Single stage posterior instrumentation and anterior interbody fusion for tuberculosis of dorsal and lumbar spines

Background: Spine is the most common site for osseous involvement of tuberculosis, accounting around 50% cases of musculoskeletal tuberculosis. The most frequent sites of the involvement are the thoracic and lumbar spine. The anterior column is primarily affected resulting in progressive or residual kyphotic deformity even after the eradication of the disease by chemotherapy. Various surgical techniques like anterior fusion, posterior or combined fusion have been described. In this study we evaluated the clinical outcome and radiological results of single stage posterior instrumentation and anterior interbody fusion for tuberculosis of dorsal and lumbar spine. Methods: Details of the patients of tuberculosis of dorsal and lumbar spine operated with single stage posterior instrumentation and anterior interbody fusion from December 2004 to June 2008 were retrieved from the hospital database. There were 55 cases operated with this technique. Thirty patients, whose final details were available, were involved in this study. Pre-operative, post-operative and final follow up clinical and radiological assessments were performed. The follow up ranged from 18 to 60 months. Results: Average operation time was 5 hours 45 minutes and blood loss was 1100 ml. Anterior body fusion was achieved in all the patients. 93.3% of the patients had neurological improvement. Satisfactory post-operative kyphotic angle correction was achieved. There was minimal final loss of kyphotic correction. One patient had post-operative wound infection. Post operative paralytic ileus, chest infection, urinary tract infection, jaundice were the complications found in the patients. No graft related complication was seen. There was no recurrence of the disease in any of the cases. Conclusion: Single stage anterior debridement and interbody fusion with posterior instrumentation can be performed safely to achieve satisfactory clinical and radiographic outcomes in patients of thoracic and lumbar tuberculosis. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8136 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 21-26

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Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine

Spinal Cord ◽

10.1038/sj.sc.3101185 ◽

2001 ◽

Vol 39 (8) ◽

pp. 429-436 ◽

Cited By ~ 53

Author(s):

VJ Laheri ◽

NP Badhe ◽

GT Dewnany

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Posterior Instrumentation ◽

Single Stage ◽

Anterior Interbody Fusion

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Role of Femoral Ring Allograft in Anterior Interbody Fusion of the Spine

Journal of Orthopaedic Surgery ◽

10.1177/230949900100900202 ◽

2001 ◽

Vol 9 (2) ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Areesak Chotivichit ◽

Takuya Fujita ◽

Tze-Hong Wong ◽

John P Kostuik ◽

Ann N Sieber

Keyword(s):

Interbody Fusion ◽

Radiolucent Line ◽

Degenerative Change ◽

Congenital Scoliosis ◽

Anterior Fusion ◽

Anterior Interbody Fusion ◽

Femoral Ring ◽

Grade Ii ◽

Posterior Laminectomy

A review was carried out on 59 patients (10 males and 49 females) who had anterior interbody fusion performed with femoral ring allograft packed with autograft bone chips with a minimum follow up of 2 years. The average age at the time of surgery was 49.1 year old (26 to 75). The total number of levels grafted was 141. The diagnosis consisted of multiple degenerative disease in 6, degenerative change below the long segment of fusion for scoliosis in 9, osteoporosis with collapsed fracture in 3, pseudarthrosis after posterior laminectomy and fusion in 35, congenital scoliosis in 3, scoliosis in 2 and paralytic scoliosis due to multiple sclerosis in one. The distribution of levels fused was T12-L1 in 6, L1–2 in 12, L2–3 in 17, L3–4 in 22, L4–5 in 35 and L5-S1 in 39. The remaining 10 levels were in the lower thoracic areas (T7-T12). The operations were performed as anterior fusion alone in 13 patients, one-stage anterior and posterior fusion in 26 patients and two-stage surgery in 20 patients. Anterior instrumentation was used in all 141 levels. At average follow-up (33.7 months) there was no significant change in allograft angles (average = 1.6o). Fusion of the allograft was classified by Bridwell's grading system. At 24 months of the follow up, 97 % of the allografts were in grade I (fully incorporated) and 3% were in grade II (partially incorporated). Compared to 12 months follow-up only 76.2% of the grafts were in grade I, 28 % were in grade II and 0.8% were in grade III. Two patients had deep posterior infections which required further surgery (without resorption of the allograft anteriorly). One patient had a screw migration anteriorly which required removal. Three patients had persistence of radiolucent line at one of the vertebral end plates – graft interfaces but no subsidence of the graft or pain. In conclusion, the femoral ring allograft appeared to benefit the anterior interbody fusion in complex spinal surgery.

