Anterior bone cement augmentation in anterior lumbar interbody fusion and percutaneous pedicle screw fixation in patients with osteoporosis

2010 ◽  
Vol 12 (5) ◽  
pp. 525-532 ◽  
Author(s):  
Kyeong Hwan Kim ◽  
Sang-Ho Lee ◽  
Dong Yeob Lee ◽  
Chan Shik Shim ◽  
Dae Hyeon Maeng
Keyword(s):  
Vertebral Body ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Cement Augmentation ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Group I ◽  
Cage Subsidence ◽  
The Mean ◽  
Group Ii

Object The purpose of the present study was to evaluate the efficacy of anterior polymethylmethacrylate (PMMA) cement augmentation in instrumented anterior lumbar interbody fusion (ALIF) for patients with osteoporosis. Methods Sixty-two patients with osteoporosis who had undergone single-level instrumented ALIF for spondylolisthesis and were followed for more than 2 years were included in the study. The patients were divided into 2 groups: instrumented ALIF alone (Group I) and instrumented ALIF with anterior PMMA augmentation (Group II). Sixty-one patients were interviewed to evaluate the clinical results, and plain radiographs and 3D CT scans were obtained at the last follow-up in 46 patients. Results The mean degree of cage subsidence was significantly higher in Group I (19.6%) than in Group II (5.2%) (p = 0.001). The mean decrease of vertebral body height at the index level was also significantly higher in Group I (10.7%) than in Group II (3.9%) (p = 0.001). No significant intergroup differences were observed in the incidence of radiographic adjacent-segment degeneration (ASD) or in terms of pain and functional improvement. The incidences of clinical ASD (23% in Group I and 10% in Group II) were not significantly different. There was 1 case of nonunion and 3 cases of screw migration in Group I, but none resulted in implant failure. Conclusions Anterior PMMA augmentation during instrumented ALIF in patients with osteoporosis was useful to prevent cage subsidence and vertebral body collapse. In addition, PMMA augmentation did not increase the nonunion rate and incidence of ASD.

scholarly journals Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Provides Sustained Improvements in Clinical and Radiological Outcomes up to 5 Years Postoperatively in Patients with Neurogenic Symptoms Secondary to Spondylolisthesis

2017 ◽  
Vol 11 (2) ◽  
pp. 204-212 ◽  
Author(s):  
Hamid Rahmatullah Bin Abd Razak ◽  
Priyesh Dhoke ◽  
Kae-Sian Tay ◽  
William Yeo ◽  
Wai-Mun Yue
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Short Form ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
Sf 36 ◽  
Cage Subsidence ◽  
The Mean

<sec><title>Study Design</title><p>Retrospective review of prospective registry data.</p></sec><sec><title>Purpose</title><p>To determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis.</p></sec><sec><title>Overview of Literature</title><p>MIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion.</p></sec><sec><title>Methods</title><p>The outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates.</p></sec><sec><title>Results</title><p>Our patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m<sup>2</sup>. The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (<italic>p</italic>&lt;0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported.</p></sec><sec><title>Conclusions</title><p>Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years postoperatively, with many patients achieving an MCID.</p></sec>

Minimally invasive anterior lumbar interbody fusion followed by percutaneous translaminar facet screw fixation in elderly patients

2009 ◽  
Vol 10 (6) ◽  
pp. 610-616 ◽  
Author(s):  
Sung Hun Park ◽  
Woo Min Park ◽  
Cheul Woong Park ◽  
Kwan Soo Kang ◽  
Young Keun Lee ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Cage Subsidence ◽  
The Mean

Object The purpose of this study was to determine whether anterior lumbar interbody fusion (ALIF) followed by percutaneous translaminar facet screw fixation is effective in elderly patients with degenerative spinal disease. Methods Twenty-nine patients > 60 years old who underwent ALIF with percutaneous translaminar facet screw fixation from January to June 2004 were studied. The radiological and clinical data of these patients were collected and analyzed. The mean follow-up period was 14.6 months (range 12–17 months). Results The mean preoperative, immediate postoperative, and 6- and 12-month postoperative posterior disc heights were 7.1, 11.6, 9.8, and 9.8 mm, respectively. Subsidences of posterior disc height > 20% developed in 9 patients (30%). The significant risk factor for subsidence was found to be 2-level operations (p = 0.023). The mean preoperative Oswestry Disability Index score and visual analog scale scores for the back and leg were 24.4, 6.6, and 7.5, respectively, and improved postoperatively to 14.2, 1.5, and 1.8, respectively. Conclusions Minimally invasive ALIF followed by percutaneous translaminar facet screw fixation was performed as a minimally invasive surgical technique in elderly patients. However, in certain circumstances such as multilevel operations or in patients with severe osteoporosis, significant cage subsidence can develop.

