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Sample records for posterior lumbar interbody

  1. Instrumented Posterior Lumbar Interbody Fusion in Adult Spondylolisthesis

    PubMed Central

    Yu, Ching-Hsiao; Wang, Chen-Ti

    2008-01-01

    It is unclear whether using artificial cages increases fusion rates compared with use of bone chips alone in posterior lumbar interbody fusion for patients with lumbar spondylolisthesis. We hypothesized artificial cages for posterior lumbar interbody fusion would provide better clinical and radiographic outcomes than bone chips alone. We assumed solid fusion would provide good clinical outcomes. We clinically and radiographically followed 34 patients with spondylolisthesis having posterior lumbar interbody fusion with mixed autogenous and allogeneic bone chips alone and 42 patients having posterior lumbar interbody fusion with implantation of artificial cages packed with morselized bone graft. Patients with the artificial cage had better functional improvement in the Oswestry disability index than those with bone chips alone, whereas pain score, patient satisfaction, and fusion rate were similar in the two groups. Postoperative disc height ratio, slip ratio, and segmental lordosis all decreased at final followup in the patients with bone chips alone but remained unchanged in the artificial cage group. The functional outcome correlated with radiographic fusion status. We conclude artificial cages provide better functional outcomes and radiographic improvement than bone chips alone in posterior lumbar interbody fusion for lumbar spondylolisthesis, although both techniques achieved comparable fusion rates. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18846411

  2. A Comparative Study of Lateral Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spondylolisthesis

    PubMed Central

    Hughes, Alexander P.; Sama, Andrew A.; Girardi, Federico P.; Lebl, Darren R.; Cammisa, Frank P.

    2015-01-01

    Study Design Level 4 retrospective review. Purpose To compare the radiographic and clinical outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) with posterior segmental spinal instrumentation (SSI) for degenerative lumbar spondylolisthesis. Overview of Literature Both PLIF and LLIF have been performed for degenerative spondylolisthesis with good results, but no study has directly compared these two techniques so far. Methods The electronic medical and radiographic records of 78 matched patients were analyzed. In one group, 39 patients underwent PLIF with SSI at 41 levels (L3-4/L4-5), while in the other group, 39 patients underwent the LLIF procedure at 48 levels (L3-4/L4-5). Radiological outcomes such as restoration of disc height and neuroforaminal height, segmental lumbar lordosis, total lumbar lordosis, incidence of endplate fracture, and subsidence were measured. Perioperative parameters were also recorded in each group. Clinical outcome in both groups was assessed by the short form-12, Oswestry disability index and visual analogue scale scores. The average follow-up period was 16.1 months in the LLIF group and 21 months in the PLIF group. Results The restoration of disc height, foraminal height, and segmental lumbar lordosis was significantly better in the LLIF group (p<0.001). The duration of the operation was similar in both groups, but the average blood loss was significantly lower in the LLIF group (p<0.001). However, clinical outcome scores were similar in both groups. Conclusions Safe, effective interbody fusion can be achieved at multiple levels with neuromonitoring by the lateral approach. LLIF is a viable treatment option in patients with new onset symptoms due to degenerative spondylolisthesis who have had previous lumbar spine surgery, and it results in improved sagittal alignment and indirect foraminal decompression. PMID:26435782

  3. Lateral Lumbar Interbody Fusion

    PubMed Central

    Hughes, Alexander; Girardi, Federico; Sama, Andrew; Lebl, Darren; Cammisa, Frank

    2015-01-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques. PMID:26713134

  4. Lateral Lumbar Interbody Fusion.

    PubMed

    Pawar, Abhijit; Hughes, Alexander; Girardi, Federico; Sama, Andrew; Lebl, Darren; Cammisa, Frank

    2015-12-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques. PMID:26713134

  5. Clinical and Radiological Results of Microsurgical Posterior Lumbar Interbody Fusion and Decompression without Posterior Instrumentation for Lateral Recess Stenosis

    PubMed Central

    Şişman, Lokman; Türkmen, Faik; Efe, Duran; Pekince, Oğuzhan; Göncü, Recep Gani; Sever, Cem

    2015-01-01

    Study Design A single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis. Purpose This study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis. Overview of Literature Although microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain. Methods A total of 34 patients (13 men, 21 women), with a mean age of 56.65±9.1 years (range, 40-77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up. Results The average follow-up time was 35.05±8.65 months (range, 24-46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports. Conclusions Although microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion. PMID:26435789

  6. Comparison of the Dynesys Dynamic Stabilization System and Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease

    PubMed Central

    Zhang, Yang; Shan, Jian-Lin; Liu, Xiu-Mei; Li, Fang; Guan, Kai; Sun, Tian-Sheng

    2016-01-01

    Background There have been few studies comparing the clinical and radiographic outcomes between the Dynesys dynamic stabilization system and posterior lumbar interbody fusion (PLIF). The objective of this study is to compare the clinical and radiographic outcomes of Dynesys and PLIF for lumbar degenerative disease. Methods Of 96 patients with lumbar degenerative disease included in this retrospectively analysis, 46 were treated with the Dynesys system and 50 underwent PLIF from July 2008 to March 2011. Clinical and radiographic outcomes were evaluated. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD). Results The mean follow-up time in the Dynesys group was 53.6 ± 5.3 months, while that in the PLIF group was 55.2 ± 6.8 months. At the final follow-up, the Oswestry disability index and visual analogue scale score were significantly improved in both groups. The range of motion (ROM) of stabilized segments in Dynesys group decreased from 7.1 ± 2.2° to 4.9 ± 2.2° (P < 0.05), while that of in PLIF group decreased from 7.3 ± 2.3° to 0° (P < 0.05). The ROM of the upper segments increased significantly in both groups at the final follow-up, the ROM was higher in the PLIF group. There were significantly more radiographic ASDs in the PLIF group than in the Dynesys group. The incidence of complications was comparable between groups. Conclusions Both Dynesys and PLIF can improve the clinical outcomes for lumbar degenerative disease. Compared to PLIF, Dynesys stabilization partially preserves the ROM of the stabilized segments, limits hypermobility in the upper adjacent segment, and may prevent the occurrence of ASD. PMID:26824851

  7. Anterior Lumbar Interbody Fusion as a Salvage Technique for Pseudarthrosis following Posterior Lumbar Fusion Surgery

    PubMed Central

    Mobbs, Ralph J.; Phan, Kevin; Thayaparan, Ganesha K.; Rao, Prashanth J.

    2015-01-01

    Study Design Retrospective analysis of prospectively collected observational data. Objective To assess the safety and efficacy of anterior lumbar interbody fusion (ALIF) as a salvage option for lumbar pseudarthrosis following failed posterior lumbar fusion surgery. Methods From 2009 to 2013, patient outcome data was collected prospectively over 5 years from 327 patients undergoing ALIF performed by a single surgeon (R.J.M.) with 478 levels performed. Among these, there were 20 cases of failed prior posterior fusion that subsequently underwent ALIF. Visual analog score (VAS), Oswestry Disability Index (ODI), and Short Form 12-item health survey (SF-12) were measured pre- and postoperatively. The verification of fusion was determined by utilizing a fine-cut computed tomography scan at 12-month follow-up. Results There was a significant difference between the preoperative (7.25 ± 0.8) and postoperative (3.1 ± 2.1) VAS scores (p < 0.0001). The ODI scale also demonstrated a statistically significant reduction from preoperative (56.3 ± 16.5) and postoperative (30.4 ± 19.3) scores (p < 0.0001). The SF-12 scores were significantly improved after ALIF salvage surgery: Physical Health Composite Score (32.18 ± 5.5 versus 41.07 ± 9.67, p = 0.0003) and Mental Health Composite Score (36.62 ± 12.25 versus 50.89 ± 10.86, p = 0.0001). Overall, 19 patients (95%) achieved successful fusion. Conclusions Overall, our results suggest that the ALIF procedure results not only in radiographic improvements in bony fusion but in significant improvements in the patient's physical and mental experience of pain secondary to lumbar pseudarthrosis. Future multicenter registry studies and randomized controlled trials should be conducted to confirm the long-term benefit of ALIF as a salvage option for failed posterior lumbar fusion. PMID:26835197

  8. Anterior Lumbar Interbody Fusion as a Salvage Technique for Pseudarthrosis following Posterior Lumbar Fusion Surgery.

    PubMed

    Mobbs, Ralph J; Phan, Kevin; Thayaparan, Ganesha K; Rao, Prashanth J

    2016-02-01

    Study Design Retrospective analysis of prospectively collected observational data. Objective To assess the safety and efficacy of anterior lumbar interbody fusion (ALIF) as a salvage option for lumbar pseudarthrosis following failed posterior lumbar fusion surgery. Methods From 2009 to 2013, patient outcome data was collected prospectively over 5 years from 327 patients undergoing ALIF performed by a single surgeon (R.J.M.) with 478 levels performed. Among these, there were 20 cases of failed prior posterior fusion that subsequently underwent ALIF. Visual analog score (VAS), Oswestry Disability Index (ODI), and Short Form 12-item health survey (SF-12) were measured pre- and postoperatively. The verification of fusion was determined by utilizing a fine-cut computed tomography scan at 12-month follow-up. Results There was a significant difference between the preoperative (7.25 ± 0.8) and postoperative (3.1 ± 2.1) VAS scores (p < 0.0001). The ODI scale also demonstrated a statistically significant reduction from preoperative (56.3 ± 16.5) and postoperative (30.4 ± 19.3) scores (p < 0.0001). The SF-12 scores were significantly improved after ALIF salvage surgery: Physical Health Composite Score (32.18 ± 5.5 versus 41.07 ± 9.67, p = 0.0003) and Mental Health Composite Score (36.62 ± 12.25 versus 50.89 ± 10.86, p = 0.0001). Overall, 19 patients (95%) achieved successful fusion. Conclusions Overall, our results suggest that the ALIF procedure results not only in radiographic improvements in bony fusion but in significant improvements in the patient's physical and mental experience of pain secondary to lumbar pseudarthrosis. Future multicenter registry studies and randomized controlled trials should be conducted to confirm the long-term benefit of ALIF as a salvage option for failed posterior lumbar fusion. PMID:26835197

  9. Intraoperative antepulsion of a posterior lumbar interbody fusion cage: three case reports

    PubMed Central

    Ceylan, Davut; Yaldiz, Can; Asil, Kiyasettin; Kaçira, Tibet; Tatarli, Necati; Can, Aytaç

    2015-01-01

    Spinal fusion surgery techniques develop together with technologic advancements. New complications are seen as the result of new techniques and these may be very severe due to spinal cord and vascular structures in the lumbar region. The posterior lumbar interbody fusion cage (PLIFC) was shown to enhance spinal fusion and to prevent pseudoarthrosis due to its basic dynamic characteristics. PLIFC migrations are usually observed during the postoperative period, just after the mobilization of the patient and usually toward spinal canal. Migration to the retroperitoneal region is a extremely rare condition in the literature. In this article we discussed three cases of PLIFC antepulsion into the retroperitoneal region during the intraoperative period. PMID:26175832

  10. Computational comparison of three posterior lumbar interbody fusion techniques by using porous titanium interbody cages with 50% porosity.

    PubMed

    Lee, Yung-Heng; Chung, Chi-Jen; Wang, Chih-Wei; Peng, Yao-Te; Chang, Chih-Han; Chen, Chih-Hsien; Chen, Yen-Nien; Li, Chun-Ting

    2016-04-01

    This study investigated the biomechanical response of porous cages and lumbar spine segments immediately after surgery and after bone fusion, in addition to the long-term effects of various posterior lumbar interbody fusion (PLIF) techniques, by using the finite element method. Lumbar L3-L4 models based on three PLIF techniques (a single cage at the center of the intervertebral space, a single cage half-anterior to the intervertebral space, and two cages bilateral to the intervertebral space) with and without bone ingrowth were used to determine the biomechanical response of porous cages and lumbar segments instrumented with porous titanium cages (cage porosity=50%, pore diameter=1mm). The results indicated that bone fusion enhanced the stability of the lumbar segments with porous cages without any posterior instrumentation and reduced the peak von Mises stress in the cortical bones and porous cages. Two cages placed bilateral to the intervertebral space achieved the highest structural stability in the lumbar segment and lowest von Mises stress in the cages under both bone fusion conditions. Under identical loading (2-Nm), the range of motion in the single cage at the center of the intervertebral space with bone fusion decreased by 11% (from 1.18° to 1.05°) during flexion and by 66.5% (from 4.46° to 1.5°) during extension in the single cage half-anterior to the intervertebral space with bone fusion compared with no-fusion models. Thus, two porous titanium cages with 50% porosity can achieve high stability of a lumbar segment with PLIF. If only one cage is available, placing the cage half-anterior to the intervertebral space is recommended for managing degenerated lumbar segments. PMID:26874064

  11. Segmental and global lordosis changes with two-level axial lumbar interbody fusion and posterior instrumentation

    PubMed Central

    Melgar, Miguel A; Tobler, William D; Ernst, Robert J; Raley, Thomas J; Anand, Neel; Miller, Larry E; Nasca, Richard J

    2014-01-01

    Background Loss of lumbar lordosis has been reported after lumbar interbody fusion surgery and may portend poor clinical and radiographic outcome. The objective of this research was to measure changes in segmental and global lumbar lordosis in patients treated with presacral axial L4-S1 interbody fusion and posterior instrumentation and to determine if these changes influenced patient outcomes. Methods We performed a retrospective, multi-center review of prospectively collected data in 58 consecutive patients with disabling lumbar pain and radiculopathy unresponsive to nonsurgical treatment who underwent L4-S1 interbody fusion with the AxiaLIF two-level system (Baxano Surgical, Raleigh NC). Main outcomes included back pain severity, Oswestry Disability Index (ODI), Odom's outcome criteria, and fusion status using flexion and extension radiographs and computed tomography scans. Segmental (L4-S1) and global (L1-S1) lumbar lordosis measurements were made using standing lateral radiographs. All patients were followed for at least 24 months (mean: 29 months, range 24-56 months). Results There was no bowel injury, vascular injury, deep infection, neurologic complication or implant failure. Mean back pain severity improved from 7.8±1.7 at baseline to 3.3±2.6 at 2 years (p < 0.001). Mean ODI scores improved from 60±15% at baseline to 34±27% at 2 years (p < 0.001). At final follow-up, 83% of patients were rated as good or excellent using Odom's criteria. Interbody fusion was observed in 111 (96%) of 116 treated interspaces. Maintenance of lordosis, defined as a change in Cobb angle ≤ 5°, was identified in 84% of patients at L4-S1 and 81% of patients at L1-S1. Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change. Conclusions/Clinical Relevance Two-level axial interbody fusion supplemented with posterior fixation does not alter segmental or global lordosis in most patients. Patients with

  12. Large volume inside the cage leading incomplete interbody bone fusion and residual back pain after posterior lumbar interbody fusion.

    PubMed

    Takeuchi, Mikinobu; Kamiya, Mitsuhiro; Wakao, Norimitsu; Hirasawa, Atsuhiko; Kawanami, Katsuhisa; Osuka, Koji; Takayasu, Masakazu

    2015-07-01

    The purpose of this study is to compare intervertebral bone fusion and clinical outcomes in L4-5 posterior lumbar interbody fusion (PLIF) using the same posterior instrumentation with four combinations of one of three types of interbody cage with one of two bone grafts, iliac and local or only local. In 67 patients who underwent L4-5 PLIF, 19 patients had the Brantigan cage and iliac and local bone graft, 18 with the TELAMON C cage and iliac and local bone graft, 16 with the TELAMON C cage and local bone graft (TL), and 14 with the OIC PEEK cage and local bone graft. Clinical assessments were based on Japanese Orthopaedic Association (JOA) scores and on the visual analogue scale (VAS). The bone fusion assessments were based on radiography and CT scans according to the Brantigan, Steffee, and Fraser criteria. More than 2 years after surgery, these assessments were made. In the results, the fusion outcome for the group receiving TL was significantly less than those for the other three groups. In TL, multivariate logistic regression analysis showed that the inside volume of the cage of ≥2.0 mL was the only significant factor for incomplete fusion. Moreover, the VAS (low back pain) score was significantly higher for TL than for the other three groups. In conclusions, we believe that the large volume inside the cage (≥2.0 mL) with local bone graft may lead incomplete interbody bone fusion and residual postsurgical low back pain after PLIF. PMID:25666390

  13. Postoperative Flat Back: Contribution of Posterior Accessed Lumbar Interbody Fusion and Spinopelvic Parameters

    PubMed Central

    Kim, Jin Kwon; Kim, Deok Ryeng; Kim, Joo Seung

    2014-01-01

    Objective Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance (R2=0.286, p=0.0005). Conclusion Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back. PMID:25371781

  14. Outcome of posterior lumbar interbody fusion versus posterolateral fusion in lumbar degenerative disease.

    PubMed

    Wu, Yungang; Tang, Hao; Li, Zhonghai; Zhang, Qiulin; Shi, Zhicai

    2011-06-01

    Between March 2003 and September 2007, 170 consecutive patients with lumbar degenerative disease were studied retrospectively. Eighty patients underwent posterior lumbar interbody fusion (PLIF group) with pedicle screw (PS) fixation, and 82 patients underwent posterolateral fusion (PLF group) with PS fixation. Eight patients were lost to follow-up. The minimum follow-up period in each group was 2.0years. The mean follow-up period for the PLIF group was 3.6years, and for the PLF group, the mean follow-up was 3.4years: there was no significant difference between the two groups for length of follow-up. The Pain Index (PI) improved from 66 to 27 in the PLF group (p<0.001) and from 69 to 29 in the PLIF group (p<0.001), but there was no significant difference between the two groups (p>0.05). In the PLF group, the preoperative mean Oswestry Disability Index (ODI) score was 34.5, which reduced to 14.2 at the final follow-up. In the PLIF group, the mean preoperative ODI was 36.4, which reduced to 16.2 at the final follow-up. There was no significant statistical difference between the two groups for ODI (p>0.05). Eighty-eight percent (n=72) of patients in the PLF group and 91% (n=73) in the PLIF group had radiologically confirmed union, with no significant difference in fusion percentage between the two groups (p>0.05). Twenty-two of 162 patients (14%) underwent a second operation: 18 (22%) in the PLF group and four (5%) patients in the PLIF group (p<0.001). The clinical and functional outcomes in both groups were similar, and no significant difference was found in the parameters tested. Both surgical procedures were effective, but patients in the PLF group showed more complications related to hardware biomechanics than patients in the PLIF group (p<0.001). PMID:21507656

  15. Mini posterior lumbar interbody fusion with presacral screw stabilization in early lumbosacral instability

    PubMed Central

    Shetty, Arjun; Kini, Abhishek R; Chacko, A; Sunil, Upadhyaya; Vinod, K; Geover, Lobo

    2015-01-01

    Background: Surgical options for the management of early lumbosacral spondylolisthesis and degenerative disc disease with instability vary from open lumbar interbody fusion with transpedicular fixation to a variety of minimal access fusion and fixation procedures. We have used a combination of micro discectomy and axial lumbosacral interbody fusion with presacral screw fixation to treat symptomatic patients with lumbosacral spondylolisthesis or lumbosacral degenerative disc disease, which needed surgical stabilization. This study describes the above technique along with analysis of results. Materials and Methods: Twelve patients with symptomatic lumbosacral (L5-S1) instability and degenerative lumbosacral disc disease were treated by micro discectomy and interbody fusion using presacral screw stabilization. Patients with history of bowel, bladder dysfunction and local anorectal diseases were excluded from this study. Postoperatively all patients were evaluated neurologically and radiologically for screw position, fusion and stability. Oswestry disability index was used to evaluate results. Results: We had nine females and three males with a mean age of 47.33 years (range 26–68 years). Postoperative assessment revealed three patients to have screw placed in anterior 1/4th of the 1st sacral body, in rest nine the screws were placed in the posterior 3/4th of sacral body. At 2 years followup, eight patients (67%) showed evidence of bridging trabeculae at bone graft site and none of the patients showed evidence of instability or implant failure. Conclusion: Presacral screw fixation along with micro discectomy is an effective procedure to manage early symptomatic lumbosacral spondylolisthesis and degenerative disc disease with instability. PMID:26015626

  16. Lifestyle-Related Diseases Affect Surgical Outcomes after Posterior Lumbar Interbody Fusion.

    PubMed

    Sakaura, Hironobu; Miwa, Toshitada; Yamashita, Tomoya; Kuroda, Yusuke; Ohwada, Tetsuo

    2016-02-01

    Study Design Retrospective study. Objective Hyperlipidemia (HL) and hypertension (HT) lead to systemic atherosclerosis. Not only atherosclerosis but also bone fragility and/or low bone mineral density result from diabetes mellitus (DM) and chronic kidney disease (CKD). The purpose of this study was to examine whether these lifestyle-related diseases affected surgical outcomes after posterior lumbar interbody fusion (PLIF). Methods The subjects comprised 122 consecutive patients who underwent single-level PLIF for degenerative lumbar spinal disorders. The clinical results were assessed using the Japanese Orthopaedic Association (JOA) score before surgery and at 2 years postoperatively. The fusion status was graded as union in situ, collapsed union, or nonunion at 2 years after surgery. The abdominal aorta calcification (AAC) score was assessed using preoperative lateral radiographs of the lumbar spine. Results HL did not significantly affect the JOA score recovery rate. On the other hand, HT and CKD (stage 3 to 4) had a significant adverse effect on the recovery rate. The recovery rate was also lower in the DM group than in the non-DM group, but the difference was not significant. The AAC score was negatively correlated with the JOA score recovery rate. The fusion status was not significantly affected by HL, HT, DM, or CKD; however, the AAC score was significantly higher in the collapsed union and nonunion group than in the union in situ group. Conclusions At 2 years after PLIF, the presence of HT, CKD, and AAC was associated with significantly worse clinical outcomes, and advanced AAC significantly affected fusion status. PMID:26835195

  17. Neurogenic Shock Immediately following Posterior Lumbar Interbody Fusion: Report of Two Cases.

    PubMed

    Matsumoto, Tomiya; Okuda, Shinya; Haku, Takamitsu; Maeda, Kazuya; Maeno, Takafumi; Yamashita, Tomoya; Yamasaki, Ryoji; Kuratsu, Shigeyuki; Iwasaki, Motoki

    2015-08-01

    Study Design Case report. Objective To present two cases of neurogenic shock that occurred immediately following posterior lumbar interbody fusion (PLIF) and that appeared to have been caused by the vasovagal reflex after dural injury and incarceration of the cauda equina. Case Report We present two cases of neurogenic shock that occurred immediately following PLIF. One patient had bradycardia, and the other developed cardiac arrest just after closing the surgical incision and opening the drainage tube. Cardiopulmonary resuscitation was performed immediately, and the patients recovered successfully, but they showed severe motor loss after awakening. The results of laboratory data, chest X-ray, electrocardiogram, computed tomography, and echocardiography ruled out pulmonary embolism, hemorrhagic shock, and cardiogenic shock. Although the reasons for the postoperative shock were obscure, reoperation was performed to explore the cause of paralysis. At reoperation, a cerebrospinal fluid collection and the incarceration of multiple cauda equina rootlets through a small dural tear were observed. The incarcerated cauda equina rootlets were reduced, and the dural defect was closed. In both cases, the reoperation was uneventful. From the intraoperative findings at reoperation, it was thought that the pathology was neurogenic shock via the vasovagal reflex. Conclusion Incarceration of multiple cauda equina rootlets following the accidental dural tear by suction drainage caused a sudden decrease of cerebrospinal fluid pressure and traction of the cauda equina, which may have led to the vasovagal reflex. PMID:26225287

  18. Neurogenic Shock Immediately following Posterior Lumbar Interbody Fusion: Report of Two Cases

    PubMed Central

    Matsumoto, Tomiya; Okuda, Shinya; Haku, Takamitsu; Maeda, Kazuya; Maeno, Takafumi; Yamashita, Tomoya; Yamasaki, Ryoji; Kuratsu, Shigeyuki; Iwasaki, Motoki

    2014-01-01

    Study Design Case report. Objective To present two cases of neurogenic shock that occurred immediately following posterior lumbar interbody fusion (PLIF) and that appeared to have been caused by the vasovagal reflex after dural injury and incarceration of the cauda equina. Case Report We present two cases of neurogenic shock that occurred immediately following PLIF. One patient had bradycardia, and the other developed cardiac arrest just after closing the surgical incision and opening the drainage tube. Cardiopulmonary resuscitation was performed immediately, and the patients recovered successfully, but they showed severe motor loss after awakening. The results of laboratory data, chest X-ray, electrocardiogram, computed tomography, and echocardiography ruled out pulmonary embolism, hemorrhagic shock, and cardiogenic shock. Although the reasons for the postoperative shock were obscure, reoperation was performed to explore the cause of paralysis. At reoperation, a cerebrospinal fluid collection and the incarceration of multiple cauda equina rootlets through a small dural tear were observed. The incarcerated cauda equina rootlets were reduced, and the dural defect was closed. In both cases, the reoperation was uneventful. From the intraoperative findings at reoperation, it was thought that the pathology was neurogenic shock via the vasovagal reflex. Conclusion Incarceration of multiple cauda equina rootlets following the accidental dural tear by suction drainage caused a sudden decrease of cerebrospinal fluid pressure and traction of the cauda equina, which may have led to the vasovagal reflex. PMID:26225287

  19. Hybrid Biosynthetic Autograft Extender for Use in Posterior Lumbar Interbody Fusion: Safety and Clinical Effectiveness.

    PubMed

    Chedid, Mokbel K; Tundo, Kelly M; Block, Jon E; Muir, Jeffrey M

    2015-01-01

    Autologous iliac crest bone graft is the preferred option for spinal fusion, but the morbidity associated with bone harvest and the need for graft augmentation in more demanding cases necessitates combining local bone with bone substitutes. The purpose of this study was to document the clinical effectiveness and safety of a novel hybrid biosynthetic scaffold material consisting of poly(D,L-lactide-co-glycolide) (PLGA, 75:25) combined by lyophilization with unmodified high molecular weight hyaluronic acid (10-12% wt:wt) as an extender for a broad range of spinal fusion procedures. We retrospectively evaluated all patients undergoing single- and multi-level posterior lumbar interbody fusion at an academic medical center over a 3-year period. A total of 108 patients underwent 109 procedures (245 individual vertebral levels). Patient-related outcomes included pain measured on a Visual Analog Scale. Radiographic outcomes were assessed at 6 weeks, 3-6 months, and 1 year postoperatively. Radiographic fusion or progression of fusion was documented in 221 of 236 index levels (93.6%) at a mean (±SD) time to fusion of 10.2+4.1 months. Single and multi-level fusions were not associated with significantly different success rates. Mean pain scores (+SD) for all patients improved from 6.8+2.5 at baseline to 3.6+2.9 at approximately 12 months. Improvements in VAS were greatest in patients undergoing one- or two-level fusion, with patients undergoing multi-level fusion demonstrating lesser but still statistically significant improvements. Overall, stable fusion was observed in 64.8% of vertebral levels; partial fusion was demonstrated in 28.8% of vertebral levels. Only 15 of 236 levels (6.4%) were non-fused at final follow-up. PMID:26161161

  20. Reduction in adjacent-segment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation.

    PubMed

    Lu, Kang; Liliang, Po-Chou; Wang, Hao-Kuang; Liang, Cheng-Loong; Chen, Jui-Sheng; Chen, Tai-Been; Wang, Kuo-Wei; Chen, Han-Jung

    2015-08-01

    OBJECT Multilevel long-segment lumbar fusion poses a high risk for future development of adjacent-segment degeneration (ASD). Creating a dynamic transition zone with an interspinous process device (IPD) proximal to the fusion has recently been applied as a method to reduce the occurrence of ASD. The authors report their experience with the Device for Intervertebral Assisted Motion (DIAM) implanted proximal to multilevel posterior lumbar interbody fusion (PLIF) in reducing the development of proximal ASD. METHODS This retrospective study reviewed 91 cases involving patients who underwent 2-level (L4-S1), 3-level (L3-S1), or 4-level (L2-S1) PLIF. In Group A (42 cases), the patients received PLIF only, while in Group B (49 cases), an interspinous process device, a DIAM implant, was put at the adjacent level proximal to the PLIF construct. Bone resection at the uppermost segment of the PLIF was equally limited in the 2 groups, with preservation of the upper portion of the spinous process/lamina and the attached supraspinous ligament. Outcome measures included a visual analog scale (VAS) for low-back pain and leg pain and the Oswestry Disability Index (ODI) for functional impairment. Anteroposterior and lateral flexion/extension radiographs were used to evaluate the fusion status, presence and patterns of ASD, and mobility of the DIAM-implanted segment. RESULTS Solid interbody fusion without implant failure was observed in all cases. Radiographic ASD occurred in 20 (48%) of Group A cases and 3 (6%) of Group B cases (p < 0.001). Among the patients in whom ASD was identified, 9 in Group A and 3 in Group B were symptomatic; of these patients, 3 in Group A and 1 in Group B underwent a second surgery for severe symptomatic ASD. At 24 months after surgery, Group A patients fared worse than Group B, showing higher mean VAS and ODI scores due to symptoms related to ASD. At the final follow-up evaluations, as reoperations had been performed to treat symptomatic ASD in some

  1. [The posterior lumbar interbody fusion with cages (PLIF) and transpedicular stabilization].

