Segmental lumbar sagittal correction after bilateral transforaminal lumbar interbody fusion

Object In this paper the authors sought to determine the segmental lumbar sagittal contour change after bilateral transforaminal lumbar interbody fusion (TLIF). Methods Between March 2007 and October 2010, 42 consecutive patients (57 levels) underwent bilateral TLIF. Standard preoperative and 6-week postoperative standing lumbar spine radiographs were examined. Preoperative and postoperative segmental lordosis was determined by manual measurements using the Cobb method. The difference between the preoperative and postoperative values were calculated and analyzed for statistical significance. Results The mean preoperative segmental alignment was 8.1°. The mean postoperative alignment was 15.3°, with a mean correction of 7.2° per segment. The largest gain in lordosis was obtained at the L5–S1 level (10.1°). There was a significant difference between the preoperative and postoperative values (p = 5 × 10−9). There was no significant difference in mean segmental correction between levels. Improvement in lordosis was higher in multilevel fusions (9.8°) than in single-level fusions (5.2°) (p = 0.047). There was an inverse correlation between preoperative sagittal lordosis measurement and change in lordosis (r = −0.599). Conclusions A significant improvement in lumbar lordosis can be gained by preforming bilateral facetectomies in TLIF with posterior compression. This procedure provides an additional option to a spine surgeon's armamentarium in dealing with significant lumbar sagittal plane deformities.

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Clinical and radiographic comparison of mini–open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up

Journal of Neurosurgery Spine ◽

10.3171/spi.2008.9.08142 ◽

2008 ◽

Vol 9 (6) ◽

pp. 560-565 ◽

Cited By ~ 234

Author(s):

Sanjay S. Dhall ◽

Michael Y. Wang ◽

Praveen V. Mummaneni

Keyword(s):

Blood Loss ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Open Group ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Mean ◽

Mini Open

Object As minimally invasive approaches gain popularity in spine surgery, clinical outcomes and effectiveness of mini–open transforaminal lumbar interbody fusion (TLIF) compared with traditional open TLIF have yet to be established. The authors retrospectively compared the outcomes of patients who underwent mini–open TLIF with those who underwent open TLIF. Methods Between 2003 and 2006, 42 patients underwent TLIF for degenerative disc disease or spondylolisthesis; 21 patients underwent mini–open TLIF and 21 patients underwent open TLIF. The mean age in each group was 53 years, and there was no statistically significant difference in age between the groups (p = 0.98). Data were collected perioperatively. In addition, complications, length of stay (LOS), fusion rate, and modified Prolo Scale (mPS) scores were recorded at routine intervals. Results No patient was lost to follow-up. The mean follow-up was 24 months for the mini-open group and 34 months for the open group. The mean estimated blood loss was 194 ml for the mini-open group and 505 ml for the open group (p < 0.01). The mean LOS was 3 days for the mini-open group and 5.5 days for the open group (p < 0.01). The mean mPS score improved from 11 to 19 in the mini-open group and from 10 to 18 in the open group; there was no statistically significant difference in mPS score improvement between the groups (p = 0.19). In the mini-open group there were 2 cases of transient L-5 sensory loss, 1 case of a misplaced screw that required revision, and 1 case of cage migration that required revision. In the open group there was 1 case of radiculitis as well as 1 case of a misplaced screw that required revision. One patient in the mini-open group developed a pseudarthrosis that required reoperation, and all patients in the open group exhibited fusion. Conclusions Mini–open TLIF is a viable alternative to traditional open TLIF with significantly reduced estimated blood loss and LOS. However, the authors found a higher incidence of hardware-associated complications with the mini–open TLIF.

