Reduction and transforaminal lumbar interbody fusion with posterior fixation versus transsacral cage fusion in situ with posterior fixation in the treatment of Grade 2 adult isthmic spondylolisthesis in the lumbosacral spine

Object In situ transsacral fusion in the treatment of low-grade isthmic spondylolisthesis has rarely been reported. The authors treated 13 cases of L-5 Grade 2 isthmic spondylolisthesis associated with collapsed disc space and osteoporosis by using transsacral fusion and fixation, and compared its clinical and radiological outcomes with the results of transforaminal lumbar interbody fusion (TLIF) and instrumental reduction in 21 patients. Methods The authors retrospectively analyzed 21 patients in Group A who were treated with reduction and TLIF, and 13 patients in Group B who were treated with transsacral cage fusion. Oswestry Disability Index and visual analog scale scores of back and leg pain were used to evaluate clinical outcomes. Radiological parameters for assessment included the percentage of slippage, whole lumbar lordosis, and lumbosacral angle. Operative data, fusion rate, and perioperative complications were recorded as well. Results The mean operation time and blood loss in Group B was less than that in Group A. Both groups realized good recovery from previous symptoms. The decrease in back and leg pain after surgery was significant within each group, without much difference between the 2 groups. No significant differences were found in lumbosacral angle, whole lumbar lordosis, visual analog scale score, and Oswestry Disability Index score between the 2 groups after surgery. The solid fusion rate was 95.2% in Group A and 92.3% in Group B. In Group A, 2 patients suffered from graft site pain, 1 had a superficial infection, and 1 had screw loosening; in Group B, dural tears were found in 2 patients, transient S-1 paresthesia in 2, and extensor hallucis longus muscle weakness in 1. Conclusions For patients with a collapsed disc space and poor bone quality, posterior in situ transsacral cage fusion may be used as an alternative to the TLIF procedure. The short-term clinical and radiological outcomes in the transsacral cage group were comparable with those in the TLIF group, although with a relatively higher neurological complication rate.

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Augmenting posterolateral fusion with transforaminal lumbar interbody fusion cage improves clinical outcome, but not fusion rate, of posterior decompression

Journal of International Medical Research ◽

10.1177/0300060520910025 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006052091002

Author(s):

Teoman Atici ◽

Selcan Yerebakan ◽

Cenk Ermutlu ◽

Ali Özyalçın

Keyword(s):

Clinical Outcome ◽

Spinal Stenosis ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Posterior Decompression ◽

Group A ◽

Group B ◽

Lumbar Spinal

Objective This study was performed to compare fusion rates and clinical outcomes of posterior decompression by posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for treatment of lumbar spinal stenosis. Methods This retrospective cohort study involved 157 patients with lumbar spinal stenosis treated with instrumented PLF alone or instrumented PLF combined with TLIF from 2010 to 2018. The patients were divided into two groups: the PLF group (Group A), in which posterior decompression with instrumented PLF was performed, and the cage-augmented group (Group B), in which TLIF was added to the procedures described for the PLF group. Patient outcomes (Oswestry Disability Index, visual analog scale score, and 36-Item Short-Form Health Survey scores) and fusion rates were compared. Results The fusion rate was similar between the two groups. Among patients with two- and three-level fusion, improvements in the clinical outcome scores were significantly greater in Group B than Group A. Conclusion Combining TLIF with PLF provides better clinical outcomes than PLF alone when multilevel fusion is indicated. TLIF augmentation does not improve the fusion rates in either single- or multi-level surgery.

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Minimally Invasive Transforaminal Lumbar Interbody Fusion With Intraoperative Fluoroscopy for Disc Space Preparation: Analysis of Fusion Rate and Clinical Results

Neurosurgery ◽

10.1093/neuros/opaa178_s153 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S153-S153

Author(s):

Guang-Xun Lin ◽

Sagar Sharma ◽

Gang Rui ◽

Myung-Soo Song ◽

Jin-Sung Kim

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Clinical Results ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Intraoperative Fluoroscopy

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A Comparison of the Bridge-type ROI-C Interbody Fusion Cage System and Titanium Mesh Graft With Titanium Plate Fixation in 2-level Anterior Cervical Discectomy and Fusion With Plating and Cage System: A Retrospective Study

10.21203/rs.3.rs-48049/v1 ◽

2020 ◽

Author(s):

Shuangjun He ◽

Zhangzhe Zhou ◽

Xiaofeng Shao ◽

Changhao Zhang ◽

Xinfeng Zhou ◽

...

