scholarly journals Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note

2020 ◽  
Vol 10 (6) ◽  
pp. 373 ◽  
Author(s):  
Pang Hung Wu ◽  
Hyeun Sung Kim ◽  
Yeon Jin Lee ◽  
Dae Hwan Kim ◽  
Jun Hyung Lee ◽  
...  
Keyword(s):  
Computer Tomography ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Foraminal Stenosis ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Computer Tomographic ◽  
Post Operation

Background: Severe collapsed disc secondary to degenerative spinal conditions leads to significant foraminal stenosis. We hypothesized that uniportal posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling technique could be safely applied to the collapsed disc space to improve patients’ pain score, restore disc height, and correct the segmental angular parameters. Methods: We included patients who met the indication criteria for lumbar fusion and underwent uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with pre-operative Computer Tomography mid disc height of less than or equal to 5 mm and MRI of Grade 3 Foraminal Stenosis. Visual analogue scale and computer tomography pre-operative and post-operative sagittal disc height in the anterior, middle and posterior part of the disc; sagittal focal segmental angle; mid coronal disc height and coronal wedge angles were evaluated. Results: 30 levels of Endo-TLIF were included, with a mean follow up of 12 months. The mean improvement in decreasing pain score was 2.5 ± 1.1, 3.2 ± 0.9 and 4.3 ± 1.0 at 1 week post operation, 3 months post operation and at final follow up, respectively, p < 0.05. There was significant increase in mid sagittal computer tomographic anterior, middle and posterior disc height of 6.99 ± 2.30, 6.28 ± 1.44, 5.12 ± 1.79 mm respectively, p < 0.05. CT mid coronal disc height showed an increase of 7.13 ± 1.90 mm, p < 0.05. There was a significant improvement in the CT coronal wedge angle of 2.35 ± 4.73 and the CT segmental focal sagittal angle of 1.98 ± 4.69, p < 0.05. Conclusion: Application of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion in patients with severe foraminal stenosis secondary to severe collapsed disc space significantly relieved patients’ pain and restored disc height without early subsidence or exiting nerve root dysesthesia in our cohort of patients.

Feasibility of Endoscopic Transforaminal Lumbar Interbody Fusion(eTLIF) 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 ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Paraspinal Approach ◽  
Segmental Lordosis

Abstract Background: Implementation of endoscopic spine surgery in the management of degenerative lumbar diseases has significantly reduced the need for fusion surgeries. The performance of a MIS-TLIF using an endoscope offers some distinct advantages, such as allowing better visualization the disc space, enhanced endplate preparation and contralateral decompression. The objective of this study was to analyze the preliminary clinical and radiological outcomes of the technique of endoscopic transforaminal lumbar interbody fusion (eTLIF).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 were noted.Results: Mean age was 63. 71 years and Mean follow-up periods was 7.78 months. 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±1.13 / 3.39±1.38 / 2.5±1.34 and ODI was improved significantly, 74.9±8.03/ 34.56±8.80 / 27.76±8.64 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, endoscopic TLIF was feasible procedure with an advantage of better visualization and preservation of endplate, minimal blood loss and minimal post-operative pain with early mobilization. In addition, the fusion volume as measured on post-operative CT scans, occupied 40% to 50% of disc space along with the use of 3D printed cages expected to give higher fusion rates. In conclusion, our preliminary results show that endoscopic TLIF is considered to be a viable surgical procedure with further long-term follow-up warranted.

scholarly journals Computerized tomography evaluation of a resorbable implant after transforaminal lumbar interbody fusion

2004 ◽  
Vol 16 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Timothy R. Kuklo ◽  
Michael K. Rosner ◽  
David W. Polly
Keyword(s):  
Computerized Tomography ◽  
Interbody Fusion ◽  
Case Series ◽  
Ct Scanning ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Delayed Union ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Screw Breakage