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Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery

Neurosurgical FOCUS ◽

10.3171/2019.1.focus18695 ◽

2019 ◽

Vol 46 (4) ◽

pp. E18 ◽

Cited By ~ 16

Author(s):

Dong Hwa Heo ◽

Choon Keun Park

Keyword(s):

Interbody Fusion ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Transforaminal Lumbar Interbody Fusion ◽

Clinical Results ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Mean

OBJECTIVEThe aims of enhanced recovery after surgery (ERAS) are to improve surgical outcomes, shorten hospital stays, and reduce complications. The objective of this study was to introduce ERAS with biportal endoscopic transforaminal lumbar interbody fusion (TLIF) and to investigate the clinical results.METHODSPatients were divided into two groups based on the fusion procedures. Patients who received microscopic TLIF without ERAS were classified as the non-ERAS group, whereas those who received percutaneous biportal endoscopic TLIF with ERAS were classified as the ERAS group. The mean Oswestry Disability Index (ODI) and visual analog scale (VAS) scores were compared between the two groups. In addition, demographic characteristics, diagnosis, mean operative time, estimated blood loss (EBL), fusion rate, readmissions, and complications were investigated and compared.RESULTSForty-six patients were grouped into the non-ERAS group (microscopic TLIF without ERAS) and 23 patients into the ERAS group (biportal endoscopic TLIF with ERAS). The VAS score for preoperative back pain on days 1 and 2 was significantly higher in the non-ERAS group than in the ERAS group (p < 0.05). The mean operative duration was significantly higher in the ERAS group than in the non-ERAS group, while the mean EBL was significantly lower in the ERAS group than in the non-ERAS group (p < 0.05). There was no significant difference in fusion rate between the two groups (p > 0.05). Readmission was required in 2 patients who were from the non-ERAS group. Postoperative complications occurred in 6 cases in the non-ERAS group and in 2 cases in the ERAS group.CONCLUSIONSPercutaneous biportal endoscopic TLIF with an ERAS pathway may have good aspects in reducing bleeding and postoperative pain. Endoscopic fusion surgery along with the ERAS concept may help to accelerate recovery after surgery.

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Increased incidence of cage migration and nonunion in instrumented transforaminal lumbar interbody fusion with bioabsorbable cages

Journal of Neurosurgery Spine ◽

10.3171/2010.3.spine09587 ◽

2010 ◽

Vol 13 (3) ◽

pp. 388-393 ◽

Cited By ~ 28

Author(s):

Arien J. Smith ◽

Marc Arginteanu ◽

Frank Moore ◽

Alfred Steinberger ◽

Martin Camins

Keyword(s):

Carbon Fiber ◽

Interbody Fusion ◽

Demographic Data ◽

Transforaminal Lumbar Interbody Fusion ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Significant Difference ◽

Screw Breakage ◽

The Mean ◽

Cage Migration

Object Recent advances in the field of spinal implants have led to the development of the bioabsorbable interbody cage. Although much has been written about their advantageous characteristics, little has been reported regarding complications associated with these cages. The authors conducted this prospective cohort study to compare fusion and complication rates in patients undergoing transforaminal lumbar interbody fusion (TLIF) with carbon fiber cages versus biodegradable cages made from 70/30 poly(l-lactide-co-d,l-lactide) (PLDLA). Methods Between January 2005 and May 2006, 81 patients with various degenerative and/or structural pathologies affecting the lumbar spine underwent single- or multilevel TLIF with posterior segmental pedicle screw fixation using implants made of carbon fiber (37 patients) or 70/30 PLDLA (44 patients). Clinical and radiological follow-up was performed at 6 weeks, 3 months, 6 months, and 1 year, and is ongoing. The incidence of nonunion, screw breakage, and cage migration were compared between the 2 groups. Results There was no significant difference in demographic data between the 2 groups, the mean number of lumbar levels operated, or distribution of the levels operated. There was a significantly increased incidence of nonunion (8 patients, 18.2%) and cage migrations (8 patients, 18.2%) in patients receiving the PLDLA implants compared with carbon fiber implants (no patients) (p = 0.006 and 0.007, respectively). There was no significant difference in demographic data between patients with cage migration and the rest of the patient population. Five of the 8 cases of migration occurred at the L5–S1 level while the remaining 3 occurred at the L4–5 level. The mean time to implant failure was 9.3 months. Conclusions This study showed an increased incidence of nonunion (18.2%) and postsurgical cage migration (18.2%) in patients undergoing TLIF with biodegradable cages versus carbon fiber implants (0%) (p = 0.006 and 0.007, respectively).

