The Changes of Sagittal Alignment after Anterior Interbody Fusion with Posterior Fixation in Spondylolisthesis of the Lumbar Spine

Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

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Current status of bone graft options for anterior interbody fusion of the cervical and lumbar spine

Neurosurgical Review ◽

10.1007/s10143-013-0483-9 ◽

2013 ◽

Vol 37 (1) ◽

pp. 23-37 ◽

Cited By ~ 17

Author(s):

Anthony Minh Tien Chau ◽

Lileane Liang Xu ◽

Johnny Ho-Yin Wong ◽

Ralph Jasper Mobbs

Keyword(s):

Lumbar Spine ◽

Bone Graft ◽

Interbody Fusion ◽

Current Status ◽

Anterior Interbody Fusion

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Evaluation of Lumbar Spine Stabilization Using Anterior Interbody Fusion Cage

Advances in Bioengineering ◽

10.1115/imece2002-33013 ◽

2002 ◽

Author(s):

Robert X. Gao ◽

Mathew E. Mitchell ◽

R. Scott Cowan

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Healing Process ◽

Spine Stabilization ◽

Anterior Interbody Fusion ◽

Wide Range ◽

Flexion Extension ◽

Fusion Cage ◽

Interbody Fusion Cage

Spinal surgery uses a wide range of instrumentation devices to provide comfort to the patient, stabilize the spine, and enhance the bony healing process after surgery. In order to improve upon the effectiveness of these devices, the interaction between the spine and the implant devices needs to be studied from both medical and engineering perspectives. This paper investigates the effect of an anterior interbody fusion cage on lumbar spine stabilization, by means of numerical analysis using the finite element technique and experimental testing. Specifically, the relative displacement within an intact L4-L5 motion segment has been simulated and measured, under a range of compression, flexion, extension, torsion, and lateral bending loads. Subsequently, the effect of a single anterior lumbar fusion cage implanted into the segment was simulated and experimentally validated, under similar loading conditions. Comparison between the intact and cage-implanted segments indicated varying stabilizing ability of the fusion cage, which is highly dependent upon the cage position and the type of loading.

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Lateral Lumbar Interbody Fusion for Ossification of the Yellow Ligament in the Lumbar Spine: First Reported Case

Case Reports in Orthopedics ◽

10.1155/2017/3404319 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

Kengo Fujii ◽

Tetsuya Abe ◽

Toru Funayama ◽

Hiroshi Noguchi ◽

Keita Nakayama ◽

...

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Pedicle Screws ◽

Lateral Wall ◽

Posterior Longitudinal Ligament ◽

Posterior Fixation ◽

Lumbar Interbody Fusion ◽

Venous Plexus ◽

Lateral Lumbar Interbody Fusion ◽

Initial Surgery

When ossification of the yellow ligament (OYL) occurs in the lumbar spine and extends to the lateral wall of the spinal canal, facetectomy is required to remove all of the ossified lesion and achieve decompression. Subsequent posterior fixation with interbody fusion will then be necessary to prevent postoperative progression of the ossification and intervertebral instability. The technique of lateral lumbar interbody fusion (LLIF) has recently been introduced. Using this procedure, surgeons can avoid excess blood loss from the extradural venous plexus and detachment of the ossified lesion and the ventral dura mater is avoidable. We present a 55-year-old male patient with OYL at L3/4 and anterior spondylolisthesis of L4 vertebra, with concomitant ossification of the posterior longitudinal ligament, who presented with a severe gait disturbance. He underwent a 2-stage operation without complications: LLIF for L3/4 and L4/5 was performed at the initial surgery, and posterior decompression fixation using pedicle screws from L3 to L5 was performed at the second surgery. His postoperative progress was favorable, and his interbody fusion was deemed successful. Here, we present the first reported case of LLIF for OYL of the lumbar spine. This procedure can be a good option for OYL of the lumbar spine.

