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Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 891-902
Author(s):  
Po-Ju Lai ◽  
Sheng-Fen Wang ◽  
Tsung-Ting Tsai ◽  
Yun-Da Li ◽  
Ping-Yeh Chiu ◽  
...  

Objective: Surgical treatment of severe infectious spondylodiskitis remains challenging. Although minimally invasive percutaneous endoscopic drainage and debridement (PEDD) may yield good results in complicated cases, outcomes of patients with extensive structural damage and mechanical instability may be unsatisfactory. To address severe infectious spondylodiskitis, we have developed a surgical technique called percutaneous endoscopic interbody debridement and fusion (PEIDF), which comprises endoscopic debridement, bonegraft interbody fusion, and percutaneous posterior instrumentation.Methods: Outcomes of PEIDF in 12 patients and PEDD in 15 patients with infectious spondylodiskitis from April 2014 to July 2018 were reviewed retrospectively. Outcome were compared between 2 kinds of surgical procedures.Results: Patients in PEIDF group had significantly lower rate of revision surgery (8.3% vs. 58.3%), better kyphosis angle (-5.73° ± 8.74 vs. 1.07° ± 2.70 in postoperative; 7.09° ± 7.23 vs. 0.79° ± 4.08 in kyphosis correction at 1 year), and higher fusion rate (83.3% vs. 46.7%) than those who received PEDD.Conclusion: PEIDF is an effective approach for treating infectious spondylodiskitis, especially in patients with spinal instability and multiple medical comorbidities.


2021 ◽  
Author(s):  
Kosuke Sato ◽  
Toru Funayama ◽  
Hiroshi Noguchi ◽  
Tomoyuki Asada ◽  
Mamoru Kono ◽  
...  

Abstract BackgroundPlatelet-rich plasma has been increasingly used in spinal fusion surgery. However, the efficacy of platelet-rich plasma in lateral lumbar interbody fusion is unclear. In Japan, Affinos® (Kuraray Co., Tokyo, Japan), which is a β-tricalcium phosphate artificial bone, has been increasingly used for spinal fusion as a bone graft. The purpose of this trial is to demonstrate whether Affinos® impregnated with platelet-rich plasma can achieve a higher fusion rate, more rapid fusion, and better clinical outcomes than Affinos® alone.Methods/DesignThe current study is a prospective randomized controlled trial. The current trial will include consecutive patients scheduled for lateral lumbar interbody fusion. Since an intervertebral cage for lateral lumbar interbody fusion has two spaces for a bone graft, two bone grafts are inserted for each intervertebral level. In the current study, an artificial bone with plate-rich plasma will be inserted into one space and an artificial bone without platelet-rich plasma will be inserted into the other space. We will compare the fusion rates between the bone graft with and without platelet-rich plasma. Our primary endpoint will be the interbody fusion rate at 1 year after surgery. DiscussionThe current trial will verify the efficacy of platelet-rich plasma with Affinos® for bony fusion in lateral lumbar interbody fusion. This trial will provide substantial evidence for the effectiveness and safety of platelet-rich plasma in spinal fusion surgery.Trial registrationJapan Registry of Clinical Trials (jRCT), ID: jRCTb032200199. First registered on 13 November 2020, https://jrct.niph.go.jp/latest-detail/jRCTb032200199. jRCT is approved as a member of the Primary Registry Network of WHO ICTRP.


2021 ◽  
Vol 2021 ◽  
pp. 1-15
Author(s):  
Zhaoyang Guo ◽  
Xiaolin Wu ◽  
Shuai Yang ◽  
Chang Liu ◽  
Youfu Zhu ◽  
...  