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A Prospective Randomized Study of the Safety and Efficacy of Transforaminal Lumbar Interbody Fusion Versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis: A Cost utility from a Lower-middle-income Country Perspective and Review of Literature

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6569 ◽

2021 ◽

Vol 9 (B) ◽

pp. 636-645

Author(s):

Nasser El-Ghandour ◽

Mohamed Sawan ◽

Atul Goel ◽

Ahmed Assem Abdelkhalek ◽

Ahmad M. Abdelmotleb ◽

...

Keyword(s):

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Cost Utility ◽

Lumbar Interbody Fusion ◽

Safety And Efficacy ◽

Significant Difference ◽

The Mean ◽

Lumbar Spondylolisthesis

BACKGROUND: The safety and efficacy of transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis have not been validated in many prospective randomized trials. AIM: We aimed to validate the safety and efficacy of TLIF and PLIF surgery in lumbar spondylolisthesis using the clinical, radiographic, and cost-utility outcomes. METHODS: The data of surgically treated single-level spondylolisthesis patients were randomized prospectively into two groups. The groups were compared regarding demographics, perioperative complications, hospital stay, total expenditure, fusion rate, and clinical outcomes (visual analog scale, Oswestry disability index, Zurich claudication scale, and Odom’s criteria). A review of literature was done to compare the outcomes with the ones from higher-income nations. RESULTS: Thirty-three patients underwent prospective randomization. The improvement in the clinical outcomes at 12-month follow-up showed improvement in the TLIF group more than the PLIF group but with no significant difference. The mean operative time was significantly longer in the PLIF (p < 0.05), also, the blood loss was significantly less in the TLIF (p < 0.001). The complications frequency did not show any statistical significance between both groups and no significant difference in the patient’s post-operative patient satisfaction (p = 0.6). The mean hospital stay was non-significantly longer in the PLIF (p = 0.7). At 12-month follow-up, 93.3% of the TLIF patients were fused versus 86.7% of the PLIF (p = 0.5). The total cost of the TLIF was significantly less (p < 0.001). CONCLUSION: Both PLIF and TLIF could achieve similar fusion rates and clinical satisfaction in the management of lumbar spondylolisthesis. The TLIF group was significantly better in terms of financial burden, operative time, and blood loss.

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Modification of Magerl’s technique for the placement of translaminar facet screws in transforaminal lumbar interbody fusion: a technical note and comparative outcome analysis

10.21203/rs.3.rs-22186/v1 ◽

2020 ◽

Author(s):

Daoliang Xu ◽

Haimin Jin ◽

Jiaoxiang Chen ◽

Xiangyang Wang

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Spinal Canal ◽

Interbody Fusion ◽

Operation Time ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Modified Technique ◽

Significant Difference ◽

The Mean

Abstract Background To describe and illustrate a safe and effective technique for the placement of translaminar facet screws (TLFS) in transforaminal lumbar interbody fusion (TLIF). Methods Forty-two patients with single-level lumbar diseases were divided into two groups randomly. 21 patients were treated by traditional TLIF using bilateral pedicle screws fixation (BPS) while the other patients underwent insertion of a unilateral pedicle screw (UPS)and contralateral TLFS using our modified technique. In this technique, a small unicortical “hole” was formed adjacent to the contralateral facet joint to ensure that insertion of the screw could be directly visualized through the hole to prevent violation of the spinal canal. The ODI, JOA, VAPS questionnaire, the mean operation time, mean operative blood loss, length of stay and postoperative complications were collected for analysis. Results There is no significant difference between the BPS and UPS + TLFS group in the preoperative and postoperative ODI, JOA or VAPS at each follow- up visit, while the UPS + TLFS group using our modified technique significantly reduced the mean operation time, the mean estimated blood loss and the length of stay. These results demonstrated this modified technique to be safe and effective in TLIF. Conclusions In contrast to conventional TLIF, our modified technique for placing TLFS in TLIF can reduce soft tissue injuries, reduce the operation risk of violation of the spinal canal and the expenses, minimize radiation exposure, and shorten the length of the operation without a concurrent reduction in clinical efficacy.