Object Synthetic bioabsorbable implants have recently been introduced in spinal surgery; consequently, the indications, applications, and results are still evolving. The authors used absorbable interbody spacers (Medtronic Sofamor Danek, Memphis, TN) packed with recombinant bone morphogenetic protein (Infuse; Medtronic Sofamor Danek) for single- and multiple-level transforaminal lumbar interbody fusion (TLIF) procedures over a period of 18 months. This is a consecutive case series in which postoperative computerized tomography (CT) scanning was used to assess fusion status. Methods There were 22 patients (17 men, five women; 39 fusion levels) whose mean age was 41.6 years (range 23–70 years) and in whom the mean follow-up duration was 12.4 months (range 6–18 months). Bridging bone was noted as early as the 3-month postoperative CT scan when obtained; solid arthrodesis was routinely noted between 6 and 12 months in 38 (97.4%) of 39 fusion levels. In patients who underwent repeated CT scanning, the fusion mass appeared to increase with time, whereas the disc space height remained stable. Although the results are early (mean 12-month follow-up duration), there was only one noted asymptomatic delayed union/nonunion at L5–S1 in a two-level TLIF with associated screw breakage. There were no infections or complications related to the cages. Conclusions The bioabsorbable cages appear to be a viable alternative to metal interbody spacers, and may be ideally suited to spinal interbody applications because of their progressive load-bearing properties.

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.

scholarly journals Superior Facet Joint Violations during Single Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Preliminary Retrospective Clinical Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Long Jia ◽  
Yan Yu ◽  
Kamran Khan ◽  
Fuping Li ◽  
Rui Zhu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intervertebral Disc ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Intervertebral Disc Height ◽  
Group A

Background. Facet joint violation (FV) was reported as variable iatrogenic damage that can be a crucial risk factor leading to the adjacent segment degeneration (ASD). “Blind” screw placement technique in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) contributes to the increasing incidence of FV that can be influenced by several potential factors. Many controversies about these factors and clinical outcomes of different types of FV patients exist, yet they have not been analyzed. Methods. 99 cases undergoing single-segment MIS-TLIF from July 2013 to December 2015 were retrospectively analyzed. Computed tomography (CT) was applied to determine the incidence of FV, and then the correlation between FV and relevant factors, including gender, age, body mass index (BMI), top-screw level, and decompression, was analyzed. A total of 53 cases were followed up after one year, 31 cases in noninjury (A group) and 22 patients in FV injury (B group). Results. The incidence of FV was 39. 39% (39/99) in the patients and 23.23% (46/198) in the screws. Logistic regression analysis showed that screw at L5 in patients with BMI > 30 kg/m2 was vulnerable to FV (P<0.05). Moreover, postoperative average intervertebral disc height (AIDH) of fusion segment, visual analog scale (VAS), and Oswestry disability index (ODI) scores improved significantly in group A and B when compared with preoperative data (P<0.05). Adjacent superior average intervertebral disc height (ASAIDH) presented decrease, but adjacent superior intervertebral disc Cobb angle (ASIDCA) appeared to increase in the two groups at the final follow-up compared with postoperative 3 days (P<0.05). Low back VAS and ODI scores in group A (31 cases) were lower than those in group B (22 cases) in the final follow-up (P<0.05). Conclusion. MIS-TLIF is an effective treatment for lumbar degenerative disease, but FV occurred at a higher incidence. Facet joints should be protected in MIS-TLIF to avoid FV.

Paraspinal-approach transforaminal lumbar interbody fusion for the treatment of lumbar foraminal stenosis

2010 ◽  
Vol 13 (4) ◽  
pp. 500-508 ◽  
Author(s):  
Shunsuke Fujibayashi ◽  
Masashi Neo ◽  
Mitsuru Takemoto ◽  
Masato Ota ◽  
Takashi Nakamura
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Foraminal Stenosis ◽  
Lumbar Interbody Fusion ◽  
Disc Space Narrowing ◽  
Disc Space ◽  
Lumbar Foraminal Stenosis ◽  
Single Level ◽  
Paraspinal Approach ◽  
Radicular Symptoms

