scholarly journals Anterior lumbar compared to oblique lumbar interbody approaches for multilevel fusions to the sacrum in adults with spinal deformity and degeneration

2020 ◽  
Vol 33 (4) ◽  
pp. 461-470
Author(s):  
Zhuo Xi ◽  
Dean Chou ◽  
Praveen V. Mummaneni ◽  
Huibing Ruan ◽  
Charles Eichler ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Height Change ◽  
The Mean ◽  
Segmental Lordosis ◽  
Lateral Interbody

OBJECTIVEIn adult spinal deformity and degenerative conditions of the spine, interbody fusion to the sacrum often is performed to enhance arthrodesis, induce lordosis, and alleviate stenosis. Anterior lumbar interbody fusion (ALIF) has traditionally been performed, but minimally invasive oblique lumbar interbody fusion (OLIF) may or may not cause less morbidity because less retraction of the abdominal viscera is required. The authors evaluated whether there was a difference between the results of ALIF and OLIF in multilevel anterior or lateral interbody fusion to the sacrum.METHODSPatients from 2013 to 2018 who underwent multilevel ALIF or OLIF to the sacrum were retrospectively studied. Inclusion criteria were adult spinal deformity or degenerative pathology and multilevel ALIF or OLIF to the sacrum. Demographic, implant, perioperative, and radiographic variables were collected. Statistical calculations were performed for significant differences.RESULTSData from a total of 127 patients were analyzed (66 OLIF patients and 61 ALIF patients). The mean follow-up times were 27.21 (ALIF) and 24.11 (OLIF) months. The mean surgical time was 251.48 minutes for ALIF patients and 234.48 minutes for OLIF patients (p = 0.154). The mean hospital stay was 7.79 days for ALIF patients and 7.02 days for OLIF patients (p = 0.159). The mean time to being able to eat solid food was 4.03 days for ALIF patients and 1.30 days for OLIF patients (p < 0.001). After excluding patients who had undergone L5–S1 posterior column osteotomy, 54 ALIF patients and 41 OLIF patients were analyzed for L5–S1 radiographic changes. The mean cage height was 14.94 mm for ALIF patients and 13.56 mm for OLIF patients (p = 0.001), and the mean cage lordosis was 15.87° in the ALIF group and 16.81° in the OLIF group (p = 0.278). The mean increases in anterior disc height were 7.34 mm and 4.72 mm for the ALIF and OLIF groups, respectively (p = 0.001), and the mean increases in posterior disc height were 3.35 mm and 1.24 mm (p < 0.001), respectively. The mean change in L5–S1 lordosis was 4.33° for ALIF patients and 4.59° for OLIF patients (p = 0.829).CONCLUSIONSPatients who underwent multilevel OLIF and ALIF to the sacrum had comparable operative times. OLIF was associated with a quicker ileus recovery and less blood loss. At L5–S1, ALIF allowed larger cages to be placed, resulting in a greater disc height change, but there was no significant difference in L5–S1 segmental lordosis.

scholarly journals Anterior Lumbar Interbody Fusion (ALIF) versus Oblique Lateral Interbody Fusion (OLIF) at L5-S1: A Comparison of Two Approaches to the Lumbosacral Junction

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Zhuo Xi ◽  
Shane Burch ◽  
Chih-Chang Chang ◽  
Hui-bing Ruan ◽  
Charles M Eichler ◽  
...  
Keyword(s):  
Blood Loss ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Lateral Interbody Fusion ◽  
Height Increase ◽  
Segmental Lordosis ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Abstract INTRODUCTION The oblique lateral interbody fusion OLIF is an alternative anterior approach to the lumbar spine at L5-S1, and it is unknown how it compares to anterior lumbar interbody fusion ALIF. This abstract is to compare the radiographic and clinical factors of ALIF and OLIF at L5-S1 only. METHODS A retrospective review of patients who underwent ALIF or OLIF at L5-S1 only at the University of California San Francisco (2013-2018) was performed. Data collected were demographics, cage parameters, perioperative factors, and radiographic parameters. RESULTS A total of 58 patients were included (33 ALIF and 25 OLIF). The average surgical time was 211.94 min for ALIF and 154.86 min for OLIF (P < .001). The average blood loss was 214 ml for ALIF and 74 ml for OLIF (P < .001). The average day to solid food was 2.55 for ALIF and 0.8 for OLIF (P < .001). The average cage height was 14.78 mm for ALIF and 12.9 mm (P < .001) for OLIF. The average cage lordosis was 15.45° for ALIF and 12.68° (P = .76) for OLIF. Average anterior L5-S1 disc height increase was 8.52 mm (ALIF) and 5.02 mm (OLIF) (P = .018), and average posterior L5-S1 disc height increase was 3.34 mm (ALIF) and 1.30 mm (OLIF) (P = .034). The average L5-S1 segmental lordosis increase was 6.82° for ALIF and 7.63° for OLIF (P = .638). CONCLUSION Patients who underwent OLIF at L5-S1 had shorter ileus duration compared to ALIF and comparable operative times and blood loss. ALIF afforded larger cages to be placed, resulting in greater disc height, but there was no significant difference in L5-S1 segmental lordosis.