    PubMed

    Diedrich, O; Kraft, C N; Perlick, L; Schmitt, O

    2001-01-01

    The development of intervertebral cages has significantly innovated the original technique of posterior lumbar interbody fusion (PLIF). In this study we present the results of patients treated for degenerative or postoperative segmental spinal instabilities by PLIF with cages and pedicular stabilisation (360 degrees-instrumentation). Between 1992 and 1999 we implanted either CFRP-, PEEK- or Titanium-cages in 86 patients. 78 patients were adequately followed up over a period of at least 12 months (average 2,6 years). 5 patients were stabilised over 2 segments, so that ultimately 83 fused segments were evaluated.15% of all patients had an excellent, 51% a good, 28% a moderate and 5% an insufficient clinical result. Degenerative instabilities had a better outcome with 73% good or excellent clinical results, compared to postoperative instabilities (56%). Based on stringent radiographic fusion criteria we found true bony fusion in 52% of all segments after 12 months, 63% after 24 months, 72% after 36 months, and 78% after 48 months. In 21 segments cage packing was performed with autologous spongiosa, while in 62 segments a combination of cortical bone and spongiosa obtained from osseous structures at the operation-site were used as packing material. At the 24 month radiographic control we found a slightly higher fusion rate for those segments treated with autologous spongiosa obtained from the iliac crest. Neither for cages nor for pedicular screws was implant failure or material fatigue found. Serious entero-, pulmo-, cardio- or urological complications were not observed. Nonetheless the necessity for operative revision was 9%. A postoperative semiquantitative evaluation of segments neighbouring the fused vertebra revealed in 28% an increase in degenerative changes. Particularly after 360 degrees-instrumentation, interpretation of the fusion-status should be based on structural and not on functional criteria. The modification of PLIF with cages compared to the use of

  2. Comparison of Posterior Lumbar Interbody Fusion and Posterolateral Lumbar Fusion in Monosegmental Vacuum Phenomenon within an Intervertebral Disc

    PubMed Central

    An, Ki-Chan; Kong, Gyu-Min; Park, Dae-Hyun; Youn, Ji-Hong; Lee, Woon-Seong

    2016-01-01

    Study Design Retrospective. Purpose To compare the clinical and radiological outcomes of posterolateral lumbar interbody fusion (PLIF) and posterolateral lumbar fusion (PLF) in monosegmental vacuum phenomenon within an intervertebral disc. Overview of Literature The vacuum phenomenon within an intervertebral disc is a serious form of degenerative disease that destabilizes the intervertebral body. Outcomes of PLIF and PLF in monosegmental vacuum phenomenon are unclear. Methods Monosegmental instrumented PLIF and PLF was performed on 84 degenerative lumbar disease patients with monosegmental vacuum phenomenon (PLIF, n=38; PLF, n=46). Minimum follow-up was 24 months. Clinical outcomes of leg and back pain were assessed using visual analogue scales for leg pain (LVAS) and back pain (BVAS), and the Oswestry disability index (ODI). The radiographic outcome was the estimated bony union rate. Results LVAS, BVAS, and ODI improved in both groups. There was no significant difference in the degree of these improvements between PLIF and PLF patients (p>0.05). Radiological union rate was 91.1% in PLIF group and 89.4% in PLF group at postoperative 24 months (p>0.05). Conclusions No significant differences in clinical results and union rates were found between PLIF and PLF patients. Selection of the operation technique will reflect the surgeon's preferences and patient condition. PMID:26949464

  3. Postoperative Cyst Associated with Bone Morphogenetic Protein Use in Posterior and Transforaminal Lumbar Interbody Fusion Managed Conservatively: Report of Two Cases

    PubMed Central

    Mejía, Diana M; Drazin, Doniel; Anand, Neel

    2016-01-01

    Bone morphogenetic protein use in spinal surgery for off-label indications continues to remain popular. One area where its use has known associated radicular complications is posterior or transforaminal lumbar interbody fusion. These complications include radiculitis, cyst development, and heterotopic ossification, amongst others. Typically, cyst development has been treated surgically. We present two cases of bone morphogenetic protein-related cysts treated medically and thus, present medical treatment as an alternative treatment option. PMID:27014519

  4. Effect of Psychological Status on Outcome of Posterior Lumbar Interbody Fusion Surgery

    PubMed Central

    Lakkol, Sandesh; Budithi, Chakra; Bhatia, Chandra; Krishna, Manoj

    2012-01-01

    Study Design Prospective longitudinal study. Purpose To determine if preoperative psychological status affects outcome in spinal surgery. Overview of Literature Low back pain is known to have a psychosomatic component. Increased bodily awareness (somatization) and depressive symptoms are two factors that may affect outcome. It is possible to measure these components using questionnaires. Methods Patients who underwent posterior interbody fusion (PLIF) surgery were assessed preoperatively and at follow-up using a self-administered questionnaire. The visual analogue scale (VAS) for back and leg pain severity and the Oswestry Disability Index (ODI) were used as outcome measures. The psychological status of patients was classified into one of four groups using the Distress and Risk Assessment Method (DRAM); normal, at-risk, depressed somatic and distressed depressive. Results Preoperative DRAM scores showed 14 had no psychological disturbance (normal), 39 were at-risk, 11 distressed somatic, and 10 distressed depressive. There was no significant difference between the 4 groups in the mean preoperative ODI (analysis of variance, p = 0.426). There was a statistically and clinically significant improvement in the ODI after surgery for all but distressed somatic patients (9.8; range, -5.2 to 24.8; p = 0.177). VAS scores for all groups apart from the distressed somatic showed a statistically and clinically significant improvement. Our results show that preoperative psychological state affects outcome in PLIF surgery. Conclusions Patients who were classified as distressed somatic preoperatively had a less favorable outcome compared to other groups. This group of patients may benefit from formal psychological assessment before undergoing PLIF surgery. PMID:22977697

  5. Demineralized Bone Matrix, as a Graft Enhancer of Auto-Local Bone in Posterior Lumbar Interbody Fusion

    PubMed Central

    Moon, Sang Ho; Kim, Tae Woo; Boo, Kyung Hwan; Hong, Sung Won

    2014-01-01

    Study Design A case controlled study with prospective data collection. Purpose To evaluate the early influence and the final consequence of demineralized bone matrix (DBM) on auto-local bone as a graft enhancer in posterior lumbar interbody fusion (PLIF). Overview of Literature DBM is known as an osteoinductive material; however, it has not been clearly recognized to enhance auto-local bone with a small amount. Methods Patients who had a PLIF were allocated into two groups. Group I (70 cases) used auto-local bone chips and group II (44 cases) used DBM as an additive to auto-local bone, 1 mL per a segment. Group selection was alternated. Early assessment was performed by computed tomography at 6 months and final assessment was done by simple radiography after 24 months at least. The degree of bone formation was assessed by 4 grade scale. Results The subjects of both groups were homogenous and had similar Oswestry Disability Index at final assessment. The ratio of auto-local bone chips and DBM was 6:1. The degree of bone formation at 6 months after surgery was superior in group II. However, there was no significant difference between the two groups at the final assessment. Conclusions DBM was not recognized to enhance auto-local bone with small amount. PMID:24761193

  6. The Negligible Influence of Chronic Obesity on Hospitalization, Clinical Status, and Complications in Elective Posterior Lumbar Interbody Fusion

    PubMed Central

    Kombos, Theodoros; Bode, Frank

    2016-01-01

    Background. Posterior lumbar interbody fusion (PLIF) is a common surgical treatment for degenerative spinal instability, but many surgeons consider obesity a contraindication for elective spinal fusion. The aim of this study was to analyze whether obesity has any influence on hospitalization parameters, change in clinical status, or complications. Methods. In this prospective study, regression analysis was used to analyze the influence of the body mass index (BMI) on operating time, postoperative care, hospitalization time, type of postdischarge care, change in paresis or sensory deficits, pain level, wound complications, cerebrospinal fluid leakage, and implant complications. Results. Operating time increased only 2.5 minutes for each increase of BMI by 1. The probability of having a wound complication increased statistically with rising BMI. Nonetheless, BMI accounted for very little of the variation in the data, meaning that other factors or random chances play a much larger role. Conclusions. Obesity has to be considered a risk factor for wound complications in patients undergoing elective PLIF for degenerative instability. However, BMI showed no significant influence on other kinds of peri- or postoperative complications, nor clinical outcomes. So obesity cannot be considered a contraindication for elective PLIF. PMID:27478866

  7. The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

    PubMed Central

    Abbushi, Alexander; Čabraja, Mario; Thomale, Ulrich-Wilhelm; Woiciechowsky, Christian

    2009-01-01

    In posterior lumbar interbody fusion, cage migrations and lower fusion rates compared to autologous bone graft used in the anterior lumbar interbody fusion procedure are documented. Anatomical and biomechanical data have shown that the cage positioning and cage type seem to play an important role. Therefore, the aim of the present study was to evaluate the impact of cage positioning and cage type on cage migration and fusion. We created a grid system for the endplates to analyze different cage positions. To analyze the influence of the cage type, we compared “closed” box titanium cages with “open” box titanium cages. This study included 40 patients with 80 implanted cages. After pedicle screw fixation, 23 patients were treated with a “closed box” cage and 17 patients with an “open box” cage. The follow-up period averaged 25 months. Twenty cages (25%) showed a migration into one vertebral endplate of <3 mm and four cages (5%) showed a migration of ≥3 mm. Cage migration was highest in the medio-medial position (84.6%), followed by the postero-lateral (42.9%), and the postero-medial (16%) cage position. Closed box cages had a significantly higher migration rate than open box cages, but fusion rates did not differ. In conclusion, cage positioning and cage type influence cage migration. The medio-medial cage position showed the highest migration rate. Regarding the cage type, open box cages seem to be associated with lower migration rates compared to closed box cages. However, the cage type did not influence bone fusion. PMID:19475436

  8. Fixation Strength of Caudal Pedicle Screws after Posterior Lumbar Interbody Fusion with the Modified Cortical Bone Trajectory Screw Method

    PubMed Central

    Miwa, Toshitada; Yamashita, Tomoya; Kuroda, Yusuke; Ohwada, Tetsuo

    2016-01-01

    Study Design Clinical case series. Purpose In the posterior lumbar interbody fusion (PLIF) procedure in our institute, the cephalad screw trajectory follows a mediolateral and caudocephalad directed path according to the original cortical bone trajectory (CBT) method. However, the starting point of the caudal screw is at the medial border of the pedicle on an articular surface of the superior articular process, and the trajectory takes a mediolateral path parallel to the cephalad endplate. The incidence of caudal screw loosening after PLIF with this modified CBT screw method was investigated, and significant risk factors for caudal screw loosening were evaluated. Overview of Literature A biomechanical study of this modified caudal screw trajectory using the finite element method reported about a 20% increase in uniaxial yield pullout load compared with the traditional trajectory. However, there has been no clinical study concerning the fixation strength of this modified caudal screw trajectory. Methods The subjects were 193 consecutive patients who underwent single-level PLIF with modified CBT screw fixation. Caudal screw loosening was checked in computed tomography at 6 months after surgery, and screw loosening was defined as a radiolucency of 1 mm or more at the bone-screw interface. Results The incidence of caudal screw loosening after lumbosacral PLIF (46.2%) was significantly higher than that after floating PLIF (6.0%). No significant differences in sex, brand of the instruments, and diameter and length of the caudal screw were evident between patients with and without caudal screw loosening. Patients with caudal screw loosening were significantly older at the time of surgery than patients without caudal screw loosening. Conclusions Fixation strength of the caudal screw after floating PLIF with this modified CBT screw technique was sufficiently acceptable. Fixation strength after the lumbosacral procedure was not. PMID:27559442

  9. Comparison of Clinical and Radiological Results of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of L4 Degenerative Lumbar Spondylolisthesis

    PubMed Central

    Kuraishi, Shugo; Mukaiyama, Keijiro; Shimizu, Masayuki; Ikegami, Shota; Futatsugi, Toshimasa; Hirabayashi, Hiroki; Ogihara, Nobuhide; Hashidate, Hiroyuki; Tateiwa, Yutaka; Kinoshita, Hisatoshi; Kato, Hiroyuki

    2016-01-01

    Study Design Multicenter analysis of two groups of patients surgically treated for degenerative L4 unstable spondylolisthesis. Purpose To compare the clinical and radiographic outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for degenerative L4 unstable spondylolisthesis. Overview of Literature Surgery for lumbar degenerative spondylolisthesis is widely performed. However, few reports have compared the outcome of PLF to that of PLIF for degenerative L4 unstable spondylolisthesis. Methods Patients with L4 unstable spondylolisthesis with Meyerding grade II or more, slip of >10° or >4 mm upon maximum flexion and extension bending, and posterior opening of >5 degree upon flexion bending were studied. Patients were treated from January 2008 to January 2010. Patients who underwent PLF (n=12) and PLIF (n=19) were followed-up for >2 years. Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups. Radiographic evaluation included slip angle, translation, slip angle and translation during maximum flexion and extension bending, intervertebral disc height, lumbar lordotic angle, and fusion rate. Results JOA scores of the PLF group before surgery and at final follow-up were 12.3±4.8 and 24.1±3.7, respectively; those of the PLIF group were 14.7±4.8 and 24.2±7.8, respectively, with no significant difference between the two groups. Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (p<0.05) better than those in the PLF group. However, there was no significant difference in lumbar lordotic angle, slip angle and translation angle upon maximum flexion, or extension bending. Fusion rates of the PLIF and PLF groups had no significant difference. Conclusions The L4–L5 level posterior instrumented fusion for unstable spondylolisthesis using both PLF and PLIF

  10. Do Trunk Muscles Affect the Lumbar Interbody Fusion Rate?: Correlation of Trunk Muscle Cross Sectional Area and Fusion Rates after Posterior Lumbar Interbody Fusion Using Stand-Alone Cage

    PubMed Central

    Choi, Man Kyu; Park, Bong Jin; Park, Chang Kyu; Kim, Sung Min

    2016-01-01

    Objective Although trunk muscles in the lumbar spine preserve spinal stability and motility, little is known about the relationship between trunk muscles and spinal fusion rate. The aim of the present study is to evaluate the correlation between trunk muscles cross sectional area (MCSA) and fusion rate after posterior lumbar interbody fusion (PLIF) using stand-alone cages. Methods A total of 89 adult patients with degenerative lumbar disease who were performed PLIF using stand-alone cages at L4–5 were included in this study. The cross-sectional area of the psoas major (PS), erector spinae (ES), and multifidus (MF) muscles were quantitatively evaluated by preoperative lumbar magnetic resonance imaging at the L3–4, L4–5, and L5–S1 segments, and bone union was evaluated by dynamic lumbar X-rays. Results Of the 89 patients, 68 had bone union and 21 did not. The MCSAs at all segments in both groups were significantly different (p<0.05) for the PS muscle, those at L3–4 and L4–5 segments between groups were significantly different (p=0.048, 0.021) for the ES and MF muscles. In the multivariate analysis, differences in the PS MCSA at the L4–5 and L5–S1 segments remained significant (p=0.048, 0.043 and odds ratio=1.098, 1.169). In comparison analysis between male and female patients, most MCSAs of male patients were larger than female's. Fusion rates of male patients (80.7%) were higher than female's (68.8%), too. Conclusion For PLIF surgery, PS muscle function appears to be an important factor for bone union and preventing back muscle injury is essential for better fusion rate. PMID:27226860

  11. Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF).

    PubMed

    Phan, Kevin; Maharaj, Monish; Assem, Yusuf; Mobbs, Ralph J

    2016-09-01

    Lumbar interbody fusion represents an effective surgical intervention for patients with lumbar degenerative diseases, spondylolisthesis, disc herniation, pseudoarthrosis and spinal deformities. Traditionally, conventional open anterior lumbar interbody fusion and posterior/transforaminal lumbar interbody fusion techniques have been employed with excellent results, but each with their own advantages and caveats. Most recently, the antero-oblique trajectory has been introduced, providing yet another corridor to access the lumbar spine. Termed the oblique lumbar interbody fusion, this approach accesses the spine between the anterior vessels and psoas muscles, avoiding both sets of structures to allow efficient clearance of the disc space and application of a large interbody device to afford distraction for foraminal decompression and endplate preparation for rapid and thorough fusion. This review aims to summarize the early clinical results and complications of this new technique and discusses potential future directions of research. PMID:27349468

  12. Evaluation of Functional Outcomes in Individuals 10 Years after Posterior Lumbar Interbody Fusion with Corundum Implants and Decompression: A Comparison of 2 Surgical Techniques

    PubMed Central

    Truszczyńska, Aleksandra; Rąpała, Kazimierz; Łukawski, Stanislaw; Trzaskoma, Zbigniew; Tarnowski, Adam; Drzal-Grabiec, Justyna; Cabak, Anna

    2014-01-01

    Background The purpose of this study was to evaluate lumbar spine-related functional disability in individuals 10 years after lumbar decompression and lumbar decompression with posterior lumbar interbody fusion (PLIF) with corundum implants surgery for degenerative stenosis and to compare the long-term outcome of these 2 surgical techniques. Material/Methods From 1998 to 2002, 100 patients with single-level lumbar stenosis were surgically treated. The patients were randomly divided into 2 groups that did not differ in terms of clinical or neurological symptoms. Group A consisted of 50 patients who were treated with PLIF and the use of porous ceramic corundum implants; the mean age was 57.74 and BMI was 27.34. Group B consisted of 50 patients treated with decompression by fenestration; mean age was 51.28 and the mean BMI was 28.84. Results There was no statistical significance regarding age, BMI, and sex. Both treatments revealed significant improvements. In group A, ODI decreased from 41.01% to 14.3% at 1 year and 16.3 at 10 years. In group B, ODI decreased from 63.8% to 18.36% at 1 year and 22.36% at 10 years. The difference between groups was statistically significant. There were no differences between the groups regarding the Rolland-Morris disability questionnaire and VAS at 1 and 10 years after surgery. Conclusions Long-term results evaluated according to the ODI, the Rolland-Morris disability questionnaire, and the VAS showed that the both methods significantly reduce patient disability, and this was maintained during next 10 years. The less invasive fenestration procedure was only slightly less favorable than surgical treatment of stenosis by both PLIF with corundum implants and decompression. PMID:25106708

  13. Hospital charges associated with "never events": comparison of anterior cervical discectomy and fusion, posterior lumbar interbody fusion, and lumbar laminectomy to total joint arthroplasty.

    PubMed

    Daniels, Alan H; Kawaguchi, Satoshi; Contag, Alec G; Rastegar, Farbod; Waagmeester, Garrett; Anderson, Paul A; Arthur, Melanie; Hart, Robert A

    2016-08-01

    OBJECTIVE Beginning in 2008, the Centers for Medicare and Medicaid Service (CMS) determined that certain hospital-acquired adverse events such as surgical site infection (SSI) following spine surgery should never occur. The following year, they expanded the ruling to include deep vein thrombosis (DVT) and pulmonary embolism (PE) following total joint arthroplasty. Due to their ruling that "never events" are not the payers' responsibility, CMS insists that the costs of managing these complications be borne by hospitals and health care providers, rather than billings to health care payers for additional care required in their management. Data comparing the expected costs of such adverse events in patients undergoing spine and orthopedic surgery have not previously been reported. METHODS The California State Inpatient Database (CA-SID) from 2008 to 2009 was used for the analysis. All patients with primary procedure codes indicating anterior cervical discectomy and fusion (ACDF), posterior lumbar interbody fusion (PLIF), lumbar laminectomy (LL), total knee replacement (TKR), and total hip replacement (THR) were analyzed. Patients with diagnostic and/or treatment codes for DVT, PE, and SSI were separated from patients without these complication codes. Patients with more than 1 primary procedure code or more than 1 complication code were excluded. Median charges for treatment from primary surgery through 3 months postoperatively were calculated. RESULTS The incidence of the examined adverse events was lowest for ACDF (0.6% DVT, 0.1% PE, and 0.03% SSI) and highest for TKA (1.3% DVT, 0.3% PE, 0.6% SSI). Median inpatient charges for uncomplicated LL was $51,817, compared with $73,432 for ACDF, $143,601 for PLIF, $74,459 for THR, and $70,116 for TKR. Charges for patients with DVT ranged from $108,387 for TKR (1.5 times greater than index) to $313,536 for ACDF (4.3 times greater than index). Charges for patients with PE ranged from $127,958 for TKR (1.8 times greater than

  14. Clinical and radiological outcome of anterior-posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients.

    PubMed

    Faundez, Antonio A; Schwender, James D; Safriel, Yair; Gilbert, Thomas J; Mehbod, Amir A; Denis, Francis; Transfeldt, Ensor E; Wroblewski, Jill M

    2009-02-01

    Abundant data are available for direct anterior/posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre- and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups. PMID:19125304

  15. Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

    PubMed Central

    Schwender, James D.; Safriel, Yair; Gilbert, Thomas J.; Mehbod, Amir A.; Denis, Francis; Transfeldt, Ensor E.; Wroblewski, Jill M.

    2009-01-01

    Abundant data are available for direct anterior/posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre- and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups. PMID:19125304

  16. Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft

    PubMed Central

    Mater, Eckhardt; Schön, Ralph

    2010-01-01

    The conservative and operative treatment strategies of hematogenous spondylodiscitis in septic patients with multiple risk factors are controversial. The present series demonstrates the outcome of 18 elderly patients (median age, 72 years) with septic hematogenous spondylodiscitis and intraspinal abscess treated with microsurgical decompression and debridement of the infective tissue, followed by posterior stabilization and interbody fusion with iliac crest bone graft in one or two lumbar segments. The majority of the patients were unsuccessfully treated with intravenous antibiotics prior to the operation. Antibiotic therapy was continued for more than 6 weeks postoperatively. Morbidity and early mortality amounted to 50 and 17%, respectively. Three patients died in the hospital from internal complications after an initial postoperative improvement of the inflammatory clinical signs and laboratory parameters. Fifteen patients recovered from the spinal infection. Three of them died several months after discharge (cerebral hemorrhage, malignancy and unknown cause). Twelve patients had excellent or good outcomes during the follow-up period of at least 1 year. The series shows that operative decompression and eradication of the intraspinal and intervertebral infective tissue with fusion and stabilization via a posterior approach is possible in septic patients with multiple risk factors and leads to good results in those patients, who survive the initial severe stage of the septic disease. However, the morbidity and mortality suggest that this surgical treatment is not the therapy of first choice in high-risk septic patients, but may be considered in patients when conservative management has failed. PMID:20495933

  17. Lateral Lumbar Interbody Fusion: Indications, Outcomes, and Complications.

    PubMed

    Kwon, Brian; Kim, David Hanwuk

    2016-02-01

    Lateral lumbar interbody fusion is a minimally invasive spinal fusion technique that uses the retroperitoneal approach to the anterior spinal column. Mechanical and technical results of the technique compare favorably with those of anterior lumbar interbody fusion in regard to large graft placement, graft volumes, and early initial stability. Lateral lumbar interbody fusion uses the transpsoas approach and traverses near the lumbar plexus. It is not, however, without its unique complications. Groin pain or numbness is well tolerated and often temporary; however, quadriceps palsy can be long-lasting and debilitating. Rarer but serious complications include vascular and visceral injury. Lateral lumbar interbody fusion has been used successfully to treat common degenerative spinal conditions such as spinal instability, stenosis, scoliosis, and degenerative disk disease. While understanding of the lumbar plexus and the technical challenges of the procedure improves, lateral lumbar interbody fusion will continue to provide safe and successful clinical outcomes with less morbidity than traditional procedures. PMID:26803545

  18. One-stage surgical treatment for thoracic and lumbar Spinal tuberculosis by transpedicular fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach.

