Comparison of Spinal Alignment between XLIF, TLIF, PLIF, and PLF in the Treatment of Single Level Spondylolisthesis: A Retrospective Study

2021 ◽  
Vol 104 (12) ◽  
pp. 1959-1965

Background: Most lumbar spinal fusion procedures are performed to increase fusion potential, correct a deformity, and decompress spinal nerve roots. Nowadays, there are several spinal fusion techniques such as extreme lateral lumbar interbody fusion (XLIF), transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterolateral fusion (PLF). However, there are no studies directly comparing their capacity to alter lumbar lordosis, segmental lordosis, intervertebral disc height, foraminal height, and the grade of slip for treating single level spondylolisthesis in Thailand. Objective: To compare which lumbar interbody technique amongst XLIF, TLIF, PLIF, and PLF, is the most effective in restoring spinal alignment in cases such as lumbar lordosis, increased segmental lordosis, increased intervertebral disc height, increased foraminal height, and a reduced slip grade in spondylolisthesis patients. Materials and Methods: The medical records and radiographs of single level spondylolisthesis patients treated in Siriraj hospital between 2002 and 2017 were retrospectively reviewed. Clinical data and radiographic parameters such as lumbar lordosis, segmental lordosis, intervertebral disc height, foraminal height, and grade of slip, including preoperative and postoperative data were collected and analyzed. An inter-observer/ intra-observer reliability test for all parameters was also performed. Results: Two hundred forty patients including 192 females and 48 males with a mean age of 60.1 years were included in the present study. There was no statistically significant difference in demographic data except in younger patients in the PLF group and those with shorter length of stays in the XLIF group. The present study results indicated that there was a statistically significant increase in lumbar lordosis, increased foraminal height, and decreased slip grade in the XLIF group when compared to other three groups as TLIF, PLIF, and PLF. Conclusion: All spinal fusion techniques could improve lumbar spinal alignment, however, XLIF is superior to other procedures, especially in lumbar lordosis, foraminal height restoration, and slip grade. Keywords: Lumbar spondylolisthesis; Extreme lateral lumbar interbody fusion; Transforaminal lumbar interbody fusion; Posterior lumbar interbody fusion; Posterolateral fusion; Lumbar lordosis

2021 ◽  
pp. 1-9
Author(s):  
S. Harrison Farber ◽  
Soumya Sagar ◽  
Jakub Godzik ◽  
James J. Zhou ◽  
Corey T. Walker ◽  
...  

OBJECTIVE Anterior lumbar interbody fusion (ALIF) used at the lumbosacral junction provides arthrodesis for several indications. The anterior approach allows restoration of lumbar lordosis, an important goal of surgery. With hyperlordotic ALIF implants, several options may be employed to obtain the desired amount of lordosis. In this study, the authors compared the degree of radiographic lordosis achieved with lordotic and hyperlordotic ALIF implants at the L5–S1 segment. METHODS All patients undergoing L5–S1 ALIF from 2 institutions over a 4-year interval were included. Patients < 18 years of age or those with any posterior decompression or osteotomy were excluded. ALIF implants in the lordotic group had 8° or 12° of inherent lordosis, whereas implants in the hyperlordotic group had 20° or 30° of lordosis. Upright standing radiographs were used to determine all radiographic parameters, including lumbar lordosis, segmental lordosis, disc space lordosis, and disc space height. Separate analyses were performed for patients who underwent single-segment fixation at L5–S1 and for the overall cohort. RESULTS A total of 204 patients were included (hyperlordotic group, 93 [45.6%]; lordotic group, 111 [54.4%]). Single-segment ALIF at L5–S1 was performed in 74 patients (hyperlordotic group, 27 [36.5%]; lordotic group, 47 [63.5%]). The overall mean ± SD age was 61.9 ± 12.3 years; 58.3% of patients (n = 119) were women. The mean number of total segments fused was 3.2 ± 2.6. Overall, 66.7% (n = 136) of patients had supine surgery and 33.3% (n = 68) had lateral surgery. Supine positioning was significantly more common in the hyperlordotic group than in the lordotic group (83.9% [78/93] vs 52.3% [58/111], p < 0.001). After adjusting for differences in surgical positioning, the change in lumbar lordosis was significantly greater for hyperlordotic versus lordotic implants (3.6° ± 7.5° vs 0.4° ± 7.5°, p = 0.048) in patients with single-level fusion. For patients receiving hyperlordotic versus lordotic implants, changes were also significantly greater for segmental lordosis (12.4° ± 7.5° vs 8.4° ± 4.9°, p = 0.03) and disc space lordosis (15.3° ± 5.4° vs 9.3° ± 5.8°, p < 0.001) after single-level fusion at L5–S1. The change in disc space height was similar for these 2 groups (p = 0.23). CONCLUSIONS Hyperlordotic implants provided a greater degree of overall lumbar lordosis restoration as well as L5–S1 segmental and disc space lordosis restoration than lordotic implants. The change in disc space height was similar. Differences in lateral and supine positioning did not affect these parameters.


Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Caleb S Edwards ◽  
Andrew Kai-Hong Chan ◽  
Dean Chou ◽  
Praveen V Mummaneni

Abstract INTRODUCTION The lumbosacral junction acts as a transition point between the mobile lumbar spine and the rigid pelvis. It is thereby susceptible to degenerative changes necessitating fusion at L5-S1. In this study, we compared radiographic outcomes observed from single-level anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF) at this level. METHODS Retrospective review of single-level ALIF and TLIF with up to one level PSF at L5-S1 between May 2007 and October 2018 was undertaken. X-ray measurements were gathered for lumbar lordosis, segmental lordosis, pelvic tilt, sacral slope, pelvic incidence, pelvic incidence-lumbar lordosis mismatch, anterior/posterior disc height, and sagittal vertical axis. Computed tomography /magnetic resonance imaging was used to determine central canal area, sagittal diameter, foraminal height, and foraminal area. RESULTS A total of 47 ALIF patients and 50 TLIF patients were included. Patients averaged 53.7 ± 10.1 yr of age for ALIF and 49.4 ± 14.7 yr old for TLIF (P = .094) with significant differences (P = .0017) seen with gender as ALIF had 60.4% males and TLIF 70.0% females. Single-level ALIF led to significantly (P = .0010) more segmental lordosis (+5.75° ± 7.31°) than TLIF (+0.25° ± 6.55°), though differences in lumbar lordosis were not statistically significant (P = .52). ALIF significantly increased both anterior (+10.4 ± 4.32 mm vs +4.30 ± 3.55 mm; P < .0001) and posterior disc height (+4.33 ± 3.32 mm vs + 2.98 ± 2.07 mm; P = .043) than TLIF. Changes in sagittal vertical axis also significantly differed (P = .030) with ALIF decreasing sagittal vertical axis by 17.8 ± 26.4 mm from +60.3 mm to + 42.5 mm, and TLIF increasing by 0.95 ± 25.8 mm from 39.9 mm to 40.9 mm. Pelvic tilt, sacral slope, pelvic incidence, pelvic incidence-lumbar lordosis mismatch had no significant differences. No statistically significant differences were observed with central canal area, sagittal diameter, foraminal height or foraminal area between ALIF and TLIF. CONCLUSION At L5-S1, the ALIF approach leads to increased segmental lordosis, disc height, while also decreasing sagittal vertical axis to a significant degree than TLIF. However, these two approaches were no different with regards to pelvic parameters and measures of central canal and foraminal decompression.


Neurosurgery ◽  
2017 ◽  
Vol 81 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Timothy J. Yee ◽  
Jacob R. Joseph ◽  
Samuel W. Terman ◽  
Paul Park