scholarly journals Prevalence and location of endplate fracture and subsidence after oblique lumbar interbody fusion for adult spinal deformity

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gen Inoue ◽  
Wataru Saito ◽  
Masayuki Miyagi ◽  
Takayuki Imura ◽  
Eiki Shirasawa ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Major Complication ◽  
Global Alignment ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Cage Subsidence ◽  
Oblique Lumbar Interbody Fusion

Abstract Background Recently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment. Methods We analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated. Results Endplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence. Conclusion Endplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients.

scholarly journals Surgical Outcomes of Multilevel Posterior Lumbar Interbody Fusion versus Lateral Lumbar Interbody Fusion for the Correction of Adult Spinal Deformity: A Comparative Clinical Study

2020 ◽  
Vol 14 (4) ◽  
pp. 421-429 ◽  
Author(s):  
Masayoshi Iwamae ◽  
Akira Matsumura ◽  
Takashi Namikawa ◽  
Minori Kato ◽  
Yusuke Hori ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Surgical Outcomes ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Posterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
The Mean

Study Design: A retrospective case control study.Purpose: The purpose of this study was to compare the surgical outcomes of multilevel lateral lumbar interbody fusion (LIF) and multilevel posterior lumbar interbody fusion (PLIF) in the surgical treatment of adult spinal deformity (ASD) and to evaluate the sagittal plane correction by combining LIF with posterior-column osteotomy (PCO).Overview of Literature: The surgical outcomes between multilevel LIF and multilevel PLIF in ASD patients remain unclear.Methods: We retrospectively reviewed 31 ASD patients who underwent multilevel LIF combined with PCO (LIF group, n=14) or multilevel PLIF (PLIF group, n=17) and with a minimum 2-year follow-up. In the comparison between LIF and PLIF groups, their mean age at surgery was 69.4 vs. 61.8 years while the mean follow-up period was 29.2 vs. 59.3 months. We evaluated the transition of pelvic incidence–lumbar lordosis (PI–LL) and disc angle (DA) in the LIF group, in fulcrum backward bending (FBB), after LIF and after posterior spinal fusion (PSF) with PCO. The spinopelvic radiographic parameters were compared between LIF and PLIF groups.Results: Compared with the PLIF group, the LIF group had less blood loss and comparable surgical outcomes with respect to radiographic data, health-related quality of life scores and surgical time. In the LIF group, the mean DA and PI–LL were unchanged after LIF (DA, 5.8°; PI–LL, 15°) compared with the values using FBB (DA, 4.3°; PI–LL, 15°) and improved significantly after PSF with PCO (DA, 8.1°; PI–LL, 0°).Conclusions: In the surgical treatment of ASD, multilevel LIF is less invasive than multilevel PLIF and combination of LIF and PCO would be necessary for optimal sagittal correction in patients with rigid deformity.

The minimally invasive interbody selection algorithm for spinal deformity

2021 ◽  
pp. 1-8
Author(s):  
Praveen V. Mummaneni ◽  
Ibrahim Hussain ◽  
Christopher I. Shaffrey ◽  
Robert K. Eastlack ◽  
Gregory M. Mundis ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Lumbar Interbody Fusion ◽  
Selection Algorithm ◽  
Data Set ◽  
Indirect Decompression ◽  
Segmental Lordosis