Object Foraminal stenosis is a common cause of lumbar radicular symptoms. Recognition of the dynamic pathology, as well as the static anatomical changes, is important to achieving successful surgical outcomes. Excessive facet and anulus removal leads to subsequent disc space narrowing and/or segmental instability, which can cause poor results after decompressive surgery. The objective of this study was to evaluate the efficacy of the paraspinalapproach transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar foraminal stenosis. Methods Twenty levels of lumbar foraminal stenosis in 16 patients were treated using an instrumented paraspinal-approach TLIF. There were 12 single-level and 4 two-level cases. Pathologies included foraminal stenosis at 13 levels and lateral disc herniation with disc space narrowing at 7. Results In all patients, preoperative radicular symptoms and mechanical low-back pain were resolved immediately after the operation and leg weakness improved gradually. The recovery rate using the Japanese Orthopaedic Association score was 89.1%. Bony union was achieved within 6 months after the operation in all cases. Postoperative MR imaging showed minimal changes in the paraspinal muscles in the single-level cases. Conclusions The paraspinal-approach TLIF is a minimally invasive, safe, and secure procedure for treating lumbar foraminal lesions. Direct visualization and decompression for the foraminal lesion, distraction of the collapsed disc space, and stabilization of the unstable segments can be achieved simultaneously through the paraspinal approach, which produces successful clinical and radiological results.

Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion

2006 ◽  
Vol 5 (6) ◽  
pp. 534-539 ◽  
Author(s):  
Aaron R. Cutler ◽  
Saquib Siddiqui ◽  
Mohan Avinash L. ◽  
Virany H. Hillard ◽  
Franco Cerabona ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Pedicle Screw Fixation ◽  
Lumbar Interbody Fusion ◽  
Peek Cage ◽  
Disc Space ◽  
The Mean

Object Transforaminal lumbar interbody fusion (TLIF) is an accepted alternative to circumferential fusion of the lumbar spine in the treatment of degenerative disc disease, spondylolisthesis, and recurrent disc herniation. To maintain disc height while arthrodesis takes place, the technique requires the use of an interbody spacer. Although titanium cages are used in this capacity, the two most common spacers are polyetheretherketone (PEEK) cages and femoral cortical allografts (FCAs). The authors compared the clinical and radiographic outcomes of patients who underwent TLIF with pedicle screw fixation, in whom either a PEEK cage or an FCA was placed as an interbody spacer. Methods The charts and x-ray films obtained in 39 patients (age range 33–68 years, mean 44.7 years) who underwent single-level TLIF between October 2001 and April 2004 and in whom either a PEEK cage (18 patients) or FCA (21 patients) was placed as an interbody spacer were evaluated in a retrospective study. Radiological outcome was based on fusion rate and a comparison of the initial postoperative lordotic angle on standing lateral radiographs with that at long-term follow up (mean follow up 15.1 months, minimum 12 months). To control for variations in radiographic magnification, the authors used lordotic angle as an indirect measure of disc space height. Clinical outcome was assessed using the Oswestry Disability Index (ODI). There were no major complications in either group. Radiographically documented fusion occurred in all patients in the PEEK group and 95.2% of those in the FCA group. Pseudarthrosis developed in one patient in the FCA group, and this patient underwent additional surgery. In both groups, the mean lordotic angle changed by less than 2.20° during the postoperative period, and the mean postoperative ODI score was more than 40 points lower than the mean preoperative score. There was no significant difference between the two groups in mean change in lordotic angle (p = 0.415) and mean change in ODI score (p = 0.491). Conclusions Both PEEK cages and FCAs are highly effective in promoting interbody fusion, maintaining postoperative disc space height, and achieving desirable clinical outcomes in patients who undergo TLIF with pedicle screw fixation. The advantages of PEEK cages include a lower incidence of subsidence and their radiolucency, which permits easier visualization of bone growth.

scholarly journals Safety of a novel modular cage for transforaminal lumbar interbody fusion − clinical cohort study in 20 patients with degenerative disc disease