Abstract BACKGROUND: One criticism of transforaminal lumbar interbody fusion (TLIF) is the inability to increase segmental lordosis (SL). Expandable interbody cages are a relatively new innovation theorized to allow improvement in SL. OBJECTIVE: To compare changes in SL and lumbar lordosis (LL) after TLIF with nonexpandable vs expandable cages. METHODS: We performed a retrospective cohort study of patients who were ≥18 years old and underwent single-level TLIF between 2011 and 2014. Patients were categorized by cage type (static vs expandable). Primary outcome of interest was change in SL and LL from preoperative values to those at 1 month and 1 year postoperatively. RESULTS: A total of 89 patients were studied (48 nonexpandable group, 41 expandable group). Groups had similar baseline characteristics. For SL, median (interquartile range) improvement was 3° for nonexpandable and 2° for expandable (unadjusted, P = .09; adjusted, P = .68) at 1 month postoperatively, and 3° for nonexpandable and 1° for expandable (unadjusted, P = .41; adjusted, P = .28) at 1 year postoperatively. For LL, median improvement was 1° for nonexpandable and 2° for expandable (unadjusted, P = .20; adjusted, P = .21), and 2° for nonexpandable and 5° for expandable (unadjusted, P = .15; adjusted, P = .51) at 1 year postoperatively. After excluding parallel expandable cages, there was still no difference in SL or LL improvement at 1 month or 1 year postoperatively between static and expandable cages (both unadjusted and adjusted, P &gt; .05). CONCLUSION: Patients undergoing single-level TLIF experienced similar improvements in SL and LL regardless of whether nonexpandable or expandable cages were placed.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hiromitsu Takaoka ◽  
Kazuhide Inage ◽  
Yawara Eguchi ◽  
Yasuhiro Shiga ◽  
Takeo Furuya ◽  
...  

AbstractThis study aimed to perform a comparative analysis of postoperative results between lumbar degenerative spondylolisthesis (LDS) treated with oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) from the Chiba spine surgery registry database. Sixty-five patients who underwent single-level OLIF (O group) for LDS with ≥ 3 years’ follow-up were retrospectively reviewed. The control group comprised 78 patients who underwent single-level TLIF (T group). The analyzed variables included global alignment, radiological parameters of fused segments, asymptomatic and symptomatic ASD incidence, clinical outcomes at 3 years postoperatively using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire data, visual analogue scale scores for low back pain, lower extremity pain, and lower extremity numbness. There was no significant change in global alignment between the two groups. The rate of improvement in anterior intervertebral disc height was not significantly different between the groups at 1-month postoperatively. However, at the final evaluation, the anterior intervertebral disc height and incidence of asymptomatic ASD were significantly higher in the O group. There was no significant difference in symptomatic ASD, reoperation cases, or clinical results between groups. Thus, single-level OLIF can maintain the corrected disc height, but as it has no effect on global alignment, its benefit is limited.


2020 ◽  
Author(s):  
Hyeun-Sung Kim ◽  
Harshavardhan Dilip Raorane ◽  
Pang Hung Wu ◽  
Dong Hwa Heo ◽  
Yeon Jin Yi ◽  
...  

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.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shih-Feng Hung ◽  
Jen-Chung Liao ◽  
Tsung-Ting Tsai ◽  
Yun-Da Li ◽  
Ping-Yeh Chiu ◽  
...  

AbstractMinimal invasive spinal fusion has become popular in the last decade. Oblique lumbar interbody fusion (OLIF) is a relatively new surgical technique and could avoid back muscle stripping and posterior complex destruction as in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Between December 2016 and September 2018, patients with single level degenerative spondylosis were selected to enroll in this retrospective study. A total of 21 patients that underwent OLIF and 41 patients that received MIS-TLIF were enrolled. OLIF showed significantly less blood loss and shorter surgery time compared to MIS-TLIF (p < 0.05). The improvement in segmental lordosis and coronal balance was significantly more in OLIF group than MIS-TLIF group (p < 0.05). When comparing with MIS-TLIF, OLIF was significantly better in Oswestry Disability Index (ODI) and visual analogue scale for back pain improvement at post-operative 6 months (p < 0.05). Both OLIF and MIS-TLIF are becoming mainstream procedures for lumbar degenerative-related disease, especially for spondylolisthesis. However, the indirect decompression of OLIF has shown to have less perioperative blood loss and shorter surgery time than that of MIS-TLIF. In addition, OLIF gives superior outcome in restoring segmental lordosis and coronal imbalance. While both OLIF and MIS-TLIF provide optimal clinical outcomes, upon comparison between the two techniques, the indirect decompression of OLIF seems to be a superior option in modern days.


2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Long Jia ◽  
Yan Yu ◽  
Kamran Khan ◽  
Fuping Li ◽  
Rui Zhu ◽  
...  

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.


Sign in / Sign up

Export Citation Format

Share Document