Keyword(s):

Interbody Fusion ◽

Operation Time ◽

Fusion Rate ◽

Cage System ◽

Significant Difference ◽

Group A ◽

Bridge Type ◽

Group B ◽

Fusion Cage

Abstract Objective To explore the clinical efficacy and radioactive results of the bridge-type ROI-C interbody fusion cage (ROI-C) and anterior cervical discectomy and fusion with plating and cage system (ACDF) for cervical spondylopathy. Methods From January 2014 to January 2018, 45 patients undergoing ACDF were retrospectively analyzed, including 24 cases of ROI-C (group A) and 21 cases of ACDF (group B). The operation time, blood loss, Neck Disability Index (NDI), Japanese Orthopaedic Association score (JOA), postoperative complications, imaging results including cervical Cobb angle and fusion were compared between groups. Results All patients were successfully treated with surgery, and no cerebrospinal fluid leakage, esophageal fistula, or hoarseness occurred after surgery. The operation time and blood loss in group A were lower than those in group B (P < 0.05). During the follow-up period, JOA score increased and NDI score decreased after operation (P < 0.05), but there was no significant difference between the groups (P > 0.05). The incidence of dysphagia in group A was lower than that in group B at 1 month and 3 months after operation (P < 0.05), but the final follow-up results showed that there was no significant difference in the incidence of dysphagia between the two groups (P > 0.05). In group A, the fusion rate was 83.3% 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 12.5%. In group B, the fusion rate was 85.7% 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 23.8%. Conclusion Both ROI-C and ACDF can achieve satisfactory results, but ROI-C has shorter operation time, less bleeding and lower incidence of dysphagia in the short term.

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Minimally Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis: In Situ Versus Reduction

World Neurosurgery ◽

10.1016/j.wneu.2016.02.033 ◽

2016 ◽

Vol 90 ◽

pp. 580-587.e1 ◽

Cited By ~ 16

Author(s):

Guoxin Fan ◽

Guangfei Gu ◽

Yanjie Zhu ◽

Xiaofei Guan ◽

Annan Hu ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Isthmic Spondylolisthesis

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Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease and Risk of Adjacent Segment Disease

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v24i2.439 ◽

2020 ◽

Vol 24 (2) ◽

Author(s):

IJAZ HUSSAIN WADD ◽

ASIF SHABIR ◽

LIAQAT MEHMOOD AWAN ◽

SYED MOHSIN AJMAL ◽

HUMAIRA MUSHTAQ ◽

...

Keyword(s):

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Disease ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Age Related ◽

Significant Difference ◽

Group A ◽

Group B

Objective: To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF). Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level. Results: The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05). Conclusion: Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome.

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Functional and radiological comparison of transforaminal lumbar interbody fusion method with interbody fusion device versus stand-alone bone graft in lumbar canal stenosis or degenerative lumbar instability

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210195 ◽

2021 ◽

Vol 7 (2) ◽

pp. 291

Author(s):

Ashish Kumar Gupta ◽

Jitendra Singh Rathore ◽

Lokpal Singh Bhati ◽

Devendra Singh Rathore ◽

R. C. Meena

Keyword(s):

Bone Graft ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Group Comparison ◽

Vas Score ◽

Current Series ◽

Local Bone ◽

Rate Score ◽

Group A

Background: Spinal stability is the vertebral ability to maintain their relationship and limit their relative displacements during physiologic postures and loads.Methods: Hospital based prospective randomized comparative study design between 2 groups included patients of both sex attending SMS hospital Jaipur, from April 2018 to June 2019 or till sample size was achieved, with due permission from institutional ethical committee and review board and after taking written informed consent from patients.Results: Inter group comparison of VAS score showed same results in both groups which showed statistically non-significant results. VAS score showed significantly reduction in both group A and B till the study period. Inter group comparison of ODI score showed same results in both groups which showed statistically non-significant results. ODI score showed significantly reduction in both group A and B till the study period. Inter group comparison of fusion rate score showed same results in both groups which showed statistically non-significant results. Fusion rate score showed significantly increased in both group A and B till the study period and at the 12 month it was 100% fusion rate.Conclusions: In the current series, the TLIF procedure with local bone graft alone improved anterior vertebral translation, disc height, and lumbar lordosis. A proper surgical technique with adequate discectomy and facetectomy would contribute greatly to the improvement of the radiological parameters; however, this improvement was not maintained at the latest follow up.