Bone mineral density and spongiosa architecture in correlation to vertebral body insufficiency fractures

1998 ◽  
Vol 39 (5) ◽  
pp. 538-542 ◽  
Author(s):  
R. Andresen ◽  
S. Radmer ◽  
D. Banzer
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Vertebral Body ◽  
Unknown Etiology ◽  
Insufficiency Fractures ◽  
Mineral Density ◽  
Group Iii ◽  
Group I ◽  
The Mean ◽  
Group Ii

Objective: the clinical value of spinal quantitative CT (sQCT) and the structural patterns of the vertebral bone were studied Material and Methods: sQCT was performed on 246 patients with a mean age of 57 years for whom conventional lateral radiographies of the thoracic and lumbar spine were available. All patients were suffering from back pain of unknown etiology. the bone mineral density (BMD) of the midvertebral section of 3 lumbar vertebral bodies was determined by means of single-energy-(SE)-weighted QCT (85 kV). Spongiosa architecture and density profile analyses were made in the axial images. This was contrasted to BMD values ascertained in SE QCT. the mean BMD was compared to the number of fractures and the patients were divided into three groups: group I — no fracture; group II — one fracture; and group III 1 fracture Results: the mean BMD was: 134.3 (74.1–187.5) mg hydroxyapatite (HA)/ml in group I; 79.6 (58.6–114.3) mg HA/ml in group II; and 52.4 (13.1–79.1)mg HA/ml in group III. A significant deterioration in spongiosa structure was found with increasing demineralization: strongly rarefied patterns predominated in the fracture groups II and III Conclusion: sQCT provides a good risk assessment of the occurrence of vertebral body insufficiency fractures

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

2013 ◽  
Vol 19 (1) ◽  
pp. 90-94 ◽  
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.

scholarly journals The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion

2020 ◽  
Vol 49 (2) ◽  
pp. E8
Author(s):  
Zhuo Xi ◽  
Praveen V. Mummaneni ◽  
Minghao Wang ◽  
Huibing Ruan ◽  
Shane Burch ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Lumbar Interbody Fusion ◽  
Hounsfield Units ◽  
Cage Subsidence ◽  
Preoperative Ct ◽  
Grade Ii ◽  
The Mean ◽  
Grade Iii

OBJECTIVEOne vexing problem after lateral lumbar interbody fusion (LLIF) surgery is cage subsidence. Low bone mineral density (BMD) may contribute to subsidence, and BMD is correlated with Hounsfield units (HUs) on CT. The authors investigated if lower HU values correlated with subsidence after LLIF.METHODSA retrospective study of patients undergoing single-level LLIF with pedicle screw fixation for degenerative conditions at the University of California, San Francisco, by 6 spine surgeons was performed. Data on demographics, cage parameters, preoperative HUs on CT, and postoperative subsidence were collected. Thirty-six–inch standing radiographs were used to measure segmental lordosis, disc space height, and subsidence; data were collected immediately postoperatively and at 1 year. Subsidence was graded using a published grade of disc height loss: grade 0, 0%–24%; grade I, 25%–49%; grade II, 50%–74%; and grade III, 75%–100%. HU values were measured on preoperative CT from L1 to L5, and each lumbar vertebral body HU was measured 4 separate times.RESULTSAfter identifying 138 patients who underwent LLIF, 68 met the study inclusion criteria. All patients had single-level LLIF with pedicle screw fixation. The mean follow-up duration was 25.3 ± 10.4 months. There were 40 patients who had grade 0 subsidence, 15 grade I, 9 grade II, and 4 grade III. There were no significant differences in age, sex, BMI, or smoking. There were no significant differences in cage sizes, cage lordosis, and preoperative disc height. The mean segmental HU (the average HU value of the two vertebrae above and below the LLIF) was 169.5 ± 45 for grade 0, 130.3 ± 56.2 for grade I, 100.7 ± 30.2 for grade II, and 119.9 ± 52.9 for grade III (p < 0.001). After using a receiver operating characteristic curve to establish separation criteria between mild and severe subsidence, the most appropriate threshold of HU value was 135.02 between mild and severe subsidence (sensitivity 60%, specificity 92.3%). After univariate and multivariate analysis, preoperative segmental HU value was an independent risk factor for severe cage subsidence (p = 0.017, OR 15.694, 95% CI 1.621–151.961).CONCLUSIONSLower HU values on preoperative CT are associated with cage subsidence after LLIF. Measurement of preoperative HU values on CT may be useful when planning LLIF surgery.

