scholarly journals A novel minimally invasive presacral approach and instrumentation technique for anterior L5–S1 intervertebral discectomy and fusion

2006 ◽  
Vol 20 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Nicola Marotta ◽  
Murat Cosar ◽  
Luiz Pimenta ◽  
Larry T. Khoo
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Pedicle Screw Fixation ◽  
Technical Note ◽  
Minimal Risk ◽  
Lumbar Interbody Fusion ◽  
Disc Disease ◽  
Percutaneous Pedicle Screw ◽  
Lower Lumbar

Object The authors describe a new paracoccygeal approach to the L5–S1 junction for interbody fusion with transsacral instrumentation. The purpose of this technical note is to demonstrate a novel surgical approach, technique, and instrumentation system for the treatment of L5–S1 instability in degenerative disc disease and spondylolisthesis. Methods This technical note highlights the AxiaLif (TranS1) transsacral system as an alternative method to transforaminal lumbar interbody fusion or posterior lumbar interbody fusion. Via a novel presacral approach corridor, a truly percutaneous L5–S1 discectomy, interbody distraction, and fixation are achieved, and retroperitoneal viscera and dorsal neural elements are avoided. Percutaneous pedicle screw fixation is then used to provide additional stabilization at the treated level. Conclusions This novel technique of interbody distraction and fusion via a truly percutaneous approach corridor allows for circumferential treatment of the lower lumbar segments with minimal risk to the anterior organs and dorsal neural elements.

Unilateral Transforaminal Lumbar Interbody Fusion: A Review of the Technique, Indications and Graft Materials

2009 ◽  
Vol 37 (3) ◽  
pp. 908-917 ◽  
Author(s):  
Y-X Xiao ◽  
Q-X Chen ◽  
F-C Li
Keyword(s):  
Interbody Fusion ◽  
Lumbar Disc ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Disc Disease ◽  
Discogenic Pain ◽  
Fusion Procedure ◽  
Local Bone ◽  
Circumferential Fusion

Transforaminal lumbar interbody fusion (TLIF) is an alternative interbody fusion procedure in which interbody space is accessed via a path that runs through the far lateral portion of the vertebral foramen. TLIF reduces the potential complications of other approaches, including the transabdominal approach or posterior lumbar interbody fusion (PLIF), but still achieves clinical outcomes and circumferential fusion results comparable with PLIF. Operative indications for TLIF are contested among many spine experts. The optimal indications for using this technique are spondylolisthesis, degenerative disc disease with a specific discogenic pain pattern, lumbar stenosis with instability and recurrent lumbar disc herniation with radiculopathy. Various instrumentation techniques and graft materials are available to use in TLIF, and each option has benefits and disadvantages. Further research is needed, however, TLIF with one cage and excised local bone and augmented with a bilateral pedicle screw seems to be an effective and affordable treatment.

Transforaminal Lumbar Interbody Fusion: Surgical Technique and Results in 24 Patients

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 368-374 ◽  
Author(s):  
Sean A. Salehi ◽  
Rabih Tawk ◽  
Aruna Ganju ◽  
Frank LaMarca ◽  
John C. Liu ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Anterior Column ◽  
Average Score ◽  
Minimal Risk ◽  
Lumbar Interbody Fusion ◽  
Circumferential Fusion ◽  
Anterior Column Support

Abstract OBJECTIVE The advantage of anterior column support and fusion in addition to pedicle fixation in patients with degenerative spinal disorders has become increasingly clear. With the increase in popularity of this treatment, a variety of techniques have been used to achieve the goal of anterior column support, fusion, and segmental instrumentation. Posterior lumbar interbody fusion has been used since the late 1940s in the treatment of degenerative lumbar spine. We evaluated a modification to posterior lumbar interbody fusion called transforaminal lumbar interbody fusion (TLIF). METHODS A retrospective analysis was performed on 24 patients (9 women, 15 men) who underwent TLIF. The approach involved a unilateral laminectomy and inferior facetectomy at the level of fusion. The interbody fusion was achieved from this unilateral approach by performing discectomy, arthrodesis, and insertion of one or two titanium cages packed with autologous bone. The average age of the patients in this study was 42.6 ± 12.5 years. Five patients were smokers. Five cases were related to workmen's compensation. Seventeen patients' original symptoms were a combination of low back pain and radiculopathy. Ten patients had had a previous spine operation. RESULTS Eleven patients had L4–S1 TLIFs. The rest of the patients had a single-level TLIF (L2–S1). Average intensive care unit and floor days were 1.1 ± 1.0 and 5.8 ± 2.2 days, respectively. The number of days to ambulation was 2.8 ± 1.6 days. There were a total of six self-limited complications in 24 patients (including one transient neurological complication). The average follow-up time was 16.9 ± 9.1 months. Twenty-two patients had solid fusions. A modified Prolo scale (4 worst, 20 best) was used to evaluate the clinical outcome. The average score was 16.1 ± 4.1. CONCLUSION TLIF is a reliable and safe technique for interbody support that can be performed with excellent clinical outcome. In the authors' experience, TLIF offers excellent exposure with minimal risk. This applies particularly in cases of repeat spine surgery, in which the presence of scar tissue makes traditional posterior lumbar interbody fusion techniques difficult or impossible. In addition, TLIF seems to be a viable alternative to anteroposterior circumferential fusion and/or anterior lumbar interbody fusion.

Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion

2013 ◽  
Vol 35 (2) ◽  
pp. E11 ◽  
Author(s):  
Un Yong Choi ◽  
Jeong Yoon Park ◽  
Kyung Hyun Kim ◽  
Sung Uk Kuh ◽  
Dong Kyu Chin ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Operative Time ◽  
Screw Fixation ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Clinical Results ◽  
Pedicle Screw Fixation ◽  
Lumbar Interbody Fusion ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation

Object Clinical results for unilateral pedicle screw fixation after lumbar interbody fusion have been reported to be as good as those for bilateral instrumentation. However, no studies have directly compared unilateral and bilateral percutaneous pedicle screw fixation after minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to determine whether unilateral percutaneous pedicle screw fixation is comparable with bilateral percutaneous pedicle screw fixation in 1-segment MIS TLIF. Methods This was a prospective randomized study of 53 patients who underwent unilateral or bilateral percutaneous pedicle screw fixation after MIS TLIF for 1-segment lumbar degenerative disc disease. Twenty-six patients were assigned to a unilateral percutaneous pedicle screw fixation group and 27 patients were assigned to a bilateral percutaneous pedicle screw fixation group. Operative time, blood loss, clinical outcomes (that is, Oswestry Disability Index [ODI] and visual analog scale [VAS] scores), complication rates, and fusion rates were assessed using CT scanning 2 years after surgical treatment. Results The 2 groups were similar in age, sex, preoperative diagnosis, and operated level, and they did not differ significantly in the length of follow-up (27.5 [Group 1] vs 28.9 [Group 2] months) or clinical results. Both groups showed substantial improvements in VAS and ODI scores 2 years after surgical treatment. The groups differed significantly in operative time (unilateral 84.2 minutes; bilateral 137.6 minutes), blood loss (unilateral 92.7 ml; bilateral, 232.0 ml), fusion rate (unilateral 84.6%; bilateral 96.3%), and postoperative scoliotic change (unilateral 23.1%; bilateral 3.7%). Conclusions Unilateral and bilateral screw fixation after MIS TLIF produced similar clinical results. Although perioperative results were better with unilateral screw fixation, the long-term results were better with bilateral screw fixation, suggesting bilateral screw fixation is a better choice after MIS TLIF.

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