    PubMed

    Ran, Bing; Xie, Yuan-Long; Yan, Lei; Cai, Lin

    2016-08-01

    This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association (ASIA) impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association (JOA) scores and oswestry disability index (ODI) of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4-12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis. PMID:27465330

  19. Mini-open anterior lumbar interbody fusion.

    PubMed

    Gandhoke, Gurpreet S; Ricks, Christian; Tempel, Zachary; Zuckerbraun, Brian; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S

    2016-07-01

    In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure. The video can be found here: https://youtu.be/r3bC4_vu1hQ . PMID:27364424

  20. Posterior lumbar interbody fusion with instrumented posterolateral fusion in adult spondylolisthesis: description and association of clinico-surgical variables with prognosis in a series of 36 cases

    PubMed Central

    Gomez-Moreta, Juan A.; Hernandez-Vicente, Javier

    2015-01-01

    Background We present our experience in the treatment of patients with isthmic or degenerative spondylolisthesis, by means of a posterior lumbar interbody fusion (PLIF) and instrumented posterolateral fusion (IPLF), and we compare them with those published in the literature. We analyse whether there exists any statistical association between the clinical characteristics of the patient, radiological characteristics of the disease and our surgical technique, with the complications and the clinical-radiological prognosis of the cases. Method We designed a prospective study. A total of 36 cases were operated. The patients included were 14 men and 22 women, with an average age of 57.17±27.32 years. Our technique consists of PLIF+IPLF, using local bone for the fusion. The clinical results were evaluated with the Visual Analogical Scale (VAS) and the Kirkaldy-Willis criteria. The radiological evaluation followed the Bratingan (PLIF) and Lenke (IPLF) methodology. A total of 42 variables were statistically analysed by means of SPSS18. We used the Paired Student's T-test, logistic regression and Pearson's Chi-square-test. Results The spondylolisthesis was isthmic in 15 cases and degenerative in 21 cases. The postoperative evaluations had excellent or good results in 94.5% (n = 34), with a statistically significant improvement in the back pain and sciatica (p < 0.01). The rate of circumferential fusion reached was approximately 92%. We had 13.88% of transitory morbility and 0% of mortality associated with our technique. A greater age, degree of listhesis or length of illness before the intervention, weakly correlated with worse clinical results (p< -0.2). In our series, the logistical regression showed that the clinical characteristics of the patient, radiological characteristics of the lesion and our surgical technique were not associated with greater postoperative complications. Conclusion Although a higher level of training is necessary, we believe that the described

  1. Minimally Invasive Transforaminal Lumbar Interbody Fusion.

    PubMed

    Ahn, Junyoung; Tabaraee, Ehsan; Singh, Kern

    2015-07-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is performed via tubular dilators thereby preserving the integrity of the paraspinal musculature. The decreased soft tissue disruption in the MIS technique has been associated with significantly decreased blood loss, shorter length of hospitalization, and an expedited return to work while maintaining comparable arthrodesis rates when compared with the open technique particularly in the setting of spondylolisthesis (isthmic and degenerative), recurrent symptomatic disk herniation, spinal stenosis, pseudoarthrosis, iatrogenic instability, and spinal trauma. The purpose of this article and the accompanying video wass to demonstrate the techniques for a primary, single-level MIS TLIF. PMID:26079840

  2. Transdural retrieval of a retropulsed lumbar interbody cage: Technical case report

    PubMed Central

    Zaidi, Hasan Aqdas; Shah, Ashish; Kakarla, Udaya Kumar

    2016-01-01

    The purpose of this case report was to describe a novel method to retrieve a herniated lumbar interbody cage. Transforaminal lumbar interbody fusion (TLIF) is an increasingly popular method of spinal fixation and fusion. Unexpected retropulsion of an interbody is a rare event that can result in intractable pain or motor compromise necessitating surgical retrieval of the interbody. Both anterior and posterior approaches to removing migrated cages may be associated with significant surgical morbidity and mortality. A 60-year-old woman underwent an L4-S1 TLIF coupled with pedicle screw fixation at a previous hospital 5 years prior to admission. She noted sudden-onset bilateral lower extremity weakness and right-sided foot drop. Magnetic resonance imaging and radiographs were notable for purely centrally herniated interbody. A posterior, midline transdural approach was used to retrieve the interbody. Situated in between nerve rootlets to the ventral canal, this virgin corridor allowed us to easily visualize and protect neurological structures while safely retrieving the interbody. The patient experienced an immediate improvement in symptoms and was discharged on postoperative day 3. At 12-month follow-up, she had no evidence of cerebrospinal fluid (CSF) leak and had returned to normal activities of daily living. While the risk of CSF leak may be higher with a transdural approach, we maintain that avoiding unnecessary retraction of the nerve roots may outweigh this risk. To our knowledge, this is the first case report of a transdural approach for the retrieval of a retropulsed lumbar interbody cage. PMID:26889290

  3. Transdural retrieval of a retropulsed lumbar interbody cage: Technical case report.

    PubMed

    Zaidi, Hasan Aqdas; Shah, Ashish; Kakarla, Udaya Kumar

    2016-01-01

    The purpose of this case report was to describe a novel method to retrieve a herniated lumbar interbody cage. Transforaminal lumbar interbody fusion (TLIF) is an increasingly popular method of spinal fixation and fusion. Unexpected retropulsion of an interbody is a rare event that can result in intractable pain or motor compromise necessitating surgical retrieval of the interbody. Both anterior and posterior approaches to removing migrated cages may be associated with significant surgical morbidity and mortality. A 60-year-old woman underwent an L4-S1 TLIF coupled with pedicle screw fixation at a previous hospital 5 years prior to admission. She noted sudden-onset bilateral lower extremity weakness and right-sided foot drop. Magnetic resonance imaging and radiographs were notable for purely centrally herniated interbody. A posterior, midline transdural approach was used to retrieve the interbody. Situated in between nerve rootlets to the ventral canal, this virgin corridor allowed us to easily visualize and protect neurological structures while safely retrieving the interbody. The patient experienced an immediate improvement in symptoms and was discharged on postoperative day 3. At 12-month follow-up, she had no evidence of cerebrospinal fluid (CSF) leak and had returned to normal activities of daily living. While the risk of CSF leak may be higher with a transdural approach, we maintain that avoiding unnecessary retraction of the nerve roots may outweigh this risk. To our knowledge, this is the first case report of a transdural approach for the retrieval of a retropulsed lumbar interbody cage. PMID:26889290

  4. True Percutaneous Transforaminal Lumbar Interbody Fusion: Case Illustrations, Surgical Technique, and Limitations.

    PubMed

    Syed, Hasan; Voyadzis, Jean-Marc

    2016-07-01

    Objective The last decade has seen significant advances in minimally invasive techniques for lumbar interbody fusion that have reduced approach-related morbidity. Percutaneous lumbar interbody fusion involves a posterior transforaminal approach to the disk space with a minimal access port through the Kambin triangle. This technique obviates the need for the facetectomy or laminectomy required in a traditional transforaminal approach. This article describes the surgical technique, potential advantages and limitations, and representative case illustrations. Methods Percutaneous transforaminal interbody fusion was performed on two patients with axial back and leg pain as a result of degenerative disk disease. Diskectomy and interbody cage insertion were completed through a tubular dilator placed onto the disk space in the Kambin triangle. Posterior fixation was achieved with percutaneous transfacet screws. Clinical outcome and postoperative complications are discussed. Results Both patients demonstrated significant clinical improvement after surgery with > 1 year follow-up despite experiencing transient neurologic symptoms. Conclusion Although this report demonstrates the feasibility and advantages of the approach, the technique is limited by the potential for nerve root injury and pseudoarthrosis. PMID:26291889

  5. Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations

    PubMed Central

    Drazin, Doniel; Kim, Terrence T.; Johnson, J. Patrick

    2015-01-01

    Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes; p = 0.009) and lower intraoperative blood loss: 108 mL (versus 93 mL; NS). Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS). There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially. PMID:26649303

  6. Transforaminal Lumbar Interbody Fusion for Management of Recurrent Lumbar Disc Herniation

    PubMed Central

    2016-01-01

    Study Design Retrospective study. Purpose To study the surgical outcome of transforaminal lumbar interbody fusion (TLIF) combined with trans-pedicular screws fixation for management of selected cases of recurrent lumbar disc herniation. Overview of Literature Recurrent lumbar disc herniation is a major cause of surgical failure, occurring in 5%–11% of cases. The optimal technique for treatment is controversial. Some authors believe that repeated simple discectomy is the treatment of choice, but approach-related complications can be considerable. Other surgeons prefer more removal of posterior elements (as lamina and facet joints) with posterior fusion. Methods The study included 15 patients who presented with symptomatic recurrent lumbar disc herniation who underwent reoperation through posterior trans-pedicular screws and TLIF in our department from April 2008 to May 2010, with a 24-month follow-up. Japanese Orthopedic Association Scale (JOA) was used for low back pain. The results of surgery were also evaluated with the MacNab classification. Results The mean JOA score showed significant improvement, increasing from 9.5 before surgery to 24.0 at the end of follow-up (p<0.001). Clinical outcome was excellent in 7 patients (46% of cases), good in 6 patients (40%) and fair in only 2 patients (14%). There was a significant difference (p<0.05) between patients presenting with recurrent disc at the ipsilateral side and those at the contralateral side. Conclusions In spite of the small number of patients and the short follow-up period, the good clinical and radiological outcome achieved in this study encourage the belief that TLIF is an effective option for the treatment of selected cases of recurrent lumbar disc herniation. PMID:26949458

  7. Current Status of Lumbar Interbody Fusion for Degenerative Spondylolisthesis

    PubMed Central

    TAKAHASHI, Toshiyuki; HANAKITA, Junya; OHTAKE, Yasufumi; FUNAKOSHI, Yusuke; OICHI, Yuki; KAWAOKA, Taigo; WATANABE, Mizuki

    2016-01-01

    Instrumented lumbar fusion can provide immediate stability and assist in satisfactory arthrodesis in patients who have pain or instability of the lumbar spine. Lumbar adjunctive fusion with decompression is often a good procedure for surgical management of degenerative spondylolisthesis (DS). Among various lumbar fusion techniques, lumbar interbody fusion (LIF) has an advantage in that it maintains favorable lumbar alignment and provides successful fusion with the added effect of indirect decompression. This technique has been widely used and represents an advancement in spinal instrumentation, although the rationale and optimal type of LIF for DS remains controversial. We evaluated the current status and role of LIF in DS treatment, mainly as a means to augment instrumentation. We addressed the basic concept of LIF, its indications, and various types including minimally invasive techniques. It also has acceptable biomechanical features, and offers reconstruction with ideal lumbar alignment. Postsurgical adverse events related to each LIF technique are also addressed. PMID:27169496

  8. Outcome of instrumented lumbar fusion for low grade spondylolisthesis; Evaluation of interbody fusion with & without cages

    PubMed Central

    Fathy, Mostafa; Fahmy, Mohamed; Fakhri, Mazen; Aref, Khaled; Abdin, Khaled; Zidan, Ihab

    2010-01-01

    Object: The aim is to evalute the outcome of posterior lumbar interbody fusion with autologous bone graft versus titanium Cages, BAK system (Bagby – Kuslich, Spine Tech, Inc. Minneapolis, MN) for low grade spondyloisthesis (Grade1,11). Interbody cages have been developed to replace tricortical Interbody grafts in posterior lumbar interbody fusion (PLIF) procedures. The cages provide immediate post operative stability and facilitate bony union with cancellous bone packed in the cage itself. METHOD: We Evaluated 50 consecutive patients in whom surgery was performed between June 2000 to June 2003 in the Main Alexandria University Hospital at EGYPT. Twenty five patients were operated using autologous bone graft and 25 patients using the BAK cages. The neuro–radiologic al work up consisted of; plain X – ray lumbosacral spine including dynamic films preoperative and postoperative follow up; C.T lumbosacral spine and MRI lumbosacral spine. The surgery was performed at L4-5 level in 34 cases and at L5-S1 level in 16 cases. The median follow up was 15 months. RESULTS: Satisfactory fusion was obtained at all levels at a minimum one year follow – up. The fusion rate was 96% (24 patients) for the cage group and 80% (20 patients) for bone graft group however clinical improvement was 64% (16 patients) for those with bone graft group. CONCLUSION: A higher fusion rates and a better clinical outcome have been obtained by Instrumented PLIF with titanium cages that with bone graft. Inderbody fusion cages help to stabilize spainal segment primarily by distracting them as well as by allowing bone ingrowth and fusion. The procedure is safe and effective with 96% fusion rate and 76% overall Satisfactory rate. The use of cages help to distract the space between the vertebral bodies making the correction of the degree of spondylolisthesis easier. Long term follow up revealed better fusion rate and better realignment and less resorption with cages than with bone grafts. PMID

  9. More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: In the lumbar spine, do more nerve root injuries occur utilizing minimally invasive surgery (MIS) techniques versus open lumbar procedures? To answer this question, we compared the frequency of nerve root injuries for multiple open versus MIS operations including diskectomy, laminectomy with/without fusion addressing degenerative disc disease, stenosis, and/or degenerative spondylolisthesis. Methods: Several of Desai et al. large Spine Patient Outcomes Research Trial studies showed the frequency for nerve root injury following an open diskectomy ranged from 0.13% to 0.25%, for open laminectomy/stenosis with/without fusion it was 0%, and for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion it was 2%. Results: Alternatively, one study compared the incidence of root injuries utilizing MIS transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) techniques; 7.8% of PLIF versus 2% of TLIF patients sustained root injuries. Furthermore, even higher frequencies of radiculitis and nerve root injuries occurred during anterior lumbar interbody fusions (ALIFs) versus extreme lateral interbody fusions (XLIFs). These high frequencies were far from acceptable; 15.8% following ALIF experienced postoperative radiculitis, while 23.8% undergoing XLIF sustained root/plexus deficits. Conclusions: This review indicates that MIS (TLIF/PLIF/ALIF/XLIF) lumbar surgery resulted in a higher incidence of root injuries, radiculitis, or plexopathy versus open lumbar surgical techniques. Furthermore, even a cursory look at the XLIF data demonstrated the greater danger posed to neural tissue by this newest addition to the MIS lumbar surgical armamentariu. The latter should prompt us as spine surgeons to question why the XLIF procedure is still being offered to our patients? PMID:26904372

  10. Analysis of Internet Information on Lateral Lumbar Interbody Fusion.

    PubMed

    Belayneh, Rebekah; Mesfin, Addisu

    2016-07-01

    Lateral lumbar interbody fusion (LLIF) is a surgical technique that is being increasingly used. The authors' objective was to examine information on the Internet pertaining to the LLIF technique. An analysis was conducted of publicly accessible websites pertaining to LLIF. The following search engines were used: Google (www.google.com), Bing (www.bing.com), and Yahoo (www.yahoo.com). DuckDuckGo (www.duckduckgo.com) was an additional search engine used due to its emphasis on generating accurate and consistent results while protecting searchers' privacy and reducing advertisements. The top 35 websites providing information on LLIF from the 4 search engines were identified. A total of 140 websites were evaluated. Each web-site was categorized based on authorship (academic, private, medical industry, insurance company, other) and content of information. Using the search term lateral lumbar interbody fusion, 174,000 Google results, 112,000 Yahoo results, and 112,000 Bing results were obtained. DuckDuckGo does not display the number of results found for a search. From the top 140 websites collected from each website, 78 unique websites were identified. Websites were authored by a private medical group in 46.2% of the cases, an academic medical group in 26.9% of the cases, and the biomedical industry in 5.1% of the cases. Sixty-eight percent of websites reported indications, and 24.4% reported contraindications. Benefits of LLIF were reported by 69.2% of websites. Thirty-six percent of websites reported complications of LLIF. Overall, the quality of information regarding LLIF on the Internet is poor. Spine surgeons and spine societies can assist in improving the quality of the information on the Internet regarding LLIF. [Orthopedics. 2016; 39(4):e701-e707.]. PMID:27111081

  11. A Biomechanical Comparison of Shape Design and Positioning of Transforaminal Lumbar Interbody Fusion Cages

    PubMed Central

    Comer, Garet C.; Behn, Anthony; Ravi, Shashank; Cheng, Ivan

    2015-01-01

    Study Design  Cadaveric biomechanical analysis. Objective  The aim of this study was to compare three interbody cage shapes and their position within the interbody space with regards to construct stability for transforaminal lumbar interbody fusion. Methods  Twenty L2–L3 and L4–L5 lumbar motion segments from fresh cadavers were potted in polymethyl methacrylate and subjected to testing with a materials testing machine before and after unilateral facetectomy, diskectomy, and interbody cage insertion. The three cage types were kidney-shaped, articulated, and straight bullet-shaped. Each cage type was placed in a common anatomic area within the interbody space before testing: kidney, center; kidney, anterior; articulated, center; articulated, anterior; bullet, center; bullet, lateral. Load-deformation curves were generated for axial compression, flexion, extension, right bending, left bending, right torsion, and left torsion. Finally, load to failure was tested. Results  For all applied loads, there was a statistically significant decrease in the slope of the load-displacement curves for instrumented specimens compared with the intact state (p < 0.05) with the exception of right axial torsion (p = 0.062). Among all instrumented groups, there was no statistically significant difference in stiffness for any of the loading conditions or load to failure. Conclusions  Our results failed to show a clearly superior cage shape design or location within the interbody space for use in transforaminal lumbar interbody fusion. PMID:27433426

  12. Biomechanical comparison of two different concepts for stand alone anterior lumbar interbody fusion

    PubMed Central

    Gerlach, R.; Schär, B.; Cain, C. M. J.; Achatz, W.; Pflugmacher, R.; Haas, N. P.; Kandziora, F.

    2008-01-01

    Segmental instability in degenerative disc disease is often treated with anterior lumbar interbody fusion (ALIF). Current techniques require an additional posterior approach to achieve sufficient stability. The test device is an implant which consists of a PEEK-body and an integrated anterior titanium plate hosting four diverging locking screws. The test device avoids posterior fixation by enhancing stability via the locking screws. The test device was compared to an already established stand alone interbody implant in a human cadaveric three-dimensional stiffness test. In the biomechanical test, the L4/5 motion segment of 16 human cadaveric lumbar spines were isolated and divided into two test groups. Tests were performed in flexion, extension, right and left lateral bending, right and left axial rotation. Each specimen was tested in native state first, then a discectomy was performed and either of the test implants was applied. Finite element analysis (FE) was also performed to investigate load and stress distribution within the implant in several loading conditions. The FE models simulated two load cases. These were flexion and extension with a moment of 5 Nm. The biomechanical testing revealed a greater stiffness in lateral bending for the SynFix-LR™ compared to the established implant. Both implants showed a significantly higher stiffness in all loading directions compared to the native segment. In flexion loading, the PEEK component takes on most of the load, whereas the majority of the extension load is put on the screws and the screw–plate junction. Clinical investigation of the test device seems reasonable based on the good results reported here. PMID:18841399

  13. Minimally invasive L5-S1 oblique lumbar interbody fusion with anterior plate.

    PubMed

    Pham, Martin H; Jakoi, Andre M; Hsieh, Patrick C

    2016-07-01

    Lumbar interbody fusion is an important technique for the treatment of degenerative disc disease and degenerative scoliosis. The oblique lumbar interbody fusion (OLIF) establishes a minimally invasive retroperitoneal exposure anterior to the psoas and lumbar plexus. In this video case presentation, the authors demonstrate the techniques of the OLIF at L5-S1 performed on a 69-year-old female with degenerative scoliosis as one component of an overall strategy for her deformity correction. The video can be found here: https://youtu.be/VMUYWKLAl0g . PMID:27364428

  14. Incidence of graft extrusion following minimally invasive transforaminal lumbar interbody fusion.

    PubMed

    Bakhsheshian, Joshua; Khanna, Ryan; Choy, Winward; Lawton, Cort D; Nixon, Alex T; Wong, Albert P; Koski, Tyler R; Liu, John C; Song, John K; Dahdaleh, Nader S; Smith, Zachary A; Fessler, Richard G

    2016-02-01

    Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been scrutinized for having a complex learning curve. Careful assessment of MI-TLIF complications and critical analyses of prevention may aid a safe adoption of this technique. The current report focuses on the incidence of interbody cage extrusions following MI-TLIF in a series of 513 patients. The authors discuss their experience with graft extrusions and provide methods to minimize this complication. This study retrospectively reviewed 513 prospectively followed patients who underwent MI-TLIF over a 10 year period. The inclusion criteria consisted of all patients who underwent one to three level MI-TLIF, from whom the incidence of cage extrusion was analyzed. Cage extrusion was defined as an interbody graft migrating outside the cephalad and caudal vertebral body posterior margin. Cage extrusions were diagnosed by comparing the intraoperative radiographs to the postoperative radiographs. Patients with >10° coronal curves, significant sagittal malalignment, infection, and preoperative instrumentation failure were excluded. Of 513 patients undergoing MI-TLIF, five patients (0.97%) were diagnosed with cage migrations. The mean follow-up duration was 13.6 ± standard deviation of 8.8 months. Complications included asymptomatic cage migration alone (two patients) neurological decline (two patients) and epidural hematoma (one patient). On average, cage migrations cost a university hospital an additional $US17,217 for revision treatment. While the incidence of cage migrations is low (0.97%), it can lead to postoperative complications that require revision surgery and increased hospital costs. The risk for this significant complication can be minimized with proper technique and patient selection. PMID:26578209

  15. Modified Mini-open Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Pakzaban, Peyman

    2016-01-01

    Study Design. Retrospective case series. Objective. To describe a modified technique for mini-open transforaminal lumbar interbody fusion (TLIF) that improves visualization for decompression, fusion, and freehand pedicle screw insertion. Accuracy of freehand pedicle screw placement with this technique was assessed. Summary of Background Data. Mini-open TLIF is a minimally invasive technique that allows limited visualization of the bone and neural anatomy via an expandable tubular retractor inserted through the Wiltse plane. No significant modification that of this technique has been described in detail. Methods. In this study, 92 consecutive patients underwent one-level modified mini-open TLIF (MOTLIF). MOTLIF modifications consisted of (i) transmuscular dissection through the multifidus muscle rather than intermuscular dissection in the Wiltse plane; (ii) microsurgical detachment of multifidus from the facet rather than muscle dilation; (iii) en bloc total facetectomy (unilateral or bilateral, as needed for decompression); (iv) facet autograft used for interbody fusion; and (v) solid pedicle screws placed bilaterally by a freehand technique under direct vision. Results. The mean age was 53 years. Mean follow-up was 35 months (minimum 2 yrs). By 6 months, mean Visual Analog Scale for back and leg pain had improved from 51 to 19 and from 58 to 17, respectively, and mean Oswestry Disability Index (ODI) improved from 53 to 16. These improvements persisted at 2 years. Solid fusion, defined by computed tomography at 1 year, was achieved in 88.1%, whereas satisfactory fusion was achieved in 95.2% of patients. Pedicle screws were accurately placed in 335 of 336 imaged pedicles (pedicle breach grades: 91.1% grade 1; 8.6% grade 2; and 0.3% grade 3). Mean fluoroscopy time was 29.3 seconds. Conclusion. MOTLIF is a safe and effective minimally invasive technique with a high fusion rate. It allows accurate pedicle screw placement by a freehand technique. By eliminating bi

  16. Focal Correction of Severe Fixed Kyphosis with Single Level Posterior Ponte Osteotomy and Interbody Fusion

    PubMed Central

    Molloy, Seth S; Ahmad, Faiz U; Green, Barth A; Lebwohl, Nathan H

    2016-01-01

    Objective: To report the successful correction of a severe, fixed kyphotic deformity utilizing a combination posterior lumbar interbody fusion (PLIF) and Ponte osteotomy at the site of acute kyphosis. Summary of Background Data: There have been no reports on the experience and surgical strategy of combined one-level focal PLIF and Ponte osteotomy for fixed severe kyphotic deformity. Typically, these corrections would need a pedicle subtraction osteotomy or a vertebrectomy. Methods: A 24-year-old man presented with progressive back pain and a fixed severe thoracolumbar kyphosis centered at the L2-L3 disc space seven years after removal of instrumentation for intractable infection following correction of Scheuermann's Kyphosis. The patient also demonstrated pseudoarthrosis of the posterior thoracolumbar fusion bed. The original operative plan was to perform a vertebral column resection (VCR) of L2 to correct his severe kyphosis.  During preparation for the VCR, the patient’s deformity corrected completely after insertion of blunt distraction paddles for the interbody fusion after the Ponte osteotomy at L2-L3. A VCR was avoided, and the construct was able to be completed with simple rod insertion and posterolateral fusion. Results: The described technique achieved 69 degrees of correction at the L2-L3 disc space without any remodeling of the surrounding vertebrae. The C7 plumb line was normalized, and the patient was able to stand upright with horizontal gaze and without pre-existing discomfort. At the six-month follow-up, the patient reported a significant improvement in pain and was able to resume normal activities. PMID:27462479

  17. [The results of decompression and anterior lumbar interbody fusion with the use of interbody cages for the treatment of degenerative lumbar spondylolisthesis].

    PubMed

    Luczkiewicz, Piotr; Smoczyński, Andrzej; Smoczyński, Maciej; Pankowski, Rafał; Piotrowski, Maciej

    2006-01-01

    In this paper we reviewed 28 patients who had been treated surgically for lumbar degenerative spondylolisthesis. They were operated between 1998-2003. The decompression and anterior lumbar interbody fusion with the use of interbody cages, was performed in all of them. The outcome was assessed using rating system of Prolo and VAPS. The disc height, degree of slippage and segmental lordosis were measured, on the radiographs, before surgery, after 6 weeks and at the time of final follow-up. In all cases spinal fusion was achieved. The disc height, degree of slipage and segmental lordosis were improved and these results were stable in time. A significant decrease in radicular pain and low back pain were seen but the relation between clinical and radiological autcomes was not observed. PMID:17131721

  18. Application of transforaminal lumbar interbody fusion in old thoracolumbar fracture and dislocation

    PubMed Central

    Fang, Xiangqian; Fan, Shunwu; Zhao, Xing

    2011-01-01

    Background The main indications for surgery for old thoracolumbar fractures are pain, progressive deformity, neurological damage, or increasing neurological deficit. These fractures have been one of the greatest therapeutic challenges in spinal surgery. Anterior, posterior, or combined anterior and posterior procedures have been successful to some extent. As far as we know, there is no report in the literature of transforaminal lumbar interbody fusion (TLIF) for old thoracolumbar fracture and dislocation. Methods Case report. Results A 26-year-old man with old fracture and dislocation of T12/L1 was treated with TLIF. At 12 months' follow-up, multi-slice computed tomography (CT) scans showed that solid fusion had been achieved between T12 and L1. Back pain had resolved completely at 2-year follow-up. Conclusions We performed TLIF for in a man with old fracture and dislocation of T12/L1, with good clinical outcome. TLIF might be an option in the treatment of old thoracolumbar fracture. PMID:22330118

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

    PubMed

    Chau, Anthony Minh Tien; Xu, Lileane Liang; Wong, Johnny Ho-Yin; Mobbs, Ralph Jasper

    2014-01-01

    Anterior cervical discectomy and fusion (ACDF) and anterior lumbar interbody fusion (ALIF) are common surgical procedures for degenerative disc disease of the cervical and lumbar spine. Over the years, many bone graft options have been developed and investigated aimed at complimenting or substituting autograft bone, the traditional fusion substrate. Here, we summarise the historical context, biological basis and current best evidence for these bone graft options in ACDF and ALIF. PMID:23743981

  20. Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disorders: Mini-open TLIF and Corrective TLIF

    PubMed Central

    HARA, Masahito; NISHIMURA, Yusuke; NAKAJIMA, Yasuhiro; UMEBAYASHI, Daisuke; TAKEMOTO, Masaya; YAMAMOTO, Yuu; HAIMOTO, Shoichi

    Minimally invasive transforaminal lumbar interbody fusion (TLIF) as a short fusion is widely accepted among the spine surgeons. However in the long fusion for degenerative kyphoscoliosis, corrective spinal fixation by an open method is thought to be frequently selected. Our objective is to study whether the mini-open TLIF and corrective TLIF contribute to the improvement of the spinal segmental and global alignment. We divided the patients who performed lumbar fixation surgery into three groups. Group 1 (G1) consisted of mini-open TLIF procedures without complication. Group 2 (G2) consisted of corrective TLIF without complication. Group 3 (G3) consisted of corrective TLIF with instrumentation-related complication postoperatively. In all groups, the lumbar lordosis (LL) highly correlated with developing surgical complications. LL significantly changed postoperatively in all groups, but was not corrected in the normal range in G3. There were statistically significant differences in preoperative and postoperative LL and mean difference between the pelvic incidence (PI) and LL between G3 and other groups. The most important thing not to cause the instrumentation-related failure is proper correction of the sagittal balance. In the cases with minimal sagittal imbalance with or without coronal imbalance, short fusion by mini-open TLIF or long fusion by corrective TLIF contributes to good clinical results if the lesion is short or easily correctable. However, if the patients have apparent sagittal imbalance with or without coronal imbalance, we should perform proper correction of the sagittal spinal alignment introducing various technologies. PMID:26119895

  1. Finite Element Analysis of a New Pedicle Screw-Plate System for Minimally Invasive Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Zhou, Yue; Li, Changqing; Liu, Huan

    2015-01-01

    Purpose Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is increasingly popular for the surgical treatment of degenerative lumbar disc diseases. The constructs intended for segmental stability are varied in MI-TLIF. We adopted finite element (FE) analysis to compare the stability after different construct fixations using interbody cage with posterior pedicle screw-rod or pedicle screw-plate instrumentation system. Methods A L3–S1 FE model was modified to simulate decompression and fusion at L4–L5 segment. Fixation modes included unilateral plate (UP), unilateral rod (UR), bilateral plate (BP), bilateral rod (BR) and UP+UR fixation. The inferior surface of the S1 vertebra remained immobilized throughout the load simulation, and a bending moment of 7.5 Nm with 400N pre-load was applied on the L3 vertebra to recreate flexion, extension, lateral bending, and axial rotation. Range of motion (ROM) and Von Mises stress were evaluated for intact and instrumentation models in all loading planes. Results All reconstructive conditions displayed decreased motion at L4–L5. The pedicle screw-plate system offered equal ROM to pedicle screw-rod system in unilateral or bilateral fixation modes respectively. Pedicle screw stresses for plate system were 2.2 times greater than those for rod system in left lateral bending under unilateral fixation. Stresses for plate were 3.1 times greater than those for rod in right axial rotation under bilateral fixation. Stresses on intervertebral graft for plate system were similar to rod system in unilateral and bilateral fixation modes respectively. Increased ROM and posterior instrumentation stresses were observed in all loading modes with unilateral fixation compared with bilateral fixation in both systems. Conclusions Transforaminal lumbar interbody fusion augmentation with pedicle screw-plate system fixation increases fusion construct stability equally to the pedicle screw-rod system. Increased posterior

  2. Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion: An Updated Meta-analysis

    PubMed Central

    Xie, Lei; Wu, Wen-Jian; Liang, Yu

    2016-01-01

    Background: The previous studies agree that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures. Methods: Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database (the literature search comprised Medical Subject Heading terms and key words or Emtree term). The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals were calculated for the clinical outcomes and perioperative data. Results: Twenty-four studies (n = 1967 patients) were included in this review (n = 951, open-TLIF, n = 1016, MIS-TLIF). MIS-TLIF was associated with a significant decrease in the visual analog score (VAS)-back pain score (WMD = −0.44; P = 0.001), Oswestry Disabilities Index (WMD = −1.57; P = 0.005), early ambulation (WMD = −1.77; P = 0.0001), less blood loss (WMD = −265.59; P < 0.00001), and a shorter hospital stay (WMD = −1.89; P < 0.0001). However, there were no significant differences in the fusion rate (RR = 0.99; P = 0.34), VAS-leg pain (WMD = −0.10; P = 0.26), complication rate (RR = 0.84; P = 0.35), operation time (WMD = −5.23; P = 0.82), or reoperation rate (RR = 0.73; P = 0.32). Conclusions: MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or

  3. Lumbar interbody expanding cage. A preliminary study on an animal model.

    PubMed

    Manunta, M L; Careddu, G M; Masala, G; Columbano, N; Doria, C; Crissantu, L; Sanna Passino, E

    2008-01-01

    Interbody fusion devices are used in human medicine for treating degenerative diseases of the spine. Currently, there is not a universally accepted assessment tool for determining fusion, and the definitive criteria for diagnosing a successful interbody fusion remain controversial. The aim of this study was to describe microscopic and helical computed tomography (CT) imaging in the assessment of lumbar interbody fusion using cylindrical threaded titanium expanding cage in sheep. One cylindrical threaded expanding titanium cage (Proconcept--SA, Orange, France) was inserted through a transperitoneal approach after radical discectomy and packed with cancellous bone autograft in five adult sheep. The subjects were euthanatized after three, six, 12, 18 and 24 months. CT images revealed lumbar fusion at 12 months post operation, whereas microscopic evaluations indicated the presence of lumbar fusion at 18 months. CT and histological grades were the same in 65% of the cases observed. There were not a significant difference between CT, histological and micro radiographic grades. Helical CT scanning can be considered to be a suitable method for the monitoring of lumbar fusion as it enables observation of the deposition of bony bridging within the cage. PMID:18704248

  4. Healing properties of allograft from alendronate-treated animal in lumbar spine interbody cage fusion.

    PubMed

    Xue, Qingyun; Li, Haisheng; Zou, Xuenong; Bünger, Mathias; Egund, Niels; Lind, Martin; Christensen, Finn Bjarke; Bünger, Cody

    2005-04-01

    This study investigated the healing potential of allograft from bisphosphonate-treated animals in anterior lumbar spine interbody fusion. Three levels of anterior lumbar interbody fusion with Brantigan cages were performed in two groups of five landrace pigs. Empty Brantigan cages or cages filled with either autograft or allograft were located randomly at different levels. The allograft materials for the treatment group were taken from the pigs that had been fed with alendronate, 10 mg daily for 3 months. The histological fusion rate was 2/5 in alendronate-treated allograft and 3/5 in non-treated allograft. The mean bone volume was 39% and 37.2% in alendronate-treated or non-treated allograft (NS), respectively. No statistical difference was found between the same grafted cage comparing two groups. The histological fusion rate was 7/10 in all autograft cage levels and 5/10 in combined allograft cage levels. No fusion was found at all in empty cage levels. With the numbers available, no statistically significant difference was found in histological fusion between autograft and allograft applications. There was a significant difference of mean bone volume between autograft (49.2%) and empty cage (27.5%) (P<0.01). In conclusion, this study did not demonstrate different healing properties of alendronate-treated and non-treated allograft for anterior lumbar interbody fusion in pigs. PMID:15248057

  5. Bilateral pulmonary emboli associated with intraoperative use of thrombin-based hemostatic matrix following lumbar spine interbody fusion.