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Unilateral versus bilateral Pedicle Screw Fixation associated with interbody fusion in degenerative Lumbar spine diseases

QJM ◽

10.1093/qjmed/hcaa055 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

E E A Emara ◽

S H Morad ◽

A R Farghaly ◽

O E Ahmed ◽

M K Khalil

Keyword(s):

Lumbar Spine ◽

Pedicle Screw ◽

Interbody Fusion ◽

Screw Fixation ◽

Operation Time ◽

Fusion Rate ◽

Pedicle Screw Fixation ◽

Bilateral Group ◽

Significant Difference

Abstract Background Lumbar interbody fusion is a recognized surgical technique in treatment of degenerative lumbar instability. Interbody fusion supplemented with pedicle screw fixation has several advantages over posterolateral fusion and has been advocated to improve fusion rates and clinical outcomes. Interbody fusion places the bone graft in the loadbearing position of the anterior and middle spinal columns thereby enhancing the potential for fusion. In addition, the interbody space has more vascularity than the posterolateral space, also increasing the potential for a solid fusion mass to form. Aim of the Work to assess safety and efficacy of unilateral pedicle screw fixation associated with interbody fusion in Lumbar spine degenerative diseases and to evaluate and compare outcomes of unilateral versus bilateral pedicle screw fixation associated with interbody fusion in lumbar spine degenerative diseases, as regard the operation time, bleeding, postoperative stay, cost, and the clinical and biomechanical results. Material & Methods This observational prospective comparative study of the 2 groups who were operated either unilateral (Group A /25 patients) or bilateral (Group B/25 patients) pedicle screw fixation with interbody fusion was done. Patients were followed up for 1, 6, 12 months. This study occurred at Ain Shams University hospitals. Results No differences were observed between the two groups with respect to demographic data. The patients of the two groups had significant improvement in functional outcome compared to preoperatively, except in early postoperative VAS back and ODI in unilateral group which is better than bilateral group. However, no significant difference noticed in the further follow up. There was no significant difference comparing fusion rate, complication rate and duration of hospital stay between the two groups at postoperative follow-up. There was significantly less blood loss, shorter postoperative pain killer use and significantly shorter operation time in the unilateral PS fixation group as compared with the bilateral PS fixation group in our study. Conclusion Our study suggested TLIF with unilateral PS fixation was as safe and effective as that with bilateral PS fixation. Unilateral PS fixation may significantly reduce the intraoperative blood loss and shorten the operation time, somewhat improve the clinical outcome scores of ODI and VAS Back without significant difference comparing fusion rate, complication rate and duration of hospital stay between the two groups at postoperative follow-up. BPSF with TLIF likely causes more degeneration at the cranial adjacent segment compared with UPSF techniques. However, the long-term follow up is required to demonstrate the impact of these findings.

