The Changes of the Dimension of Intervertebral Disc,-Neural Foramen and Spinal Canal after Anterior Lumbar Interbody Fusion in the Lumbar Spine

Abstract OBJECTIVE Anterior approaches to the lumbar spine for the treatment of various degenerative or postoperative abnormalities associated with low back pain have always been a matter of debate. They are known to be associated with considerable surgical trauma, high postoperative morbidity, and, occasionally, unacceptably high complication rates. In 1997, we inaugurated two new microsurgical modifications of conventional anterior approach techniques, which have been applied in anterior lumbar interbody fusion and more recently in total disc replacement. This article describes the results of microsurgical anterior interbody fusion in a consecutive series of 171 patients as well as preliminary results of these techniques for total disc replacement in 26 patients. METHODS The approaches are performed with the use of a surgical microscope. Lumbar segments L2–L5 are exposed through a lateral retroperitoneal approach. L5–S1 can be reached through a midline retroperitoneal or transperitoneal approach. Both approaches can be performed through a limited skin incision of 4 cm. RESULTS An independent observer evaluated results of anterior lumbar interbody fusion in 171 patients during a 2-year follow-up period. The clinical follow-up demonstrated low perioperative and postoperative morbidity with an average blood loss of less than 100 ml at the fusion site. Pseudoarthrosis rates were less than 5%, and clinical results, as evaluated in accordance with the scoring system developed by Prolo et al., did not differ significantly from conventional open techniques. Total disc replacement through a microsurgical anterior approach seems to be a promising alternative to fusion procedures with even less intraoperative and perioperative morbidity. CONCLUSION Microsurgical anterior approaches to the lumbar spine provide a reasonable surgical alternative to conventional approaches for anterior interbody fusion and total disc replacement.

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Clinical and radiological results of indirect decompression after anterior lumbar interbody fusion in central spinal canal stenosis

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine191335 ◽

2021 ◽

pp. 1-9

Author(s):

Dong Hyun Lee ◽

Dong-Geun Lee ◽

Jin Sub Hwang ◽

Jae-Won Jang ◽

Dae Hyeon Maeng ◽

...

Keyword(s):

Spinal Canal ◽

Oswestry Disability Index ◽

Interbody Fusion ◽

Visual Analog Scale Score ◽

Spinal Canal Stenosis ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Analog Scale ◽

Canal Stenosis ◽

Indirect Decompression

OBJECTIVEWhereas the benefits of indirect decompression after lateral lumbar interbody fusion are well known, the effects of anterior lumbar interbody fusion (ALIF) have not yet been verified. The purpose of this study was to evaluate the clinical and radiological effects of indirect decompression after ALIF for central spinal canal stenosis. In this report, along with the many advantages of the anterior approach, the authors share cases with good outcomes that they have encountered.METHODSThe authors performed a retrospective analysis of 64 consecutive patients who underwent ALIF for central spinal canal stenosis with instability and mixed foraminal stenosis between January 2015 and December 2018 at their hospital. Clinical assessments were performed using the visual analog scale score, the Oswestry Disability Index, and the modified Macnab criteria. The radiographic parameters were determined from pre- and postoperative cross-sectional MRI scans of the spinal canal and were compared to evaluate neural decompression after ALIF. The average follow-up period was 23.3 ± 1.3 months.RESULTSAll clinical parameters, including the visual analog scale score, Oswestry Disability Index, and modified Macnab criteria, improved significantly. The mean operative duration was 254.8 ± 60.8 minutes, and the intraoperative bleeding volume was 179.8 ± 119.3 ml. In the radiological evaluation, radiological parameters of the cross-sections of the spinal canal showed substantial development. The spinal canal size improved by an average of 43.3% (p < 0.001) after surgery. No major complications occurred; however, aspiration guided by ultrasonography was performed in 2 patients because of a pseudocyst and fluid collection.CONCLUSIONSALIF can serve as a suitable alternative to extensive posterior approaches. The authors suggest that ALIF can be used for decompression in central spinal canal stenosis as well as restoration of the foraminal dimensions, thus allowing decompression of the nerve roots.

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Finite Element Analysis of S1 Fracture Following Anterior Lumbar Interbody Fusion With Concomitant Bilateral Spondylolysis

ASME 2008 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2008-193080 ◽

2008 ◽

Author(s):

Ferris M. Pfeiffer ◽

Dennis L. Abernathie ◽

John D. Miles ◽

Jeffery W. Parker

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Complete Loss ◽

Lumbar Interbody Fusion ◽

Loss Of Function ◽

Disc Disease ◽

Element Analysis ◽

Cause Of Pain ◽

Growth Abnormalities

Instability of the lumbar spine is a significant cause of pain and loss of function in the human population. There are a multitude of causes for a reduction or complete loss of stability of the lumbar spine. These causes include but are not limited to degenerative disc disease, spondylolysis, spondylolisthesis, genetic and growth abnormalities, and ligament laxity. Regardless of the cause, instability of the spine often leads to discomfort and loss of function. When conservative options have been exhausted, the surgeon in consultation with the patient may opt for surgical treatment of the unstable segment.

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Stand-Alone Anterior Lumbar Interbody Fusion for Degenerative Disc Disease of the Lumbar Spine: Results with a Two-Year Follow-Up

The Spine Journal ◽

10.1016/j.spinee.2012.08.042 ◽

2012 ◽

Vol 12 (9) ◽

pp. S7-S8

Author(s):

John Lammli ◽

Camden Whitaker ◽

Alan Moskowitz ◽

Brent D. Adams ◽

Jennifer Duong ◽

...