scholarly journals Preliminary Results of Expandable Transforaminal Lumbar Interbody Fusion Cages

2021 ◽  
Vol 15 (1) ◽  
pp. 35-40
Author(s):  
Kyriakos Kitsopoulos ◽  
Bernd Wiedenhoefer ◽  
Stefan Hemmer ◽  
Christoph Fleege ◽  
Mohammad Arabmotlagh ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Life Outcomes ◽  
Disc Disease ◽  
Cage Subsidence ◽  
The Mean ◽  
Expandable Titanium Cage ◽  
Segmental Lordosis

Background: Compared with static cages, expandable cages for Transforaminal Lumbar Interbody Fusion (TLIF), are thought to require less posterior bony removal and nerve root retraction. They may allow the creation of a greater lordotic angle and lordosis restoration. Objective: This study investigated whether TLIF using an expandable lordotic interbody cage facilitates an improvement in both segmental lordosis and the restoration of intradiscal height. Methods: A total of 32 patients with 40 operated segments underwent TLIF surgery for lumbar degenerative disc disease and were consecutively included in this prospective observational study. Of those patients, 25 received monosegmental treatment, six were treated bisegmentally, and one was treated trisegmentally. All patients were assessed clinically and radiographically preoperatively, as well as one week, six months, and two years postoperatively. Results: Two patients required revision for screw loosening and pseudarthrosis. In four patients, the endplate was violated intraoperatively due to cage placement. Postoperatively, cage subsidence was observed in four patients. Significant improvement in the mean degree of spondylolisthesis was noted at the two-year mark. Mean segmental lordosis improved postoperatively. A significant increase in mean disc height of the treated segment was also found. Overall, with the exception of pain, no significant clinical or radiographic changes were reported between the first postoperative week and the two-year year follow-up mark. The mean pain, functional, and quality of life outcomes improved significantly from the preoperative to postoperative period, with no deterioration between six months and two years. Conclusion: This study demonstrates that favorable outcomes can be achieved by using an expandable titanium cage in TLIF procedures.

scholarly journals Comparison of Incidence of Adjacent Segment Pathology between Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion Treatments for Lumbosacral Junction

Tomography ◽  
2021 ◽  
Vol 7 (4) ◽  
pp. 855-865
Author(s):  
Po-Kuan Wu ◽  
Meng-Huang Wu ◽  
Cheng-Min Shih ◽  
Yen-Kuang Lin ◽  
Kun-Hui Chen ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Medical Center ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Lumbosacral Junction ◽  
The Mean ◽  
Anterior Interbody Lumbar Fusion

This research compared the incidence of adjacent segment pathology (ASP) between anterior interbody lumbar fusion (ALIF) treatment and transforaminal lumbar interbody fusion (TLIF) treatment. Seventy patients were included in this retrospective study: 30 patients received ALIF treatment, and 40 patients received TLIF treatment at a single medical center between 2011 and 2020 with a follow-up of at least 12 months. The outcomes were radiographic adjacent segment pathology (RASP) and clinical adjacent segment pathology (CASP). The mean follow-up period was 42.10 ± 22.61 months in the ALIF group and 56.20 ± 29.91 months in the TLIF group. Following single-level lumbosacral fusion, ALIF is superior to TLIF in maintaining lumbar lordosis, whereas the risk of adjacent instability in the ALIF group is significantly higher. Regarding ASP, the incidence of overall RASP and CASP did not differ significantly between ALIF and TLIF groups.

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