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 24
Author(s):  
Mohamed Elmekaty ◽  
Emad ElMehy ◽  
Peter Försth ◽  
Anna MacDowall ◽  
Ahmed El Elemi ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Screw Loosening ◽  
Non Union ◽  
Cage Subsidence ◽  
One Year

Introduction: Transforaminal lumbar interbody fusion (TLIF) is used to reconstruct disc height and reduce degenerative deformity in spinal fusion. Patients with osteoporosis are at high risk of TLIF cage subsidence; possibly due to the relatively small footprint compared to anterior interbody devices. Recently, modular TLIF cage with an integral rail and slot system was developed to reduce cage subsidence and allow early rehabilitation. Objective: To study the safety of a modular TLIF device in patients with degenerative disc disorders (DDD) with regard to surgical complications, non-union, and subsidence. Methods: Patients with DDD treated with a modular TLIF cage (Polyetheretherketone (PEEK), VTI interfuse S) were analysed retrospectively with one-year follow-up. Lumbar sagittal parameters were collected preoperatively, postoperatively and at one year follow-up. Cage subsidence, fusion rate, screw loosening and proportion of endplate coverage were assessed in computed tomography scan. Results: 20 patients (age 66 ± 10 years, 65% female, BMI 28 ± 5 kg/m2) with a total of 37 fusion levels were included. 15 patients had degenerative spondylosis and 5 patients had degenerative scoliosis. The cages covered >60% of the vertebral body diameters. Lumbar lordosis angle and segmental disc angle increased from 45.2 ± 14.5 and 7.3 ± 3.6 to 52.7 ± 9.1 and 10.5 ± 3.5 (p =  0.029 and 0.0002) postoperatively for each parameter respectively without loss of correction at one year follow up. One case of deep postoperative infection occurred (5%). No cage subsidence occurred. No non-union or screw loosening occurred. Conclusions: The modular TLIF cage was safe with regard to subsidence and union-rate. It restored and maintained lumbar lordosis angle, segmental disc angle and disc height, which can be attributed to the large footprint of this modular cage.

scholarly journals Extended interbody fusion using cortical bone trajectory screws vs. traditional pedicle screws in the treatment of adjacent segment disease after transforaminal lumbar interbody fusion with pedicle screws: a retrospective case control study

2020 ◽  
Author(s):  
Xin Song ◽  
Dong lin Ren ◽  
Shuai Han ◽  
Feng Zhang ◽  
Jian Wang
Keyword(s):  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Minimally Invasive Surgical ◽  
Post Operation ◽  
The Mean

Abstract Background To present two minimally invasive surgical techniques using cortical bone trajectory screws with posterior lumbar interbody fusion (CBT-PLIF) and traditional pedicle screws and a domino system with transforaminal lumbar interbody fusion (TPS-Domino-TLIF) for adjacent segment disease (ASD) after lumbar fusion surgery, and compare the postoperative radiographic and clinical outcomes between the two techniques for ASD. Methods Of the 36 patients included in this study, 16 patients received CBT-PLIF and the other 20 patients received TPS-Domino-TLIF. Patient demographics, surgical data, complications, radiologic and clinical outcomes were evaluated and compared between the two groups. Results The surgical duration of TPS-Domino-TLIF was significantly shorter than that of CBT-PLIF (p < 0.001). There was less estimated blood loss (EBL) and a lower frequency of intra-operative fluoroscopy in TPS-Domino-TLIF as compared with CBT-PLIF (p < 0.001). The lumbar lordotic angle was improved both at immediate post-operation (p = 0.006) and the last follow-up (p = 0.007) in TPS-Domino-TLIF group as compared with CBT-PLIF group. The mean inter-vertebral height in TPS-Domino-TLIF group was significantly larger than that in CBT-PLIF group at immediate post-operation (p = 0.007) and the last follow-up (p = 0.005). The clinical outcomes in terms of the mean VAS-back, VAS-leg and ODI were improved significantly postoperatively in both groups. Conclusions As a more minimally invasive surgical technique for ASD, TPS-Domino-TLIF could be considered a viable alternative to the midline fusion technique using CBT.