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Oblique Fixation from Posterior Corner in Lumbar Spine Through Kambin’s Triangle: A Neuroimaging Anatomic Assessment

10.21203/rs.3.rs-28077/v1 ◽

2020 ◽

Author(s):

Feifei Chen ◽

Jun Xin ◽

Cheng Su ◽

Jianmin Sun ◽

Xiaoyang Liu ◽

...

Keyword(s):

Lumbar Spine ◽

Posterior Margin ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Nerve Roots ◽

Dural Sac ◽

Significant Difference ◽

One Stop ◽

The Mean

Abstract Background: Traditional lumbar interbody fusion has many limitations, such as large trauma, severe damage to the normal posterior structure, and long postoperative recovery period. With the advance of minimally invasive surgery and spinal endoscopy, new fusion technologies such as percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) and endoscopic transforaminal lumbar interbody fusion (Endo-LIF) through Kambin’s triangle with less trauma, less bleeding and faster recovery have been developed. However, nerve root injury and dural tears are important complications, and Kambin’s triangle is not "safe". Moreover, fusion after decompression often requires placement of a 14-mm channel, removal of more articular processes, fixation with posterior percutaneous pedicle screw, and changes of intraoperative position or anesthesia, which are inconvenient. One-stop percutaneous endoscopic transforaminal oblique fixation from posterior corner in lumbar spine overcomes the above limitations, and realizes one-stop decompression, fusion and fixation in a single regular minimally invasive channel. The purpose of this study is to measure the neuroimaging anatomic parameters of the nerves related to oblique fixation from posterior corner in lumbar spine through Kambin’s triangle, to define and evaluate the safe working area in Kambin’s triangle, and to identify the optimal target area for endoscopic fusion and fixation.Methods: Sixty volunteers (27 males and 33 females) underwent lumbar MR examination (VISTA,3D-STIR-TSE Sequence) and the data were uploaded to Philips (Achieva 1.5T MR) workstation. Three working targets (P1, P2, P3) were preset for oblique fixation from posterior corner in lumbar spine. The distances from the working targets to exiting nerve roots and dural sac/traversing nerve roots in the coronal and sagittal planes, and the distances from the exiting roots to the dural sac/traversing nerve roots in the upper and lower endplate planes were measured and statistically analyzed.Results: In L1/2–L5/S1, the P values of paired t-test for the distances (c1, c2, c3, c4, c5 and c6) from each target (P1, P2 and P3) to the ipsilateral exiting nerve roots and dural sac/traversing nerve roots were all greater than 0.05. There were no statistically significant differences between the targets at both sides of the same segment, and the mean values of both sides were calculated. The c1, c2, c3, c4, c5 and c6 all increased and then decreased, gradually increased from L1/2, maximized in L4/5, and decreased slightly in L5/S1. As the targets (P1, P2, P3) moved laterally along the horizontal midline of the posterior margin of intervertebral disc, the distance to the dural sac/traversing nerve roots gradually increased, while the distance to the exiting roots gradually decreased. The distance from P1 to exiting nerve roots was significantly greater (1–3 mm) than that to dural sac/traversing nerve roots. The distance from P3 to exiting nerve roots was significantly smaller (1–3 mm) than that to dural sac/traversing nerve roots. The distances from P2 to exiting nerve roots and to dural sac/traversing nerve roots did not different significantly in each segment, and the differences in means were within 1 mm.The distances from exiting nerve roots to dural sac/traversing nerve roots in the upper and lower endplate planes (d1, d2) gradually increased in L1/2–L5/S1 (P<0.0001) and the means of d2 were greater than d1 (P<0.05). There was no statistically significant difference between the left and right sides in the upper and lower endplates in each segment (P=0.26).In L1/2–L5/S1, the P values of paired t-test for the distances (s1, s2, s3, s4, s5, s6) from the projection points of posterior-inferior (posterior-superior) corner of upper (lower) vertebral body to exiting nerve roots in the sagittal planes passing the targets were all greater than 0.05. There was no statistically significant difference between both sides of the same segment, and thus the mean value was calculated. With the outward shift of the targets in the sagittal planes, s1, s3 and s5 gradually decreased (s1>s3>s5), and the same trend was found for s2, s4 and s6 (s2>s4>s6). The distances gradually increased in each segment from the smallest value in L1/2 to the largest value in L5/S1.Conclusion: Kambin’s triangle can be used as a working area for oblique fixation from posterior corner in lumbar spine, but the actual safe area is smaller than theoretical prediction. The intersection point between the vertical line from the medial 1/3 of pedicle and the horizontal midline of the posterior margin of intervertebral disc (P2) is an ideal "target" for oblique fixation from posterior corner in lumbar spine. It is neuroanatomically feasible to achieve one-stop complete decompression, fusion, and fixation in a single channel under spinal endoscopy. Further biomechanical studies and clinical trials are needed to determine whether it can be a new option for posterior spinal fusion.