OBJECTIVE Minimally invasive surgery (MIS) for spinal deformity uses interbody techniques for correction, indirect decompression, and arthrodesis. Selection criteria for choosing a particular interbody approach are lacking. The authors created the minimally invasive interbody selection algorithm (MIISA) to provide a framework for rational decision-making in MIS for deformity. METHODS A retrospective data set of circumferential MIS (cMIS) for adult spinal deformity (ASD) collected over a 5-year period was analyzed by level in the lumbar spine to identify surgeon preferences and evaluate segmental lordosis outcomes. These data were used to inform a Delphi session of minimally invasive deformity surgeons from which the algorithm was created. The algorithm leads to 1 of 4 interbody approaches: anterior lumbar interbody fusion (ALIF), anterior column release (ACR), lateral lumbar interbody fusion (LLIF), and transforaminal lumbar interbody fusion (TLIF). Preoperative and 2-year postoperative radiographic parameters and clinical outcomes were compared. RESULTS Eleven surgeons completed 100 cMISs for ASD with 338 interbody devices, with a minimum 2-year follow-up. The type of interbody approach used at each level from L1 to S1 was recorded. The MIISA was then created with substantial agreement. The surgeons generally preferred LLIF for L1–2 (91.7%), L2–3 (85.2%), and L3–4 (80.7%). ACR was most commonly performed at L3–4 (8.4%) and L2–3 (6.2%). At L4–5, LLIF (69.5%), TLIF (15.9%), and ALIF (9.8%) were most commonly utilized. TLIF and ALIF were the most selected approaches at L5–S1 (61.4% and 38.6%, respectively). Segmental lordosis at each level varied based on the approach, with greater increases reported using ALIF, especially at L4–5 (9.2°) and L5–S1 (5.3°). A substantial increase in lordosis was achieved with ACR at L2–3 (10.9°) and L3–4 (10.4°). Lateral interbody arthrodesis without the use of an ACR did not generally result in significant lordosis restoration. There were statistically significant improvements in lumbar lordosis (LL), pelvic incidence–LL mismatch, coronal Cobb angle, and Oswestry Disability Index at the 2-year follow-up. CONCLUSIONS The use of the MIISA provides consistent guidance for surgeons who plan to perform MIS for deformity. For L1–4, the surgeons preferred lateral approaches to TLIF and reserved ACR for patients who needed the greatest increase in segmental lordosis. For L4–5, the surgeons’ order of preference was LLIF, TLIF, and ALIF, but TLIF failed to demonstrate any significant lordosis restoration. At L5–S1, the surgical team typically preferred an ALIF when segmental lordosis was desired and preferred a TLIF if preoperative segmental lordosis was adequate.

scholarly journals Outcomes of Oblique Lateral Interbody Fusion for Adult Spinal Deformity: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822097914
Author(s):  
Lei Zhu ◽  
Jun-Wu Wang ◽  
Liang Zhang ◽  
Xin-Min Feng
Keyword(s):  
Systematic Review ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Meta Analysis ◽  
Fusion Rate ◽  
The Mean ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Study Design: A systematic review and meta-analysis. Objectives: To evaluate clinical and radiographic outcomes, and perioperative complications of oblique lateral interbody fusion (OLIF) for adult spinal deformity (ASD). Methods: We performed a systematic review and meta-analysis of related studies reporting outcomes of OLIF for ASD. The clinical outcomes were assessed by visual analogue scale (VAS) and Oswestry Disability Index (ODI). The radiographic parameters were evaluated by sagittal vertical axis (SVA), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence-lumbar lordosis (PI-LL), Cobb angle and fusion rate. A random effects model and 95% confidence intervals (CI) were performed to investigate the results. Results: A total of 16 studies involving 519 patients were included in the present study. The mean difference of VAS-back score, VAS-leg score and ODI score before and after surgery was 5.1, 5.0 and 32.3 respectively. The mean correction of LL was 20.6°, with an average of 6.9° per level and the mean correction of Cobb was 16.4°, with an average of 4.7° per level. The mean correction of SVA, PT, SS, TK and PI-LL was 59.3 mm, 11.7°, 6.9°, 9.4° and 20.6° respectively. The mean fusion rate was 94.1%. The incidence of intraoperative and postoperative complications was 4.9% and 29.6% respectively. Conclusions: OLIF is an effective and safe surgery method in the treatment of mild or moderate ASD and it has advantages in less intraoperative blood loss and lower perioperative complications.

Strategies for prevention of rod fracture in adult spinal deformity: cobalt chrome rod, accessory rod technique, and lateral lumbar interbody fusion

2021 ◽  
pp. 1-10
Author(s):  
Ki Young Lee ◽  
Jung-Hee Lee ◽  
Kyung-Chung Kang ◽  
Sang-Kyu Im ◽  
Hae Seong Lim ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Lumbar Interbody Fusion ◽  
Patient Factors ◽  
Rod Fracture ◽  
Cobalt Chrome