Objective. The current study aimed to explore the efficacy of Zero profile intervertebral fusion system (Zero-P) and traditional anterior plate cage system (PC) in the treatment of cervical spondylotic myelopathy (CSM). Further, the present study evaluated effects of the treatments on medical security, height of intervertebral disc, adjacent-level ossification development (ALOD), and adjacent segmentation disease (ASD) through a systematic retrospective analysis. Methods. Studies on Zero-P system and traditional anterior plate cage system for ACDF in the treatment of CSM were searched in PubMed, Web of Science, Ovid, Embase, and Cochrane Library databases. Two independent researchers screened articles, extracted data, and evaluated the quality of the articles based on the inclusion and exclusion criteria of the current study. RevMan5.3 software was used for meta-analysis following the guidelines of Cochrane collaboration network. Cervical curvature, interbody fusion rate, preoperative and postoperative disc height index (DHI), fusion cage sinking rate, postoperative dysphagia, ASD, ALOD, and loosening of screw were compared between the two groups. Results. A total of 17 literatures were included in the present study, including 6 randomized controlled trials and 11 observational studies. The studies comprised a total of 1204 patients with CSM, including 605 patients in the Zero-P system group (Zero-P group) and 599 patients in the traditional animal plate cage group (PC group). Results of this meta-analysis showed that postoperative dysphagia [OR = 0.40, CI (0.28, 95% 0.58), P  < 0.00001], ALOD [OR = 0.09, CI (0.02, 95% 0.39), P  = 0.001], ASD [OR = 0.42, CI (0.20, 95% 0.86), P  = 0.02], and screw loosening [OR = 0.20, CI (0.08, 95% 0.52), P  = 0.0009] of the Zero-P group were significantly lower compared with the PC group. On the other hand, preoperative cervical curvature [WMD = −0.23, CI (−1.38, 95% 0.92), P  = 0.69], postoperative cervical curvature [WMD = −0.38, CI (−1.77, 95% 1.01), P  = 0.59], cage sinking rate [OR = 1.41, CI [0.52, 95% 3.82], P  = 0.50], intervertebral fusion rate [OR = 0.76, CI (0.27, 95% 2.48), P  = 0.38], preoperative DHI [WMD = −0.04, CI (−0.14, 95% 0.22), P  = 0.65], and postoperative DHI [WMD = 0.06, CI (−0.22, 95% 0.34), P  = 0.675] were not significantly different between the two groups. Conclusion. It was evident that the Zero-P system used in ACDF is superior compared with the traditional anterior plate cage system in postoperative dysphagia, avoiding ALOD, ASD, and screw loosening.


2021 ◽  
Author(s):  
Dae Jean Jo ◽  
Ho Yong Choi

Abstract PURPOSE. To evaluate the surgical outcomes and fusion rate following lumbar fusion surgeries in patients with chronic kidney disease (CKD) according to kidney function.METHODS. From March 2017 to February 2021, 54 consecutive adult patients with CKD who underwent spine fusion surgery were enrolled. According to the glomerular filtration rate (GFR) categories, 35 patients were classified into the non-end-stage renal disease (ESRD) group (GFR categories 3a–4, eGFR 15–59 mL/min/1.73 m2) and 19 patients into the ESRD group (GFR category 5, eGFR <15 mL/min/1.73 m2).RESULTS. Baseline characteristics did not differ between the groups. The mean number of fused vertebrae (4.9 ± 2.3 vs. 4.1 ± 2.0, p = 0.122), operative time (228.4 ± 129.6 min vs. 160.5 ± 87.5 min, p = 0.113), and surgical bleeding (743.1 ± 630.5 mL vs. 539.5 ± 384.4 mL, p = 0.354) did not differ between the groups. The rates of medical complications (25.7% vs. 52.6%, p = 0.048) and 3-month readmission (8.6% vs. 35.3%, p = 0.045) were significantly different between the groups. The 3-month mortality tended to be higher in the ESRD group (10.5%) than which in the non-ESRD group (2.9%), but the difference was not statistically significant (p = 0.280). The rate of pseudarthrosis was significantly higher in the ESRD group (35.3%) than in the non-ESRD group (9.1%, p = 0.047).CONCLUSIONS. Surgeons should be aware of the high morbidity and the pseudarthrosis when considering spine surgeries in patients with ESRD.


2021 ◽  
Author(s):  
Jian-cheng Peng ◽  
Hui-zhi Guo ◽  
Chen-guang Zhan ◽  
Hua-sheng Huang ◽  
Yan-huai Ma ◽  
...  

Abstract PurposeThis study aims to investigate the necessity of cement-augmented pedicle screw fixation in single-segment isthmic spondylolisthesis with osteoporosis.MethodFifty-nine cases were reviewed retrospectively. Thirty-three cases were in the polymethylmethacrylate-augmented pedicle screw (PMMA-PS) group, and the other 26 cases were in the conventional pedicle screw (CPS) group. Evaluation data included operation time, intraoperative blood loss,hospitalization cost, hospitalization days, rates of fusion, screw loosening, bone cement leakage, visual analog scores (VAS) , Oswestry disability index (ODI) , Lumbar Lordosis(LL), Pelvic Tilt(PT) and Sacral Slope(SS). ResultsThe operation time and blood loss in the CPS group decreased significantly compared to the PMMA-PS group (P < 0.05). The average hospitalization cost of the PMMA group was significantly higher than that of the CPS group (P < 0.05). There was no significant difference for the average hospital stay between the 2 groups (P > 0.05). The initial and the last follow-up postoperative VAS and ODI improved significantly in the two groups (P < 0.05). There were no significant differences in VAS and ODI at each time point between the 2 groups (P > 0.05). The last postoperative spine-pelvic parameters were significantly improved compared with preoperation (P < 0.05). In the PMMA-PS group, the fusion rate was 100%. The fusion rate was 96.15% in the CPS group. No significant difference was found between the two groups for the fusion rate (P > 0.05). Nine cases in the PMMA-PS group had bone cement leakage (27.27%). There was not screw loosening in the PMMA-PS group. There were 2 cases of screw loosening in the CPS group. There were no significant differences in screw loosening, postoperative adjacent segment fractures, postoperative infection or postoperative revision between the 2 groups (P > 0.05). ConclusionsThe use of PMMA-PS on a regular basis is not recommended for posterior lumbar interbody fusion for the treatment of single-segment isthmic spondylolisthesis with osteoporosis.