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A comparison of the bridge-type ROI-C interbody fusion cage system and ACDF with plating and cage system in 2-level anterior cervical discectomy and fusion: A retrospective study

10.21203/rs.3.rs-48049/v2 ◽

2021 ◽

Author(s):

Shuangjun He ◽

Zhangzhe Zhou ◽

Xiaofeng Shao ◽

Changhao Zhang ◽

Xinfeng Zhou ◽

...

Keyword(s):

Interbody Fusion ◽

Operation Time ◽

Fusion Rate ◽

Postoperative Dysphagia ◽

Cage System ◽

Group A ◽

Bridge Type ◽

Group B ◽

Fusion Cage

Abstract Objective: A study was conducted to explore the clinical efficacy and radioactive results of the bridge-type ROI-C interbody fusion cage (ROI-C) and anterior cervical discectomy and fusion with plating and cage system (ACDF) for cervical spondylopathy.Methods: From January 2014 to January 2018, 45 patients who underwent operations were retrospectively analyzed, including 24 cases of ROI-C (group A) and 21 cases of ACDF (group B). The operation time, blood loss, Neck Disability Index (NDI), Japanese Orthopaedic Association score (JOA), postoperative complications, imaging results including cervical Cobb angle, and fusion were compared between groups.Results: All patients were successfully treated with surgery. No cerebrospinal fluid leakage, esophageal fistula, or hoarseness occurred after the surgery. The operation time and blood loss in group A were lower than those in group B (P<0.05). During the follow-up period, JOA score increased and NDI score decreased after the operation (P<0.05), but no significant difference was found between the groups (P>0.05). In group A, the incidence of postoperative dysphagia was 12.5%, which returned to normal after 1 month. In group B, the incidence of postoperative dysphagia was 38.1%, which was 19% after 1 month and 4.8% at the final follow-up. In group A, the fusion rate was 83.3% at 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 12.5%. In group B, the fusion rate was 85.7% at 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 23.8%.Conclusion: Both ROI-C and ACDF achieved satisfactory results, but ROI-C had a shorter operation time, less bleeding, and lower incidence of dysphagia in the short term.

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Clinical and radiographically/neuroimaging documented outcome in transforaminal lumbar interbody fusion

Neurosurgical FOCUS ◽

10.3171/foc.2006.20.3.9 ◽

2006 ◽

Vol 20 (3) ◽

pp. 1-5 ◽

Cited By ~ 29

Author(s):

John K. Houten ◽

Nicholas H. Post ◽

Joseph W. Dryer ◽

Thomas J. Errico

Keyword(s):

Back Pain ◽

Disc Herniation ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Leg Pain ◽

Sensory Loss ◽

Symptom Duration ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Recurrent Disc Herniation

Object Although transforaminal lumbar interbody fusion (TLIF) is an increasingly popular surgical technique, there are a limited number of studies in which investigators have stratified outcome data with respect to surgical indications or documented radiographically proven and clinical results with respect to disc space height (DSH). The authors conducted a study to evaluate the long-term outcomes after TLIF with respect to surgical indication and radiographic/neuroimaging results. Methods Thirty-three consecutive TLIF-treated patients underwent follow-up investigation for a mean of 37 months. Isthmic spondylolysis was present in eight patients, recurrent disc herniation in 14, and degenerative disc disease (DDD) in 11. The operative technique involved the placement of interbody structural allograft, pedicle screw instrumentation, and morcellized autograft in the anterior interbody space and the contralateral intertransverse gutter. Surgery was performed at L4–5 in 16 patients, L5–S1 in 14, L3–4 in two, and both L4–5 and L5–S1 in one patient. Preoperative symptoms were back pain (in 91% of cases), leg pain (in 94%), sensory loss (in 67%), and motor deficits (in 30%). Postoperatively, back pain was improved in 67% of the patients, unchanged in 27%, and worsened in 7%. Leg pain improved in 80% of patients, was unchanged in 10%, and worsened in 10%. Outcome, as measured using the Prolo Functional and Economic Scales, improved from a score of 4.9 to 7. In patients with spondylolysis and recurrent disc herniation outcomes were better than in those with DDD only. There was no correlation of outcome with symptom duration, patient age, or level of surgery. In an independent review of pre- and late postoperative radiographs no significant differences in lordosis angles, Cobb angles, or DSHs were found. Fusion occurred in all cases. Conclusions The TLIF procedure was associated with good clinical outcomes and a high fusion rate but no change in the DSH. Patients who present with spondylolysis and recurrent herniations experience better outcome than those with degenerative disease alone.