OBJECTIVERestoring the proper sagittal alignment in adult spinal deformity (ASD) can improve radiological and clinical outcomes, but pseudarthrosis including rod fracture (RF) is a common problematic complication. The purpose of this study was to analyze the methods for reducing the incidence of RF in deformity correction of ASD.METHODSThe authors retrospectively selected 178 consecutive patients (mean age 70.8 years) with lumbar degenerative kyphosis (LDK) who underwent deformity correction with a minimum 2-year follow-up. Patients were classified into the non-RF group (n = 131) and the RF group (n = 47). For predicting the crucial factors of RF, patient factors, radiographic parameters, and surgical factors were analyzed.RESULTSThe overall incidence of RF was 26% (47/178 cases), occurring in 42% (42/100 cases) of pedicle subtraction osteotomy (PSO), 7% (5/67 cases) of lateral lumbar interbody fusion (LLIF) with posterior column osteotomy, 18% (23/129 cases) of cobalt chrome rods, 49% (24/49 cases) of titanium alloy rods, 6% (2/36 cases) placed with the accessory rod technique, and 32% (45/142 cases) placed with the 2-rod technique. There were no significant differences in the incidence of RF regarding patient factors between two groups. While both groups showed severe sagittal imbalance before operation, lumbar lordosis (LL) was more kyphotic and pelvic incidence (PI) minus LL (PI-LL) mismatch was greater in the RF group (p < 0.05). Postoperatively, while LL and PI-LL did not show significant differences between the two groups, LL and sagittal vertical axis correction were greater in the RF group (p < 0.05). Nonetheless, at the last follow-up, the two groups did not show significant differences in radiographic parameters except thoracolumbar junctional angles. As for surgical factors, use of the cobalt chrome rod and the accessory rod technique was significantly greater in the non-RF group (p < 0.05). As for the correction method, PSO was associated with more RFs than the other correction methods, including LLIF (p < 0.05). By logistic regression analysis, PSO, preoperative PI-LL mismatch, and the accessory rod technique were crucial factors for RF.CONCLUSIONSGreater preoperative sagittal spinopelvic malalignment including preoperative PI-LL mismatch was the crucial risk factor for RF in LDK patients 65 years or older. For restoring and maintaining sagittal alignment, use of the cobalt chrome rod, accessory rod technique, or LLIF was shown to be effective for reducing RF in ASD 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 Feasibility of Endoscopic Transforaminal Lumbar Interbody Fusion through the Posterior Paraspinal Approach: Technical Note and Preliminary Result

2020 ◽  
Author(s):  
Hyeun-Sung Kim ◽  
Harshavardhan Dilip Raorane ◽  
Pang Hung Wu ◽  
Dong Hwa Heo ◽  
Yeon Jin Yi ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Plain Radiograph ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Graft Material ◽  
Lumbar Interbody Fusion ◽  
Paraspinal Approach ◽  
Segmental Lordosis

Abstract Background: The implement of endoscopic spinal surgery into degenerative spinal disease has minimized the requirement of fusion procedures. However, it is still necessary to develop endoscopic spine surgery in certain patients requiring fusion such as instability. We performed a full-endoscopic transforaminal lumbar interbody fusion(eTLIF) through a conventional paraspinal approach. The feasibility of procedure and early outcome were evaluated.Materials and Methods: eighteen consecutive patients with degenerative lumbar disease underwent eTLIF through a conventional paraspinal approach. Their clinical outcomes were evaluated with visual analog scale(VAS) leg pain score, Oswestry Disability Index(ODI) and the MacNab's criteria; radiological outcome measured with segmental lordosis, global lumbar lordosis, disc height on plain radiograph and percentage of potential fusion mass on CT scan at pre-operative, post-operative and final follow up period. intra operative and post-operative complications noted.Results: Mean age was 63. 71 years and Mean follow-up periods was 7.78 months. According to the level, L2-3 (1 case), L3-4 (4 cases), L4-5 (13 cases) and L5-S1 (2 cases). In the X-ray result, mean segmental lordosis angle(SLA) improved in pre-operative/post-operative/follow-up period 9.87±2.74 degree/ 11.79±3.74 degree/ 10.56±3.69 degree (p > 0.01); mean lumbar lordosis angle(LLA) improved 37.1±7.04 degree/ 39.2±7.13 degree/ 35.7±7.25 degree(p > 0.01). Mean preoperative disc height(DH) improved from 8.97±1.49 mm/ 12.34±1.39 mm/ 11.44±1.98 mm (p < 0.01). In the CT result, Average percentage of fusion mass was 42.61%. VAS was improved significantly, 7.67 / 3.39 / 2.5 and ODI was improved significantly, 74.9 / 34.56 / 27.76 by each preoperative / postoperative / final follow-up. In the clinical result, excellent was 5 cases and good was 13 cases. Conclusion: According to the results of this study, eTLIF was competent enough to perform as open TLIF. and good results were obtained in the form of endplate preservation, disc height restoration, minimal blood loss and post-operative pain with early mobilization. In addition, the fusion volume including the cage and the bone graft material occupies 40% to 50% of disc space is expected to give sufficient fusion by using 3D printed cages which gives the high fusion rate. In conclusion, eTLIF is considered to be a viable surgical procedure.

Sign in / Sign up

Export Citation Format

Share Document