Keyword(s):

Lumbar Spine ◽

Degenerative Disc Disease ◽

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Disc Disease ◽

Degenerative Disc

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A Computed Tomographic Analysis of Changes in the Spinal Canal After Anterior Lumbar Interbody Fusion

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-199301000-00027 ◽

1993 ◽

Vol &NA; (286) ◽

pp. 180???191 ◽

Cited By ~ 1

Author(s):

NAM HYUN KIM ◽

HYUN KON KIM ◽

JIN SUCK SUH

Keyword(s):

Spinal Canal ◽

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Computed Tomographic ◽

Tomographic Analysis

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Revision surgery of the lumbar spine: anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.5.3.228 ◽

2006 ◽

Vol 5 (3) ◽

pp. 228-233 ◽

Cited By ~ 20

Author(s):

Sang-Ho Lee ◽

Byung-Uk Kang ◽

Sang Hyeop Jeon ◽

Jong Dae Park ◽

Dae Hyeon Maeng ◽

...

Keyword(s):

Lumbar Spine ◽

Revision Surgery ◽

Interbody Fusion ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Percutaneous Pedicle Screw ◽

The Mean ◽

Percutaneous Pedicle Screw Fixation

Object The aim of this study was to evaluate the efficacy of anterior lumbar interbody fusion (ALIF) augmented by percutaneous pedicle screw fixation (PSF) for revision surgery in the lumbar spine and to determine the prognostic factors affecting surgical outcomes. Methods The population included 54 consecutively treated patients in whom revision surgery involving ALIF with PSF was performed between 2001 and 2004. There were 22 men and 32 women, whose mean age was 59.5 years (range 25–78 years). The diagnoses prior to revision ALIF were as follows: degenerative disc disease in 25 patients, instability/spondylolisthesis in 15, recurrent disc herniation in seven, and pseudarthrosis in seven. The mean follow-up period was 24 months (range 12–52 months). The mean visual analog scale score for back and leg pain decreased, respectively, from 7.8 to 2.3 and 8.0 to 2.3 (p < 0.001). The mean Oswestry Disability Index score improved from 70 to 25% (p < 0.001). Radiological evidence of fusion was noted in 52 of 54 patients. The mean preoperative segmental lordosis, whole lumbar lordosis, and sacral tilt were 15.2, 35.5, and 28.3°, respectively; these values were significantly increased to 20.4, 40.7, and 31.4°, respectively, after revision surgery (p < 0.001). The increase in sacral tilt was positively correlated with improvement in back pain (p = 0.028) and functional status (p = 0.025). Conclusions The results demonstrate that ALIF followed by PSF can be an effective alternative in revision surgery of the lumbosacral spine in selected cases. Not only can solid fusion be achieved, sagittal alignment can also be restored in the majority of patients.

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Psoas Morphology Differs between Supine and Sitting Magnetic Resonance Imaging Lumbar Spine: Implications for Lateral Lumbar Interbody Fusion

Asian Spine Journal ◽

10.4184/asj.2018.12.1.29 ◽

2018 ◽

Vol 12 (1) ◽

pp. 29-36 ◽

Cited By ~ 4

Author(s):

Aaron J. Buckland ◽

Bryan M. Beaubrun ◽

Evan Isaacs ◽

John Moon ◽

Peter Zhou ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Lumbar Spine ◽

Magnetic Resonance ◽

Intervertebral Disc ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Psoas Muscle ◽

Lumbar Interbody Fusion ◽

Resonance Imaging ◽

Lateral Lumbar Interbody Fusion

<sec><title>Study Design</title>Retrospective radiological review.</sec><sec><title>Purpose</title>To quantify the effect of sitting vs supine lumbar spine magnetic resonance imaging (MRI) and change in anterior displacement of the psoas muscle from L1–L2 to L4–L5 discs.</sec><sec><title>Overview of Literature</title>Controversy exists in determining patient suitability for lateral lumbar interbody fusion (LLIF) based on psoas morphology. The effect of posture on psoas morphology has not previously been studied; however, lumbar MRI may be performed in sitting or supine positions.</sec><sec><title>Methods</title>A retrospective review of a single-spine practice over 6 months was performed, identifying patients aged between 18–90 years with degenerative spinal pathologies and lumbar MRIs were evaluated. Previous lumbar fusion, scoliosis, neuromuscular disease, skeletal immaturity, or intrinsic abnormalities of the psoas muscle were excluded. The anteroposterior (AP) dimension of the psoas muscle and intervertebral disc were measured at each intervertebral disc from L1–L2 to L4–L5, and the AP psoas:disc ratio calculated. The morphology was compared between patients undergoing sitting and/or supine MRI.</sec><sec><title>Results</title>Two hundred and nine patients were identified with supine-, and 60 patients with sitting-MRIs, of which 13 patients had undergone both sitting and supine MRIs (BOTH group). A propensity score match (PSM) was performed for patients undergoing either supine or sitting MRI to match for age, BMI, and gender to produce two groups of 43 patients. In the BOTH and PSM group, sitting MRI displayed significantly higher AP psoas:disc ratio compared with supine MRI at all intervertebral levels except L1–L2. The largest difference observed was a mean 32%–37% increase in sitting AP psoas:disc ratio at the L4–L5 disc in sitting compared to supine in the BOTH group (range, 0%–137%).</sec><sec><title>Conclusions</title>The psoas muscle and the lumbar plexus become anteriorly displaced in sitting MRIs, with a greater effect noted at caudal intervertebral discs. This may have implications in selecting suitability for LLIF, and intra-operative patient positioning.</sec>

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