used did not have anterior screw through cage fixation. Results Seventy (82%) patients had adequate radiological follow-up at a mean of 19 months. Forty patients had anterior surgery alone (24 single level and 16 two levels) and 30 had front-back surgery (15 single level and 15 two levels). Anterior locked pseudarthrosis was only seen in the anterior surgery–alone group when using the STALIF cage (Surgicraft, Worcestershire, UK) (37 patients). This occurred in five of the single-level surgeries (5/22) and nine of the two-level surgeries (9/15). Fusion was achieved in 100% of the front-back group and only 65% (26/40) of the anterior surgery–alone group. Conclusion Posterior pedicle screw supplementation without posterolateral fusion improves the fusion rate of ALIF when using anterior cage and screw constructs. We would recommend supplementary posterior fixation especially in cases where more than one level is being operated.

scholarly journals Minimally invasive anterior lumbar interbody fusion for adult degenerative scoliosis with 1 or 2 dislocated levels

2015 ◽  
Vol 23 (6) ◽  
pp. 739-746 ◽  
Author(s):  
Charles-Henri Flouzat-Lachaniette ◽  
Louis Ratte ◽  
Alexandre Poignard ◽  
Jean-Charles Auregan ◽  
Steffen Queinnec ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Lumbar Interbody Fusion ◽  
Degenerative Scoliosis ◽  
Surgical Morbidity ◽  
Adult Degenerative Scoliosis ◽  
The Mean

OBJECT Frequent complications of posterolateral instrumented fusion have been reported after treatment of degenerative scoliosis in elderly patients. Considering that in some cases, most of the symptomatology of adult degenerative scoliosis (ADS) is a consequence of the segmental instability at the dislocated level, the use of minimally invasive anterior lumbar interbody fusion (ALIF) to manage symptoms can be advocated to reduce surgical morbidity. The purpose of this study was to evaluate the midterm outcomes of 1- or 2-level minimally invasive ALIFs in ADS patients with 1- or 2-level dislocations. METHODS A total of 47 patients (average age 64 years; range 43–80 years) with 1- or 2-level ALIF performed for ADS (64 levels) in a single institution were included in the study. An independent spine surgeon retrospectively reviewed all the patients’ medical records and radiographs to assess operative data and surgery-related complications. Clinical outcome was reported using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for lumbar and leg pain. Intraoperative data and complications were collected. Fusion and risk for adjacent-level degeneration were assessed. RESULTS The mean follow-up duration was 3 years (range 1–10 years). ODI, and back and leg pain VAS scores were significantly improved at last follow-up. A majority of patients (74%) had a statistically significant improvement in their ODI score of more than 20 points at latest follow-up and 1 had a worsening of his disability. The mean operating time was 166 minutes (range 70–355 minutes). The mean estimated blood loss was 410 ml (range 50–1700 ml). Six (5 major and 1 minor) surgical complications (12.7% of patients) and 13 (2 major and 11 minor) medical complications (27.7% of patients) occurred without death or wound infection. Fusion was achieved in 46 of 47 patients. Surgery resulted in a slight but significant decrease of the Cobb angle, and improved the pelvic parameters and lumbar lordosis, but had no effect on the global sagittal balance. At latest follow-up, 9 patients (19.1%) developed adjacent-segment disease at a mean of 2 years’ delay from the index surgery; 4 were symptomatic but treated medically, and none required iterative surgery. CONCLUSIONS Single- or 2-level minimally invasive fusion through a minimally invasive anterior approach in some selected cases of ADS produced a good functional outcome with a high fusion rate. They were associated with a significantly lower rate of complications in this study than the historical control.

Laparoscopic anterior lumbar interbody fusion

1999 ◽  
Vol 7 (6) ◽  
pp. E10 ◽  
Author(s):  
Mark R. McLaughlin ◽  
Jonathan Y. Zhang ◽  
Brian R. Subach ◽  
Regis W. Haid ◽  
Gerald E. Rodts
Keyword(s):  
Interbody Fusion ◽  
Significant Risk ◽  
Posterior Lumbar Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Degenerative Disease ◽  
Laparoscopic Technique ◽  
Lumbar Interbody Fusion ◽  
Lumbar Degenerative Disease ◽  
Single Level ◽  
Number Of Patients

In recent years, there has been an unprecedented increase in the number of patients undergoing treatment with interbody fusion devices for degenerative disease of the lumbar spine. These devices can be placed either anteriorly or posteriorly. With the advent of minimally invasive surgery and the increasing ability of general surgeons to perform transperitoneal procedures laparoscopically, a new laparoscopic technique has been developed for placing lumbar interbody fusion devices. Although this procedure has some advantages over posterior lumbar interbody fusion, it is not without significant risk, and the learning curve is steep. The authors review a series of 32 consecutive patients who underwent single-level laparoscopic anterior lumbar interbody fusion at L4–5 or L5–S1 over a 2-year period for the treatment of single-level lumbar degenerative disease. In this report they review the technical aspects of the procedure and the important lessons they have learned through their early experience with this technique.

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