Posterior lumbar interbody fusion with cages: an independent review of 71 cases

1999 ◽  
Vol 91 (2) ◽  
pp. 186-192 ◽  
Author(s):  
Siviero Agazzi ◽  
Alain Reverdin ◽  
Daniel May
Keyword(s):  
Retrospective Study ◽  
Clinical Outcome ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Fixation Techniques ◽  
Independent Review ◽  
Fine Print

Object. The authors conducted a retrospective study to provide an independent evaluation of posterior lumbar interbody fusion (PLIF) in which impacted carbon cages were used. Interbody cages have been developed to replace tricortical interbody grafts in anterior and PLIF procedures. Superior fusion rates and clinical outcomes have been claimed by the developers. Methods. In a retrospective study, the authors evaluated 71 consecutive patients in whom surgery was performed between 1995 and 1997. The median follow-up period was 28 months. Clinical outcome was assessed using the Prolo scale. Fusion results were interpreted by an independent radiologist. The fusion rate was 90%. Overall, 67% of the patients were satisfied with their outcome and would undergo the same operation again. Based on the results of the Prolo scale, however, in only 39% of the patients were excellent or good results achieved. Forty-six percent of the work-eligible patients resumed their working activity. Clinical outcome and return-to-work status were significantly associated with socioeconomic factors such as preoperative employment (p = 0.03), compensation issues (p = 0.001), and length of preoperative sick leave (p = 0.01). Radiographically demonstrated fusion was not statistically related to clinical outcome (p = 0.2). Conclusions. This is one of the largest independent series in which PLIF with cages has been evaluated. The results show that the procedure is safe and effective with a 90% fusion rate and a 66% overall satisfaction rate, which compare favorably with those of traditional fixation techniques but fail to match the higher results claimed by the innovators of the cage techniques. The authors' experience confirms the reports of others that many patients continue to experience incapacitating back pain despite successful fusion and neurological recovery.

Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion?

2003 ◽  
Vol 99 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Giovanni La Rosa ◽  
Alfredo Conti ◽  
Fabio Cacciola ◽  
Salvatore Cardali ◽  
Domenico La Torre ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Pedicle Screw Fixation ◽  
Posterolateral Fusion ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis ◽  
Content Type ◽  
Fine Print

Object. Posterolateral fusion involving instrumentation-assisted segmental fixation represents a valid procedure in the treatment of lumbar instability. In cases of anterior column failure, such as in isthmic spondylolisthesis, supplemental posterior lumbar interbody fusion (PLIF) may improve the fusion rate and endurance of the construct. Posterior lumbar interbody fusion is, however, a more demanding procedure and increases costs and risks of the intervention. The advantages of this technique must, therefore, be weighed against those of a simple posterior lumbar fusion. Methods. Thirty-five consecutive patients underwent pedicle screw fixation for isthmic spondylolisthesis. In 18 patients posterior lumbar fusion was performed, and in 17 patients PLIF was added. Clinical, economic, functional, and radiographic data were assessed to determine differences in clinical and functional results and biomechanical properties. At 2-year follow-up examination, the correction of subluxation, disc height, and foraminal area were maintained in the group in which a PLIF procedure was performed, but not in the posterolateral fusion—only group (p < 0.05). Nevertheless, no statistical intergroup differences were demonstrated in terms of neurological improvement (p = 1), economic (p = 0.43), or functional (p = 0.95) outcome, nor in terms of fusion rate (p = 0.49). Conclusions. The authors' findings support the view that an interbody fusion confers superior mechanical strength to the spinal construct; when posterolateral fusion is the sole intervention, progressive loss of the extreme correction can be expected. Such mechanical insufficiency, however, did not influence clinical outcome.

Posterior lumbar interbody fusion for revision disc surgery: review of 50 cases in which carbon fiber cages were implanted

2001 ◽  
Vol 95 (2) ◽  
pp. 190-195 ◽  
Author(s):  
Bhupal Chitnavis ◽  
Giuseppe Barbagallo ◽  
Richard Selway ◽  
Ronan Dardis ◽  
Ahmed Hussain ◽  
...  
Keyword(s):  
Back Pain ◽  
Carbon Fiber ◽  
Interbody Fusion ◽  
Clinical Success ◽  
Pedicle Screws ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Fine Print