    PubMed

    Wei, Zhikui; Elder, Benjamin D; Goodwin, C Rory; Witham, Timothy F

    2015-09-01

    Here we describe a patient with bilateral pulmonary emboli (PE) associated with thrombin-based hemostatic matrix (TBHM) use in the setting of a possible venous injury during transforaminal lumbar interbody fusion in the treatment of degenerative spondylolisthesis at L4-5. TBHM products are gelatin granules mixed with human or bovine thrombin. They have been used in a wide variety of surgical procedures to facilitate local hemostasis though their use is not without complications. This is the first reported patient, to our knowledge, with a TBHM-related PE following spinal fusion. As TBHM is a widely used intraoperative hemostatic agent, surgeons should be aware of the risk of TBHM-associated PE, particularly when there is the potential for intravascular injection or dissemination. While our experience indicates that common pharmacological prophylaxis such as subcutaneous heparin is likely ineffective in reducing occurrence of PE in the setting of TBHM use, the PE was successfully treated with standard systemic anticoagulation. The authors would also add that when iliac injury is encountered during discectomy or interbody fusion through a posterior approach, use of TBHM may be a life-saving technique. Postoperatively, vascular surgery consultation is recommended and consideration should be given to systemic anticoagulation. PMID:25943630

  6. Hemothorax caused by the trocar tip of the rod inserter after minimally invasive transforaminal lumbar interbody fusion: case report.

    PubMed

    Maruo, Keishi; Tachibana, Toshiya; Inoue, Shinichi; Arizumi, Fumihiro; Yoshiya, Shinichi

    2016-03-01

    Minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion (MIS-TLIF) is widely used for lumbar degenerative diseases. In the paper the authors report a unique case of a hemothorax caused by the trocar tip of the rod inserter after MIS-TLIF. A 61-year-old woman presented with thigh pain and gait disturbance due to weakness in her lower right extremity. She was diagnosed with a lumbar disc herniation at L1-2 and the MIS-TLIF procedure was performed. Immediately after surgery, the patient's thigh pain resolved and she remained stable with normal vital signs. The next day after surgery, she developed severe anemia and her hemoglobin level decreased to 7.6 g/dl, which required blood transfusions. A chest radiograph revealed a hemothorax. A CT scan confirmed a hematoma of the left paravertebral muscle. A chest tube was placed to treat the hemothorax. After 3 days of drainage, there was no active bleeding. The patient was discharged 14 days after surgery without leg pain or any respiratory problems. This complication may have occurred due to injury of the intercostal artery by the trocar tip of the rod inserter. A hemothorax after spine surgery is a rare complication, especially in the posterior approach. The rod should be caudally inserted in the setting of the thoracolumbar spine. PMID:26588499

  7. Choice of Approach Does Not Affect Clinical and Radiologic Outcomes: A Comparative Cohort of Patients Having Anterior Lumbar Interbody Fusion and Patients Having Lateral Lumbar Interbody Fusion at 24 Months

    PubMed Central

    Malham, Gregory M.; Parker, Rhiannon M.; Blecher, Carl M.; Chow, Fiona Y.; Seex, Kevin A.

    2015-01-01

    Study Design  Retrospective analysis of prospectively collected registry data. Objective  This study aimed to compare the clinical and radiologic outcomes between comparative cohorts of patients having anterior lumbar interbody fusion (ALIF) and patients having lateral lumbar interbody fusion (LLIF). Methods  Ninety consecutive patients were treated by a single surgeon with either ALIF (n = 50) or LLIF (n = 40). Inclusion criteria were patients age 45 to 70 years with degenerative disk disease or grade 1 to 2 spondylolisthesis and single-level pathology from L1 to S1. Patient-reported outcome measures included pain (visual analog scale), disability (Oswestry Disability Index [ODI]), and quality of life (Short Form 36 physical component score [PCS] and mental component scores [MCS]). Assessment of fusion and measurement of lordosis and posterior disk height were performed on computed tomography scans. Results  At 24 months, patients having ALIF had significant improvements in back (64%) and leg (65%) pain and ODI (60%), PCS (44%), and MCS (26%; p < 0.05) scores. Patients having LLIF had significant improvements in back (56%) and leg (57%) pain and ODI (52%), PCS (48%), and MCS (12%; p < 0.05) scores. Fourteen complications occurred in the ALIF group, and in the LLIF group, there were 17 complications (p > 0.05). The fusion rate was 100% for ALIF and 95% for LLIF (p = 0.1948). ALIF added ∼6 degrees of lordosis and 3 mm of height, primarily measured at L5–S1, and LLIF added ∼3 degrees of lordosis and 2 mm of height between L1 to L5. Mean follow-up was 34.1 months. Conclusions  In comparative cohorts of patients having ALIF and patients having LLIF at 24 months postoperatively, there were no significant differences in clinical outcomes, complication rates, or fusion rates. PMID:27433432

  8. Prevalence and Risk Factors of Deep Vein Thrombosis in Patients Undergoing Lumbar Interbody Fusion Surgery

    PubMed Central

    Yang, Si-Dong; Ding, Wen-Yuan; Yang, Da-Long; Shen, Yong; Zhang, Ying-Ze; Feng, Shi-Qing; Zhao, Feng-Dong

    2015-01-01

    Abstract This cross-sectional study was designed to obtain the current prevalence of deep vein thrombosis (DVT) and analyze related risk factors in patients undergoing lumbar interbody fusion. Medical record data were collected from Department of Spinal Surgery, The Third Hospital of Hebei Medical University, between July 2014 and March 2015. Both univariate analysis and binary logistic regression analysis were performed to determine risk factors for DVT. A total of 995 patients were admitted into this study, including 484 men and 511 women, aged from 14 to 89 years old (median 50, IQR 19). The detection rate of lower limb DVT by ultrasonography was 22.4% (223/995) in patients undergoing lumbar interbody fusion. Notably, average VAS (visual analog scale) score in the first 3 days after surgery in the DVT group was more than that in the non-DVT group (Z = −21.69, P < 0.001). The logistic regression model was established as logit P = −13.257 + 0.056∗X1 − 0.243∗X8 + 2.085∗X10 + 0.001∗X12, (X1 = age; X8 = HDL; X10 = VAS; X12 = blood transfusion; x2 = 677.763, P < 0.001). In conclusion, advanced age, high postoperative VAS scores, and blood transfusion were risk factors for postoperative lower limb DVT. As well, the logistic regression model may contribute to an early evaluation postoperatively to ascertain the risk of lower limb DVT in patients undergoing lumbar interbody fusion surgery. PMID:26632909

  9. Clinical outcomes of single-level lumbar artificial disc replacement compared with transforaminal lumbar interbody fusion in an Asian population

    PubMed Central

    Lee, Wei Ting; Liu, Gabriel; Thambiah, Joseph; Wong, Hee Kit

    2015-01-01

    INTRODUCTION The objective of this study was to examine the clinical outcome of single-level lumbar artificial disc replacement (ADR) compared to that of transforaminal lumbar interbody fusion (TLIF) for the treatment of symptomatic degenerative disc disease (DDD) in an Asian population. METHODS This was a retrospective review of 74 patients who had surgery performed for discogenic lower backs that involved only the L4/5 and L5/S1 levels. All the patients had lumbar DDD without radiculopathy or spondylolithesis, and concordant pain with discogram at the pathological level. The patients were divided into two groups – those who underwent ADR and those who underwent TLIF. RESULTS A trend suggesting that the ADR group had better perioperative outcomes (less blood loss, shorter operating time, shorter hospital stay and shorter time to ambulation) than the TLIF group was observed. However, a trend indicating that surgical-approach-related complications occurred more frequently in the ADR group than the TLIF group was also observed. The rate of revision surgery was comparable between the two groups. CONCLUSION Our findings suggest that for the treatment of discogenic lower back pain, lumbar ADR has better perioperative outcomes and a similar revision rate when compared with TLIF. However, the use of ADR was associated with a higher incidence of surgical-approach-related complications. More studies with bigger cohort sizes and longer follow-up periods are needed to determine the long-term efficacy and safety of ADR in lumbar DDD. PMID:25917472

  10. Lateral Lumbar Interbody Fusion for the Correction of Spondylolisthesis and Adult Degenerative Scoliosis in High-Risk Patients: Early Radiographic Results and Complications

    PubMed Central

    Waddell, Brad; Briski, David; Qadir, Rabah; Godoy, Gustavo; Houston, Allison Howard; Rudman, Ernest; Zavatsky, Joseph

    2014-01-01

    Background Lateral lumbar interbody fusion (LLIF) is not associated with many of the complications seen in other interbody fusion techniques. This study used computed tomography (CT) scans, the radiographic gold standard, to assess interbody fusion rates achieved utilizing the LLIF technique in high-risk patients. Methods We performed a retrospective review of patients who underwent LLIF between January 2008 and July 2013. Forty-nine patients underwent nonstaged or staged LLIF on 119 levels with posterior correction and augmentation. Per protocol, patients received CT scans at their 1-year follow-up. Of the 49 patients, 21 patients with LLIF intervention on 54 levels met inclusion criteria. Two board-certified musculoskeletal radiologists and the senior surgeon (JZ) assessed fusion. Results Of the 21 patients, 6 patients had had previous lumbar surgery, and the cohort's comorbidities included osteoporosis, diabetes, obesity, and smoking, among others. Postoperative complications occurred in 12 (57.1%) patients and included anterior thigh pain and weakness in 6 patients, all of which resolved by 6 months. Two cases of proximal junctional kyphosis occurred, along with 1 case of hardware pullout. Two cases of abdominal atonia occurred. By CT scan assessment, each radiologist found fusion was achieved in 53 of 54 levels (98%). The radiologists' findings were in agreement with the senior surgeon. Conclusion Several studies have evaluated LLIF fusion and reported fusion rates between 88%-96%. Our results demonstrate high fusion rates using this technique, despite multiple comorbidities in the patient population. Spanning the ring apophysis with large LLIF cages along with supplemental posterior pedicle screw augmentation can enhance stability of the fusion segment and increase fusion rates. PMID:24688329

  11. Iatrogenic Baastrup's Syndrome: A Potential Complication Following Anterior Interbody Lumbar Spinal Surgery

    PubMed Central

    Russo, Glenn S.; Castro, Carlos A.

    2015-01-01

    Background Baastrup's Syndrome is a condition that occurs when there is abnormal contact between two adjacent spinous processes resulting in back pain. An alteration in lumbar spinal alignment and/or adjacent segment compensatory motion is thought to be potential causative factors. The objective of this study was to present a case series of what appears to be iatrogenic Baastrup's Syndrome as a mid-to-late term complication following anterior lumbar interbody surgery. Methods A retrospective chart review was performed of all patients undergoing anterior lumbar surgery for either fusion or disc replacement to determine the prevalence of Baastrup's Syndrome. Results Over a 12-year period, 855 patients who had undergone an anterior approach for lumbar spine surgery were identified. Of them 8 patients with evidence of Baastrup's Syndrome were found; this demonstrated a prevalence of 0.9%. Diagnostic injection was a helpful clinical tool in confirming the diagnosis of iatrogenic Baastrup's Syndrome. The partial removal of the impinging spinous processes resulted in excellent clinical relief. Conclusions Iatrogenic Baastrup's Syndrome may be an iatrogenic result of anterior lumbar surgery in small group of patients. Spinous process excision is a suggested treatment option. Further studies are necessary to explore the above phenomenon. This study is a Level 3 retrospective case series. PMID:26767158

  12. Neurological complications using a novel retractor system for direct lateral minimally invasive lumbar interbody fusion.

    PubMed

    Sedra, Fady; Lee, Robert; Dominguez, Ignacio; Wilson, Lester

    2016-09-01

    We describe our experience using the RAVINE retractor (K2M, Leesburg, VA, USA) to gain access to the lateral aspect of the lumbar spine through a retroperitoneal approach. Postoperative neurological adverse events, utilising the mentioned retractor system, were recorded and analysed. We included 140 patients who underwent minimally invasive lateral lumbar interbody fusion (MI-LLIF) for degenerative spinal conditions between 2011 and 2015 at two major spinal centres. A total of 228 levels were treated, 35% one level, 40% two level, 20% three level and 5% 4 level surgeries. The L4/5 level was instrumented in 28% of cases. 12/140 patients had postoperative neurological complications. Immediately after surgery, 5% of patients (7/140) had transient symptoms in the thigh ranging from sensory loss, pain and paraesthesia, all of which recovered within 12weeks following surgery. There were five cases of femoral nerve palsy (3.6% - two ipsilateral and three contralateral), all of which recovered completely with no residual sensory or motor deficit within 6months. MI-LLIF done with help of the described retractor system has proved a safe and efficient way to achieve interbody fusion with minimal complications, mainly nerve related, that recovered quickly. Judicious use of the technique to access the L4/5 level is advised. PMID:27349467

  13. Interbody Fusion in Low Grade Lumbar Spondylolsithesis: Clinical Outcome Does Not Correalte with Slip Reduction and Neural Foraminal Dimension

    PubMed Central

    Chatterjee, Atanu; McConnell, Jeffrey R.; Jha, Deepak K.; Chakraburtty, Tapas

    2016-01-01

    Study Design Prospective nonrandomized study. Purpose To find a possible correlation between clinical outcome and extent of lumbar spondylolisthesis reduction. Overview of Literature There is no consensus in the literature concerning whether a beneficial effect of reduction on outcome can be expected following reduction and surgical fusion for low grade lumbar spondylolisthesis. Methods Forty six patients with a mean age of 37.5 years (age, 17–48 years) with isthmic spondylolisthesis underwent interbody fusion with cages with posterior instrumentation (TLIF). Clinical outcome was measured using visual analogue score (VAS) and Oswestry disability index (ODI). Foraminal dimensions and disc heights were measured in standard digital radiographs. These were analyzed at baseline and 1 year after surgery and changes were compared. Radiographic fusion was judged with computed tomography scans at 1 year. Results Ninety percent of the patients had good or very good clinical results with fusion and instrumentation. Baseline and one-year postoperative mean VAS score was 6.33 (range, 5–8) and 0.76 (range, 0–3), respectively (p=0.004). Baseline and one-year postoperative, mean ODI score was 48 (range, 32–62) and 10 (range, 6–16), respectively (p<0.001). A mean spondylolisthesis slip of 32.1% was reduced to 6.7% at 1 year. Average anterior disc height, posterior disc height, vertical foraminal dimension), and foraminal) diameter improved from 9.8 to 11.7 mm (p=0.005), 4.5 to 5.8 mm (p=0.004), 11.3 to 12.6 mm (p=0.002), and 18.6 to 20.0 mm (p<0.001), respectively. The fusion rate was 75% with TLIF. There is no significant correlation between the improvements of ODI scores and the extent of slip reduction. Conclusions Neural decompression and interbody fusion can significantly improve pain and disability but the clinical outcome does not correlate with radiological improvement in the neural foraminal dimension. PMID:27114773

  14. A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions

    SciTech Connect

    Mooney, V. )

    1990-07-01

    A randomized double-blind prospective study of pulsed electromagnetic fields for lumbar interbody fusions was performed on 195 subjects. There were 98 subjects in the active group and 97 subjects in the placebo group. A brace containing equipment to induce an electromagnetic field was applied to patients undergoing interbody fusion in the active group, and a sham brace was used in the control group. In the active group there was a 92% success rate, while the control group had a 65% success rate (P greater than 0.005). The effectiveness of bone graft stimulation with the device is thus established.

  15. Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only.

    PubMed

    Tang, Ming-xing; Zhang, Hong-qi; Wang, Yu-xiang; Guo, Chao-feng; Liu, Jin-yang

    2016-02-01

    Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three-column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68-year-old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting

  16. Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only

    PubMed Central

    Tang, Ming‐xing; Wang, Yu‐xiang; Guo, Chao‐feng; Liu, Jin‐yang

    2016-01-01

    Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three‐column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68‐year‐old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone

  17. Matched Comparison of Fusion Rates between Hydroxyapatite Demineralized Bone Matrix and Autograft in Lumbar Interbody Fusion

    PubMed Central

    Kim, Dae Hwan; Lee, Nam; Shin, Dong Ah; Yi, Seong; Kim, Keung Nyun

    2016-01-01

    Objective To compare the fusion rate of a hydroxyapatite demineralized bone matrix (DBM) with post-laminectomy acquired autograft in lumbar interbody fusion surgery and to evaluate the correlation between fusion rate and clinical outcome. Methods From January 2013 to April 2014, 98 patients underwent lumbar interbody fusion surgery with hydroxyapatite DBM (HA-DBM group) in our institute. Of those patients, 65 received complete CT scans for 12 months postoperatively in order to evaluate fusion status. For comparison with autograft, we selected another 65 patients who underwent lumbar interbody fusion surgery with post-laminectomy acquired autograft (Autograft group) during the same period. Both fusion material groups were matched in terms of age, sex, body mass index (BMI), and bone mineral density (BMD). To evaluate the clinical outcomes, we analyzed the results of visual analogue scale (VAS), Oswestry Disability Index (ODI), and Short Form Health Survey (SF-36). Results We reviewed the CT scans of 149 fusion levels in 130 patients (HA-DBM group, 75 levels/65 patients; Autograft group, 74 levels/65 patients). Age, sex, BMI, and BMD were not significantly different between the groups (p=0.528, p=0.848, p=0.527, and p=0.610, respectively). The HA-DBM group showed 39 of 75 fused levels (52%), and the Autograft group showed 46 of 74 fused levels (62.2%). This difference was not statistically significant (p=0.21). In the HA-DBM group, older age and low BMD were significantly associated with non-fusion (61.24 vs. 66.68, p=0.027; -1.63 vs. -2.29, p=0.015, respectively). VAS and ODI showed significant improvement after surgery when fusion was successfully achieved in both groups (p=0.004, p=0.002, HA-DBM group; p=0.012, p=0.03, Autograft group). Conclusion The fusion rates of the hydroxyapatite DBM and Autograft groups were not significantly different. In addition, clinical outcomes were similar between the groups. However, older age and low BMD are risk factors that might

  18. A Randomized Controlled Trial Comparing Transforaminal Lumbar Interbody Fusion and Uninstrumented Posterolateral Fusion in the Degenerative Lumbar Spine.

    PubMed

    Jalalpour, Kourosh; Neumann, Pavel; Johansson, Christer; Hedlund, Rune

    2015-08-01

    Study Design Randomized controlled trial. Objective Despite a large number of publications of outcomes after spinal fusion surgery, there is still no consensus on the efficacy of the several different fusion methods. The aim of this study was to determine whether transforaminal lumbar interbody fusion (TLIF) results in an improved clinical outcome compared with uninstrumented posterolateral fusion (PLF) in the surgical treatment for chronic low back pain. Methods This study included 135 patients with degenerative disk disease (n = 96) or postdiskectomy syndrome (n = 39). Inclusion criteria were at least 1 year of back pain with or without leg pain in patients aged 20 to 65 with one- or two-level disease. Exclusion criteria were sequestration of disk hernia, psychosocial instability, isthmic spondylolisthesis, drug abuse, and previous spine surgery other than diskectomy. Pain was assessed by visual analog scale (pain index). Functional disability was quantified by the disability rating index and Oswestry Disability Index. The global outcome was assessed by the patient and classified as much better, better, unchanged, or worse. The patients were randomized to conventional uninstrumented PLF (n = 67) or TLIF (n = 68). PLF was performed in a standardized fashion using autograft. TLIF was performed with pedicle titanium screw fixation and a porous tantalum interbody spacer with interbody and posterolateral autograft. The clinical outcome measurements were obtained preoperatively and at 12 and 24 months postoperatively. The 2-year follow-up rate was 98%. Results The two treatment groups improved significantly from preoperatively to 2 years' follow-up. At final follow-up, the results in the TLIF group were significantly superior to those in the PLF group in pain index (2.0 versus 3.9, p = 0.007) and in disability rating index (22 versus 36, p = 0.003). The Oswestry Disability Index was better in the TLIF group (20 versus 28, p = 0

  19. Improvement of Segmental Lordosis in Transforaminal Lumbar Interbody Fusion: A Comparison of Two Techniques

    PubMed Central

    Rice, James W.; Sedney, Cara L.; Daffner, Scott D.; Arner, Justin W.; Emery, Sanford E.; France, John C.

    2015-01-01

    Study Design Retrospective review. Objective The purpose of this study was to determine the radiographic impact of a transforaminal lumbar interbody fusion (TLIF) versus a cantilever TLIF technique on segmental lordosis, segmental coronal alignment, and disk height. Methods A retrospective review was done of all patients undergoing TLIF procedures from 2006 to 2011 by three spine surgeons. Traditional TLIF versus cantilever TLIF results were compared, and radiographic outcomes were assessed. Results One hundred one patients were included in the study. Patients undergoing the cantilever TLIF procedure had a significantly greater change in segmental lordosis and disk height compared with those who underwent the traditional procedure (p > 0.0001). Conclusions The cantilever TLIF technique can lead to greater change in segmental lordosis based upon radiographic outcomes. PMID:27099813

  20. Improvement of Segmental Lordosis in Transforaminal Lumbar Interbody Fusion: A Comparison of Two Techniques.

    PubMed

    Rice, James W; Sedney, Cara L; Daffner, Scott D; Arner, Justin W; Emery, Sanford E; France, John C

    2016-05-01

    Study Design Retrospective review. Objective The purpose of this study was to determine the radiographic impact of a transforaminal lumbar interbody fusion (TLIF) versus a cantilever TLIF technique on segmental lordosis, segmental coronal alignment, and disk height. Methods A retrospective review was done of all patients undergoing TLIF procedures from 2006 to 2011 by three spine surgeons. Traditional TLIF versus cantilever TLIF results were compared, and radiographic outcomes were assessed. Results One hundred one patients were included in the study. Patients undergoing the cantilever TLIF procedure had a significantly greater change in segmental lordosis and disk height compared with those who underwent the traditional procedure (p > 0.0001). Conclusions The cantilever TLIF technique can lead to greater change in segmental lordosis based upon radiographic outcomes. PMID:27099813

  1. Impact on Neurological Recovery of Transforaminal Debridement and Interbody Fusion versus Transpedicular Decompression in Combination with Pedicle Screw Instrumentation for Treating Thoracic and Lumbar Spinal Tuberculosis

    PubMed Central

    Choovongkomol, Kongtush; Piyapromdee, Urawit; Leownorasate, Manoon

    2016-01-01

    Study Design Retrospective study. Purpose To compare the neurological outcome of transforaminal debridement and interbody fusion with transpedicular decompression for treatment of thoracic and lumbar spinal tuberculosis. Overview of Literature Few articles have addressed the impact of neurological recovery in patients with tuberculosis who were treated by two different operative methods via the posterior-only approach. Methods Clinical and radiographic results of one-stage posterior instrumented spinal fusion for treatment of tuberculous spondylodiscitis with neurological deficits were reviewed and analyzed from 2009 to 2013. The extensive (E) group consisted of patients who received transforaminal debridement and interbody fusion, whereas transpedicular decompression was performed on limited (L) group. Rapid recovery was improvement of at least one Frankel grade within 6 weeks after operation. Otherwise, it was slow recovery. Results All 39 patients had improved neurological signs. The median follow-up period was 24 months. Proportionately younger patients (under 65 years of age) received extensive surgery (15 of 18, 83.3% vs. 11 of 21, 52.4%; p=0.04). The mean operative time and blood loss in the group E were higher than in the group L (both p<0.01). With regard to type of procedure, especially at thoracic and thoracolumbar spine, patients who underwent extensive surgery had rapid neurological recovery significantly different from those of limited surgery (p=0.01; Relative Risk, 3.06; 95% Confidence Interval, 1.13 to 8.29). Conclusions Transforaminal debridement and interbody fusion provides more rapid neurological recovery in patients with thoracic and thoracolumbar spinal tuberculosis compared to transpedicular decompression. PMID:27340536

  2. Anterior Lumbar Interbody Fusion for Degenerative Discogenic Low Back Pain: Evaluation of L4-S1 Fusion.

    PubMed

    Ni, Jianqiang; Fang, Xiutong; Zhong, Weiye; Liu, Ning; Wood, Kirkham B

    2015-10-01

    occurred during surgery and was successfully repaired in 6 of the 84 patients. Also, out of the 84 patients, 6 were found with pseudarthrosis during the follow-up, and these patients underwent a spinal fusion with instrumentation, with a posterior approach after a mean of 1 year. The complications secondary to the surgical approach were persistent abdominal pain (1/84, 1.2%) and wound dehiscence (1/84, 1.2%).Anterior lumbar interbody fusion for L4-L5 had better clinical results than the 2-segmental L4-L5/L5-S1 disc fusion, and the 2-segmental L4-L5/L5-S1 disc fusion had better clinical results than the L5-S1 disc fusion. Also, the 2-segmental L4-L5/L5-S1 disc fusion had a higher complication rate (27.3%), but there was no difference between the L4-L5 group (9.1%) and the L5-S1 group (12.5%). PMID:26512594

  3. Comparison Between Posterior Short-segment Instrumentation Combined With Lateral-approach Interbody Fusion and Traditional Wide-open Anterior-Posterior Surgery for the Treatment of Thoracolumbar Fractures

    PubMed Central

    Li, Xiang; Zhang, Junwei; Tang, Hehu; Lu, Zhen; Liu, Shujia; Chen, Shizheng; Hong, Yi

