EVALUATION OF VARIOUS DEVICE DESIGNS FOR POSTERIOR LUMBAR INTERBODY FUSION SURGERY USING A T10–S1 MULTILEVEL SPINE MODEL

2018 ◽  
Vol 30 (01) ◽  
pp. 1850003
Author(s):  
Minh-Thai Le ◽  
Ching-Chi Hsu ◽  
Kao-Shang Shih
Keyword(s):  
Interbody Fusion ◽  
Numerical Models ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Computational Time ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Fusion Surgery ◽  
Rod System ◽  
Spine Model

A spinal fusion surgery has been the gold standard treatment for treating lumbar degenerative disc disease. Many clinical studies have demonstrated that adjacent segment degeneration was observed in patients over time. Different types of stabilization systems have been investigated using numerical approaches. However, numerical models developed in the past were simplified to reduce computational time. Additionally, it is quite difficult to compare different stabilization systems in clinical application due to variation in bone anatomy and density. The aim of this study is to evaluate and compare the biomechanical performances of different stabilization systems using a more realistic spine model. In this study, three-dimensional finite element models of the intact, injured and treated T10–S1 multilevel spines are developed. The intersegmental rotation, the maximum disc stress and the maximum implant stress are calculated. The results showed that the pedicle screw–rod system can provide better fixation stability and lower implant stress. The Coflex system (CFS) has an advantage on reducing the risk of adjacent segment degeneration. This study could provide useful information to surgeons understanding the effects of different stabilization systems on the biomechanical performances for the posterior lumbar interbody fusion surgery.

Repeated adjacent-segment degeneration after posterior lumbar interbody fusion

2014 ◽  
Vol 20 (5) ◽  
pp. 538-541 ◽  
Author(s):  
Shinya Okuda ◽  
Takenori Oda ◽  
Ryoji Yamasaki ◽  
Takafumi Maeno ◽  
Motoki Iwasaki
Keyword(s):  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Long Term Results ◽  
Sacral Slope ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Primary Operation ◽  
The Third

One of the most important sequelae affecting long-term results is adjacent-segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF). Although several reports have described the incidence rate, there have been no reports of repeated ASD. The purpose of this report was to describe 1 case of repeated ASD after PLIF. A 62-year-old woman with L-4 degenerative spondylolisthesis underwent PLIF at L4–5. At the second operation, L3–4 PLIF was performed for L-3 degenerative spondylolisthesis 6 years after the primary operation. At the third operation, L2–3 PLIF was performed for L-2 degenerative spondylolisthesis 1.5 years after the primary operation. Vertebral collapse of L-1 was detected 1 year after the third operation, and the collapse had progressed. At the fourth operation, 3 years after the third operation, vertebral column resection of L-1 and replacement of titanium mesh cages with pedicle screw fixation between T-4 and L-5 was performed. Although the patient's symptoms resolved after each operation, the time between surgeries shortened. The sacral slope decreased gradually although each PLIF achieved local lordosis at the fused segment.

scholarly journals Does Atherosclerosis Have Negative Impacts on Early Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion?

2020 ◽  
pp. 219256822091937
Author(s):  
Hironobu Sakaura ◽  
Daisuke Ikegami ◽  
Takahito Fujimori ◽  
Tsuyoshi Sugiura ◽  
Yoshihiro Mukai ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Interbody Fusion ◽  
Surrogate Marker ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Negative Impacts

Study Design: Retrospective study. Objective: To examine whether atherosclerosis has negative impacts on early adjacent segment degeneration (ASD) after posterior lumbar interbody fusion using traditional trajectory pedicle screw fixation (TT-PLIF). Methods: The subjects were 77 patients who underwent single-level TT-PLIF for degenerative lumbar spondylolisthesis. Using dynamic lateral radiographs of the lumbar spine before surgery and at 3 years postoperatively, early radiological ASD (R-ASD) was examined. Early symptomatic ASD (S-ASD) was diagnosed when neurologic symptoms deteriorated during postoperative 3-year follow-up and the responsible lesions adjacent to the fused segment were also confirmed on magnetic resonance imaging. According to the scoring system by Kauppila et al, the abdominal aortic calcification score (AAC score: a surrogate marker of systemic atherosclerosis) was assessed using preoperative lateral radiographs of the lumbar spine. Results: The incidence of early R-ASD was 41.6% at the suprajacent segment and 8.3% at the subjacent segment, respectively. Patients with R-ASD had significantly higher AAC score than those without R-ASD. The incidence of early S-ASD was 3.9% at the suprajacent segment and 1.4% at the subjacent segment, respectively. Patients with S-ASD had higher AAC score than those without S-ASD, although there was no significant difference. Conclusions: At 3 years after surgery, the advanced AAC had significantly negative impacts on early R-ASD after TT-PLIF. This result indicates that impaired blood flow due to atherosclerosis can aggravate degenerative changes at the adjacent segments of the lumbar spine after PLIF.

