scholarly journals Efficacy of Platelet-Rich Plasma for Bone Fusion in Transforaminal Lumbar Interbody Fusion

2018 ◽  
Vol 12 (1) ◽  
pp. 112-118 ◽  
Author(s):  
Go Kubota ◽  
Hiroto Kamoda ◽  
Sumihisa Orita ◽  
Kazuhidee Inage ◽  
Michihiro Ito ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Platelet Rich Plasma ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Bone Union ◽  
Leg Pain ◽  
Control Group ◽  
Bone Fusion ◽  
Local Bone ◽  
Fusion Cage

<sec><title>Study Design</title><p>Retrospective case series.</p></sec><sec><title>Purpose</title><p>To examine the efficacy of platelet-rich plasma (PRP) for bone fusion in transforaminal lumbar interbody fusion (TLIF) using local bone grafting.</p></sec><sec><title>Overview of Literature</title><p>Several authors have reported the efficacy of PRP for bone union in animal models. However, the use of PRP for bone fusion in TLIF surgery has not been fully explored.</p></sec><sec><title>Methods</title><p>Twenty patients underwent single-level TLIF surgery because of L4 spondylolisthesis. An interbody fusion cage and local bone were used in nine patients (control group) and an interbody fusion cage, local bone, and PRP were used in 11 patients (PRP group). PRP was prepared from the patients' blood samples (400 mL) immediately before surgery. The duration of bone union and postoperative bone fusion rate were assessed using plain radiography at every 3 months postoperatively and computed tomography at 12 or 24 months postoperatively, respectively. Lower back pain, leg pain, and leg numbness were evaluated using the visual analog scale preoperatively and at 3, 6, 12, and 24 months postoperatively.</p></sec><sec><title>Results</title><p>The platelet count was 8.7 times higher in PRP than in blood. The bone union rate was significantly superior in the PRP group than in the control group (91% and 77%, respectively; <italic>p</italic>=0.035), whereas the average duration of bone union was not significantly different between the groups (7.7±0.74 and 10.0±2.00 months, respectively; <italic>p</italic>=0.131). There was no significant difference in lower back pain, leg pain, and leg numbness in both groups during follow-up (<italic>p</italic>&gt;0.05).</p></sec><sec><title>Conclusions</title><p>Our study suggests that the use of PRP in TLIF surgery increases bone fusion rate.</p></sec>

Reduction and transforaminal lumbar interbody fusion with posterior fixation versus transsacral cage fusion in situ with posterior fixation in the treatment of Grade 2 adult isthmic spondylolisthesis in the lumbosacral spine

2010 ◽  
Vol 13 (3) ◽  
pp. 394-400 ◽  
Author(s):  
Kai Gong ◽  
Zhe Wang ◽  
Zhuojing Luo
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Leg Pain ◽  
Posterior Fixation ◽  
Isthmic Spondylolisthesis ◽  
Disc Space ◽  
Group A ◽  
Group B

Object In situ transsacral fusion in the treatment of low-grade isthmic spondylolisthesis has rarely been reported. The authors treated 13 cases of L-5 Grade 2 isthmic spondylolisthesis associated with collapsed disc space and osteoporosis by using transsacral fusion and fixation, and compared its clinical and radiological outcomes with the results of transforaminal lumbar interbody fusion (TLIF) and instrumental reduction in 21 patients. Methods The authors retrospectively analyzed 21 patients in Group A who were treated with reduction and TLIF, and 13 patients in Group B who were treated with transsacral cage fusion. Oswestry Disability Index and visual analog scale scores of back and leg pain were used to evaluate clinical outcomes. Radiological parameters for assessment included the percentage of slippage, whole lumbar lordosis, and lumbosacral angle. Operative data, fusion rate, and perioperative complications were recorded as well. Results The mean operation time and blood loss in Group B was less than that in Group A. Both groups realized good recovery from previous symptoms. The decrease in back and leg pain after surgery was significant within each group, without much difference between the 2 groups. No significant differences were found in lumbosacral angle, whole lumbar lordosis, visual analog scale score, and Oswestry Disability Index score between the 2 groups after surgery. The solid fusion rate was 95.2% in Group A and 92.3% in Group B. In Group A, 2 patients suffered from graft site pain, 1 had a superficial infection, and 1 had screw loosening; in Group B, dural tears were found in 2 patients, transient S-1 paresthesia in 2, and extensor hallucis longus muscle weakness in 1. Conclusions For patients with a collapsed disc space and poor bone quality, posterior in situ transsacral cage fusion may be used as an alternative to the TLIF procedure. The short-term clinical and radiological outcomes in the transsacral cage group were comparable with those in the TLIF group, although with a relatively higher neurological complication rate.