    2015-01-01

    Abstract The aim of the study was to compare the radiographic and clinical outcomes between posterior short-segment pedicle instrumentation combined with lateral-approach interbody fusion and traditional anterior-posterior (AP) surgery for the treatment of thoracolumbar fractures. Lateral-approach interbody fusion has achieved satisfactory results for thoracic and lumbar degenerative disease. However, few studies have focused on the use of this technique for the treatment of thoracolumbar fractures. Inclusion and exclusion criteria were established. All patients who meet the above criteria were prospectively treated by posterior short-segment instrumentation and secondary-staged minimally invasive lateral-approach interbody fusion, and classified as group A. A historical group of patients who were treated by traditional wide-open AP approach was used as a control group and classified as group B. The radiological and clinical outcomes were compared between the 2 groups. There were 12 patients in group A and 18 patients in group B. The mean operative time and intraoperative blood loss of anterior reconstruction were significantly higher in group B than those in group A (127.1 ± 21.7 vs 197.5 ± 47.7 min, P < 0.01; 185.8 ± 62.3 vs 495 ± 347.4 mL, P < 0.01). Two of the 12 (16.7%) patients in group A experienced 2 surgical complications: 1 (8.3%) major and 1 (8.3%) minor. Six of the 18 (33%) patients in group B experienced 9 surgical complications: 3 (16.7%) major and 6 (33.3%) minor. There was no significant difference between the 2 groups regarding loss of correction (4.3 ± 2.1 vs 4.2 ± 2.4, P = 0.89) and neurological function at final follow-up (P = 0.77). In both groups, no case of instrumentation failure, pseudarthrosis, or nonunion was noted. Compared with the wide-open AP surgery, posterior short-segment pedicle instrumentation, combined with minimally invasive lateral-approach interbody fusion, can achieve similar

  4. Novel indication for posterior dynamic stabilization: Correction of disc tilt after lumbar total disc replacement

    PubMed Central

    Cheng, Wayne K.; Palmer, Daniel Kyle; Jadhav, Vikram

    2011-01-01

    Background The increase in total disc replacement procedures performed over the last 5 years has increased the occurrence of patients presenting with postoperative iatrogenic deformity requiring revision surgery. Proposed salvage treatments include device retrieval followed by anterior lumbar interbody fusion or posterior fusion. We propose a novel approach for the correction of disc tilt after total disc replacement using a posterior dynamic stabilization system. Methods Pedicle screws can be inserted either in an open manner or percutaneously by standard techniques under fluoroscopy. The collapsed side is expanded, and the convex side is compressed. Universal spacers are placed bilaterally, with the spacer on the collapsed side being taller by 6 mm. Cords are threaded through the spacers and pulled into place with the tensioning instrument. Extra tension is applied to the convex side, and the wound is closed by standard techniques. Results Three patients presenting with tilted total disc replacement devices underwent corrective surgery with posterior dynamic stabilization. Radiographs confirmed correction of deformity in all cases. Conclusions/Level of Evidence This technical note presents a novel indication for posterior dynamic stabilization and describes its surgical application to the correction of disc tilt after total disc replacement. This is level V evidence. PMID:25802667

  5. Total 3D Airo® Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion.

    PubMed

    Lian, Xiaofeng; Navarro-Ramirez, Rodrigo; Berlin, Connor; Jada, Ajit; Moriguchi, Yu; Zhang, Qiwei; Härtl, Roger

    2016-01-01

    Introduction. A new generation of iCT scanner, Airo®, has been introduced. The purpose of this study is to describe how Airo facilitates minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Method. We used the latest generation of portable iCT in all cases without the assistance of K-wires. We recorded the operation time, number of scans, and pedicle screw accuracy. Results. From January 2015 to December 2015, 33 consecutive patients consisting of 17 men and 16 women underwent single-level or two-level MIS-TLIF operations in our institution. The ages ranged from 23 years to 86 years (mean, 66.6 years). We treated all the cases in MIS fashion. In four cases, a tubular laminectomy at L1/2 was performed at the same time. The average operation time was 192.8 minutes and average time of placement per screw was 2.6 minutes. No additional fluoroscopy was used. Our screw accuracy rate was 98.6%. No complications were encountered. Conclusions. Airo iCT MIS-TLIF can be used for initial planning of the skin incision, precise screw, and cage placement, without the need for fluoroscopy. "Total navigation" (complete intraoperative 3D navigation without fluoroscopy) can be achieved by combining Airo navigation with navigated guide tubes for screw placement. PMID:27529069

  6. Total 3D Airo® Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Lian, Xiaofeng; Berlin, Connor; Moriguchi, Yu; Zhang, Qiwei; Härtl, Roger

    2016-01-01

    Introduction. A new generation of iCT scanner, Airo®, has been introduced. The purpose of this study is to describe how Airo facilitates minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Method. We used the latest generation of portable iCT in all cases without the assistance of K-wires. We recorded the operation time, number of scans, and pedicle screw accuracy. Results. From January 2015 to December 2015, 33 consecutive patients consisting of 17 men and 16 women underwent single-level or two-level MIS-TLIF operations in our institution. The ages ranged from 23 years to 86 years (mean, 66.6 years). We treated all the cases in MIS fashion. In four cases, a tubular laminectomy at L1/2 was performed at the same time. The average operation time was 192.8 minutes and average time of placement per screw was 2.6 minutes. No additional fluoroscopy was used. Our screw accuracy rate was 98.6%. No complications were encountered. Conclusions. Airo iCT MIS-TLIF can be used for initial planning of the skin incision, precise screw, and cage placement, without the need for fluoroscopy. “Total navigation” (complete intraoperative 3D navigation without fluoroscopy) can be achieved by combining Airo navigation with navigated guide tubes for screw placement. PMID:27529069

  7. Accidental Durotomy in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Frequency, Risk Factors, and Management

    PubMed Central

    Volz, Florian; Krüger, Marie T.; Kogias, Evangelos; Rölz, Roland; Sircar, Ronen; Hubbe, Ulrich

    2015-01-01

    Purpose. To assess the frequency, risk factors, and management of accidental durotomy in minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Methods. This single-center study retrospectively investigates 372 patients who underwent MIS TLIF and were mobilized within 24 hours after surgery. The frequency of accidental durotomies, intraoperative closure technique, body mass index, and history of previous surgery was recorded. Results. We identified 32 accidental durotomies in 514 MIS TLIF levels (6.2%). Analysis showed a statistically significant relation of accidental durotomies to overweight patients (body mass index ≥25 kg/m2; P = 0.0493). Patient age older than 65 years tended to be a positive predictor for accidental durotomies (P = 0.0657). Mobilizing patients on the first postoperative day, we observed no durotomy-associated complications. Conclusions. The frequency of accidental durotomies in MIS TLIF is low, with overweight being a risk factor for accidental durotomies. The minimally invasive approach seems to minimize durotomy-associated complications (CSF leakage, pseudomeningocele) because of the limited dead space in the soft tissue. Patients with accidental durotomy can usually be mobilized within 24 hours after MIS TLIF without increased risk. The minimally invasive TLIF technique might thus be beneficial in the prevention of postoperative immobilization-associated complications such as venous thromboembolism. This trial is registered with DRKS00006135. PMID:26075294

  8. Minimally invasive transforaminal lumbosacral interbody fusion.

    PubMed

    Chang, Peng-Yuan; Wang, Michael Y

    2016-07-01

    In minimally invasive spinal fusion surgery, transforaminal lumbar (sacral) interbody fusion (TLIF) is one of the most common procedures that provides both anterior and posterior column support without retraction or violation to the neural structure. Direct and indirect decompression can be done through this single approach. Preoperative plain radiographs and MR scan should be carefully evaluated. This video demonstrates a standard approach for how to perform a minimally invasive transforaminal lumbosacral interbody fusion. The video can be found here: https://youtu.be/bhEeafKJ370 . PMID:27364426

  9. Surgical Management of Minimally Invasive Anterior Lumbar Interbody Fusion with Stand-Alone Interbody Cage for L4-5 Degenerative Disorders: Clinical and Radiographic Findings

    PubMed Central

    Hironaka, Yasuo; Morimoto, Tetsuya; Motoyama, Yasushi; Park, Young-Su; Nakase, Hiroyuki

    2013-01-01

    Surgical treatment for degenerative spinal disorders is controversial, although lumbar fusion is considered an acceptable option for disabling lower back pain. Patients underwent instrumented minimally invasive anterior lumbar interbody fusion (mini-ALIF) using a retroperitoneal approach except for requiring multilevel fusions, severe spinal canal stenosis, high-grade spondylolisthesis, and a adjacent segments disorders. We retrospectively reviewed the clinical records and radiographs of 142 patients who received mini-ALIF for L4-5 degenerative lumbar disorders between 1998 and 2010. We compared preoperative and postoperative clinical data and radiographic measurements, including the modified Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back and leg pain, disc height (DH), whole lumbar lordosis (WL), and vertebral wedge angle (WA). The mean follow-up period was 76 months. The solid fusion rate was 90.1% (128/142 patients). The average length of hospital stay was 6.9 days (range, 3–21 days). The mean blood loss was 63.7 ml (range, 10–456 ml). The mean operation time was 155.5 min (range, 96–280 min). The postoperative JOA and VAS scores for back and leg pain were improved compared with the preoperative scores. Radiological analysis showed significant postoperative improvements in DH, WL, and WA, and the functional and radiographical outcomes improved significantly after 2 years. The 2.8% complication rate included cases of wound infection, liquorrhea, vertebral body fractures, and a misplaced cage that required revision. Mini-ALIF was found to be associated with improved clinical results and radiographic findings for L4-5 disorders. A retroperitoneal approach might therefore be a valuable treatment option. PMID:24140782

  10. Open and Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Intermediate Results and Complications

    PubMed Central

    Hee, Hwan Tak

    2015-01-01

    Study Design Prospective study. Purpose To compare clinical and radiological outcomes of open vs. minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Overview of Literature MI-TLIF promises smaller incisions and less soft tissue dissection resulting in lower morbidity and faster recovery; however, it is technically challenging. Methods Twenty-five patients with MI-TLIF were compared with 25 matched open TLIF controls. A minimum 2 year follow-up and a statistical analysis of perioperative and long-term outcomes were performed. Potential complications were recorded. Results The mean ages for the open and MI-TLIF cases were 44.4 years (range, 19-69 years) and 43.6 years (range, 20-69 years), respectively. The male:female ratio was 13:12 for both groups. Average follow-up was 26.9 months for the MI-TLIF group and 29.3 months for the open group. Operative duration was significantly longer in the MI-TLIF group than that in the open group (p<0.05). No differences in estimated blood loss, duration to ambulation, or length of stay were found. Significant improvements in the Oswestry disability index and EQ-5D functional scores were observed at 6-, 12-, and 24-months in both groups, but no significant difference was detected between the groups. Fusion rates were comparable. Cage sizes were significantly smaller in the MI-TLIF group at the L5/S1 level (p<0.05). One patient had residual spinal stenosis at the MI-TLIF level, and one patient who underwent two-level MI-TLIF developed a deep vein thrombosis resulting in a pulmonary embolism. Conclusions MI-TLIF and open TLIF had comparable long-term benefits. Due to technical constraints, patients should be advised on the longer operative time and potential undersizing of cages at the L5S1 level. PMID:25901228

  11. Vasculopathy, Ischemia, and the Lateral Lumbar Interbody Fusion Surgery: Report of Three Cases.

    PubMed

    Allison, David W; Allen, Richard T; Kohanchi, David D; Skousen, Collin B; Lee, Yu-Po; Gertsch, Jeffrey H

    2015-12-01

    Multi-modal neurophysiologic monitoring consisting of triggered and spontaneous electromyography and transcranial motor-evoked potentials may detect and prevent both acute and slow developing mechanical and vascular nerve injuries in lateral lumbar interbody fusion (LLIF) surgery. In case report 1, a marked reduction in the transcranial motor-evoked potentials on the operative side alerted to a 28% decrease in mean arterial blood pressure in a 54-year-old woman during an L3-4, L4-5 LLIF. After hemodynamic stability was regained, transcranial motor-evoked potentials returned to baseline and the patient suffered no postoperative complications. In case report 2, a peroneal nerve train-of-four stimulation threshold of 95 mA portended the potential for a triggered electromyography false negative in a 70-year-old woman with type 2 diabetes, peripheral neuropathy, and body mass index of 30.7 kg/m undergoing an L3-4, L4-5 LLIF. Higher triggered electromyography threshold values were applied to this patient's relatively quiescent triggered electromyography and the patient suffered no postoperative complications. In case report 3, the loss of right quadriceps motor-evoked potentials detected a retractor related nerve injury in a 59-year-old man undergoing an L4-5 LLIF. The surgery was aborted, but the patient suffered persistent postoperative right leg paresthesia and weakness. These reports highlight the sensitivity of peripheral nerve elements to ischemia (particularly in the presence of vascular risk factors) during the LLIF procedure and the need for dynamic multi-modal intraoperative monitoring. PMID:26629762

  12. Outcomes of Two Different Techniques Using the Lateral Approach for Lumbar Interbody Arthrodesis

    PubMed Central

    Cheng, Ivan; Briseño, Michael R.; Arrigo, Robert T.; Bains, Navpreet; Ravi, Shashank; Tran, Andrew

    2015-01-01

    Study Design Retrospective cohort study. Objective To determine the short-term outcomes of two different lateral approaches to the lumbar spine. Methods This was a retrospective review performed with four fellowship-trained spine surgeons from a single institution. Two different approach techniques were identified. (1) Traditional transpsoas (TP) approach: dissection was performed through the psoas performed using neuromonitored sequential dilation. (2) Direct visualization (DV) approach: retractors are placed superficial to the psoas followed by directly visualized dissection through psoas. Outcome measures included radiographic fusion and adverse event (AE) rate. Results In all, 120 patients were identified, 79 women and 41 men. Average age was 64.2 years (22 to 86). When looking at all medical and surgical AEs, 31 patients (25.8%) had one or more AEs; 22 patients (18.3%) had a total of 24 neurologically related AEs; 15 patients (12.5%) had anterior/lateral thigh dysesthesias; 6 patients (5.0%) had radiculopathic pain; and 3 patients (2.5%) had postoperative weakness. Specifically, for neurologic AEs, the DV group had a rate of 28.0% and the TP group had a rate of 14.2% (p < 0.18). When looking at the rate of neurologic AEs in patients undergoing single-level fusions only, the DV group rate was 28.6% versus 10.2% for the TP group (p < 0.03). Conclusion Overall, 18.3% of patients sustained a postoperative neurologic AE following lateral interbody fusions. The TP approach had a statistically lower rate of neurologic-specific AE for single-level fusions. PMID:26225280

  13. Injection of Bupivacaine into Disc Space to Detect Painful Nonunion after Anterior Lumbar Interbody Fusion (ALIF) Surgery in Patients with Discogenic Low Back Pain

    PubMed Central

    Kimura, Seiji; Orita, Sumihisa; Inoue, Gen; Eguchi, Yawara; Takaso, Masashi; Ochiai, Nobuyasu; Kuniyoshi, Kazuki; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Gou; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Yamauchi, Kazuyo; Toyone, Tomoaki; Nakamura, Junichi; Kishida, Shunji; Sato, Jun; Takahashi, Kazuhisa

    2014-01-01

    Purpose Bupivacaine is commonly used for the treatment of back pain and the diagnosis of its origin. Nonunion is sometimes observed after spinal fusion surgery; however, whether the nonunion causes pain is controversial. In the current study, we aimed to detect painful nonunion by injecting bupivacaine into the disc space of patients with nonunion after anterior lumbar interbody fusion (ALIF) surgery for discogenic low back pain. Materials and Methods From 52 patients with low back pain, we selected 42 who showed disc degeneration at only one level (L4-L5 or L5-S1) on magnetic resonance imaging and were diagnosed by pain provocation on discography and pain relief by discoblock (the injection of bupivacaine). They underwent ALIF surgery. If the patients showed low back pain and nonunion 2 years after surgery, we injected bupivacaine into the nonunion disc space. Patients showing pain relief after injection of bupivacaine underwent additional posterior fixation using pedicle screws. These patients were followed up 2 years after the revision surgery. Results Of the 42 patient subjects, 7 showed nonunion. Four of them did not show low back pain; whereas 3 showed moderate or severe low back pain. These 3 patients showed pain reduction after injection of bupivacaine into their nonunion disc space and underwent additional posterior fixation. They showed bony union and pain relief 2 years after the revision surgery. Conclusion Injection of bupivacaine into the nonunion disc space after ALIF surgery for discogenic low back pain is useful for diagnosis of the origin of pain. PMID:24532522

  14. [Three-dimensional Finite Element Analysis of Biomechanical Effect of Rigid Fixation and Elastic Fixation on Lumbar Interbody Fusion].

    PubMed

    Wei, Jiangbo; Song, Yueming; Liu, Limin; Zhou, Chunguan; Yang, Xi

    2015-04-01

    This study was aimed to compare the mechanical characteristics under different physiological load conditions with three-dimensional finite element model of rigid fixation and elastic fixation in the lumbar. We observed the stress distribution characteristics of a sample of healthy male volunteer modeling under vertical, flexion and extension torque situation. The outcomes showed that there existed 4-6 times pressure on the connecting rod of rigid fixation compared with the elastic fixations under different loads, and the stress peak and area of force on elastic fixation were much higher than that of the rigid fixations. The elastic fixation has more biomechanical advantages than rigid fixation in promoting interbody lumbar fusion after surgery. PMID:26211247

  15. Emerging Techniques for Posterior Fixation of the Lumbar Spine.

    PubMed

    Verma, Kushagra; Boniello, Anthony; Rihn, Jeffrey

    2016-06-01

    Pedicle screw fixation is the preferred method of posterior fusion in lumbar spinal surgery. The technique provides three-column support of the vertebrae, contributing to the biomechanical strength of the construct. However, open pedicle screw fixation often necessitates wide posterior exposure and dissection with soft-tissue disruption of the facet joint. Alternative posterior fixation techniques have been developed to reduce surgical time, soft-tissue dissection, disruption of the adjacent facet joint capsule, neurologic risk, and implant cost. Results of these techniques are comparable to those of standard pedicle screw fixation systems. Certain patients, especially those at a lower risk of nonunion or those who require posterior fixation only as an adjunct to anterior column support, may benefit from the shorter surgical time and limited posterior exposure of the alternative techniques. However, the decreased rigidity of these alternative constructs can result in excessive motion, which can lead to nonunion and early hardware failure. PMID:27077477

  16. Evaluation of the 96/4 PLDLLA polymer resorbable lumbar interbody cage in a long term animal model.

    PubMed

    Lazennec, Jean Y; Madi, Abdallah; Rousseau, Marc A; Roger, Bernard; Saillant, Gérard

    2006-10-01

    Arthrodesis using interbody cages has demonstrated high fusion rates. However, permanent cages are exposed to stress-shielding, corrosion, and may require explanation when necessary. Polylactic acid (PLA) bioresorbable cages are developed for avoiding these problems, but significant tissue reaction has been reported with 70/30 PLDLLA in some preclinical animal studies. The objective was to evaluate 96/4 PLDLLA cages in a sheep model over 3 years. Sixteen sheeps underwent one level anterior lumbar interbody fusion using 96/4 PLDLLA cages, filled and surrounded with cancellous bone graft from the iliac crest. Six groups of three animals were killed after 3, 6, 9, 12, 24, and 36 months. Harvested lumbar spine had radiographic, MRI, and CT evaluation and histological analysis. Histological results: cage swelling and slight signs of fragmentation associated to fibrocartilaginous tissue apposition at 3 months; bone remodeling around the cage with direct apposition of the mineralization front at 6 months; active cage degradation and complete fusion around the cage at 9 months; cage fragmentation and partial replacement by bone tissue at 12 months; bone bridges in and around the cage at 24 months; full resorption and intervertebral fusion at 36 months. Radiological results: partial arthrodesis at 3 months; definite peripheral arthrodesis at 6 months; similar aspect at 9 months; significant cage resorption at 12 months; definite inner and outer fusion at 24 months; complete cage resorption and calcification at the location of the cage at 36 months confirmed histological observations. Radiographic, CT scan, MRI, and histological data were consistent for showing progressive resorption of 96/4 PLDLLA, interbody fusion, and bone remodeling, with no significant signs of local intolerance reaction. These results are promising and suggest further development of 96/4 PLDLLA cages. PMID:16736199

  17. Preliminary Results of Bioactive Amniotic Suspension with Allograft for Achieving One and Two-Level Lumbar Interbody Fusion

    PubMed Central

    Kerr, Eubulus J.; Utter, Philip A.; Cavanaugh, David A.; Frank, Kelly A.; Moody, Devan; McManus, Brian; Stone, Marcus B.

    2016-01-01

    Background Bone graft material for lumbar fusion was historically autologous bone graft (ABG). In recent years alternatives such as allograft, demineralized bone matrix (DBM), ceramics, and bone morphogenetic protein (BMP) have gained favor, although the complications of these are not fully understood. Bioactive amniotic suspension (BAS) with allograft is a new class of material derived from human amniotic tissue. Methods Eligible patients receiving a one or two level lumbar interbody fusion with Nucel, a BAS with allograft, were contacted and scheduled for a mininmim 12 month follow-up visit. Patients were evaluated for fusion using CT's and plain radiographs. Clincal outcomes, including ODI, VAS back and leg were collected, as well as comorbidities including BMI, smoking status, diabetes and previous lumbar surgery. Results One-level patients (N=38) were 71.1% female with mean age of 58.4 ± 12.7 and mean BMI of 30.6 ± 6.08. Two-level patients (N=34) were 58.8% female with mean age of 49.3 ±10.9 and mean BMI of 30.1 ± 5.82. Kinematic fusion was achieved in 97.4% of one-level patients and 100% of two-level patients. Baseline comorbidities were present in 89.5% of one-level patients and 88.2% of two-level patients. No adverse events related to BAS were reported in this study. Conclusion Fusion status is evaluated with many different biologics and varying methods in the literature. BAS with allograft in this study demonstrated high fusion rates with no complications within a largely comorbid population. Although a small population, BAS with allograft results were encouraging for one and two-level lumbar interbody fusion in this study. Further prospective studies should be conducted to investigate safety and efficacy in a larger population. PMID:27162714

  18. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review.

    PubMed

    Bonaldi, G; Brembilla, C; Cianfoni, A

    2015-05-01

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered "standard of care", are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists' interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications. PMID:24906245

  19. Novel Pedicle Screw and Plate System Provides Superior Stability in Unilateral Fixation for Minimally Invasive Transforaminal Lumbar Interbody Fusion: An In Vitro Biomechanical Study

    PubMed Central

    Zhu, Qingan; Zhou, Yue; Li, Changqing; Liu, Huan; Huang, Zhiping; Shang, Jin

    2015-01-01

    Purpose This study aims to compare the biomechanical properties of the novel pedicle screw and plate system with the traditional rod system in asymmetrical posterior stabilization for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). We compared the immediate stabilizing effects of fusion segment and the strain distribution on the vertebral body. Methods Seven fresh calf lumbar spines (L3-L6) were tested. Flexion/extension, lateral bending, and axial rotation were induced by pure moments of ± 5.0 Nm and the range of motion (ROM) was recorded. Strain gauges were instrumented at L4 and L5 vertebral body to record the strain distribution under flexion and lateral bending (LB). After intact kinematic analysis, a right sided TLIF was performed at L4-L5. Then each specimen was tested for the following constructs: unilateral pedicle screw and rod (UR); unilateral pedicle screw and plate (UP); UR and transfacet pedicle screw (TFS); UP and TFS; UP and UR. Results All instrumented constructs significantly reduced ROM in all motion compared with the intact specimen, except the UR construct in axial rotation. Unilateral fixation (UR or UP) reduced ROM less compared with the bilateral fixation (UP/UR+TFS, UP+UR). The plate system resulted in more reduction in ROM compared with the rod system, especially in axial rotation. UP construct provided more stability in axial rotation compared with UR construct. The strain distribution on the left and right side of L4 vertebral body was significantly different from UR and UR+TFS construct under flexion motion. The strain distribution on L4 vertebral body was significantly influenced by different fixation constructs. Conclusions The novel plate could provide sufficient segmental stability in axial rotation. The UR construct exhibits weak stability and asymmetrical strain distribution in fusion segment, while the UP construct is a good alternative choice for unilateral posterior fixation of MI-TLIF. PMID:25807513

  20. One-Stage Posterior Debridement and Transpedicular Screw Fixation for Treating Monosegmental Thoracic and Lumbar Spinal Tuberculosis in Adults

    PubMed Central

    Liu, Zhili; Peng, Aifeng; Long, Xinhua; Yang, Dong; Huang, Shanhu

    2014-01-01

    Spinal tuberculosis is still prevalent in some developing countries. The purpose of this study is to investigate the efficacy and safety of one-stage posterior debridement, autogenous bone grafting, and transpedicular screw fixation in treating monosegmental thoracic and lumbar tuberculosis in adults. 37 patients were retrospectively reviewed in this study. The data of images, operative time and blood loss volume, perioperative complications, time to achieve bony fusion, VAS score, and neurologic function preoperatively and postoperatively were collected. The mean follow-up period was 21.5 ± 3.5 months. The tuberculosis was cured after surgery in all patients, and no recurrence was observed. Bony fusion was achieved in all patients with a mean time of 5.6 ± 2.5 months. Neurological outcome did not change in one case with grade A, and increased by 1–3 grades in the other patients with nerve deficit. The average preoperative and postoperative VAS scores were 5.5 ± 2.23 and 1.5 ± 1.22, respectively; the difference was significant (P < 0.05). There were three perioperative complications (8.1%, 3/37) observed in this study. In conclusion, the procedure of one-stage posterior debridement, interbody fusion with autogenous bone grafting, and posterior fixation with pedicle screw is effective and safe for treating monosegmental thoracic and lumbar spinal tuberculosis in adults. PMID:24701134

  1. Evaluation of a novel tool for bone graft delivery in minimally invasive transforaminal lumbar interbody fusion

    PubMed Central

    Kleiner, Jeffrey B; Kleiner, Hannah M; Grimberg, E John; Throlson, Stefanie J

    2016-01-01

    Study design Disk material removed (DMR) during L4-5 and L5-S1 transforaminal lumbar interbody fusion (T-LIF) surgery was compared to the corresponding bone graft (BG) volumes inserted at the time of fusion. A novel BG delivery tool (BGDT) was used to apply the BG. In order to establish the percentage of DMR during T-LIF, it was compared to DMR during anterior diskectomy (AD). This study was performed prospectively. Summary of background data Minimal information is available as to the volume of DMR during a T-LIF procedure, and the relationship between DMR and BG delivered is unknown. BG insertion has been empiric and technically challenging. Since the volume of BG applied to the prepared disk space likely impacts the probability of arthrodesis, an investigation is justified. Methods A total of 65 patients with pathology at L4-5 and/or L5-S1 necessitating fusion were treated with a minimally invasive T-LIF procedure. DMR was volumetrically measured during disk space preparation. BG material consisting of local autograft, BG extender, and bone marrow aspirate were mixed to form a slurry. BG slurry was injected into the disk space using a novel BGDT and measured volumetrically. An additional 29 patients who were treated with L5-S1 AD were compared to L5-S1 T-LIF DMR to determine the percent of T-LIF DMR relative to AD. Results DMR volumes averaged 3.6±2.2 mL. This represented 34% of the disk space relative to AD. The amount of BG delivered to the disk spaces was 9.3±3.2 mL, which is 2.6±2.2 times the amount of DMR. The BGDT allowed uncomplicated filling of the disk space in <1 minute. Conclusion The volume of DMR during T-LIF allows for a predictable volume of BG delivery. The BGDT allowed complete filling of the entire prepared disk space. The T-LIF diskectomy debrides 34% of the disk relative to AD. PMID:27274320