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Microsurgical Anterior Approaches to the Lumbar Spine for Interbody Fusion and Total Disc Replacement

Neurosurgery ◽

10.1097/00006123-200211002-00022 ◽

2002 ◽

Vol 51 (suppl_2) ◽

pp. S2-159-S2-165 ◽

Cited By ~ 35

Author(s):

H. Michael Mayer ◽

Karsten Wiechert

Keyword(s):

Lumbar Spine ◽

Anterior Approach ◽

Interbody Fusion ◽

Postoperative Morbidity ◽

Total Disc Replacement ◽

Anterior Lumbar Interbody Fusion ◽

Disc Replacement ◽

Lumbar Interbody Fusion ◽

Anterior Interbody Fusion

Abstract OBJECTIVE Anterior approaches to the lumbar spine for the treatment of various degenerative or postoperative abnormalities associated with low back pain have always been a matter of debate. They are known to be associated with considerable surgical trauma, high postoperative morbidity, and, occasionally, unacceptably high complication rates. In 1997, we inaugurated two new microsurgical modifications of conventional anterior approach techniques, which have been applied in anterior lumbar interbody fusion and more recently in total disc replacement. This article describes the results of microsurgical anterior interbody fusion in a consecutive series of 171 patients as well as preliminary results of these techniques for total disc replacement in 26 patients. METHODS The approaches are performed with the use of a surgical microscope. Lumbar segments L2–L5 are exposed through a lateral retroperitoneal approach. L5–S1 can be reached through a midline retroperitoneal or transperitoneal approach. Both approaches can be performed through a limited skin incision of 4 cm. RESULTS An independent observer evaluated results of anterior lumbar interbody fusion in 171 patients during a 2-year follow-up period. The clinical follow-up demonstrated low perioperative and postoperative morbidity with an average blood loss of less than 100 ml at the fusion site. Pseudoarthrosis rates were less than 5%, and clinical results, as evaluated in accordance with the scoring system developed by Prolo et al., did not differ significantly from conventional open techniques. Total disc replacement through a microsurgical anterior approach seems to be a promising alternative to fusion procedures with even less intraoperative and perioperative morbidity. CONCLUSION Microsurgical anterior approaches to the lumbar spine provide a reasonable surgical alternative to conventional approaches for anterior interbody fusion and total disc replacement.

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Comparison between single anterior and single posterior approaches of debridement interbody fusion and fixation for the treatment of mono-segment lumbar spine tuberculosis

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03955-4 ◽

2021 ◽

Author(s):

Hangli Wu ◽

Yaqing Cui ◽

Liqun Gong ◽

Jun Liu ◽

Yayi Fan ◽

...

Keyword(s):

Lumbar Spine ◽

Blood Loss ◽

Posterior Approach ◽

Interbody Fusion ◽

Operation Time ◽

Group A ◽

Spine Tuberculosis ◽

Group B ◽

Single Posterior Approach

Abstract Purpose To compare the efficacy of single anterior and single posterior approach of debridement, interbody fusion, and fixation for the treatment of mono-segment lumbar spine tuberculosis (TB) patients. Methods Eighty-seven patients with mono-segment lumbar TB who underwent debridement, interbody fusion, and fixation through either single anterior (Group A) or single posterior approach (Group B) from January 2007 to January 2017 were enrolled in this study. The duration of the operation, blood loss, complication rate, visual analog scale (VAS), Oswestry disability index (ODI), Frankel scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphosis angle, correction rate, correction loss, and time taken for bone graft fusion were compared between the groups. Results The average period of follow-up was 34.3 ± 9.5 months (24–56 months). No significant differences were observed between patients in Group A and patients in Group B in terms of gender, age, body mass index (BMI), duration of illness and preoperative evaluative indices (P > 0.05). The mean operation time and blood loss was significantly higher in Group A (P = 0.000), along with a slightly higher rate of complications compared with Group B (P = 0.848). The VAS, ODI and Frankel scale scores showed significant improvement in both groups (P = 0.000), along with the ESR, CRP and kyphosis indices (P = 0.000), which were similar in both groups at the final follow-up. Conclusion Both single anterior and single posterior approaches of debridement, interbody fusion and fixation are effective for mono-segment lumbar TB patients, although the single posterior approach is of a shorter duration and results in less blood loss.

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Single posterior debridement, interbody fusion, and fixation on patients with continuous multivertebral lumbar spine tuberculosis (CMLSTB)

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03628-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Weihong Long ◽

Liqun Gong ◽

Yaqing Cui ◽

Jie Qi ◽

Dapeng Duan ◽

...

