scholarly journals A comparative study of new-type-retractor-assisted wiltse approach TLIF, MIS-TLIF and traditional PLIF in the treatment of single- level lumbar degenerative diseases

2021 ◽  
Author(s):  
HuanAn Liu ◽  
JiaQi Li ◽  
XianZheng Wang ◽  
WeiJian Wang ◽  
YaPeng Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Interbody Fusion ◽  
Fluoroscopy Time ◽  
Lumbar Interbody Fusion ◽  
Degenerative Diseases ◽  
Single Level ◽  
Drainage Volume ◽  
New Type ◽  
Wiltse Approach ◽  
Lumbar Degenerative Diseases

Abstract Background To compare the clinical efficacy of new-type-retractor assisted wiltse approach Transforaminal lumbar Interbody Fusion (TLIF), Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) and traditional Posterior Lumbar Interbody Fusion (PLIF)in single-level lumbar degenerative diseases. Methods A retrospective study was conducted by analyzing clinical and imaging information of consecutive patients with single-level lumbar degenerative diseases who underwent either the new-type-retractor assisted wiltse approach TLIF or the MIS-TLIF or the traditional PLIF. 87 concurrent patients with similar age ,weight and severity of the imaging and symptom between June 2016 and December 2019 were included(wiltse approach 29 cases; MIS-TLIF 28 cases; PLIF 30 cases).The three groups were compared for perioperative indicators(including intraoperative blood loss, postoperative drainage volume, operation time, intraoperative fluoroscopy time, bed time), creatine kinase (CK), Visual Analogue Scale(VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, intervertebral fusion rate, muscle atrophy and fatty infiltration(including ratio of multifidus atrophy and ratio of lean-to-total cross sectional area(CSA)). Results Intraoperative blood loss, postoperative drainage volume and bed time in MIS-TILF group and wiltse group was significantly lower than PLIF group. The operative time and intraoperative radiation time of MIS-TILF group was significantly longer than wiltse group and PLIF group. CK level in wiltse and MIS-TILF group were significantly lower than PLIF group 1 and 3 days after surgery. PLIF group back pain VAS score was higher than wiltse and MIS-TLIF group. PLIF group displayed a higher ODI and a lower JOA score than the wiltse and MIS-TLIF group 6 months and 12 months after surgery. There was no significant statistical difference in lower limb pain VAS score and intervertebral fusion rate. Ratio of multifidus atrophy in the PLIF group was significantly higher than the wiltse group and the MIS-TILF group. Ratio of lean-to-total CSA (cross-sectional area) in PLIF group was lower than wiltse group and MIS-TLIF group after surgery. There was no significant difference between wiltse group and MIS-TLIF group except that MIS-TLIF group showed longer operation time and intraoperative fluoroscopy time while lower blood loss and drainage volume. 2 cases of durotomy and 2 cases of incision fat liquefaction occurred in PLIF group, 1 case of skin edge necrosis was found in MIS-TILF group. Patients were followed up at 3 months,6moyhs,12months after surgery, The mean follow-up time of the patients was 12.14±2.78 months in wiltse group, 13.57±2.60 months in MIS-TLIF group, and 12.73±2.80 months in PLIF group, with no significant diffirence among 3 groups. (P༞0.05) Conclusion Wiltse approach TLIF assisted with the new-type retractor is a more convenient and simple minimally invasive surgical method than traditional PLIF and MIS-TLIF, which requires a long learning curve, long operation and fluoroscopy time.

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 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 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.

Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation

2005 ◽  
Vol 3 (2) ◽  
pp. 98-105 ◽  
Author(s):  
Robert E. Isaacs ◽  
Vinod K. Podichetty ◽  
Paul Santiago ◽  
Faheem A. Sandhu ◽  
John Spears ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Hospital Length Of Stay ◽  
Lumbar Interbody Fusion ◽  
Intraoperative Blood Loss ◽  
Disc Space ◽  
Single Level

Object The authors have developed a novel technique for percutaneous fusion in which standard microendoscopic discectomy is modified. Based on data obtained in their cadaveric studies they considered that this minimally invasive interbody fusion could be safely implemented clinically. The authors describe their initial experience with a microendoscopic transforaminal lumbar interbody fusion (METLIF) technique, with regard to safety in the placement of percutaneous instrumentation, perioperative morbidity, and early postoperative results. Methods The METLIF procedure was performed unilaterally in 20 patients with single-level lumbar spondylolisthesis or pure mechanical back pain with endoscopic assistance, hemilaminectomy, unilateral facetectomy, and microdiscectomy. Two interbody grafts were placed via the lateral exposure of the disc space. Bilateral percutaneous pedicle screws were then inserted. Compared with patients who had undergone single-level posterior LIF at the same institutions, intraoperative blood loss, hospital length of stay (LOS), and postoperative narcotic agent use were significantly lower in the METLIF group. The mean LOS for the percutaneous fusion group was 3.4 days (5.1 days in those who underwent PLIF; p < 0.02). There have been no procedure-related complications in this series to date. Conclusions The METLIF technique provided an option for percutaneous interbody fusion similar to that in open surgery while minimizing destruction to adjacent tissues. This technique was safe and exhibited a trend toward decreased intraoperative blood loss, postoperative pain, total narcotic use, and the risk of transfusion.

scholarly journals Comparison of outcomes between indirect decompression of oblique lumbar interbody fusion and MIS-TLIF in one single-level lumbar spondylosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shih-Feng Hung ◽  
Jen-Chung Liao ◽  
Tsung-Ting Tsai ◽  
Yun-Da Li ◽  
Ping-Yeh Chiu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Minimal Invasive ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
Coronal Imbalance ◽  
Indirect Decompression ◽  
Oblique Lumbar Interbody Fusion ◽  
Segmental Lordosis

AbstractMinimal invasive spinal fusion has become popular in the last decade. Oblique lumbar interbody fusion (OLIF) is a relatively new surgical technique and could avoid back muscle stripping and posterior complex destruction as in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Between December 2016 and September 2018, patients with single level degenerative spondylosis were selected to enroll in this retrospective study. A total of 21 patients that underwent OLIF and 41 patients that received MIS-TLIF were enrolled. OLIF showed significantly less blood loss and shorter surgery time compared to MIS-TLIF (p < 0.05). The improvement in segmental lordosis and coronal balance was significantly more in OLIF group than MIS-TLIF group (p < 0.05). When comparing with MIS-TLIF, OLIF was significantly better in Oswestry Disability Index (ODI) and visual analogue scale for back pain improvement at post-operative 6 months (p < 0.05). Both OLIF and MIS-TLIF are becoming mainstream procedures for lumbar degenerative-related disease, especially for spondylolisthesis. However, the indirect decompression of OLIF has shown to have less perioperative blood loss and shorter surgery time than that of MIS-TLIF. In addition, OLIF gives superior outcome in restoring segmental lordosis and coronal imbalance. While both OLIF and MIS-TLIF provide optimal clinical outcomes, upon comparison between the two techniques, the indirect decompression of OLIF seems to be a superior option in modern days.

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