  2. Lateral Pressure and VAS Pain Score Analysis for the Lateral Lumbar Interbody Fusion Procedure

    PubMed Central

    2015-01-01

    Background The lateral lumbar interbody fusion (LLIF) procedure is a minimally invasive procedure that has become widely utilized. The LLIF procedure typically involves bending the table to access the disc spaces of interest due to anatomical constraints. It is unknown if this bending process is painful or what pressures are exhibited on the downside part of the body. The goal of the study was to determine whether sex, height, weight, body mass index, bed angle, or positioning relative to the break of the bed affects the downside skin pressures and VAS pain scores in awake volunteers. Methods Fifty-six volunteers were placed in the lateral decubitus position and pressure sensors were placed at the downside part of their anatomy (shoulder, T10 rib , iliac crest, and greater trochanter). The pressures were checked with the iliac crest or greater trochanter at 0, 10, 20, 30, 40 degree bed angles. VAS scores were checked when the iliac crest or greater trochanter were at the maximum bed break angles. Results A significant positive association was found between increased bed angle and pressure at all five areas on the downside body locations (p<0.0001). The greatest pressures were located at the iliac crest and greater trochanter when these specific locations were centered over the break of the bed (p<0.0001). When the iliac crest was placed at maximal bed break, each unit increase in BMI increased the VAS pain by 0.13 (p<0.0001)and men had 1.96 (p=0.0009)higher VAS scores then women. When the greater trochanter was placed at the maximal bed break, each unit increase in BMI decreased VAS pain by 0.19 (p<0.0001) and women had 1.55 (p=0.0002)higher VAS pain scores then men. Conclusions In awake volunteers, the pressure at the iliac crest or greater trochanter at the break of the bed increases by increasing the bed angle. Women with a lower BMI had high VAS pain scores when their greater trochanter was at maximal bed break. Men with higher BMI had high VAS pain scores when

  3. Anterior lumbar interbody surgery for spondylosis results from a classically-trained neurosurgeon.

    PubMed

    Chatha, Gurkirat; Foo, Stacy W L; Lind, Christopher R P; Budgeon, Charley; Bannan, Paul E

    2014-09-01

    Anterior lumbar surgery for degenerative disc disease (DDD) is a relatively novel technique that can prevent damage to posterior osseous, muscular and ligamentous spinal elements. This study reports the outcomes and complications in 286 patients who underwent fusion - with artificial disc implants or combined fusion and artificial disc implants - by a single-operator neurosurgeon, with up to 24 months of follow-up. The visual analogue scale (VAS), Oswestry Disability Index (ODI), Short Form 36 (SF36) and prospective log of adverse events were used to assess the clinical outcome. Radiographic assessments of implant position and bony fusion were analysed. Intraoperative and postoperative complications were also recorded. Irrespective of pre-surgical symptoms (back pain alone or back and leg pain combined), workers' compensation status and type of surgical implant, clinically significant improvements in VAS, ODI and SF36 were primarily observed at 3 and/or 6 month follow-up, and improvements were maintained at 24 months after surgery. A 94% fusion rate was obtained; the overall complication was 9.8% which included 3.5% with vascular complications. The anterior lumbar approach can be used for treating DDD for both back pain and back and leg pain with low complication rates. With appropriate training, single-operator neurosurgeons can safely perform these surgeries. PMID:24786717

  4. Prospective Analysis of a New Bone Graft in Lumbar Interbody Fusion: Results of a 2- Year Prospective Clinical and Radiological Study

    PubMed Central

    Raskin, Yannic

    2015-01-01

    Background This study examined the efficacy and safety of bone graft material ABM/P-15 (iFACTOR) for use in posterior lumbar interbody fusion. ABM/P-15 has been used safely for more than a decade in dental applications. Methods Forty patients underwent PLIF surgery, with each patient as control. Assessments up to 24 months included radiographs, CT scan, VAS, and ODI. Primary success criteria were fusion and safety. Results Intra-cage bridging bone occurred earlier with ABM/P-15 than autograft (97.73% vs. 59.09% at 6 months). On average pain decreased 29 points and function improved 43 points. Radio dense material outside the disk space occurred more frequently with ABM/P-15 than autograft, without clinical consequence. Conclusions This study suggests that ABM/P-15 has equal or greater efficacy at 6 and 12 months. Pain improvements exceeded success criteria at all time points. Functional improvement exceeded success criteria at all time points. Clinical Relevance This study explores the safety and efficacy of an osteobiologic peptide enhanced bone graft material as a viable alternative to autograft and its attendant risks. PMID:25709887

  5. Analysis of spinal lumbar interbody fusion cage subsidence using Taguchi method, finite element analysis, and artificial neural network

    NASA Astrophysics Data System (ADS)

    Nassau, Christopher John; Litofsky, N. Scott; Lin, Yuyi

    2012-09-01

    Subsidence, when implant penetration induces failure of the vertebral body, occurs commonly after spinal reconstruction. Anterior lumbar interbody fusion (ALIF) cages may subside into the vertebral body and lead to kyphotic deformity. No previous studies have utilized an artificial neural network (ANN) for the design of a spinal interbody fusion cage. In this study, the neural network was applied after initiation from a Taguchi L 18 orthogonal design array. Three-dimensional finite element analysis (FEA) was performed to address the resistance to subsidence based on the design changes of the material and cage contact region, including design of the ridges and size of the graft area. The calculated subsidence is derived from the ANN objective function which is defined as the resulting maximum von Mises stress (VMS) on the surface of a simulated bone body after axial compressive loading. The ANN was found to have minimized the bone surface VMS, thereby optimizing the ALIF cage given the design space. Therefore, the Taguchi-FEA-ANN approach can serve as an effective procedure for designing a spinal fusion cage and improving the biomechanical properties.

  6. Minimally invasive transforaminal lumbar interbody fusion with percutaneous navigated guidewireless lumbosacral pedicle screw fixation.

    PubMed

    Chen, Kevin S; Park, Paul

    2016-07-01

    This video details the minimally invasive approach for treatment of a symptomatic Grade II lytic spondylolisthesis with high-grade foraminal stenosis. In this procedure, the use of a navigated, guidewireless technique for percutaneous pedicle screw placement at the lumbosacral junction is highlighted following initial decompression and transforaminal interbody fusion. Key steps of the procedure are delineated that include positioning, exposure, technique for interbody fusion, intraoperative image acquisition, and use of a concise 2-step process for navigated screw placement without using guidewires. The video can be found here: https://youtu.be/2u6H4Pc_8To . PMID:27364422

  7. Posterior convex release and interbody fusion for thoracic scoliosis: technical note.

    PubMed

    Mac-Thiong, Jean-Marc; Asghar, Jahangir; Parent, Stefan; Shufflebarger, Harry L; Samdani, Amer; Labelle, Hubert

    2016-09-01

    Anterior release and fusion is sometimes required in pediatric patients with thoracic scoliosis. Typically, a formal anterior approach is performed through open thoracotomy or video-assisted thoracoscopic surgery. The authors recently developed a technique for anterior release and fusion in thoracic scoliosis referred to as "posterior convex release and interbody fusion" (PCRIF). This technique is performed via the posterior-only approach typically used for posterior instrumentation and fusion and thus avoids a formal anterior approach. In this article the authors describe the technique and its use in 9 patients-to prevent a crankshaft phenomenon in 3 patients and to optimize the correction in 6 patients with a severe thoracic curve showing poor reducibility. After Ponte osteotomies at the levels requiring anterior release and fusion, intervertebral discs are approached from the convex side of the scoliosis. The annulus on the convex side of the scoliosis is incised from the lateral border of the pedicle to the lateral annulus while visualizing and protecting the pleura and spinal cord. The annulus in contact with the pleura and the anterior longitudinal ligament are removed before completing the discectomies and preparing the endplates. The PCRIF was performed at 3 levels in 4 patients and at 4 levels in 5 patients. Mean correction of the main thoracic curve, blood loss, and length of stay were 74.9%, 1290 ml, and 7.6 days, respectively. No neurological deficit, implant failure, or pseudarthrosis was observed at the last follow-up. Two patients had pleural effusion postoperatively, with 1 of them requiring placement of a chest tube. One patient had pulmonary edema secondary to fluid overload, while another patient underwent reoperation for a deep wound infection 3 weeks after the initial surgery. The technique is primarily indicated in skeletally immature patients with open triradiate cartilage and/or severe scoliosis. It can be particularly useful if there is

  8. Intervertebral prosthesis versus anterior lumbar interbody fusion: one-year results of a prospective non-randomised study.

    PubMed

    Schroven, Ive; Dorofey, Dimitri

    2006-01-01

    The authors conducted a prospective non-randomised study on the ProDisc intervertebral prosthesis versus anterior lumbar interbody fusion (ALIF). The first group included 14 patients, the second group 10 patients. In the ProDisc group the Oswestry Disability Index improved from +/- 38.42 preoperatively (60 being the worst possible condition) to +/- 15.21 after 6 months and to +/- 12.5 after 12 months. This was definitely better than the ALIF group, where the corresponding figures were +/- 38, +/- 25 and +/- 21.4. The ProDisc patients also scored better with respect to duration of hospitalisation, blood loss and operation time. The complications were comparable in both groups. PMID:16570900

  9. Clear Zone Formation around Screws in the Early Postoperative Stages after Posterior Lumbar Fusion Using the Cortical Bone Trajectory Technique

    PubMed Central

    Iwatsuki, Koichi; Ohnishi, Yu-Ichiro; Ohkawa, Toshika; Yoshimine, Toshiki

    2015-01-01

    Study Design Retrospective study. Purpose To evaluate the initial fixation using the cortical bone trajectory (CBT) technique for posterior lumbar fusion through assessment of the clear zones around the screws and the risk factors involved. Overview of Literature Postoperative radiolucent zones (clear zones) are an indicator of poor conventional pedicle screw fixation. Methods Between January 2013 and April 2014, 19 patients (8 men and 11 women) underwent posterior lumbar interbody fusion or posterior lumbar fusion using the CBT technique. A total of 109 screws were used for evaluation with measurement of the maximum insertional torque of last two screw rotations. Clear zone-positivity on plain radiographs was investigated 6 months after surgery. The relation between intraoperative insertional torque and clear zone-positivity was investigated by one-way analysis of variance. In addition, the correlation between clear zone-positivity and gender, age (<75 years old or >75 years old), or operative stabilization level (<2 or >3 vertebral levels) was evaluated using the chi-square test. Results Clear zones were observed around six screws (5.50%) in five patients (26.3%). The mean insertional torque (4.00±2.09 inlbs) of clear zone-positive screws was lower than that of clear zone-negative screws (8.12±0.50 in-lbs), but the difference was not significant. There was a significant correlation between clear zone-positivity and operative level of stabilization. Conclusions The low incidence of clear zone-positive screws indicates good initial fixation using the CBT technique. Multilevel fusions may be risk factors for clear zone generation. PMID:26713120

  10. Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Relief in Patients with Lumbar Disc Degeneration Compared to Anterior Lumbar Interbody Fusion

    PubMed Central

    Rischke, Burkhard; Smith, Eric

    2015-01-01

    Background Lumbar disc degeneration (LDD) is one of the most frequently diagnosed spinal diseases. The symptoms these disorders cause are anticipated to increase as the population in Western countries ages. Purpose Compare back and leg pain alleviation in patients with LDD and a viscoelastic disc prosthesis documented in the SWISSspine registry versus patients with anterior lumbar interbody fusion documented in the Spine Tango registry. Study Design Prospectively collected clinical and outcome data in two independent spine registries. Outcome Measures were back and leg pain relief on 0 to 10 numerical rating scales. Materials and Methods The analysis included a single surgeon series of 48 patients with viscoelastic total disc replacement (VTDR) from the SWISSspine registry which were compared to 131 patients with anterior lumbar interbody fusion (ALIF) from the Spine Tango registry. Two linear multivariate regression models were built to assess the associations of patient characteristics with back and leg pain relief. The following covariates were included in the models: patient age and sex, disc herniation as additional diagnosis, number of treated segments, level of treated segment, treatment type (VTDR, ALIF), preoperative back and leg pain levels and follow-up interval. Results Both models showed VTDR to be associated with significantly higher back (2.76 points; 95% confidence interval (CI) 1.78 - 3.73; p < 0.001) and leg pain (2.12 points; 95% CI 1.12 to 3.13; p < 0.001) relief than ALIF. Other influential factors for higher back pain relief were female sex compared with male sex (1.03 additional points; 95% CI 0.27 to 1.78; p = 0.008), monosegmental surgery compared with bisegmental surgery (1.02 additional points; 95% CI 0.21 to 1.83; p = 0.014), and higher back pain at baseline (0.87 points additional pain relief per level of preoperative back pain; 95% CI 0.70 to 1.03; p < 0.001). Other influential factors for leg pain relief were monosegmental surgery (0

  11. Ogilvie's syndrome following posterior spinal instrumentation in thoraco lumbar trauma

    PubMed Central

    Krishnakumar, R.; Kuzhimattam, Mathew John; Kumar, Gaurav

    2015-01-01

    Objectives: To report unique cases of Ogilvie's syndrome (acute intestinal pseudo-obstruction) following posterior spinal instrumentation in thoraco lumbar trauma. Materials and Methods: A single centre retrospective study. We reviewed the surgical data of 420 patients who underwent thoracolumbar spinal surgery over a period of four years. Two patients who developed post operative Ogilvie's syndromes were identified. Results: The clinical presentation and blood investigations ruled out any infectious pathology. Computed tomography scans ruled out the mechanical obstruction. All patients improved with conservative management. Conclusion: Ogilvie's syndrome should be considered as a differential diagnosis in patients with postoperative significant abdominal distension who had undergone posterior instrumentation for spinal trauma. Early recognition and appropriate conservative treatment would be necessary to prevent complications such as bowel ischemia and perforation. PMID:26692695

  12. Treatment of Symptomatic Lumbar Disc Degeneration with the VariLift-L Interbody Fusion System: Retrospective Review of 470 Cases

    PubMed Central

    Neely, Warren F.; Fichtel, Frank; del Monaco, Diana Cardenas

    2016-01-01

    Background Many first generation stand-alone fusion cages required endplate decortication and surgical impaction during the procedure resulting in segmental subsidence, implant migration and loss of lordosis postoperatively. The primary objective of this study was to evaluate radiographically, in a large series of patients, whether engineering and design modifications incorporated in a specific stand-alone, expandable interbody fusion device (VariLift®-L) adequately addressed previously recognized deficiencies of stand-alone interbody cages. Methods In this retrospective chart review of 470 patients (642 treated levels), we evaluated radiographic evidence of fusion, subsidence and migration following a one- or two-level PLIF procedure utilizing this stand-alone expandable interbody fusion device. A secondary objective was to corroborate the low morbidity and symptomatic improvements achieved with previous interbody cage devices used to treat symptomatic disc degeneration. Results The average postoperative followup was 3.9 ± 1.8 years and a solid fusion rate of 94% was achieved among patients with ≥ 9 months of radiographic followup. Subsidence > 3 mm was noted at 10 levels with no cases of device migration. Composite back pain severity scores improved from 8.5 ± 1.5 preoperatively to 0.8 ± 1.5 at final followup (p<0.001) and 94% of patients met or exceeded the minimal clinical important difference of 3.8 points. Eighteen patients required reoperation following the index procedure; 16 of these patients were treated for adjacent segment disease. Conclusions (LOE) The VariLift-L device has excellent clinical and technical performance characteristics, providing adequate stabilization of the anterior column without the need for supplemental posterior instrumentation. Level of Evidence IV. IRB Approval: Expedited Federal Register Categories 5& 7: Methodist IRB 3/30/2011; Informed Consent statement: retrospective data collection, patients signed consent forms

  13. Minimally Invasive Transforaminal Lumbar Interbody Fusion at L5-S1 through a Unilateral Approach: Technical Feasibility and Outcomes

    PubMed Central

    Choi, Won-Suh; Kim, Jin-Sung; Ryu, Kyeong-Sik; Hur, Jung-Woo; Seong, Ji-Hoon

    2016-01-01

    Background. Minimally invasive spinal transforaminal lumbar interbody fusion (MIS-TLIF) at L5-S1 is technically more demanding than it is at other levels because of the anatomical and biomechanical traits. Objective. To determine the clinical and radiological outcomes of MIS-TLIF for treatment of single-level spinal stenosis low-grade isthmic or degenerative spondylolisthesis at L5-S1. Methods. Radiological data and electronic medical records of patients who underwent MIS-TLIF between May 2012 and December 2014 were reviewed. Fusion rate, cage position, disc height (DH), disc angle (DA), disc slope angle, segmental lordotic angle (SLA), lumbar lordotic angle (LLA), and pelvic parameters were assessed. For functional assessment, the visual analogue scale (VAS), Oswestry disability index (ODI), and patient satisfaction rate (PSR) were utilized. Results. A total of 21 levels in 21 patients were studied. DH, DA, SLA, and LLA had increased from their preoperative measures at the final follow-up. Fusion rate was 86.7% (18/21) at 12 months' follow-up. The most common cage position was anteromedial (15/21). The mean VAS scores for back and leg pain mean ODI scores improved significantly at the final follow-up. PSR was 88%. Cage subsidence was observed in 33.3% (7/21). Conclusions. The clinical and radiologic outcomes after MIS-TLIF at L5-S1 in patients with spinal stenosis or spondylolisthesis are generally favorable. PMID:27433472

  14. Sacrum fracture following L5-S1 stand-alone interbody fusion for isthmic spondylolisthesis.

    PubMed

    Phan, Kevin; Mobbs, Ralph J

    2015-11-01

    We report a 72-year-old man with a rare sacral fracture following stand-alone L5-S1 anterior lumbar interbody fusion for isthmic spondylolisthesis. The man underwent a minimally invasive management strategy using posterior percutaneous pedicle fixation and partial reduction of the deformity. We also discuss the current literature on fusion procedures for isthmic spondylolisthesis. PMID:26100158

  15. Successful salvage surgery for failed transforaminal lumbosacral interbody fusion using the anterior transperitoneal approach.

    PubMed

    Hozumi, Takashi; Orita, Sumihisa; Inage, Kazuhide; Fujimoto, Kazuki; Sato, Jun; Shiga, Yasuhiro; Kanamoto, Hirohito; Abe, Koki; Yamauchi, Kazuyo; Aoki, Yasuchika; Nakamura, Junichi; Matsuura, Yusuke; Suzuki, Takane; Takahashi, Kazuhisa; Ohtori, Seiji; Sainoh, Takeshi

    2016-05-01

    Transforaminal lumbar interbody fusion (TLIF) is a popular posterior spinal fusion technique, but sometimes require salvage surgery when implant failure occurs, which involves possible neural damage due to postoperative adhesion. The current report deals with successful anterior transperitoneal salvage surgery for failed L5-S TLIF with less neural invasiveness. PMID:27190611

  16. Minimally Invasive Unilateral vs. Bilateral Pedicle Screw Fixation and Lumbar Interbody Fusion in Treatment of Multi-Segment Lumbar Degenerative Disorders

    PubMed Central

    Liu, Xiaoyang; Li, Guangrun; Wang, Jiefeng; Zhang, Heqing

    2015-01-01

    Background The choice for instrumentation with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in treatment of degenerative lumbar disorders (DLD) remains controversial. The goal of this study was to investigate clinical outcomes in consecutive patients with multi-segment DLD treated with unilateral pedicle screw (UPS) vs. bilateral pedicle screw (BPS) instrumented TLIF. Material/Methods Eighty-four consecutive patients who had multi-level MIS-TLIF were retrospectively reviewed. All data were collected to compare the clinical outcomes between the 2 groups. Results Both groups showed similar clinical function scores in VAS and ODI. The two groups differed significantly in operative time (P<0.001), blood loss (P<0.001), and fusion rate (P=0.043), respectively. Conclusions This study demonstrated similar clinical outcomes between UPS fixation and BPS procedure after MIS-TLIF for multi-level DLD. Moreover, UPS technique was superior in operative time and blood loss, but represented lower fusion rate than the BPS construct did. PMID:26603050

  17. The Use of a Dehydrated Amnion/Chorion Membrane Allograft in Patients Who Subsequently Undergo Reexploration after Posterior Lumbar Instrumentation

    PubMed Central

    Subach, Brian R.; Copay, Anne G.

    2015-01-01

    Background Context. Products that can reduce development of epidural fibrosis may reduce risk for ongoing pain associated with development of scar tissue and make subsequent epidural reexploration easier. Purpose. To evaluate the use of dehydrated human amnion/chorion membrane (dHACM) on the formation of soft tissue scarring in the epidural space. Study Design. Case series. Patient Sample. Five patients having transforaminal lumbar interbody lumbar fusion (TLIF) with posterior instrumentation and implantation of dHACM in the epidural space and subsequent epidural reexploration. Outcome Measures. Degree of scar tissue adjacent to the epidural space at reexploration. Intraoperative and postoperative complications related to dHACM and patient reported outcomes. Methods. The degree of scar tissue adjacent to the epidural space was assessed during the reexploration surgery. Patients' outcomes were collected using standard validated questionnaires. Results. Four of 5 cases had easily detachable tissue during epidural reexploration. Angiolipoma of 10% was noted in 1 case and 5% in 2 cases. Significant improvements in patient reported outcomes were observed. No intraoperative or postoperative complications occurred. Conclusions. Our findings suggest that dHACM implant during TLIF may have favorable effects on epidural fibrosis and is well tolerated. Further studies with larger cohorts are required to prove our results. PMID:25653880

  18. Approach-Related Complications of Anterior Lumbar Interbody Fusion: Results of a Combined Spine and Vascular Surgical Team.

    PubMed

    Mobbs, Ralph J; Phan, Kevin; Daly, Daniel; Rao, Prashanth J; Lennox, Andrew

    2016-03-01

    Study Design Retrospective analysis of prospectively collected cohort data. Objective Anterior lumbar interbody fusion (ALIF) is a commonly performed procedure for the treatment of degenerative diseases of the lumbar spine. Detailed and comprehensive descriptions of intra- and postoperative complications of ALIF are surprisingly limited in the literature. In this report, we describe our experience with a team model for ALIF and report all complications occurring in our patient series. Methods Patients were prospectively enrolled between January 2009 and January 2013 by a combined spine surgeon and vascular surgeon team. All patients underwent an open ALIF using an anterior approach to the lumbosacral spine. Results From the 227 ALIF cases, mean operative blood loss was 103 mL, ranging from 30 to 900 mL. Mean operative time was 78 minutes. The average length of stay was 5.2 days. Intraoperative vascular injury requiring primary repair with suturing occurred in 15 patients (6.6%). There were 2 cases of postoperative retroperitoneal hematoma. Three patients (1.3%) had incisional hernia requiring revision surgery; 7 (3.1%) patients had prolonged ileus (>7 days) managed conservatively. Four patients described retrograde ejaculation. Sympathetic dysfunction occurred in 15 (6.6%) patients. There were 5 (2.2%) cases of superficial wound infection treated with oral antibiotics, with no deep wound infections requiring reoperation or intravenous therapy. There were no mortalities in this series. Conclusions ALIF is a safe procedure when performed by a combined vascular surgeon and spine surgeon team with acceptably low complication rates. Our series confirms that the team approach results in short operative times and length of stay, with rapid control of intraoperative vessel injury and low overall blood loss. PMID:26933616

  19. Approach-Related Complications of Anterior Lumbar Interbody Fusion: Results of a Combined Spine and Vascular Surgical Team

    PubMed Central

    Mobbs, Ralph J.; Phan, Kevin; Daly, Daniel; Rao, Prashanth J.; Lennox, Andrew

    2015-01-01

    Study Design Retrospective analysis of prospectively collected cohort data. Objective Anterior lumbar interbody fusion (ALIF) is a commonly performed procedure for the treatment of degenerative diseases of the lumbar spine. Detailed and comprehensive descriptions of intra- and postoperative complications of ALIF are surprisingly limited in the literature. In this report, we describe our experience with a team model for ALIF and report all complications occurring in our patient series. Methods Patients were prospectively enrolled between January 2009 and January 2013 by a combined spine surgeon and vascular surgeon team. All patients underwent an open ALIF using an anterior approach to the lumbosacral spine. Results From the 227 ALIF cases, mean operative blood loss was 103 mL, ranging from 30 to 900 mL. Mean operative time was 78 minutes. The average length of stay was 5.2 days. Intraoperative vascular injury requiring primary repair with suturing occurred in 15 patients (6.6%). There were 2 cases of postoperative retroperitoneal hematoma. Three patients (1.3%) had incisional hernia requiring revision surgery; 7 (3.1%) patients had prolonged ileus (>7 days) managed conservatively. Four patients described retrograde ejaculation. Sympathetic dysfunction occurred in 15 (6.6%) patients. There were 5 (2.2%) cases of superficial wound infection treated with oral antibiotics, with no deep wound infections requiring reoperation or intravenous therapy. There were no mortalities in this series. Conclusions ALIF is a safe procedure when performed by a combined vascular surgeon and spine surgeon team with acceptably low complication rates. Our series confirms that the team approach results in short operative times and length of stay, with rapid control of intraoperative vessel injury and low overall blood loss. PMID:26933616

  20. Screw Placement Accuracy for Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery: A Study on 3-D Neuronavigation-Guided Surgery

    PubMed Central

    Torres, Jorge; James, Andrew R.; Alimi, Marjan; Tsiouris, Apostolos John; Geannette, Christian; Härtl, Roger

    2012-01-01

    Purpose The aim of this study was to assess the impact of 3-D navigation for pedicle screw placement accuracy in minimally invasive transverse lumbar interbody fusion (MIS-TLIF). Methods A retrospective review of 52 patients who had MIS-TLIF assisted with 3D navigation is presented. Clinical outcomes were assessed with the Oswestry Disability Index (ODI), Visual Analog Scales (VAS), and MacNab scores. Radiographic outcomes were assessed using X-rays and thin-slice computed tomography. Result The mean age was 56.5 years, and 172 screws were implanted with 16 pedicle breaches (91.0% accuracy rate). Radiographic fusion rate at a mean follow-up of 15.6 months was 87.23%. No revision surgeries were required. The mean improvement in the VAS back pain, VAS leg pain, and ODI at 11.3 months follow-up was 4.3, 4.5, and 26.8 points, respectively. At last follow-up the mean postoperative disc height gain was 4.92 mm and the mean postoperative disc angle gain was 2.79 degrees. At L5–S1 level, there was a significant correlation between a greater disc space height gain and a lower VAS leg score. Conclusion Our data support that application of 3-D navigation in MIS-TLIF is associated with a high level of accuracy in the pedicle screw placement. PMID:24353961

  1. Prevalence and Risk Factors of Deep Vein Thrombosis in Patients Undergoing Lumbar Interbody Fusion Surgery: A Single-Center Cross-Sectional Study.

    PubMed

    Yang, Si-Dong; Ding, Wen-Yuan; Yang, Da-Long; Shen, Yong; Zhang, Ying-Ze; Feng, Shi-Qing; Zhao, Feng-Dong

    2015-12-01

    This cross-sectional study was designed to obtain the current prevalence of deep vein thrombosis (DVT) and analyze related risk factors in patients undergoing lumbar interbody fusion. Medical record data were collected from Department of Spinal Surgery, The Third Hospital of Hebei Medical University, between July 2014 and March 2015. Both univariate analysis and binary logistic regression analysis were performed to determine risk factors for DVT. A total of 995 patients were admitted into this study, including 484 men and 511 women, aged from 14 to 89 years old (median 50, IQR 19). The detection rate of lower limb DVT by ultrasonography was 22.4% (223/995) in patients undergoing lumbar interbody fusion. Notably, average VAS (visual analog scale) score in the first 3 days after surgery in the DVT group was more than that in the non-DVT group (Z = -21.69, P < 0.001). The logistic regression model was established as logit P = -13.257 + 0.056*X1 - 0.243*X8 + 2.085*X10 + 0.001*X12, (X1 = age; X8 = HDL; X10 = VAS; X12 = blood transfusion; x = 677.763, P < 0.001). In conclusion, advanced age, high postoperative VAS scores, and blood transfusion were risk factors for postoperative lower limb DVT. As well, the logistic regression model may contribute to an early evaluation postoperatively to ascertain the risk of lower limb DVT in patients undergoing lumbar interbody fusion surgery. PMID:26632909

  2. Spontaneous slip reduction of low-grade isthmic spondylolisthesis following circumferential release via bilateral minimally invasive transforaminal lumbar interbody fusion: technical note and short-term outcome.