scholarly journals Contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion: causes and prevention

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110374
Author(s):  
Yun-lin Chen ◽  
Xu-dong Hu ◽  
Yang Wang ◽  
Wei-yu Jiang ◽  
Wei-hu Ma
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Compact Bone ◽  
Disc Height ◽  
Foraminal Stenosis ◽  
Lumbar Interbody Fusion ◽  
Common Cause ◽  
Circumferential Fusion ◽  
Segmental Angle

Background Unilateral transforminal lumbar interbody fusion (TLIF) with a single cage can provide circumferential fusion and biomechanical stability. However, the causes and prevention of contralateral radiculopathy following unilateral TLIF remain unclear. Methods In total, 190 patients who underwent unilateral TLIF from January 2017 to January 2019 were retrospectively reviewed. Radiological parameters including lumbar lordosis, segmental angle, anterior disc height, posterior disc height (PDH), foraminal height (FH), foraminal width, and foraminal area (FA) were measured preoperatively and postoperatively. Preoperative and postoperative visual analog scale scores were also recorded. Results The incidence of contralateral radiculopathy after unilateral TLIF was 5.3% (10/190). The most common cause was contralateral foraminal stenosis. Unilateral TLIF could increase the lumbar lordosis, segmental angle, and anterior disc height but decrease the PDH, FA, and FH in patients with symptomatic contralateral radiculopathy. The intervertebral cage should be placed to cover the epiphyseal ring and cortical compact bone of the midline, and the disc height can be increased to enlarge the contralateral foramen. Conclusion The most common cause of contralateral radiculopathy is contralateral foraminal stenosis. Careful preoperative planning is necessary to achieve satisfactory outcomes. Improper unilateral TLIF will decrease the PDH, FA, and FH, resulting in contralateral radiculopathy.

Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up

2012 ◽  
Vol 17 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Luis Marchi ◽  
Leonardo Oliveira ◽  
Etevaldo Coutinho ◽  
Luiz Pimenta
Keyword(s):  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Intraoperative Complications ◽  
Major Complication ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Screw Breakage ◽  
Segmental Lordosis

Object Axial lumbar interbody fusion (AxiaLIF) is a minimally invasive presacral surgical technique that damages neither the anulus fibrosus nor the anterior or posterior longitudinal ligaments. The technique was initially designed and used for L5–S1 interbody fusions and recently was extended to 2-level fusions (L4–5 and L5–S1). Until now, only biomechanical and radiological studies have discussed the feasibility of this new indication, and no clinical study has been published. The purpose of this article is to report results and complications associated with 2-level presacral AxiaLIF with a minimum of 24 months of follow-up. Methods In this prospective, nonrandomized, single-center study, 27 patients underwent presacral AxiaLIF surgery at the L4–5 and L5–S1 levels. Clinical outcomes were assessed using the visual analog scale for back and leg symptoms and the Oswestry Disability Index. Radiographic parameters, such as disc height, segmental lordosis, and bone fusion, were analyzed using radiographs and CT scans. Complications and revision surgeries were recorded as needed. The minimum follow-up was 24 months (up to 72 months). Results There were no intraoperative complications. One major complication was observed: a patient developed septicemia that resolved after proper care. Clinical outcomes scores showed overall improvement in pain and physical function. During follow-up, the following complications were observed in the construct: screw breakage (14.8%), proximal/distal transsacral rod detachment (11.1%), radiolucency around the transsacral rod (52%), and cephalic rod migration (24%). Disc height gain was reported early after surgery, but at the 24-month follow-up the disc space was diminished in comparison with the preoperative status. Compared with preoperative values, the 24-month results showed loss of segmental lordosis. Only 22% of all treated levels were considered to have solid fusion at the 24-month radiological evaluation. Conclusions Patients undergoing presacral 2-level AxiaLIF experienced satisfactory short-term clinical outcomes; however, complications were commonly seen on imaging studies obtained 24 months postoperatively. Additional studies are required to better understand the 2-level indications for this technique.

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