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Preliminary Results of Expandable Transforaminal Lumbar Interbody Fusion Cages

The Open Orthopaedics Journal ◽

10.2174/1874325002115010035 ◽

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.

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Effects of Orthokeratology Lens On Axial Length Elongation in Myopia With Anisometropia Children

10.21203/rs.3.rs-741927/v1 ◽

2021 ◽

Author(s):

Ziyang Chen ◽

Kai-Ming Chen ◽

Ying Shi ◽

Zhao-Da Ye ◽

Sheng Chen ◽

...

Keyword(s):

Retrospective Study ◽

Axial Length ◽

Statistical Significance ◽

Spherical Equivalent ◽

Significant Difference ◽

The Mean ◽

The Difference ◽

Better Than ◽

Group 1

Abstract AimTo investigate the effect of orthokeratology (OK) lens on axial length (AL) elongation in myopia with anisometropia children.MethodsThirty-seven unilateral myopia (group 1) and fifty-nine bilateral myopia with anisometropia children were involved in this 1-year retrospective study. And bilateral myopia with anisometropia children were divided into group 2A (diopter of the lower SER eye under − 2.00D) and group 2B(diopter of the lower SER eye is equal or greater than − 2.00D). The change in AL were observed.The datas were analysed using SPSS 21.0.Results(1) In group 1, the mean baseline AL of the H eyes and L eye were 24.70 ± 0.89 mm and 23.55 ± 0.69 mm, respectively. In group 2A, the mean baseline AL of the H eyes and L eyes were 24.61 ± 0.84 mm and 24.00 ± 0.70 mm respectively. In group 2B, the mean baseline AL of the H eyes and L eyes were 25.28 ± 0.72 mm and 24.70 ± 0.74 mm. After 1 year, the change in AL of the L eyes was faster than the H eyes in group 1 and group 2A (all P<0.001).While the AL of the H eyes and L eyes had the same increased rate in group 2B. (2) The effect of controlling AL elongation of H eyes is consistent in three groups (P = 0.559).The effect of controlling AL elongation of L eyes in group 2B was better than that in group 1 and group 2A (P < 0.001). And the difference between group 1 and group 2A has no statistical significance. (3) The AL difference in H eyes and L eyes decreased from baseline 1.16 ± 0.55mm to 0.88 ± 0.68mm after 1 year in group 1.And in group 2A, the AL difference in H eyes and L eyes decreased from baseline 0.61 ± 0.34mm to 0.48 ± 0.28mm. There was statistically significant difference (all P<0.001). In group 2B, the baseline AL difference in H eyes and L eyes has no significant difference from that after 1 year (P = 0.069).ConclusionsMonocular OK lens is effective on suppression AL growth of the myopic eyes and reduce anisometropia value in unilateral myopic children. Binocular OK lenses only reduce anisometropia with the diopter of the low eye under − 2.00D. Binocular OK lenses cannot reduce anisometropia with the diopter of the low eye equal or greater than − 2.00D. Whether OK lens can reduce refractive anisometropia value is related to the spherical equivalent refractive of low refractive eye in bilateral myopia with anisometropia children after 1-year follow-up.