scholarly journals Functional and radiological comparison of transforaminal lumbar interbody fusion method with interbody fusion device versus stand-alone bone graft in lumbar canal stenosis or degenerative lumbar instability

2021 ◽  
Vol 7 (2) ◽  
pp. 291
Author(s):  
Ashish Kumar Gupta ◽  
Jitendra Singh Rathore ◽  
Lokpal Singh Bhati ◽  
Devendra Singh Rathore ◽  
R. C. Meena
Keyword(s):  
Bone Graft ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Group Comparison ◽  
Vas Score ◽  
Current Series ◽  
Local Bone ◽  
Rate Score ◽  
Group A

<p><strong>Background: </strong>Spinal stability is the vertebral ability to maintain their relationship and limit their relative displacements during physiologic postures and loads.</p><p><strong>Methods:</strong> Hospital based prospective randomized comparative study design between 2 groups included patients of both sex attending SMS hospital Jaipur, from April 2018 to June 2019 or till sample size was achieved, with due permission from institutional ethical committee and review board and after taking written informed consent from patients.</p><p><strong>Results: </strong>Inter group comparison of VAS score showed same results in both groups which showed statistically non-significant results. VAS score showed significantly reduction in both group A and B till the study period. Inter group comparison of ODI score showed same results in both groups which showed statistically non-significant results. ODI score showed significantly reduction in both group A and B till the study period. Inter group comparison of fusion rate score showed same results in both groups which showed statistically non-significant results. Fusion rate score showed significantly increased in both group A and B till the study period and at the 12 month it was 100% fusion rate.</p><p><strong>Conclusions: </strong>In the current series, the TLIF procedure with local bone graft alone improved anterior vertebral translation, disc height, and lumbar lordosis. A proper surgical technique with adequate discectomy and facetectomy would contribute greatly to the improvement of the radiological parameters; however, this improvement was not maintained at the latest follow up.</p><p><strong> </strong></p>

scholarly journals Low-grade spondylolisthesis: is transforaminal lumbar interbody fusion superior to posterolateral fusion

2020 ◽  
Vol 6 (3) ◽  
pp. 597
Author(s):  
Hiranya Kumar Seenappa ◽  
Karthik Narayanamurthy Mittemari ◽  
Vamshikrishna Chand Nimmagadda
Keyword(s):  
Clinical Outcomes ◽  
Oswestry Disability Index ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Posterolateral Fusion ◽  
Leg Pain ◽  
Low Grade ◽  
Lumbar Interbody Fusion ◽  
Caudal Segment

<p class="abstract"><strong>Background:</strong> Spondylolisthesis is anterior translation of the cephalad vertebra relative to the adjacent caudal segment. Both posterolateral fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) and have shown high fusion rates with good clinical outcomes. But it is not clear which treatment leads to better outcomes, as limited studies have been done to compare PLF and TLIF in low grade spondylolisthesis. Our objective is to determine whether PLF or TLIF was associated with better clinical and radiological outcomes in patients with low grade spondylolisthesis.</p><p class="abstract"><strong>Methods:</strong> Fourty patients were enrolled and assigned into PLF (n=20) or TLIF (n=20) group. The outcome measures were: clinical outcomes as assessed with a visual analogue scale and the modified Oswestry disability index, the fusion rate based on radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> The improvement of visual analog score (VAS) of low back pain was greater in TLIF than in PLF (89.6% versus 88.7%, p=0.79). The improvement of VAS of leg pain was greater in TLIF than in PLF (96.5% versus 94.8%; p=0.27). The improvement of Oswestry disability index (ODI) was greater in TLIF than in PLF (71.7% vs 69.8%, p=0.32). The fusion rate was 85% in TLIF and 75% in PLF (p=0.43).  Overall outcome was excellent in 80% in TLIF compared to 65% in PLF (p=0.29).</p><p class="abstract"><strong>Conclusions:</strong> Fusion rates are higher in TLIF and average functional outcomes (VAS and ODI) were better in TLIF compared to PLF.  Larger and longer studies may provide a significant outcome. Based on our results and literature review, we conclude that TLIF is superior to PLF.</p>

Do we need a transforaminal lumbar interbody fusion cage to increase the stability of functional spinal unit when comparing unilateral and bilateral fixation?