Object. The authors undertook a study to assess the value of posterior lumbar interbody fusion (PLIF) in which carbon fiber cages (CFCs) were placed in patients undergoing revision disc surgery for symptoms suggesting neural compression with low-back pain. Methods. The authors followed their first 50 patients for a maximum of 5 years and a minimum of 6 months after implantation of the CFCs. Patients in whom magnetic resonance (MR) imaging demonstrated “simple” recurrent herniation did not undergo PLIF. Surgery was performed in patients with symptoms of neural root compression, tension signs, and back pain with focal disc degeneration and nerve root distortion depicted on MR imaging compatible with clinical signs and symptoms. In 40 patients (80%) pedicle screws were not used. Clinical outcome was assessed using the Prolo Functional Economic Outcome Rating scale. Fusion outcome was assessed using an established classification. Symptoms in 46 patients (92%) improved after surgery, and given their outcomes, 45 (90%) would have undergone the same surgery again. Two thirds of patients experienced good or excellent outcomes (Prolo score ≥ 8) at early and late follow up. There was no difference in clinical outcome between those in whom pedicle screws were and were not implanted (p = 0.83, Mann—Whitney U-test). The fusion rate at 2 years postsurgery was 95%. There were minimal complications, and no patients fared worse after surgery. No patient has undergone additional surgical treratment of the fused intervertebral space. Conclusions. In this difficult group of patients the aim remains to improve symptoms but not cure the disease. A high fusion rate is possible when using the CFCs. Clinical success depends on selecting patients in whom radiological and clinical criteria accord. Pedicle screws are not necessary if facet joints are preserved, and high fusion rates and clinical success are possible without them.

Retroperitoneal lateral lumbar interbody fusion with titanium threaded fusion cages

2002 ◽  
Vol 96 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Christopher E. Wolfla ◽  
Dennis J. Maiman ◽  
Frank J. Coufal ◽  
James R. Wallace
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Anterior Longitudinal Ligament ◽  
Content Type ◽  
Single Cage ◽  
Novel Technique ◽  
Methodological Problems ◽  
Fine Print

Object. Intertransverse arthrodesis in which instrumentation is placed is associated with an excellent fusion rate; however, treatment of patients with symptomatic nonunion presents a number of difficulties. Revision posterior and traditional anterior procedures are associated with methodological problems. For example, in the latter, manipulation of the major vessels from L-2 to L-4 may be undesirable. The authors describe a method for performing retroperitoneal lumbar interbody fusion (LIF) in which a threaded cage is placed from L-2 through L-5 via a lateral trajectory, and they also detail a novel technique for implanting a cage from L-5 to S-1 via an oblique trajectory. Although they present data obtained over a 2-year period in the study of 15 patients, the focus of this report is primarily on describing the surgical procedure. Methods. The lateral lumbar spine was exposed via a standard retroperitoneal approach. Using the anterior longitudinal ligament as a landmark, the L2–3 through L4–5 levels were fitted with instrumentation via a true lateral trajectory; the L5—S1 level was fitted with instrumentation via an oblique trajectory. A single cage was placed at each instrumented level. Fifteen symptomatic patients in whom previous lumbar fusion had failed underwent retroperitoneal LIF. Thirty-eight levels were fitted with instrumentation. There have been no instrumentation-related failures, and fusion has occurred at 37 levels during the 2-year postoperative period. Conclusions. The use of retroperitoneal LIF in which threaded fusion cages are used avoids the technical difficulties associated with repeated posterior procedures. In addition, it allows L2—S1 instrumentation to be placed anteriorly via a single surgical approach. This construct has been shown to be biomechanically sound in animal models, and it appears to be a useful alternative for the management of failed multilevel intertransverse arthrodesis.

Stabilizing effect of posterior lumbar interbody fusion cages before and after cyclic loading

2000 ◽  
Vol 92 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Annette Kettler ◽  
Hans-Joachim Wilke ◽  
Rupert Dietl ◽  
Matthias Krammer ◽  
Christianto Lumenta ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Axial Rotation ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Content Type ◽  
Flexion Extension ◽  
Stabilizing Effect ◽  
Fine Print

Object. The function of interbody fusion cages is to stabilize spinal segments primarily by distracting them as well as by allowing bone ingrowth and fusion. An important condition for efficient formation of bone tissue is achieving adequate spinal stability. However, the initial stability may be reduced due to repeated movements of the spine during everyday activity. Therefore, in addition to immediate stability, stability after cyclic loading is of remarkable relevance; however, this has not yet been investigated. The object of this study was to investigate the immediate stabilizing effect of three different posterior lumbar interbody fusion cages and to clarify the effect of cyclic loading on the stabilization. Methods. Before and directly after implantation of a Zientek, Stryker, or Ray posterior lumbar interbody fusion cage, 24 lumbar spine segment specimens were each evaluated in a spine tester. Pure lateral bending, flexion—extension, and axial rotation moments (± 7.5 Nm) were applied continuously. The motion in each specimen was measured simultaneously. The specimens were then loaded cyclically (40,000 cycles, 5 Hz) with an axial compression force ranging from 200 to 1000 N. Finally, they were tested once again in the spine tester. Conclusions. In general, a decrease of movement in all loading directions was noted after insertion of the Zientek and Ray cages and an increase of movement after implantation of a Stryker cage. In all three cage groups greater stability was demonstrated in lateral bending and flexion than in extension and axial rotation. Reduced stability during cyclic loading was observed in all three cage groups; however, loss of stability was most pronounced when the Ray cage was used.