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Efficacy of Platelet-Rich Plasma for Bone Fusion in Transforaminal Lumbar Interbody Fusion

Asian Spine Journal ◽

10.4184/asj.2018.12.1.112 ◽

2018 ◽

Vol 12 (1) ◽

pp. 112-118 ◽

Cited By ~ 5

Author(s):

Go Kubota ◽

Hiroto Kamoda ◽

Sumihisa Orita ◽

Kazuhidee Inage ◽

Michihiro Ito ◽

...

Keyword(s):

Interbody Fusion ◽

Platelet Rich Plasma ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Bone Union ◽

Leg Pain ◽

Control Group ◽

Bone Fusion ◽

Local Bone ◽

Fusion Cage

<sec><title>Study Design</title>Retrospective case series.</sec><sec><title>Purpose</title>To examine the efficacy of platelet-rich plasma (PRP) for bone fusion in transforaminal lumbar interbody fusion (TLIF) using local bone grafting.</sec><sec><title>Overview of Literature</title>Several authors have reported the efficacy of PRP for bone union in animal models. However, the use of PRP for bone fusion in TLIF surgery has not been fully explored.</sec><sec><title>Methods</title>Twenty patients underwent single-level TLIF surgery because of L4 spondylolisthesis. An interbody fusion cage and local bone were used in nine patients (control group) and an interbody fusion cage, local bone, and PRP were used in 11 patients (PRP group). PRP was prepared from the patients' blood samples (400 mL) immediately before surgery. The duration of bone union and postoperative bone fusion rate were assessed using plain radiography at every 3 months postoperatively and computed tomography at 12 or 24 months postoperatively, respectively. Lower back pain, leg pain, and leg numbness were evaluated using the visual analog scale preoperatively and at 3, 6, 12, and 24 months postoperatively.</sec><sec><title>Results</title>The platelet count was 8.7 times higher in PRP than in blood. The bone union rate was significantly superior in the PRP group than in the control group (91% and 77%, respectively; <italic>p</italic>=0.035), whereas the average duration of bone union was not significantly different between the groups (7.7±0.74 and 10.0±2.00 months, respectively; <italic>p</italic>=0.131). There was no significant difference in lower back pain, leg pain, and leg numbness in both groups during follow-up (<italic>p</italic>>0.05).</sec><sec><title>Conclusions</title>Our study suggests that the use of PRP in TLIF surgery increases bone fusion rate.</sec>

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Low-grade spondylolisthesis: is transforaminal lumbar interbody fusion superior to posterolateral fusion

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201734 ◽

2020 ◽

Vol 6 (3) ◽

pp. 597

Author(s):

Hiranya Kumar Seenappa ◽

Karthik Narayanamurthy Mittemari ◽

Vamshikrishna Chand Nimmagadda

Keyword(s):

Clinical Outcomes ◽

Oswestry Disability Index ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Posterolateral Fusion ◽

Leg Pain ◽

Low Grade ◽

Lumbar Interbody Fusion ◽

Caudal Segment

Background: Spondylolisthesis is anterior translation of the cephalad vertebra relative to the adjacent caudal segment. Both posterolateral fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) and have shown high fusion rates with good clinical outcomes. But it is not clear which treatment leads to better outcomes, as limited studies have been done to compare PLF and TLIF in low grade spondylolisthesis. Our objective is to determine whether PLF or TLIF was associated with better clinical and radiological outcomes in patients with low grade spondylolisthesis.Methods: Fourty patients were enrolled and assigned into PLF (n=20) or TLIF (n=20) group. The outcome measures were: clinical outcomes as assessed with a visual analogue scale and the modified Oswestry disability index, the fusion rate based on radiographs.Results: The improvement of visual analog score (VAS) of low back pain was greater in TLIF than in PLF (89.6% versus 88.7%, p=0.79). The improvement of VAS of leg pain was greater in TLIF than in PLF (96.5% versus 94.8%; p=0.27). The improvement of Oswestry disability index (ODI) was greater in TLIF than in PLF (71.7% vs 69.8%, p=0.32). The fusion rate was 85% in TLIF and 75% in PLF (p=0.43). Overall outcome was excellent in 80% in TLIF compared to 65% in PLF (p=0.29).Conclusions: Fusion rates are higher in TLIF and average functional outcomes (VAS and ODI) were better in TLIF compared to PLF. Larger and longer studies may provide a significant outcome. Based on our results and literature review, we conclude that TLIF is superior to PLF.

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