    PubMed

    Pan, Jie; Li, Lijun; Qian, Lie; Zhou, Wei; Tan, Jun; Zou, Le; Yang, Mingjie

    2011-02-15

    STUDY DESIGN.: Retrospective clinical data analysis. OBJECTIVE.: To investigate and verify our philosophy of spontaneous slip reduction following circumferential release via bilateral minimally invasive transforaminal lumbar interbody fusion (Mini-TLIF) for treatment of low-grade symptomatic isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA.: Symptomatic isthmic spondylolisthesis usually requires surgical intervention, and the most currently controversial focus is on method and degree of reduction; and Mini-TLIF is an attractive surgical procedure for isthmic spondylolisthesis. METHODS.: Between February 2004 and June 2008, 21 patients with low-grade isthmic spondylolisthesis underwent Mini-TLIF in our institute. Total resection of the scar around the pars interarticularis liberated the nerve roots, achieving posterior release as well. The disc was thoroughly resected, and the disc space was gradually distracted and thoroughly released with sequential disc shavers until rupture of anulus conjunct with anterior longitudinal ligament, accomplishing anterior release, so as to insert Cages. Because of circumferential release, the slipped vertebrae would tend to obtain spontaneous reduction, and with pedicle screw fixation, additional reduction would be achieved without any application of posterior translation force. Radiographs, Visual Analogue Scale, and Oswestry Disability Index were documented. All the cases were followed up for 10 to 26 months. RESULTS.: Slip percentage was reduced from 24.2% ± 6.9% to 10.5% ± 4.0%, and foraminal area percentage increased from 89.1% ± 3.0% to 93.6% ± 2.1%. Visual Analogue Scale and Oswestry Disability Index decreased from 7.8 ± 1.5 to 2.1 ± 1.1 and from 53.3 ± 16.2 to 17.0 ± 7.8, respectively. No neurologic complications were encountered. There were no signs of instrumentation failure. The fusion rate approached 100%. CONCLUSION.: Slip reduction is based on circumferential release. The procedure can be well performed

  3. Biomechanical comparison of unilateral and bilateral pedicle screws fixation for transforaminal lumbar interbody fusion after decompressive surgery -- a finite element analysis

    PubMed Central

    2012-01-01

    Background Little is known about the biomechanical effectiveness of transforaminal lumbar interbody fusion (TLIF) cages in different positioning and various posterior implants used after decompressive surgery. The use of the various implants will induce the kinematic and mechanical changes in range of motion (ROM) and stresses at the surgical and adjacent segments. Unilateral pedicle screw with or without supplementary facet screw fixation in the minimally invasive TLIF procedure has not been ascertained to provide adequate stability without the need to expose on the contralateral side. This study used finite element (FE) models to investigate biomechanical differences in ROM and stress on the neighboring structures after TLIF cages insertion in conjunction with posterior fixation. Methods A validated finite-element (FE) model of L1-S1 was established to implant three types of cages (TLIF with a single moon-shaped cage in the anterior or middle portion of vertebral bodies, and TLIF with a left diagonally placed ogival-shaped cage) from the left L4-5 level after unilateral decompressive surgery. Further, the effects of unilateral versus bilateral pedicle screw fixation (UPSF vs. BPSF) in each TLIF cage model was compared to analyze parameters, including stresses and ROM on the neighboring annulus, cage-vertebral interface and pedicle screws. Results All the TLIF cages positioned with BPSF showed similar ROM (<5%) at surgical and adjacent levels, except TLIF with an anterior cage in flexion (61% lower) and TLIF with a left diagonal cage in left lateral bending (33% lower) at surgical level. On the other hand, the TLIF cage models with left UPSF showed varying changes of ROM and annulus stress in extension, right lateral bending and right axial rotation at surgical level. In particular, the TLIF model with a diagonal cage, UPSF, and contralateral facet screw fixation stabilize segmental motion of the surgical level mostly in extension and contralaterally axial

  4. Biomechanical Analysis of a Newly Developed Shape Memory Alloy Hook in a Transforaminal Lumbar Interbody Fusion (TLIF) In Vitro Model

    PubMed Central

    Wang, Xi; Xu, Jing; Zhu, Yuexing; Li, Jiukun; Zhou, Si; Tian, Shunliang; Xiang, Yucheng; Liu, Xingmo; Zheng, Ying; Pan, Tao

    2014-01-01

    Objective The objective of this biomechanical study was to evaluate the stability provided by a newly developed shape memory alloy hook (SMAH) in a cadaveric transforaminal lumbar interbody fusion (TLIF) model. Methods Six human cadaveric spines (L1-S2) were tested in an in vitro flexibility experiment by applying pure moments of ±8 Nm in flexion/extension, left/right lateral bending, and left/right axial rotation. After intact testing, a TLIF was performed at L4-5. Each specimen was tested for the following constructs: unilateral SMAH (USMAH); bilateral SMAH (BSMAH); unilateral pedicle screws and rods (UPS); and bilateral pedicle screws and rods (BPS). The L3–L4, L4–L5, and L5-S1 range of motion (ROM) were recorded by a Motion Analysis System. Results Compared to the other constructs, the BPS provided the most stability. The UPS significantly reduced the ROM in extension/flexion and lateral bending; the BSMAH significantly reduced the ROM in extension/flexion, lateral bending, and axial rotation; and the USMAH significantly reduced the ROM in flexion and left lateral bending compared with the intact spine (p<0.05). The USMAH slightly reduced the ROM in extension, right lateral bending and axial rotation (p>0.05). Stability provided by the USMAH compared with the UPS was not significantly different. ROMs of adjacent segments increased in all fixed constructs (p>0.05). Conclusions Bilateral SMAH fixation can achieve immediate stability after L4–5 TLIF in vitro. Further studies are required to determine whether the SMAH can achieve fusion in vivo and alleviate adjacent segment degeneration. PMID:25474112

  5. Biomechanical comparison of a new stand-alone anterior lumbar interbody fusion cage with established fixation techniques – a three-dimensional finite element analysis

    PubMed Central

    Chen, Shih-Hao; Tai, Ching-Lung; Lin, Chien-Yu; Hsieh, Pang-Hsing; Chen, Weng-Pin

    2008-01-01

    Background Initial promise of a stand-alone interbody fusion cage to treat chronic back pain and restore disc height has not been realized. In some instances, a posterior spinal fixation has been used to enhance stability and increase fusion rate. In this manuscript, a new stand-alone cage is compared with conventional fixation methods based on the finite element analysis, with a focus on investigating cage-bone interface mechanics and stress distribution on the adjacent tissues. Methods Three trapezoid 8° interbody fusion cage models (dual paralleled cages, a single large cage, or a two-part cage consisting of a trapezoid box and threaded cylinder) were created with or without pedicle screws fixation to investigate the relative importance of the screws on the spinal segmental response. The contact stress on the facet joint, slip displacement of the cage on the endplate, and rotational angle of the upper vertebra were measured under different loading conditions. Results Simulation results demonstrated less facet stress and slip displacement with the maximal contact on the cage-bone interface. A stand-alone two-part cage had good slip behavior under compression, flexion, extension, lateral bending and torsion, as compared with the other two interbody cages, even with the additional posterior fixation. However, the two-part cage had the lowest rotational angles under flexion and torsion, but had no differences under extension and lateral bending. Conclusion The biomechanical benefit of a stand-alone two-part fusion cage can be justified. This device provided the stability required for interbody fusion, which supports clinical trials of the cage as an alternative to circumferential fixations. PMID:18559117

  6. Can the human lumbar posterior columns be stimulated by transcutaneous spinal cord stimulation? A modeling study.

    PubMed

    Danner, Simon M; Hofstoetter, Ursula S; Ladenbauer, Josef; Rattay, Frank; Minassian, Karen

    2011-03-01

    Stimulation of different spinal cord segments in humans is a widely developed clinical practice for modification of pain, altered sensation, and movement. The human lumbar cord has become a target for modification of motor control by epidural and, more recently, by transcutaneous spinal cord stimulation. Posterior columns of the lumbar spinal cord represent a vertical system of axons and when activated can add other inputs to the motor control of the spinal cord than stimulated posterior roots. We used a detailed three-dimensional volume conductor model of the torso and the McIntyre-Richard-Grill axon model to calculate the thresholds of axons within the posterior columns in response to transcutaneous lumbar spinal cord stimulation. Superficially located large-diameter posterior column fibers with multiple collaterals have a threshold of 45.4 V, three times higher than posterior root fibers (14.1 V). With the stimulation strength needed to activate posterior column axons, posterior root fibers of large and small diameters as well as anterior root fibers are coactivated. The reported results inform on these threshold differences, when stimulation is applied to the posterior structures of the lumbar cord at intensities above the threshold of large-diameter posterior root fibers. PMID:21401670

  7. Surgeons' Exposure to Radiation in Single- and Multi-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion; A Prospective Study

    PubMed Central

    Funao, Haruki; Ishii, Ken; Momoshima, Suketaka; Iwanami, Akio; Hosogane, Naobumi; Watanabe, Kota; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

    2014-01-01

    Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has widely been developed in patients with lumbar diseases, surgeons risk exposure to fluoroscopic radiation. However, to date, there is no studies quantifying the effective dose during MIS-TLIF procedure, and the radiation dose distribution is still unclear. In this study, the surgeons' radiation doses at 5 places on the bodies were measured and the effective doses were assessed during 31 consecutive 1- to 3-level MIS-TLIF surgeries. The operating surgeon, assisting surgeon, and radiological technologist wore thermoluminescent dosimeter on the unshielded thyroid, chest, genitals, right middle finger, and on the chest beneath a lead apron. The doses at the lens and the effective doses were also calculated. Mean fluoroscopy times were 38.7, 53.1, and 58.5 seconds for 1, 2, or 3 fusion levels, respectively. The operating surgeon's mean exposures at the lens, thyroid, chest, genitals, finger, and the chest beneath the shield, respectively, were 0.07, 0.07, 0.09, 0.14, 0.32, and 0.05 mSv in 1-level MIS-TLIF; 0.07, 0.08, 0.09, 0.18, 0.34, and 0.05 mSv in 2-level; 0.08, 0.09, 0.14, 0.15, 0.36, and 0.06 mSv in 3-level; and 0.07, 0.08, 0.10, 0.15, 0.33, and 0.05 mSv in all cases. Mean dose at the operating surgeon's right finger was significantly higher than other measurements parts (P<0.001). The operating surgeon's effective doses (0.06, 0.06, and 0.07 mSv for 1, 2, and 3 fusion levels) were low, and didn't differ significantly from those of the assisting surgeon or radiological technologist. Revision MIS-TLIF was not associated with higher surgeons' radiation doses compared to primary MIS-TLIF. There were significantly higher surgeons' radiation doses in over-weight than in normal-weight patients. The surgeons' radiation exposure during MIS-TLIF was within the safe level by the International Commission on Radiological Protection's guidelines. The accumulated radiation exposure, especially to

  8. Survivorship and clinical outcomes after multi-level anterior lumbar reconstruction with stand-alone anterior lumbar interbody fusion or hybrid construct.

    PubMed

    Chen, Benjamin; Akpolat, Yusuf T; Williams, Paul; Bergey, Darren; Cheng, Wayne K

    2016-06-01

    In multilevel disc disease, there is still uncertainty regarding whether multiple total disc replacement is more effective and safer than fusion. Our objective was to measure and compare the clinical outcome of multilevel hybrid constructs with stand-alone anterior lumbar interbody fusion (ALIF) using a retrospective analysis. Sixty-four patients with chronic low back pain determined to be from two or three-level degenerative disc disease were included. Thirty-three patients were treated with hybrid fusion and 31 with ALIF. Several parameters were retrospectively reviewed, including blood loss, operation time, hospital stay, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), and survivorship without the need for revision surgery. Telephone follow-ups were conducted to ascertain survivorship, clinical outcomes (VAS, ODI) and patient satisfaction. Operation time was longer in the hybrid group (p=0.021). The hybrid group showed a significant improvement in VAS and ODI with 52.2% and 50.0% improvement versus 28.3% and 25.5% in the ALIF group (p<0.05). At the telephone follow-up for patient satisfaction, 95.7% (n=22) of the hybrid group were satisfied and 95.2% (n=21) of the ALIF group were satisfied. Seventy-four percent (n=17) in the hybrid group and 85.7% (n=18) in the ALIF group would choose to do the initial surgery again. Kaplan-Meier analysis showed 80.5% survivorship for hybrids and 75.9% for ALIF at 5years. With our clinical outcomes in VAS and ODI scores, these results, when taken together, indicate that hybrid fusion is a valid and viable alternative to ALIF fusion, with at least equal if not better clinical outcomes in terms of survivorship, back pain, and disability scores. PMID:26896904

  9. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review.

    PubMed

    Goldstein, Christina L; Macwan, Kevin; Sundararajan, Kala; Rampersaud, Y Raja

    2016-03-01

    OBJECT The objective of this study was to determine the clinical comparative effectiveness and adverse event rates of posterior minimally invasive surgery (MIS) compared with open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). METHODS A systematic review of the Medline, EMBASE, PubMed, Web of Science, and Cochrane databases was performed. A hand search of reference lists was conducted. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) or comparative cohort studies including at least 10 patients undergoing MIS or open TLIF/PLIF for degenerative lumbar spinal disorders and reporting at least 1 of the following: clinical outcome measure, perioperative clinical or process measure, radiographic outcome, or adverse events. Study quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. When appropriate, a meta-analysis of outcomes data was conducted. RESULTS The systematic review and reference list search identified 3301 articles, with 26 meeting study inclusion criteria. All studies, including 1 RCT, were of low or very low quality. No significant difference regarding age, sex, surgical levels, or diagnosis was identified between the 2 cohorts (856 patients in the MIS cohort, 806 patients in the open cohort). The meta-analysis revealed changes in the perioperative outcomes of mean estimated blood loss, time to ambulation, and length of stay favoring an MIS approach by 260 ml (p < 0.00001), 3.5 days (p = 0.0006), and 2.9 days (p < 0.00001), respectively. Operative time was not significantly different between the surgical techniques (p = 0.78). There was no significant difference in surgical adverse events (p = 0.97), but MIS cases were significantly less likely to experience medical adverse events (risk ratio [MIS vs open] = 0.39, 95% confidence interval 0.23-0.69, p = 0.001). No difference in nonunion (p = 0.97) or reoperation rates (p = 0.97) was

  10. [Anterior and posterior stabilization of the lumbosacral spine with the usage of interbody cages in the operational treatment of the isthmic spondylolisthesis].

    PubMed

    Pankowski, Rafał; Smoczyński, Andrzej; Smoczyński, Maciej; Luczkiewicz, Piotr; Piotrowski, Maciej

    2006-01-01

    In the following work results of the operational treatment of the isthmic spondylolisthesis by the posterior stabilization and anterior lumbosacral interbody fusion with the use of interbody implants--cages was taken under evaluation. The test group consisted of 21 patients (13 male and 8 male). The follow up period exceeded 2 years. The objective clinical outcome assessment was based on Oswestry disability questionnaire. Subjective clinical evaluation was done by the visual analog pain score and two questions concerning the evaluation of success of the operative treatment and a possible agreement to a following operation if necessary. The radiological results were done upon evaluation of the degree of the spondylolisthesis, the angle of the lumbosacral lordosis, the height of the interbody space and intervertebral foramen and the evaluation of the spinal fusion. The conclusion was that the usage of the distraction of the lumbosacral spine in the operational treatment of the isthmic spondylolisthesis result in the reduction of the slippage and the dynamic decompression of the compressed neural roots. The usage of the interbody cages prevented the loss of slippage correction, permanently reconstructed the anatomical conditions in the area of the operated spinal segment and helped to achieve good and very good clinical results in over 95% of patients. The fusion rate was 100%. The restoration of the correct height of the intervertebral foramen in the slip segment caused an improvement of the neurologic state. The usage of two level stabilization in the operative treatment of the isthmic spondylolisthesis prevented the initiation of the secondary degenerative changes adjacent to the fusion. PMID:17128767

  11. Systematic Review of Thigh Symptoms after Lateral Transpsoas Interbody Fusion for Adult Patients with Degenerative Lumbar Spine Disease

    PubMed Central

    Gammal, Isaac D.; Bendo, John A.

    2015-01-01

    Background Lateral transpsoas interbody fusion (LTIF) is a minimally invasive technique for achieving lumbar spinal fusion. While it has many advantages over open techniques it carries with it a distinct set of risks, most commonly post-operative ipsilateral thigh pain, weakness and sensory disturbances. It is vital for both the surgeon and patient to understand the risks for and outcomes of injury associated with this procedure. We conducted a systematic review of the literature to evaluate the incidence, risks, and long-term clinical outcomes of post-operative thigh symptoms in patients treated with LTIF. Methods We conducted a search of MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Collaboration Library, using keywords and MeSH terms, for English-language literature published through September 2014, as well as reference lists from key articles. Studies were then manually filtered to retrieve articles that met inclusion criteria. We were interested in studies that reported postoperative lower extremity symptoms after LTIF, such as pain, weakness and changes in sensation. The strength of evidence was determined based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation Working Group (GRADE). Results A total of 392 articles were initially retrieved, with 24 ultimately meeting criteria for inclusion. The incidence of any post-operative thigh symptom varied, ranging as high as 60.7%, with 9.3% of patients experiencing a motor deficit related to direct nerve injury. Several studies reported cases of persistent symptoms at 6 months follow up. Additionally, inclusion of the L4-5 disc space and a longer duration of surgery were both identified as risks for developing postoperative thigh symptoms. Conclusion The risk of postoperative thigh symptoms after LTIF is high. Thigh pain, paresthesias and weakness were the most commonly reported symptoms. While most patients’ symptoms resolved by 6 months follow up

  12. Modeled cost-effectiveness of transforaminal lumbar interbody fusion compared with posterolateral fusion for spondylolisthesis using N(2)QOD data.

    PubMed

    Carreon, Leah Y; Glassman, Steven D; Ghogawala, Zoher; Mummaneni, Praveen V; McGirt, Matthew J; Asher, Anthony L

    2016-06-01

    OBJECTIVE Transforaminal lumbar interbody fusion (TLIF) has become the most commonly used fusion technique for lumbar degenerative disorders. This suggests an expectation of better clinical outcomes with this technique, but this has not been validated consistently. How surgical variables and choice of health utility measures drive the cost-effectiveness of TLIF relative to posterolateral fusion (PSF) has not been established. The authors used health utility values derived from Short Form-6D (SF-6D) and EQ-5D and different cost-effectiveness thresholds to evaluate the relative cost-effectiveness of TLIF compared with PSF. METHODS From the National Neurosurgery Quality and Outcomes Database (N(2)QOD), 101 patients with spondylolisthesis who underwent PSF were propensity matched to patients who underwent TLIF. Health-related quality of life measures and perioperative parameters were compared. Because health utility values derived from the SF-6D and EQ-5D questionnaires have been shown to vary in patients with low-back pain, quality-adjusted life years (QALYs) were derived from both measures. On the basis of these matched cases, a sensitivity analysis for the relative cost per QALY of TLIF versus PSF was performed in a series of cost-assumption models. RESULTS Operative time, blood loss, hospital stay, and 30-day and 90-day readmission rates were similar for the TLIF and PSF groups. Both TLIF and PSF significantly improved back and leg pain, Oswestry Disability Index (ODI) scores, and EQ-5D and SF-6D scores at 3 and 12 months postoperatively. At 12 months postoperatively, patients who had undergone TLIF had greater improvements in mean ODI scores (30.4 vs 21.1, p = 0.001) and mean SF-6D scores (0.16 vs 0.11, p = 0.001) but similar improvements in mean EQ-5D scores (0.25 vs 0.22, p = 0.415) as patients treated with PSF. At a cost per QALY threshold of $100,000 and using SF-6D-based QALYs, the authors found that TLIF would be cost-prohibitive compared with PSF at a

  13. Short term outcome of posterior dynamic stabilization system in degenerative lumbar diseases

    PubMed Central

    Yang, Mingyuan; Li, Chao; Chen, Ziqiang; Bai, Yushu; Li, Ming

    2014-01-01

    Background: Decompression and fusion is considered as the ‘gold standard’ for the treatment of degenerative lumbar diseases, however, many disadvantages have been reported in several studies, recently like donor site pain, pseudoarthrosis, nonunion, screw loosening, instrumentation failure, infection, adjacent segment disease (ASDis) and degeneration. Dynamic neutralization system (Dynesys) avoids many of these disadvantages. This system is made up of pedicle screws, polyethylene terephthalate cords, and polycarbonate urethane spacers to stabilize the functional spinal unit and preserve the adjacent motion after surgeries. This was a retrospective cohort study to compare the effect of Dynesys for treating degenerative lumbar diseases with posterior lumbar interbody fusion (PLIF) based on short term followup. Materials and Methods: Seventy five consecutive patients of lumbar degenerative disease operated between October 2010 and November 2012 were studied with a minimum followup of 2 years. Patients were divided into two groups according to the different surgeries. 30 patients underwent decompression and implantation of Dynesys in two levels (n = 29) or three levels (n = 1) and 45 patients underwent PLIF in two levels (n = 39) or three levels (n = 6). Clinical and radiographic outcomes between two groups were reviewed. Results: Thirty patients (male:17, female:13) with a mean age of 55.96 ± 7.68 years were included in Dynesys group and the PLIF group included 45 patients (male:21, female:24) with a mean age of 54.69 ± 3.26 years. The average followup in Dynesys group and PLIF group was 2.22 ± 0.43 year (range 2-3.5 year) and 2.17 ± 0.76 year (range 2-3 year), respectively. Dynesys group showed a shorter operation time (141.06 ± 11.36 min vs. 176.98 ± 6.72 min, P < 0.001) and less intraoperative blood loss (386.76 ± 19.44 ml vs. 430.11 ± 24.72 ml, P < 0.001). For Dynesys group, visual analogue scale (VAS) for back and leg pain improved from 6.87 ± 0

  14. Stability and Load Sharing Characteristics of a Posterior Dynamic Stabilization Device

    PubMed Central

    Cook, Daniel J.; Yeager, Matthew S.; Thampi, Shankar S.; Whiting, Donald M.

    2015-01-01

    Background Lumbar interbody fusion is a common treatment for a variety of spinal pathologies. It has been hypothesized that insufficient mechanical loading of the interbody graft can prevent proper fusion of the joint. The purpose of this study was to evaluate the mechanical stability and anterior column loading sharing characteristics of a posterior dynamic system compared to titanium rods in an anterior lumbar interbody fusion (ALIF) model. Methods Range of motion, interpedicular kinematics and interbody graft loading were measured in human cadaveric lumbar segments tested under a pure moment flexibility testing protocol. Results Both systems provided significant fixation compared to the intact condition and to an interbody spacer alone in flexion extension and lateral bending. No significant differences in fixation were detected between the devices. A significant decrease in graft loading was detected in flexion for the titanium rod treatment compared to spacer alone. No significant differences in graft loading were detected between the spacer alone and posterior dynamic system or between the posterior dynamic system and the titanium rod. Conclusions The results of this study indicate that the posterior dynamic system provides similar fixation compared to that of a titanium rod, however, studies designed to evaluate the efficacy of fixation in a cadaver model may not be sufficiently powered to establish differences in load sharing using the techniques described here. PMID:26131403

  15. Sleep apnoea adversely affects the outcome in patients who undergo posterior lumbar fusion

    PubMed Central

    Stundner, O.; Chiu, Y-L.; Sun, X.; Ramachandran, S-K.; Gerner, P.; Vougioukas, V.; Mazumdar, M.; Memtsoudis, S. G.

    2014-01-01

    Despite the increasing prevalence of sleep apnoea, little information is available regarding its impact on the peri-operative outcome of patients undergoing posterior lumbar fusion. Using a national database, patients who underwent lumbar fusion between 2006 and 2010 were identified, sub-grouped by diagnosis of sleep apnoea and compared. The impact of sleep apnoea on various outcome measures was assessed by regression analysis. The records of 84 655 patients undergoing posterior lumbar fusion were identified and 7.28% also had a diagnostic code for sleep apnoea. Compared with patients without sleep apnoea, these patients were older, more frequently female, had a higher comorbidity burden and higher rates of peri-operative complications, post-operative mechanical ventilation, blood transfusion, and intensive care. Patients with sleep apnoea also had longer and more costly periods of hospitalisation. In the regression analysis, sleep apnoea emerged as an independent risk factor for the development of peri-operative complications (Odds Ratio (OR) 1.50, Confidence Interval (CI) 1.38;1.62), blood transfusions (OR 1.12, CI 1.03;1.23), mechanical ventilation (OR 6.97, CI 5.90;8.23), critical care services (OR 1.86, CI 1.71;2.03), prolonged hospitalisation and increased cost (OR 1.28, CI 1.19;1.37; OR 1.10, CI 1.03;1.18). Patients with sleep apnoea who undergo posterior lumbar fusion pose significant challenges to clinicians. PMID:24493191

  16. Clinical outcomes of two types of cages used in transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases: n-HA/PA66 cages versus PEEK cages.

    PubMed

    Deng, Qian-xing; Ou, Yun-sheng; Zhu, Yong; Zhao, Zeng-hui; Liu, Bo; Huang, Qiu; Du, Xing; Jiang, Dian-ming

    2016-06-01

    This study reports the clinical effects of nano-hydroxyapatite/polyamide66 cages (n-HA/PA66 cages) and compares the clinical outcomes between n-HA/PA66 and polyetheretherketone cages (PEEK cages) for application in transforaminal lumbar interbody fusion (TLIF). A retrospective and case-control study involving 124 patients using n-HA/PA66 cages and 142 patients using PEEK cages was conducted. All patients underwent TLIF and had an average of 2-years of follow-up. The Oswestry Disability Index and Visual Analog Scale were selected to assess the pain of low back and leg, as well as neurological status. The intervertebral space height and segmental angle were also measured to estimate the radiological changes. At the 1-year and final follow-ups, the fusion and subsidence rates were evaluated. There was no significant difference between the two groups regarding clinical and radiological results. At the final follow-up, the bony fusion rate was 92.45 and 91.57 % for the n-HA/PA66 and PEEK groups, respectively, and the subsidence rate was 7.55 and 8.99 %, respectively. The study indicated that both n-HA/PA66 and PEEK cages could promote effective clinical and radiographic outcomes when used to treat degenerative lumbar diseases. The high fusion and low subsidence rates revealed that n-HA/PA66 cages could be an alternative ideal choice as the same to PEEK cages for lumbar reconstruction after TLIF. PMID:27091044

  17. Posterior Interspinous Fusion Device for One-Level Fusion in Degenerative Lumbar Spine Disease : Comparison with Pedicle Screw Fixation - Preliminary Report of at Least One Year Follow Up

    PubMed Central

    Kim, Ho Jung; Chun, Hyoung Joon; Oh, Suck Jun; Kang, Tae Hoon; Yang, Moon Sool

    2012-01-01

    Objective Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. Methods From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. Results The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16±2.1 and 8.03±2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3±2.9 and 1.2±3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029). Conclusion Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case. PMID:23133725

  18. Clinical Use of 3D Printing Guide Plate in Posterior Lumbar Pedicle Screw Fixation.

    PubMed

    Chen, Hongliang; Wu, Dongying; Yang, Huilin; Guo, Kaijin

    2015-01-01

    BACKGROUND This study aimed to evaluate the clinical efficacy of use of a 3D printing guide plate in posterior lumbar pedicle screw fixation. MATERIAL AND METHODS We enrolled 43 patients receiving posterior lumbar pedicle screw fixation. The experimental group underwent 3D printing guide plate-assisted posterior lumbar pedicle screw fixation, while the control group underwent traditional x-ray-assisted posterior lumbar pedicle screw fixation. After surgery, CT scanning was done to evaluate the accuracy of screw placement according to the Richter standard. RESULTS All patients were followed up for 1 month. The mean time of placement for each screw and the amount of hemorrhage was 4.9±2.1 min and 8.0±11.1 mL in the experimental group while 6.5±2.2 min and 59.9±13.0 mL in the control group, respectively, with significant differences (p<0.05). The fluoroscopy times of each screw placement was 0.5±0.4 in the experimental group, which was significantly lower than that in the control group 1.2±0.7 (p<0.05). The excellent and good screw placement rate was 100% in the experimental group and 98.4% in the control group, without any statistical difference (P>0.05). No obvious complications were reported in either group. CONCLUSIONS Compared with the traditional treatment methods, the intra-operative application of 3D printing guide plate can shorten the operation time and reduce the amount of hemorrhage. It can also reduce the fluoroscopy times compared with the traditional fluoroscopy, which cannot improve the accuracy rate of screw placement. PMID:26681388

  19. Evaluation of Outcome of Posterior Decompression and Instrumented Fusion in Lumbar and Lumbosacral Tuberculosis

    PubMed Central

    Jain, Ravikant; Kiyawat, Vivek

    2016-01-01

    Background For surgical treatment of lumbar and lumbosacral tuberculosis, the anterior approach has been the most popular approach because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The posterior approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach. The purpose of this study was to evaluate the outcome (functional, neurological, and radiological) in patients with lumbar and lumbosacral tuberculosis operated through the posterior approach. Methods Twenty-eight patients were diagnosed with tuberculosis of the lumbar and lumbosacral region from August 2012 to August 2013. Of these, 13 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent posterior decompression and pedicle screw fixation with posterolateral fusion. Antitubercular therapy was given till signs of radiological healing were evident (9 to 16 months). Functional outcome (visual analogue scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediately postoperatively and 3 months, 6 months, and 1 year postoperatively. Results The mean VAS score for back pain improved from 7.89 (range, 9 to 7) preoperatively to 2.2 (range, 3 to 1) at 1-year follow-up. Frankel grading was grade B in 3, grade C in 7, and grade D in 3 patients preoperatively, which improved to grade D in 7 and grade E in 6 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. The mean correction of segmental kyphosis was 9.85° postoperatively. The mean loss of correction at final follow-up was 3.15°. Conclusions

  20. Clinical Use of 3D Printing Guide Plate in Posterior Lumbar Pedicle Screw Fixation

    PubMed Central

    Chen, Hongliang; Wu, Dongying; Yang, Huilin; Guo, Kaijin

    2015-01-01

    Background This study aimed to evaluate the clinical efficacy of use of a 3D printing guide plate in posterior lumbar pedicle screw fixation. Material/Methods We enrolled 43 patients receiving posterior lumbar pedicle screw fixation. The experimental group underwent 3D printing guide plate-assisted posterior lumbar pedicle screw fixation, while the control group underwent traditional x-ray-assisted posterior lumbar pedicle screw fixation. After surgery, CT scanning was done to evaluate the accuracy of screw placement according to the Richter standard. Results All patients were followed up for 1 month. The mean time of placement for each screw and the amount of hemorrhage was 4.9±2.1 min and 8.0±11.1 mL in the experimental group while 6.5±2.2 min and 59.9±13.0 mL in the control group, respectively, with significant differences (p<0.05). The fluoroscopy times of each screw placement was 0.5±0.4 in the experimental group, which was significantly lower than that in the control group 1.2±0.7 (p<0.05). The excellent and good screw placement rate was 100% in the experimental group and 98.4% in the control group, without any statistical difference (P>0.05). No obvious complications were reported in either group. Conclusions Compared with the traditional treatment methods, the intra-operative application of 3D printing guide plate can shorten the operation time and reduce the amount of hemorrhage. It can also reduce the fluoroscopy times compared with the traditional fluoroscopy, which cannot improve the accuracy rate of screw placement. PMID:26681388

  1. Posterior-Only Circumferential Decompression and Reconstruction in the Surgical Management of Lumbar Vertebral Osteomyelitis.