2018 ◽  
Vol 232 (7) ◽  
pp. 655-664
Author(s):  
Murat Ulutaş ◽  
Mustafa Özkaya ◽  
Onur Yaman ◽  
Teyfik Demir
Keyword(s):  
Pedicle Screw ◽  
Axial Compression ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Pedicle Screw Fixation ◽  
Control Group ◽  
Lumbar Interbody Fusion ◽  
Fusion Cage ◽  
Interbody Fusion Cage

Transforaminal lumbar interbody fusion was an alternative to posterior lumbar interbody fusion for decompression surgeries. This study investigates the biomechanical responses of the unilateral and bilateral pedicle screw fixations with/without transforaminal lumbar interbody fusion cages under axial compression, flexion, and torsional loads. Ovine vertebrae were used in this study. Cadavers, randomly divided into five, were intact control group, bilateral pedicle screw fixation group, bilateral pedicle screw fixation group with transforaminal lumbar interbody fusion cage, unilateral pedicle screw fixation group, and unilateral pedicle screw fixation group with transforaminal lumbar interbody fusion cage. Axial compression, flexion, and torsion tests were performed on specimens. All study groups provided higher stiffness and yield load values than control group under axial compression. Addition of transforaminal lumbar interbody fusion cage to bilateral fixation increased the stiffness under axial compression. Moreover, additional use of transforaminal lumbar interbody fusion in unilateral fixation increased the yield load values under axial compression. Control group was the stiffest in flexion test. Placing a transforaminal lumbar interbody fusion cage to both unilateral and bilateral fixations did not significantly change the stiffness values. Additional transforaminal lumbar interbody fusion cage increased the yield moment of the bilateral fixation. In torsion test, control group had the highest stiffness and yield torque. The facet joints are the most important parts of the vertebrae on the stability. When comparing the bilateral and unilateral fixations with transforaminal lumbar interbody fusion addition, the more facet preserving approach has significantly higher stability under axial compression, flexion, and torsion. Unilateral fixation with transforaminal lumbar interbody fusion cage can be said biomechanically stable and advantageous fixation system because of the advantage on the less facet and soft tissue resection compared to bilateral fixation with transforaminal lumbar interbody fusion.

scholarly journals Does Subcutaneous Infiltration of Liposomal Bupivacaine Following Single-Level Transforaminal Lumbar Interbody Fusion Surgery Improve Immediate Postoperative Pain Control?

2018 ◽  
Vol 12 (1) ◽  
pp. 85-93 ◽  
Author(s):  
Marko Tomov ◽  
Kevin Tou ◽  
Rose Winkel ◽  
Ross Puffer ◽  
Mohamad Bydon ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Control Group ◽  
Lumbar Interbody Fusion ◽  
Control Cohort ◽  
Liposomal Bupivacaine ◽  
Single Level ◽  
The Impact

<sec><title>Study Design</title><p>Retrospective case-control study using prospectively collected data.</p></sec><sec><title>Purpose</title><p>Evaluate the impact of liposomal bupivacaine (LB) on postoperative pain management and narcotic use following standardized single-level low lumbar transforaminal lumbar interbody fusion (TLIF).</p></sec><sec><title>Overview of Literature</title><p>Poor pain control after surgery has been linked with decreased pain satisfaction and increased economic burden. Unfortunately, opioids have many limitations and side effects despite being the primary treatment of postoperative pain. LB may be a form of pre-emptive analgesia used to reduce the use of postoperative narcotics as evidence in other studies evaluating its use in single-level microdiskectomies.</p></sec><sec><title>Methods</title><p>The infiltration of LB subcutaneously during wound closure was performed by a single surgeon beginning in July 2014 for all single-level lumbar TLIF spinal surgeries at Landstuhl Regional Medical Center. This cohort was compared against a control cohort of patients who underwent the same surgery by the same surgeon in the preceding 6 months. Statistical analysis was performed on relevant variables including: morphine equivalents of narcotic medication used (primary outcome), length of hospitalization, Visual Analog Scale pain scores, and total time spent on a patient-controlled analgesia (PCA) pump.</p></sec><sec><title>Results</title><p>A total of 30 patients were included in this study; 16 were in the intervention cohort and 14 were in the control cohort. The morphine equivalents of intravenous narcotic use postoperatively were significantly less in the LB cohort from day of surgery to postoperative day 3. Although the differences lost their statistical significance, the trend remained for total (oral and intravenous) narcotic consumption to be lower in the LB group. The patients who received the study intervention required an acute pain service consult less frequently (62.5% in LB cohort vs. 78.6% in control cohort). The amount of time spent on a PCA pump in the LB group was 31 hours versus 47 hours in the control group (<italic>p</italic>=0.1506).</p></sec><sec><title>Conclusions</title><p>Local infiltration of LB postoperatively to the subcutaneous tissues during closure following TLIF significantly decreased the amount of intravenous narcotic medication required by patients. Well-powered prospective studies are still needed to determine optimal dosing and confirm benefits of LB on total narcotic consumption and other measures of pain control following major spinal surgery.</p></sec>