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Operation Time ◽

Cure Rate ◽

Spine Tuberculosis ◽

Cobb’S Angle ◽

Perioperative Complication ◽

The Mean ◽

Posterior Debridement

Abstract Background Patients with continuous multi-vertebral lumbar spine tuberculosis (CMLSTB) were subjected to single posterior debridement, interbody fusion, and fixation to explore their clinical outcomes. Methods Sixty-seven CMLSTB patients who underwent single posterior debridement interbody fusion and fixation between January 2008 to December 2017 were studied. The operation time, blood loss, perioperative complication rate, cure rate, Visual Analog Scale (VAS), Oswetry disability index (ODI), Japanese Orthopedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle and time of interbody fusion were analyzed to understand their therapeutic effects on CMLSTB patients. Results The patients were followed up for 20–48 months, with a mean of 24.3 months. The mean operation time was 215.5 min (range, 120–280 min), whereas 818.0 ml of blood was lost (range, 400–1500 ml) with a perioperative complication rate of 6.0% and a cure rate of 95.5%. During the last phase of follow-up, the mean preoperative VAS score (5.7) and ODI (72.0%) decreased significantly to 1.4 (t = 31.4, P<0.01) and 8.4% (t = 48.4, P<0.01), respectively. Alternatively, the mean preoperative ESR and CRP (74.7 mm /h and 69.3 mg/L, respectively) decreased to average values (tESR = 39.7, PESR<0.001; tCRP = 50.2, PCRP<0.001), while the JOA score (13.9) significantly increased to 23.0 (t = − 11.6, P<0.01). The preoperative kyphotic Cobb’s angle (20.5°) decreased to 4.8° after the operation (t = 14.0, P<0.01); however, the kyphotic correction remained intact at the time of follow-up (t = − 0.476, P = 0.635). Furthermore, the mean of interbody fusion time was identified to be 8.8 months (range, 6–16 months). Conclusion Single posterior debridement, interbody fusion, and fixation may be one of the surgical choices for the treatment of CMLSTB patients.

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Combined posterior instrumentation and anterior interbody fusion for active tuberculous kyphosis of the thoraco-lumbar spine

Current Orthopaedics ◽

10.1016/0268-0890(91)90039-3 ◽

1991 ◽

Vol 5 (3) ◽

pp. 177-179 ◽

Cited By ~ 24

Author(s):

Myung-Sang Moon

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Posterior Instrumentation ◽

Anterior Interbody Fusion

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Single-level instrumented posterolateral fusion versus non-instrumented anterior interbody fusion for lumbar spondylolisthesis: a prospective study with a 2-year follow-up

Journal of Orthopaedic Science ◽

10.1007/s00776-011-0088-5 ◽

2011 ◽

Vol 16 (4) ◽

pp. 352-358 ◽

Cited By ~ 32

Author(s):

Seiji Ohtori ◽

Takana Koshi ◽

Masaomi Yamashita ◽

Masashi Takaso ◽

Kazuyo Yamauchi ◽

...

Keyword(s):

Prospective Study ◽

Interbody Fusion ◽

Posterolateral Fusion ◽

Single Level ◽

Anterior Interbody Fusion ◽

Lumbar Spondylolisthesis ◽

A Prospective Study

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Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis

Journal of Neurosurgery Spine ◽

10.3171/2013.4.spine12651 ◽

2013 ◽

Vol 19 (1) ◽

pp. 90-94 ◽

Cited By ~ 18

Author(s):

Hironobu Sakaura ◽

Tomoya Yamashita ◽

Toshitada Miwa ◽

Kenji Ohzono ◽

Tetsuo Ohwada

Keyword(s):

Lumbar Spine ◽

Clinical Outcome ◽

Interbody Fusion ◽

Sagittal Alignment ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Single Level ◽

The Mean

Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

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