Complications of posterior lumbar interbody fusion when using a titanium threaded cage device

2000 ◽  
Vol 93 (1) ◽  
pp. 45-52 ◽  
Author(s):  
W. Jeffrey Elias ◽  
Nathan E. Simmons ◽  
George J. Kaptain ◽  
James B. Chadduck ◽  
Richard Whitehill
Keyword(s):  
Back Pain ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Motor Deficit ◽  
Spinal Instability ◽  
Graft Material ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Flexion Extension ◽  
Fine Print

Object. The authors reviewed their series of patients to quantify clinical and radiographic complications in those who underwent a posterior lumbar interbody fusion (PLIF) procedure in which a threaded interbody cage (TIC) was implanted. Methods. Sixty-seven patients underwent a posterior lumbar interbody fusion procedure in which a TIC was used. The authors excluded patients who underwent procedures in which other instrumentation was used or a nondorsal approach was performed. Fifteen percent of the cases (10 patients) were complicated by laceration of the dura. In three cases, bilateral implantation could not be performed. The average blood loss was 670 ml for all cases, and blood transfusion was required in 25% of the cases (17 patients). The rate of minor wound complication was 4.5% (three patients). One patient died. The average period of hospitalization was 4.25 days. Twenty-eight patients (42%) experienced significant low-back pain 3 months postoperatively, and in 10 (15%) of these cases it persisted beyond 1 year. In 10 patients postoperative radiculopathy was demonstrated, and magnetic resonance imaging revealed epidural fibrosis in six patients, arachnoiditis in one, and a recurrent disc herniation in one. One patient incurred a permanent motor deficit with sexual dysfunction. Pseudarthrosis was suggested radiographically with evidence of motion on lateral flexion—extension radiographs (10 cases), lucencies around the implants (seven cases), and posterior migration of the cage (two cases). Additional procedures (in 14 patients) consisted primarily of transverse process fusion with pedicle screw and plate augmentation for persistent back pain and radiographically demonstrated signs of spinal instability. In two patients with radiculopathy, migration of the TIC required that it be removed. Graft material that extruded from one implant necessitated its removal. In one patient scarectomy was performed. Conclusions. Our high incidence of TIC-related complications in PLIF is inconsistent with that reported in previous studies.

scholarly journals In vitro biomechanical effects of reconstruction on adjacent motion segment: comparison of aligned/kyphotic posterolateral fusion with aligned posterior lumbar interbody fusion/posterolateral fusion

2003 ◽  
Vol 99 (2) ◽  
pp. 221-228 ◽  
Author(s):  
Hideki Sudo ◽  
Itaru Oda ◽  
Kuniyoshi Abumi ◽  
Manabu Ito ◽  
Yoshihisa Kotani ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Posterolateral Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Motion Segment ◽  
Flexion Extension ◽  
Fine Print

Object. Posterior lumbar interbody fusion (PLIF) was developed to overcome the limitations of posterolateral fusion in correcting spinal deformity and maintaining lumbar lordosis. In this study the authors compare the biomechanical effects of three different posterior reconstructions on the adjacent motion segment. Methods. Ten calf spinal (L2—S1) specimens underwent nondestructive flexion—extension testing (± 6 Nm). The specimens were destabilized at the L5—S1 levels after intact testing. This was followed by pedicle screw fixation with and without interbody cages as follows: 1) with straight rods (“aligned” posterolateral fusion); 2) with kyphotically prebent rods (“kyphotic” posterolateral fusion); and 3) with interbody cages combined with straight rods (“aligned” PLIF/posterolateral fusion). The range of motion (ROM) of the operative segments, the intradiscal pressure (IDP), and longitudinal lamina strain in the superior adjacent segment (L4–5) were analyzed. The ROM associated with aligned PLIF/posterolateral fusion-treated specimens was significantly less than both the aligned and kyphotic posterolateral fusion-treated procedures in both flexion and extension loading (p < 0.05). The aligned PLIF/posterolateral fusion was associated with greater IDP and the lamina strain compared with the aligned and kyphotic posterolateral fusion groups in flexion loading. Under extension loading, greater IDP and lamina strain were present in the kyphotic posterolateral fusion group than in the aligned posterolateral fusion group. The highest IDP and lamina strain were shown in the aligned PLIF/posterolateral fusion group. Conclusions. Compared with kyphotic posterolateral fusion, PLIF may lead to even higher load at the superior adjacent level because of the increased stiffness of the fixed segments even if local kyphosis is corrected by PLIF.

scholarly journals Posterior Lumbar Interbody Fusion with Interspinous Fastener Provides Comparable Clinical Outcome and Fusion Rate to Pedicle Screws

2017 ◽  
Vol 9 (2) ◽  
pp. 198-205
Author(s):  
Wei-min Huang ◽  
Xing-ming Yu ◽  
Xiao-duo Xu ◽  
Ruo-xian Song ◽  
Li-li Yu ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Interbody Fusion ◽  
Pedicle Screws ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion

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.