“Pin Method” for Endoscopic Lumbar Interbody Fusion

2021 ◽  
Author(s):  
Ting-Chun Huang
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Skin Incision ◽  
Neurogenic Claudication ◽  
Lumbar Interbody Fusion ◽  
Neural Structure ◽  
Oriented Parallel ◽  
Blind Spots

Abstract Background Endoscopic lumbar interbody fusion using a cage can have a similar fusion rate as minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or open lumbar interbody fusion. Direct visual control during cage insertion is the key to prevent neural structure incarceration in endoscopic lumbar interbody fusion. Creating a track with any kind of retractor or cannula for cage insertion under fluoroscopic guidance is not safe enough, because the retractor and cannula can create many blind spots and can displace during cage insertion. Method The pin method utilizes two flexible metallic guide pins inserted from the skin incision through the annulotomy site into the disk space until the anterior longitudinal ligament is reached under direct endoscopic monitoring. The two guide pins could be oriented parallel or perpendicular or even reduce to one or increase to many as needed to serve as a sliding track and a see-through barrier to prevent neural incarceration. Results and Conclusion Two cases of L4/L5 grade 2 spondylolisthesis with neurogenic claudication were treated with endoscopic lumbar interbody fusion with 1-year follow-up, and the visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, EuroQol five-dimensional questionnaire (EQ-5D, %) score, and modified Macnab score all improved greatly in both. The author developed an original, cheap, accessible, and safe method called the “pin method,” which can be used in both full-endoscopic and biportal surgery and can apply to various approaches and has no limitation on the size and shape of the cage.

Comparison of Clinical Outcomes and Complications Between Percutaneous Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 24 (6) ◽  
pp. 441-452
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Degenerative Lumbar Disease

BACKGROUND: Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) has been increasingly used to treat degenerative lumbar disease in recent years. However, there are still controversies about whether PE-TLIF is superior to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). OBJECTIVES: To compare clinical outcomes and complications of PE-TLIF and MIS-TLIF in treating degenerative lumbar disease. STUDY DESIGN: A systematic review and meta-analysis. METHODS: A comprehensive search of online databases including PubMed, Embase, and the Cochrane Library was performed to identify related studies reporting the outcomes and complications of PE-TLIF and MIS-TLIF for degenerative lumbar disease. The clinical outcomes were assessed by the Visual Analog Scale and Oswestry Disability Index. In addition, the operative time, intraoperative blood loss, time to ambulation, length of hospital stay, fusion rate, and surgery-related complications were summarized. Forest plots were constructed to investigate the results. RESULTS: A total of 28 studies involving 1,475 patients were included in this meta-analysis. PE-TLIF significantly reduced operative time, intraoperative blood loss, time to ambulation, and length of hospital stay compared to MIS-TLIF. Moreover, PE-TLIF was superior to MIS-TLIF in the early postoperative relief of back pain. However, there were no significant differences in medium to long-term clinical outcomes, fusion rate, and incidence of complications between PE-TLIF and MIS-TLIF. LIMITATIONS: The current evidence is heterogeneous and most studies included in this meta-analysis are nonrandomized controlled trials. CONCLUSIONS: The present meta-analysis indicates that medium to long-term clinical outcomes and complication rates of PE-TLIF were similar to MIS-TLIF for the treatment of degenerative lumbar disease. However, PE-TLIF shows advantages in less surgical trauma, faster recovery, and early postoperative relief of back pain. KEY WORDS: Percutaneous endoscopic transforaminal lumbar interbody fusion, minimally invasive transforaminal lumbar interbody fusion, degenerative lumbar disease, chronic pain, systematic review, meta-analysis

Sign in / Sign up

Export Citation Format

Share Document