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Anterior Interbody Fusion using a Horizontal Cylinder Cage in a Degenerative Lumbar Spine

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2001.36.3.265 ◽

2001 ◽

Vol 36 (3) ◽

pp. 265

Author(s):

Seok Woo Kim ◽

Young Seok Chung ◽

Yung Khee Chung ◽

Jun Dong Chang ◽

Chang Ju Lee

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Horizontal Cylinder ◽

Degenerative Lumbar Spine ◽

Anterior Interbody Fusion

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Anterior interbody fusion of the lumbar spine

Der Orthopäde ◽

10.1007/pl00003412 ◽

1997 ◽

Vol 26 (6) ◽

pp. 563-567

Author(s):

C. Wimmer ◽

M. Krismer ◽

H. Gluch ◽

W. Sterzinger ◽

M. Ogon

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Anterior Interbody Fusion

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Effects of autogenous bone graft impaction and tricalcium phosphate on anterior interbody fusion in the porcine lumbar spine

Acta Orthopaedica ◽

10.1080/759369191 ◽

2004 ◽

Vol 75 (4) ◽

pp. 1-1

Author(s):

Haisheng Li ◽

Xuenong Zou ◽

Qingyun Xue ◽

Niels Egund ◽

Martin Lind ◽

...

Keyword(s):

Lumbar Spine ◽

Bone Graft ◽

Tricalcium Phosphate ◽

Interbody Fusion ◽

Autogenous Bone Graft ◽

Autogenous Bone ◽

Anterior Interbody Fusion

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Single stage posterior instrumentation and anterior interbody fusion for tuberculosis of dorsal and lumbar spines

Nepal Orthopaedic Association Journal ◽

10.3126/noaj.v2i1.8136 ◽

2013 ◽

Vol 2 (1) ◽

pp. 21-26

Author(s):

BK Pandey ◽

GM Sangondimath ◽

HS Chhabra

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Posterior Instrumentation ◽

Surgical Techniques ◽

Operation Time ◽

Single Stage ◽

Anterior Fusion ◽

Related Complication ◽

Anterior Interbody Fusion

Background: Spine is the most common site for osseous involvement of tuberculosis, accounting around 50% cases of musculoskeletal tuberculosis. The most frequent sites of the involvement are the thoracic and lumbar spine. The anterior column is primarily affected resulting in progressive or residual kyphotic deformity even after the eradication of the disease by chemotherapy. Various surgical techniques like anterior fusion, posterior or combined fusion have been described. In this study we evaluated the clinical outcome and radiological results of single stage posterior instrumentation and anterior interbody fusion for tuberculosis of dorsal and lumbar spine. Methods: Details of the patients of tuberculosis of dorsal and lumbar spine operated with single stage posterior instrumentation and anterior interbody fusion from December 2004 to June 2008 were retrieved from the hospital database. There were 55 cases operated with this technique. Thirty patients, whose final details were available, were involved in this study. Pre-operative, post-operative and final follow up clinical and radiological assessments were performed. The follow up ranged from 18 to 60 months. Results: Average operation time was 5 hours 45 minutes and blood loss was 1100 ml. Anterior body fusion was achieved in all the patients. 93.3% of the patients had neurological improvement. Satisfactory post-operative kyphotic angle correction was achieved. There was minimal final loss of kyphotic correction. One patient had post-operative wound infection. Post operative paralytic ileus, chest infection, urinary tract infection, jaundice were the complications found in the patients. No graft related complication was seen. There was no recurrence of the disease in any of the cases. Conclusion: Single stage anterior debridement and interbody fusion with posterior instrumentation can be performed safely to achieve satisfactory clinical and radiographic outcomes in patients of thoracic and lumbar tuberculosis. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8136 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 21-26

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Microsurgical Anterior Approaches to the Lumbar Spine for Interbody Fusion and Total Disc Replacement

Neurosurgery ◽

10.1097/00006123-200211002-00022 ◽

2002 ◽

Vol 51 (suppl_2) ◽

pp. S2-159-S2-165 ◽

Cited By ~ 35

Author(s):

H. Michael Mayer ◽

Karsten Wiechert

Keyword(s):

Lumbar Spine ◽

Anterior Approach ◽

Interbody Fusion ◽

Postoperative Morbidity ◽

Total Disc Replacement ◽

Anterior Lumbar Interbody Fusion ◽

Disc Replacement ◽

Lumbar Interbody Fusion ◽

Anterior Interbody Fusion

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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