2021 ◽  
Vol 10 (22) ◽  
pp. 5315
Author(s):  
Takashi Hirai ◽  
Toshitaka Yoshii ◽  
Kenichiro Sakai ◽  
Hiroyuki Inose ◽  
Masato Yuasa ◽  
...  

Various studies have found a high incidence of early graft dislodgement after multilevel corpectomy. Although a hybrid fusion technique was developed to resolve implant failure, the hybrid and conventional techniques have not been clearly compared in terms of perioperative complications in patients with severe ossification of the posterior longitudinal ligament (OPLL) involving three or more levels. The purpose of this study was to compare clinical and radiologic outcomes between anterior cervical corpectomy with fusion (ACCF) and anterior hybrid fusion for the treatment of multilevel cervical OPLL. We therefore retrospectively reviewed the clinical and radiologic data of 53 consecutive patients who underwent anterior fusion to treat cervical OPLL: 30 underwent ACCF and 23 underwent anterior hybrid fusion. All patients completed 2 years of follow-ups. Implant migration was defined as subsidence > 3 mm. There were no significant differences in demographics or clinical characteristics between the ACCF and hybrid groups. Early implant failure occurred significantly more frequently in the ACCF group (5 cases, 16.7%) compared with the hybrid group (0 cases, 0%). The fusion rate was 80% in the ACCF group and 100% in the hybrid group. Although both procedures can achieve satisfactory neurologic outcomes for multilevel OPLL patients, hybrid fusion likely provides better biomechanical stability than the conventional ACCF technique.


2021 ◽  
Author(s):  
Hai-dong Li ◽  
Li Zhong ◽  
Xiang-Qian Fang ◽  
Lei-Sheng Jiang

Abstract Background The oblique lateral interbody fusion (OLIF) is a minimally invasive indirect decompression technique for the treatment of degenerative spinal disease. OLIF with posterior pedicle screws fixation frequently is performed, whereas it requires much more surgery time and blood loss. The purpose of this study was to compare the oblique lateral interbody fusion (OLIF) combined with lateral plate (LP) vs. OLIF combined with posterior pedicle screw (PS) fixation for the treatment of lumbar degenerative diseases.Methods The clinical data of 53 patients with lumbar degenerative diseases who underwent OLIF from January 2020 to September 2020 were retrospectively analyzed,24 in OLIF combined with lateral plate (OLIF+LP) group and 29 in OLIF combined with pedicle screw (OLIF+PS) group. All patients completed a minimum 1-year follow-up. The duration of operation, blood loss, fusion rate and complications were recorded. The visual analog scale (VAS) score, Oswestry Disability Index (ODI), disc height (DH), foraminal height (FH) and cross-sectional area (CSA) were also evaluated.Results The operation time was 75.41±11.53 min in the OLIF+LP group, which shorter than that in OLIF+PS group(127.05±5.62min, P<0.01). Also, the blood loss was significantly less in the OLIF+LP group (39.55±5.32 ml ) than in the OLIF+PS group (89.81±9.62, P<0.01). The VAS and ODI scores both significantly reduced after operation in OLIF+LP group. There was no difference either in VAS or ODI scores by 1 year after surgery between two groups (P>0.01). The DH, FH, and CSA parameters were all improved significantly after operation in both groups, however, there was no significant difference at the any follow-up point between the two groups. The total complication rate was 13.21% (7/53) in this study, and there was no siginificant difference between the two groups. The fusion rate was 91.67% in the OLIF+LP group and 93.10% in the OLIF+PS group (P =0.69).Conclusions OLIF+LP fixation seems to be a valuable surgical option for single-segmental lumbar degenerative disease, it can achieve much better clinical outcomes than OLIF+PS group.


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