Posterolateral instrumented fusion with and without transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis: A randomized clinical trial with 2-year follow-up

BACKGROUND Operative treatment and fusion for isthmic spondylolisthesis can be achieved by various fusion techniques such as posterolateral fusion (PLF), anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and circumferential fusion. The purpose of this study is to evaluate the clinical outcome and radiological correction achieved after TLIF and assess the correlation between them if any. METHODS This is a retrospective cohort study analysing 30 cases of adult isthmic spondylolisthesis who failed conservative treatment and were then treated with transforaminal lumbar interbody fusion between 2011 and 2013. The clinical follow-up was done with the modified Oswestry disability index (ODI) and visual pain analogue score (VPAS). For the radiological follow-up radiographs were taken and several radiographic parameters were noted and analysed. RESULTS The mean of the Oswestry disability index scores in all patients decreased from 67.73 to 13.1 at final follow up. Similarly, visual pain analogue score reduced from mean 8.43 to 1.76 at final follow up. The average anterolisthesis was significantly reduced from the preoperative 27.1 ± 14 % to 7.1 ± 5 % at final follow-up radiographs (P < 0.001). Segmental lordosis increased from a mean of 11.5 degrees to 15.7 degrees. The difference in slip angle was significant from preoperative -4.87 ± 4.8 degrees and - 7.23 ± 4.63 degrees on the initial postoperative and - 7.2 ± 4.57 degrees at final follow-up radiographs (P = 0.14 and 0.13 respectively). CONCLUSIONS Thus, adult isthmic spondylolisthesis can be safely and effectively treated by TLIF with significant clinical relief and decrease in disability. TLIF procedure in isthmic spondylolisthesis is capable of reducing the sagittal translation and restoring disc height. Also, sagittal alignment and lordosis can be restored to a large extent. KEYWORDS Spondylolisthesis, Pelvic Incidence, Sagittal Balance, TLIF

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Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20159 ◽

2021 ◽

Vol 34 (1) ◽

pp. 83-88

Author(s):

Ping-Guo Duan ◽

Praveen V. Mummaneni ◽

Minghao Wang ◽

Andrew K. Chan ◽

Bo Li ◽

...

Keyword(s):

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Inclusion Criteria ◽

Single Level ◽

Degenerative Lumbar Spondylolisthesis ◽

Surgery Rates

OBJECTIVEIn this study, the authors’ aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.METHODSPatients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters.RESULTSA total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24–135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49–0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05).CONCLUSIONSIn patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.

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

Neurosurgical FOCUS ◽

10.3171/foc.2004.16.3.11 ◽

2004 ◽

Vol 16 (3) ◽

pp. 1-6 ◽

Cited By ~ 27

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.

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