scholarly journals Comparison of pedicle screw–based dynamic stabilization and fusion surgery in the treatment of radiographic adjacent-segment degeneration: a retrospective analysis of single L5–S1 degenerative spondylosis covering 4 years

2016 ◽  
Vol 25 (6) ◽  
pp. 706-712 ◽  
Author(s):  
Yu Han ◽  
Jianguang Sun ◽  
Chenghan Luo ◽  
Shilei Huang ◽  
Liren Li ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Spinopelvic Parameters ◽  
Fusion Surgery ◽  
Spinal Stabilization ◽  
Pfirrmann Grade

OBJECTIVE Pedicle screw–based dynamic spinal stabilization systems (PDSs) were devised to decrease, theoretically, the risk of long-term complications such as adjacent-segment degeneration (ASD) after lumbar fusion surgery. However, to date, there have been few studies that fully proved that a PDS can reduce the risk of ASD. The purpose of this study was to examine whether a PDS can influence the incidence of ASD and to discuss the surgical coping strategy for L5–S1 segmental spondylosis with preexisting L4–5 degeneration with no related symptoms or signs. METHODS This study retrospectively compared 62 cases of L5–S1 segmental spondylosis in patients who underwent posterior lumbar interbody fusion (n = 31) or K-Rod dynamic stabilization (n = 31) with a minimum of 4 years' follow-up. The authors measured the intervertebral heights and spinopelvic parameters on standing lateral radiographs and evaluated preexisting ASD on preoperative MR images using the modified Pfirrmann grading system. Radiographic ASD was evaluated according to the results of radiography during follow-up. RESULTS All 62 patients achieved remission of their neurological symptoms without surgical complications. The Kaplan-Meier curve and Cox proportional-hazards model showed no statistically significant differences between the 2 surgical groups in the incidence of radiographic ASD (p > 0.05). In contrast, the incidence of radiographic ASD was 8.75 times (95% CI 1.955–39.140; p = 0.005) higher in the patients with a preoperative modified Pfirrmann grade higher than 3 than it was in patients with a modified Pfirrmann grade of 3 or lower. In addition, no statistical significance was found for other risk factors such as age, sex, and spinopelvic parameters. CONCLUSIONS Pedicle screw–based dynamic spinal stabilization systems were not found to be superior to posterior lumbar interbody fusion in preventing radiographic ASD (L4–5) during the midterm follow-up. Preexisting ASD with a modified Pfirrmann grade higher than 3 was a risk factor for radiographic ASD. In the treatment of degenerative diseases of the lumbosacral spine, the authors found that both of these methods are feasible. Also, the authors believe that no extra treatment, other than observation, is needed for preexisting degeneration in L4–5 without any clinical symptoms or signs.

Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients

2006 ◽  
Vol 4 (4) ◽  
pp. 304-309 ◽  
Author(s):  
Shinya Okuda ◽  
Akira Miyauchi ◽  
Takenori Oda ◽  
Takamitsu Haku ◽  
Tomio Yamamoto ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Complications ◽  
Interbody Fusion ◽  
Intraoperative Complications ◽  
Posterior Lumbar Interbody Fusion ◽  
Clinical Results ◽  
Neurological Complications ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion

Object Previous studies of surgical complications associated with posterior lumbar interbody fusion (PLIF) are of limited value due to intrastudy variation in instrumentation and fusion techniques. The purpose of the present study was to examine rates of intraoperative and postoperative complications of PLIF using a large number of cases with uniform instrumentation and a uniform fusion technique. Methods The authors reviewed the hospital records of 251 patients who underwent PLIF for degenerative lumbar disorders between 1996 and 2002 and who could be followed for at least 2 years. Intraoperative, early postoperative, and late postoperative complications were investigated. Intraoperative complications occurred in 26 patients: dural tearing in 19 patients and pedicle screw malposition in seven patients. Intraoperative complications did not affect the postoperative clinical results. Early postoperative complications occurred in 19 patients: brain infarction occurred in one, infection in one, and neurological complications in 17. Of the 17 patients with neurological complications, nine showed severe motor loss such as foot drop; the remaining eight patients showed slight motor loss or radicular pain alone, and their symptoms improved within 6 weeks. Late postoperative complications occurred in 17 patients: hardware failure in three, nonunion in three, and adjacent-segment degeneration in 11. Postoperative progression of symptomatic adjacentsegment degeneration was defined as a condition that required additional surgery to treat neurological deterioration. Conclusions The most serious complications of PLIF were postoperative severe neurological deficits and adjacent-segment degeneration. Prevention and management of such complications are necessary to attain good long-term clinical results.

scholarly journals Adjacent Segment Degeneration after Posterior Lumbar Interbody Fusion: Based on Cases with a Minimum of 10 years of Follow-Up

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554255-s-0035-1554255
Author(s):  
Hiroaki Nakashima ◽  
Noriaki Kawakami ◽  
Taichi Tsuji ◽  
Shiro Imagama
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion

Preventive Effect of Dynamic Stabilization Against Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion

Spine ◽  
2017 ◽  
Vol 42 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Naohiro Tachibana ◽  
Naohiro Kawamura ◽  
Daiki Kobayashi ◽  
Takaki Shimizu ◽  
Takeshi Sasagawa ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Dynamic Stabilization ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Preventive Effect

59. Risk factors for adjacent segment degeneration after posterior lumbar interbody fusion

2004 ◽  
Vol 4 (5) ◽  
pp. S31-S32
Author(s):  
Shinya Okuda ◽  
Motoki Iwasaki ◽  
Akira Miyauchi ◽  
Masahiro Morita ◽  
Hiroyuki Aono
Keyword(s):  
Risk Factors ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion

Negative impact of short-level posterior lumbar interbody fusion in patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segment

2021 ◽  
pp. 1-7
Author(s):  
Hideaki Nakajima ◽  
Kazuya Honjoh ◽  
Shuji Watanabe ◽  
Arisa Kubota ◽  
Akihiko Matsumine
Keyword(s):  
Clinical Outcome ◽  
Revision Surgery ◽  
Interbody Fusion ◽  
Negative Impact ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Fusion Surgery ◽  
Lumbar Segment

OBJECTIVE The development of diffuse idiopathic skeletal hyperostosis (DISH) often requires further surgery after posterior decompression without fusion because of postoperative intervertebral instability. However, there is no information on whether fusion surgery is recommended for these patients as the standard surgery. The aim of this study was to review the clinical and imaging findings in lumbar spinal canal stenosis (LSS) patients with DISH affecting the lumbar segment (L-DISH) and to assess the indication for fusion surgery in patients with DISH. METHODS A total of 237 patients with LSS underwent 1- or 2-level posterior lumbar interbody fusion (PLIF) at the authors’ hospital and had a minimum follow-up period of 2 years. Patients with L-DISH were classified as such (n = 27, 11.4%), whereas those without were classified as controls (non-L-DISH; n = 210, 88.6%). The success rates of short-level PLIF were compared in patients with and those without L-DISH. The rates of adjacent segment disease (ASD), pseudarthrosis, postoperative symptoms, and revision surgery were examined in the two groups. RESULTS L-DISH from L2 to L4 correlated significantly with early-onset ASD, pseudarthrosis, and the appearance of postsurgical symptoms, especially at a lower segment and one distance from the segment adjacent to L-DISH, which were associated with the worst clinical outcome. Significantly higher percentages of L-DISH patients developed ASD and pseudarthrosis than those in the non-L-DISH group (40.7% vs 4.8% and 29.6% vs 2.4%, respectively). Of those patients with ASD and/or pseudarthrosis, 69.2% were symptomatic and 11.1% underwent revision surgery. CONCLUSIONS The results highlighted the negative impact of short-level PLIF surgery for patients with L-DISH. Increased mechanical stress below the fused segment was considered the reason for the poor clinical outcome.

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