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Biomechanical comparison between cortical screw–rod construct versus pedicle screw–rod construct in transforaminal lumbar interbody fusion

Journal of Orthopaedic Surgery ◽

10.1177/2309499017690656 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901769065

Author(s):

Chris Chan Yin Wei ◽

Sem Sei Haw ◽

Elrofai Suliman Bashir ◽

Saw Lim Beng ◽

Rukmanikanthan Shanmugam ◽

...

Keyword(s):

Lumbar Spine ◽

Pedicle Screw ◽

Interbody Fusion ◽

Testing Machine ◽

Transforaminal Lumbar Interbody Fusion ◽

Axial Rotation ◽

Lumbar Interbody Fusion ◽

Lateral Flexion ◽

Cortical Screw ◽

Significant Difference

Objective: To compare construct stiffness of cortical screw (CS)-rod transforaminal lumbar interbody fusion (TLIF) construct (G2) versus pedicle screw (PS)-rod TLIF construct (G1) in the standardized porcine lumbar spine. Methods: Six porcine lumbar spines (L2–L5) were separated into 12 functional spine units. Bilateral total facetectomies and interlaminar decompression were performed for all specimens. Non-destructive loading to assess stiffness in lateral bending, flexion and extension as well as axial rotation was performed using a universal material testing machine. Results: PS and CS constructs were significantly stiffer than the intact spine except in axial rotation. Using the normalized ratio to the intact spine, there is no significant difference between the stiffness of PS and CS: flexion (1.41 ± 0.27, 1.55 ± 0.32), extension (1.98 ± 0.49, 2.25 ± 0.44), right lateral flexion (1.93 ± 0.57, 1.55 ± 0.30), left lateral flexion (2.00 ± 0.73, 2.16 ± 0.20), right axial rotation (0.99 ± 0.21, 0.83 ± 0.26) and left axial rotation (0.96 ± 0.22, 0.92 ± 0.25). Conclusion: The CS-rod TLIF construct provided comparable construct stiffness to a traditional PS-rod TLIF construct in a ‘standardized’ porcine lumbar spine model.

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Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.3.198 ◽

2006 ◽

Vol 4 (3) ◽

pp. 198-205 ◽

Cited By ~ 38

Author(s):

Hiroshi Taneichi ◽

Kota Suda ◽

Tomomichi Kajino ◽

Akira Matsumura ◽

Hiroshi Moridaira ◽

...

Keyword(s):

Clinical Outcomes ◽

Interbody Fusion ◽

Japanese Orthopaedic Association ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Anterior Column ◽

Lumbar Interbody Fusion ◽

Anterior Column Support ◽

The Mean

Object There are no published reports of unilateral transforaminal lumbar interbody fusion (TLIF) in which two Brantigan I/F cages were placed per level through a single portal to achieve bilateral anterior-column support. The authors describe such a surgical technique and evaluate the clinical outcomes of this procedure. Methods Data obtained in 86 (93.5%) of the first 92 consecutive patients who underwent the procedure were retrospectively reviewed; the minimum follow-up duration was 2 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Disc height, disc angle, cage positioning in the axial plane, and fusion status were radiographically evaluated. The mean follow-up period was 33.8 months. The mean improvement in the JOA score was 77.2%. Fusion was successful in 93% of the cases. According to the Farfan method, the mean anterior and posterior disc heights increased from 20.2 and 16.9% preoperatively to 35.9 and 22.7% at follow up, respectively (p < 0.01). The mean disc angle increased from 4.8° preoperatively to 7.5° at last follow-up examination (p < 0.01). Two cages were correctly placed to achieve bilateral anterior-column support in greater than 85% of the cases. The following complications occurred: hardware migration in two patients and deep infection cured by intravenous antibiotic therapy in one patient. Conclusions Unilateral TLIF involving the placement of two Brantigan cages per level led to good clinical results. Two Brantigan cages were adequately placed via a single portal, and reliable bilateral anterior-column support was achieved. Although the less invasive unilateral approach was used, the outcomes were as good as those in many reported series of posterior lumbar interbody fusion in which the Brantigan cages were placed via the bilateral approach.

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