Safety of transforaminal lumbar interbody fusion and intervertebral recombinant human bone morphogenetic protein—2

2005 ◽  
Vol 3 (6) ◽  
pp. 436-443 ◽  
Author(s):  
Alan T. Villavicencio ◽  
Sigita Burneikiene ◽  
E. Lee Nelson ◽  
Ketan R. Bulsara ◽  
Mark Favors ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Bone Morphogenetic Protein 2 ◽  
Content Type ◽  
Morphogenetic Protein ◽  
Human Bone Morphogenetic Protein ◽  
Recombinant Human Bone ◽  
Fine Print

Object. Recombinant human bone morphogenetic protein—2 (rhBMP-2) is being increasingly used for spinal fusion. There are few data regarding its clinical safety, effectiveness, and clinical outcome when applied on an absorbable collagen sponge (ACS) in conjunction with allograft for transforaminal lumbar interbody fusion (TLIF). Methods. Seventy-four consecutive patients undergoing TLIF for degenerative disc disease were divided into five groups depending on whether the patient underwent a minimally invasive or open approach, as well as the number of spinal levels surgically treated. Surgery-related data, fusion results, complications, and clinical outcome were evaluated. The mean follow-up duration was 20.6 months (range 14–28 months). The radiographic fusion rate was 100% at 12 and 24 months after the surgery. No bone overgrowth or other complications related to BMP use were demonstrated. Conclusions. Analysis of the results demonstrated that TLIF combined with a BMP-2—soaked ACS is a feasible, effective, and safe method to promote lumbar fusion. There were no significant intergroup differences in clinical outcome between patients who underwent open compared with minimally invasive procedures. Patient satisfaction rates, however, were higher in the minimally invasive procedure group. The efficacy of BMP-2 was not dependent on which approach was used or the number of spinal levels that were treated.

Extraforaminal Lumbar Interbody Fusion at the L5–S1 Level: Technical Considerations and Feasibility

2017 ◽  
Vol 78 (05) ◽  
pp. 507-512
Author(s):  
Denis Kaech ◽  
Pawel Baranowski ◽  
Alicja Baranowska ◽  
Didier Recoules-Arche ◽  
Arthur Kurzbuch
Keyword(s):  
Clinical Outcome ◽  
Interbody Fusion ◽  
Fusion Rate ◽  
Intervertebral Disk ◽  
Spinal Diseases ◽  
Lumbar Interbody Fusion ◽  
Short Term ◽  
Postoperative Result ◽  
Disk Space ◽  
Intervertebral Disk Space

Background Extraforaminal lumbar interbody fusion (ELIF) surgery is a muscle-sparing approach that allows the treatment of various degenerative spinal diseases. It is technical challenging to perform the ELIF approach at the L5–S1 level because the sacral ala obstructs the view of the intervertebral disk space. Methods We reported earlier on the ELIF technique in which the intervertebral disk is targeted at an angle of 45 degrees relative to the midline. In this article we describe the technical process we developed to overcome the anatomic relation between the sacral ala and the intervertebral disk space L5–S1 that hinders the ELIF approach at this level. We then report in a retrospective analysis on the short-term clinical and radiologic outcome of 100 consecutive patients with degenerative L5–S1 pathologies who underwent ELIF surgery. Results The L5–S1 ELIF approach could be realized in all patients. The short-term clinical outcome was evaluated 5 months after surgery: 92% of the patients were satisfied with their postoperative result; 8% had a poor result. Overall, 17% of the patients presented light radicular or low back pain not influencing their daily activity, and 82% of the patients working before surgery returned to work 3 to 7 months after surgery. The radiologic outcome was documented by computed tomography at 5 months after surgery and showed fusion in 99% of the patients. Lumbar magnetic resonance imaging performed in 5 patients at 6 months after surgery revealed the integrity of the paraspinal muscles. Conclusions ELIF surgery at the L5–S1 level is technically feasible for various degenerative spinal diseases. Analysis of the clinical and radiologic data in a consecutive retrospective cohort of patients who underwent this surgical procedure showed a good short-term clinical outcome and fusion rate.

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