    PubMed

    Skovrlj, Branko; Guzman, Javier Z; Caridi, John; Cho, Samuel K

    2016-02-01

    Study Design Case report. Objective The purpose of this report is to discuss the surgical management of lumbar vertebral osteomyelitis with a spinal epidural abscess (SEA) and present a single-stage, posterior-only circumferential decompression and reconstruction with instrumentation using an expandable titanium cage and without segmental nerve root sacrifice as an option in the treatment of this disease process. Methods We report a 42-year-old man who presented with 3 days of low back pain and chills who rapidly decompensated with severe sepsis following admission. Magnetic resonance imaging of his lumbosacral spine revealed intramuscular abscesses of the left paraspinal musculature and iliopsoas with SEA and L4 vertebral body involvement. The patient failed maximal medical treatment, which necessitated surgical treatment as a last resort for infectious source control. He underwent a previously undescribed procedure in the setting of SEA: a single-stage, posterior-only approach for circumferential decompression and reconstruction of the L4 vertebral body with posterior segmental instrumented fixation. Results After the surgery, the patient's condition gradually improved; however, he suffered a wound dehiscence necessitating a surgical exploration and deep wound debridement. Six months after the surgery, the patient underwent a revision surgery for adjacent-level pseudarthrosis. At 1-year follow-up, the patient was pain-free and off narcotic pain medication and had returned to full activity. Conclusion This patient is the first reported case of lumbar osteomyelitis with SEA treated surgically with a single-stage, posterior-only circumferential decompression and reconstruction with posterior instrumentation. Although this approach is more technically challenging, it presents another viable option for the treatment of lumbar vertebral osteomyelitis that may reduce the morbidity associated with an anterior approach. PMID:26835214

  2. Retrospective Comparison of Radiological and Clinical Outcomes of PLIF and TLIF Techniques in Patients Who Underwent Lumbar Spinal Posterior Stabilization

    PubMed Central

    Asil, Kiyasettin; Yaldiz, Can

    2016-01-01

    Abstract Degenerative disc disease and spinal stenosis lead to various symptoms. Degeneration of facet joints is added to this degenerative process with aging. Seventy-four patients who were admitted to the Spinal Column Outpatient Clinic of the Neurosurgery Department with a diagnosis of degenerative narrow spinal canal and lumbar spondylolisthesis between 2011 and 2013 and who underwent surgery were included in the study. Our study was conducted with 74 patients of whom 73.0% (n = 54) were female and 27.0% (n = 20) were male. Mean age was 54.86 ± 7.87 years (range 34–74). Although we did not detect a difference between the two surgical methods with regard to clinical improvement, transforaminal lumbar interbody fusion (TLIF) is preferred due to radiological advantages observed one year later, ease of application, and the development of fewer complications. PMID:27124016

  3. More nerve root injuries occur with minimally invasive lumbar surgery: Let's tell someone

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: In a recent study entitled: “More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion (XLIF): A review”, Epstein documented that more nerve root injuries occurred utilizing minimally invasive surgery (MIS) versus open lumbar surgery for diskectomy, decompression of stenosis (laminectomy), and/or fusion for instability. Methods: In large multicenter Spine Patient Outcomes Research Trial reviews performed by Desai et al., nerve root injury with open diskectomy occurred in 0.13–0.25% of cases, occurred in 0% of laminectomy/stenosis with/without fusion cases, and just 2% for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion. Results: In another MIS series performed largely for disc disease (often contained nonsurgical disc herniations, therefore unnecessary procedures) or spondylolisthesis, the risk of root injury was 2% for transforaminal lumbar interbody fusion (TLIF) versus 7.8% for posterior lumbar interbody fusion (PLIF). Furthermore, the high frequencies of radiculitis/nerve root/plexus injuries incurring during anterior lumbar interbody fusions (ALIF: 15.8%) versus extreme lumbar interbody fusions (XLIF: 23.8%), addressing disc disease, failed back surgery, and spondylolisthesis, were far from acceptable. Conclusions: The incidence of nerve root injuries following any of the multiple MIS lumbar surgical techniques (TLIF/PLIF/ALIF/XLIF) resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques. Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients? PMID:26904373

  4. 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

    PubMed Central

    Etemadifar, Mohammad Reza; Hadi, Abdollah; Masouleh, Mehran Feizi

    2016-01-01

    Background: Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although posterolateral fusion and pedicle screw fixation are a relatively common treatment method for the treatment of spondylolisthesis, controversy exists about the necessity of adding interbody fusion to posterolateral fusion. The aim of our study was to assess the functional disability, pain, and complications in patients with spondylolisthesis treated by posterolateral instrumented fusion (PLF) with and without transforaminal lumbar interbody fusion (TLIF) in a randomized clinical trial. Materials and Methods: From February 2007 to February 2011, 50 adult patients with spondylolisthesis were randomly assigned to be treated with PLF or PLF+TLIF techniques (25 patients in each group) by a single surgeon. Back pain, leg pain, and disability were assessed before treatment and until 2 years after surgical treatment using visual analog scale (VAS) and oswestry disability index (ODI). Patients were also evaluated for postoperative complications such as infection, neurological complications, and instrument failure. Results: All patients completed the 24 months of follow-up. Twenty patients were females and 30 were males. Average age of the patients was 53 ± 11 years for the PLF group and 51 ± 13 for the PLF + TLIF group. Back pain, leg pain, and disability score were significantly improved postoperatively compared to preoperative scores (P < 0.001). At 3 months of follow-up, there was no statistically significant difference in VAS score for back pain and leg pain in both groups; however, after 6 months and 1 year and 2 years follow-up, the reported scores for back pain and leg pain were significantly lower in the PLF+TLIF group (P < 0.05). The ODI score was also significantly lower in the PLF+TLIF group at 1 year and 2 years of follow-up (P < 0.05). One screw breakage and one superficial infection occurred in the PLF+TLIF group, which had no statistical significance (P = 0

  5. The SNAP trial: a double blind multi-center randomized controlled trial of a silicon nitride versus a PEEK cage in transforaminal lumbar interbody fusion in patients with symptomatic degenerative lumbar disc disorders: study protocol

    PubMed Central

    2014-01-01

    Background Polyetheretherketone (PEEK) cages have been widely used in the treatment of lumbar degenerative disc disorders, and show good clinical results. Still, complications such as subsidence and migration of the cage are frequently seen. A lack of osteointegration and fibrous tissues surrounding PEEK cages are held responsible. Ceramic implants made of silicon nitride show better biocompatible and osteoconductive qualities, and therefore are expected to lower complication rates and allow for better fusion. Purpose of this study is to show that fusion with the silicon nitride cage produces non-inferior results in outcome of the Roland Morris Disability Questionnaire at all follow-up time points as compared to the same procedure with PEEK cages. Methods/Design This study is designed as a double blind multi-center randomized controlled trial with repeated measures analysis. 100 patients (18–75 years) presenting with symptomatic lumbar degenerative disorders unresponsive to at least 6 months of conservative treatment are included. Patients will be randomly assigned to a PEEK cage or a silicon nitride cage, and will undergo a transforaminal lumbar interbody fusion with pedicle screw fixation. Primary outcome measure is the functional improvement measured by the Roland Morris Disability Questionnaire. Secondary outcome parameters are the VAS leg, VAS back, SF-36, Likert scale, neurological outcome and radiographic assessment of fusion. After 1 year the fusion rate will be measured by radiograms and CT. Follow-up will be continued for 2 years. Patients and clinical observers who will perform the follow-up visits will be blinded for type of cage used during follow-up. Analyses of radiograms and CT will be performed independently by two experienced radiologists. Discussion In this study a PEEK cage will be compared with a silicon nitride cage in the treatment of symptomatic degenerative lumbar disc disorders. To our knowledge, this is the first randomized controlled

  6. Combined Anterior and Posterior Lumbar Rhizotomy for Treatment of Mixed Dystonia and Spasticity in Children With Cerebral Palsy

    PubMed Central

    Nada, Mohamed; Mahran, Mahmoud A.; Aboud, Ahmed; Mahran, Moustafa G.; Nasef, Marwa A.A.; Gaber, Mohamed; Sabry, Tamer; Ibrahim, Mohamed H.; Taha, Mohamed H.

    2016-01-01

    BACKGROUND: Children with cerebral palsy (CP) can present with severe secondary dystonia with or without associated spasticity of their extremities. OBJECTIVE: To assess the outcomes of combined anterior and posterior lumbar rhizotomy for the treatment of mixed hypertonia in the lower extremities of children with CP. METHODS: Fifty children with CP were subjected to combined anterior and posterior lumbar rhizotomies in a prospective study. Clinical outcome measurements were recorded preoperatively and were evaluated at 2, 6, and 12 months postoperatively. The operative techniques were performed by laminotomy from L1-S1, and intraoperative monitoring was used in all cases. All patients underwent intensive postoperative physiotherapy programs. RESULTS: Changes in muscle tone, joint range of motion, and dystonia were significant (P = .000) at postoperative assessment visits. CONCLUSION: This study demonstrated the potential of combined anterior and posterior lumbar rhizotomies to improve activities of daily living in children with CP and with mixed spasticity and dystonia. ABBREVIATIONS: BAD, Barry-Albright Dystonia Scale CAPR, combined anterior and posterior lumbar rhizotomy CP, cerebral palsy ITB, intrathecal baclofen MAS, modified Ashworth Scale ROM, range of motion SDR, selective dorsal rhizotomy PMID:27244465

  7. Two one-stage posterior approaches for treating thoracic and lumbar spinal tuberculosis: A retrospective case-control study

    PubMed Central

    XU, ZHENGQUAN; WANG, XIYANG; SHEN, XIONGJIE; WU, PING; PANG, XIAOYANG; LUO, CHENGKE; ZENG, HAO

    2015-01-01

    The aim of this retrospective study was to analyze the results of two surgical treatments for thoracic and lumbar spinal tuberculosis. A total of 73 patients with monosegmental thoracic or lumbar spinal tuberculosis were enrolled from January 2006 to April 2011. The patients were divided into two groups. Patients in group A (n=34) underwent one-stage posterior debridement, limited decompression, bone grafting and internal fixation combined with lamina reconstruction, while those in group B (n=39) underwent one-stage posterior debridement, decompression, bone grafting and posterior instrumentation. Clinical and radiographic results were analyzed and compared between the groups. Patients were followed for a mean 31.3 months (range, 21–42 months). Fusion occurred at 4–12 months (mean, 7.7 months). Surgical complications affected one and five patients in groups A and B, respectively. There was extraction of internal fixation in two group B patients. Postoperatively, there was significant Cobb angle correction in the two groups. By the last follow-up, the Cobb angle and correction loss in group A were significantly better than that in group B; the group A Oswestry Disability Index and Frankel grade were better than that in group B. In conclusion, one-stage posterior limited decompression, bone grafting and internal fixation combined with lamina reconstruction enables rapid management of monosegmental thoracic and lumbar spinal tuberculosis with fewer complications and minimal invasion. PMID:26136972

  8. Conservative management of psoas haematoma following complex lumbar surgery

    PubMed Central

    Lakkol, Sandesh; Sarda, Praveen; Karpe, Prasad; Krishna, Manoj

    2014-01-01

    We report psoas hematoma communicating with extradural hematoma and compressing on lumbar nerve roots during the postoperative period in a patient who underwent L3/4 level dynamic stabilization and L4/5 and L5/S1 posterior lumbar interbody fusion. Persistent radicular symptoms occurring soon after posterior lumbar surgery are not an unknown entity. However, psoas hematoma communicating with the extradural hematoma and compressing on L4 and L5 nerve roots soon after surgery, leading to radicular symptoms has not been reported. In addition to the conservative approach in managing such cases, this case report also emphasizes the importance of clinical evaluation and utilization of necessary imaging techniques such as computed tomography (CT) scan and magnetic resonance imaging (MRI) scan to diagnose the cause of persistent severe radicular pain in the postoperative period. PMID:24600073

  9. Percutaneous Transforaminal Lumbar Interbody Fusion (pTLIF) with a Posterolateral Approach for the Treatment of Degenerative Disk Disease: Feasibility and Preliminary Results

    PubMed Central

    Morgenstern, Christian

    2015-01-01

    Background Interbody fusion by open discectomy is the usual treatment for degenerative disk disease but requires a relatively long recovery period. The transforaminal posterolateral approach is a well-known standard in endoscopic spine surgery that allows direct access to the disk with progressive tissue dilation. The aim of this study was to assess the feasibility of percutaneous transforaminal interbody fusion (pTLIF) with insertion of an expandable or a standard rigid interbody implant for patients with degenerative disk disease with or without spondylolisthesis and for revision surgery. Methods Between 2009 and 2014, the pTLIF procedure was performed in 30 patients. Ten patients underwent insertion of a rigid implant (group A) and the remaining 20 underwent insertion of an expandable titanium interbody implant as the initial procedure (n = 10) (group B) or after failed back surgery (n = 10) (group C). Patient outcomes were scored with visual analogic scale (VAS), Oswestry disability index (ODI) and modified Macnab criteria. Results The mean follow-up period was 38 (17) (range 11 to 67) months. The outcome was excellent in 18, good in 10 and fair in 2. No poor results and no major complications were reported. No differences in VAS and ODI scores according to the study group were found. Median postoperative time until hospital discharge was 26 hours (20 to 68 hours). Postoperative values for VAS and ODI scores improved significantly (p<0.05) compared to preoperative data in all study groups. Conclusions These preliminary results have shown the feasibility and efficacy of the pTLIF procedure using a posterolateral approach for the treatment of degenerative disk disease with or without spondylolisthesis up to grade 2 and in revision surgery. No significant differences in outcome were observed between an expandable and a rigid cage. Median postoperative time until hospital discharge was faster compared to standard TLIF (26 hours vs. 9.3 days). PMID:26484004

  10. Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

    PubMed Central

    Lykissas, Marios G; Aichmair, Alexander

    2013-01-01

    Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into sub-categories based on the part of the vertebral column that is addressed (anterior vs posterior). Furthermore, one has to differentiate between approaches aiming at a solid fusion in contrast to motion-sparing techniques with the proposed advantage of a reduced risk of developing adjacent disc disease. However, the field of application and long-term outcomes of these novel motion-preserving surgical techniques, including facet arthroplasty, nucleus replacement, and lumbar disc arthroplasty, need to be more precisely evaluated in long-term prospective studies. Innovative surgical treatment strategies involving minimally invasive techniques, such as lateral lumbar interbody fusion or transforaminal lumbar interbody fusion, as well as percutaneous implantation of transpedicular or transfacet screws, have been established with the reported advantages of reduced tissue invasiveness, decreased collateral damage, reduced blood loss, and decreased risk of infection. The aim of this study was to review well-established procedures for lumbar spinal fusion with the main focus on current concepts on spinal arthrodesis and motion-sparing techniques in degenerative disorders of the lumbar spine. PMID:24303453

  11. Posterior reversible encephalopathy syndrome: temporary visual loss after spinal deformity surgery.

    PubMed

    Kueper, Janina; Loftus, Michael L; Boachie-Adjei, Oheneba; Lebl, Darren

    2015-11-01

    Posterior reversible encephalopathy syndrome (PRES) is a rare cause of temporary postoperative visual loss (POVL) after spinal deformity surgery. We report on 2 patients diagnosed with PRES after spinal deformity surgery, who were closely examined postoperatively. A 78-year-old woman with severe disability due to degenerative lumbar spondylosis after laminectomy was treated with transpsoas lumbar interbody fusion from L1 to L4 and posterior spinal fusion from T10 to pelvis. She developed confusion and bilateral visual loss on postoperative day 7. A second patient, a 51-year-old woman with progressive pain and decompensation caused by adult scoliosis, was treated with posterior spinal fusion from T3 to pelvis and interbody fusion from L4 to S1 via a presacral interbody fusion approach. She developed bilateral visual loss on postoperative day 15. Both patients achieved a complete recovery of their vision after medical management of PRES. Timely diagnosis of PRES and prompt intervention allow for a good patient prognosis and complete recovery of eyesight. PMID:26566564

  12. Congenital Posterior Spinal Agenesis Leads to L2-L3 Instability: a Case Report and Review of the Literature.

    PubMed

    Samadian, Mohammad; Hosseinzadeh Bakhtevari, Mehrdad; Jahangiri Babadi, Armin; Nabizadeh, Naveed; Rezaei, Omidvar

    2015-12-01

    Congenital absence of posterior elements of the lumbar column is an extremely uncommon anomaly and we found no any reported cases of incomplete congenital absence of the posterior elements of lumbar vertebra in the literature.  Here, we present a case with congenital absence of posterior elements of lumbar vertebra. The patient was a 51-year-old man with a history of 20 years of back pain. Imaging of the lumbar spine revealed instability in L2 and L3 and there was evidence of retrolisthesis, agenesis of pars interarticularis, spinous processes, lamina, transverse processes and facets at L2 and L3. The patient underwent lumbar discectomy and posterior spinal fixation and instrumentation was then done using pedicle screw fixation. Four pedicle screws, two rods, and one cross link were employed to bilaterally fix the L2 and L3 and then we used autograft and allograft bone for interbody fusion, substitutes from iliac crest for posterior fusion. There were no postoperative complications, and at 6, 12 and 24 months of follow-up, his leg and back pain had improved, and the patient did not need any analgesic for pain relief. Complete congenital absence of the lumbar posterior element has been rarely reported in the literature. Patients whose congenital anomalies lead to segmental instability are surgical fusion candidates, but if these anomalies occur in pars interarticularis such as spondylolysis isthmus, fixation and inter segmental fusion techniques are useful. PMID:26621021

  13. Time-sequential changes of differentially expressed miRNAs during the process of anterior lumbar interbody fusion using equine bone protein extract, rhBMP-2 and autograft

    NASA Astrophysics Data System (ADS)

    Chen, Da-Fu; Zhou, Zhi-Yu; Dai, Xue-Jun; Gao, Man-Man; Huang, Bao-Ding; Liang, Tang-Zhao; Shi, Rui; Zou, Li-Jin; Li, Hai-Sheng; Bünger, Cody; Tian, Wei; Zou, Xue-Nong

    2014-03-01

    The precise mechanism of bone regeneration in different bone graft substitutes has been well studied in recent researches. However, miRNAs regulation of the bone formation has been always mysterious. We developed the anterior lumbar interbody fusion (ALIF) model in pigs using equine bone protein extract (BPE), recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS), and autograft as bone graft substitute, respectively. The miRNA and gene expression profiles of different bone graft materials were examined using microarray technology and data analysis, including self-organizing maps, KEGG pathway and Biological process GO analyses. We then jointly analyzed miRNA and mRNA profiles of the bone fusion tissue at different time points respectively. Results showed that miRNAs, including let-7, miR-129, miR-21, miR-133, miR-140, miR-146, miR-184, and miR-224, were involved in the regulation of the immune and inflammation response, which provided suitable inflammatory microenvironment for bone formation. At late stage, several miRNAs directly regulate SMAD4, Estrogen receptor 1 and 5-hydroxytryptamine (serotonin) receptor 2C for bone formation. It can be concluded that miRNAs play important roles in balancing the inflammation and bone formation.

  14. Early failure of lumbar disc replacement: case report and review of the literature.

    PubMed

    Stieber, Jonathan R; Donald, Gordon D

    2006-02-01

    We report a case of a patient who underwent two-level lumbar total disc replacement at L4-L5 and L5-S1 with the ProDisc II prosthesis, who was diagnosed with early anterior migration of the caudally placed device with partial occlusion of the left common iliac vein. The device was explanted and revised to an anterior lumbar interbody fusion with posterior instrumented fusion. Despite the substantial experience with lumbar disc arthroplasty in Europe and the United States, there exist few reports of device explantation or revision. To our knowledge, early postoperative vascular complications, while discussed hypothetically, have not been reported. With implantation of the total disc replacement in proximity to the great vessels, the potential for vascular complications is clearly substantial. The technical aspects of the device explantation are discussed as well as issues pertinent to early failure. A literature review of device complications associated with lumbar total disc replacement is also presented. PMID:16462220

  15. Posterior Epidural Migration of a Sequestrated Lumbar Disk Fragment Causing Cauda Equina Syndrome in an Old Patient: A Case Report

    PubMed Central

    Haddadi, Kaveh; Qazvini, Hamid Reza Ganjeh

    2016-01-01

    Disk fragment relocation is commonly limited to the anterior epidural space, although posterior epidural movement of a sequestrated disk piece to the posterior epidural space is infrequent. We present an uncommon case of dorsal extradural sequestration of lumbar disk herniation. A 77-year-old man presented with severe leg pain, low back pain, and urinary incontinence. Deep tendon reflexes were inattentive at the knee and ankle, and the motor power in terms of ankle dorsiflexion and great toe dorsiflexion was 2/5 in both lower limbs. There was hypoesthesia in the S1, S2, and S3 dermatomes. Magnetic resonance imaging displayed a large isointensity lesion at the L4–L5 level on the T2 sagittal image, indenting circumferentially the thecal sac from lateral to posterior of the thecal sac. The patient underwent an L4–L5 central laminectomy. A large, solid epidural disk fragment was recognized dorsally, with major compression of the thecal sac. The patient report improved lower extremity motor function at three-month follow-up. A displaced disk fragment should be considered as causative when patients present with cauda equine syndrome and be treated as a surgical emergency. PMID:27257401

  16. 100 Consecutive Cases of Degenerative Lumbar Conditions Using a Non-Threaded Locking Screw System With a 90-Degree Locking Cap

    PubMed Central

    Cunningham, Bryan W.; Tortolani, P. Justin; Fedder, Ira L.; Sefter, John C.; Davis, Charles

    2009-01-01

    Background This prospective study analyzes the perioperative outcomes and long-term fusion success of 100 consecutive lumbar degenerative cases. The cases were managed using a non-threaded locking screw system, in conjunction with polyetheretherketone (PEEK) cages, for posterior lumbar interbody fusion (PLIF) procedures. These 100 cases were compared to another prospective study treating patients with the same inclusion and exclusion criteria using conventional plate-based pedicle screw spinal instrumentation augmented with carbon fiber interbody cages. Methods A total of 167 operative levels were treated in 100 patients (51 single-level, 39 two-level and 10 three-level cases). Eleven cases were revisions and 67 patients received interbody fusion cages. Patients had an average of 22.8 ± 4.0 months followup. Results: There was one instrumentation failure but no significant subsidence at the interbody fusion level. The disc space height was restored as part of the surgical procedure at the interbody cage levels: from 7.5 ± 2.3 mm preoperative to 9.0 ± 2.1 mm postoperative. There were 2 cases of pseudarthrosis (2 / 100 = 2%). The average operative time for 1-level cases was 111 ± 25 minutes; for 2-level cases it was 132.4 ± 21.8 minutes; and for 3-level cases it was 162.6 ± 33 minutes. Blood loss averaged 800 ± 473 cc for 1-level cases, 1055 ± 408 cc for 2 levels, and 1155 ± 714 cc for 3 levels. The length of stay was similar between the 3 groups (4.4 ± 1.2 days for single-level cases, 4.7 ± 1.1 for 2 levels, and 5.0 ± 1.1 for 3 levels; P > .05). There were 3 incidental durotomies, and 4 other patients developed infections postoperatively that required reoperation. Conclusion The disc and foraminal heights can be restored and maintained with a unilateral cage and pedicle screw construct. Unilateral transforaminal lumbar interbody fusion using a PEEK cage combined with a non-threaded locking pedicle screw and rod system results in similar fusion rates to

  17. Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain

    PubMed Central

    Deukmedjian, Ara J; Cianciabella, Augusto J; Cutright, Jason; Deukmedjian, Arias

    2015-01-01

    Background: Lumbar fusion is a proven treatment for chronic lower back pain (LBP) in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD). Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD. Materials and Methods: Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS), patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS). Results: The average resolution of preoperative back pain per patient was 84% (n = 205) while the average resolution of preoperative leg pain was 90% (n = 190) while a mean follow-up period of 528 days (1.5 years). Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001), a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4). Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4). Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge. Conclusion: Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain. PMID:26692696

  18. Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty.

    PubMed

    Jackson, Keith L; Hire, Justin M; Jacobs, Jeremy M; Key, Charles C; DeVine, John G

    2015-06-01

    To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy. Radiographs and a computed tomography myelogram revealed an implant malposition posteriorly with heterotopic bone formation in the canal, causing an impingement of the traversing nerve root. Revision surgery was performed with implant extraction, L5/S1 anterior lumbar interbody fusion, supplemental posterior decompression, and pedicle screw fixation. The patient tolerated the procedure well, with complete resolution of the radicular leg pain. At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone. This case represents a novel pattern of heterotopic ossification, and it describes a previously unreported cause for implant failure in lumbar disc replacement surgery-reinforcing the importance of proper intraoperative component positioning. We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO. PMID:26097664

  19. Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty

    PubMed Central

    Jackson, Keith L.; Jacobs, Jeremy M.; Key, Charles C.; DeVine, John G.

    2015-01-01

    To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy. Radiographs and a computed tomography myelogram revealed an implant malposition posteriorly with heterotopic bone formation in the canal, causing an impingement of the traversing nerve root. Revision surgery was performed with implant extraction, L5/S1 anterior lumbar interbody fusion, supplemental posterior decompression, and pedicle screw fixation. The patient tolerated the procedure well, with complete resolution of the radicular leg pain. At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone. This case represents a novel pattern of heterotopic ossification, and it describes a previously unreported cause for implant failure in lumbar disc replacement surgery-reinforcing the importance of proper intraoperative component positioning. We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO. PMID:26097664

  20. Lateral retroperitoneal transpsoas interbody fusion in a patient with achondroplastic dwarfism.

    PubMed

    Staub, Blake N; Holman, Paul J

    2015-02-01

    The authors present the first reported use of the lateral retroperitoneal transpsoas approach for interbody arthrodesis in a patient with achondroplastic dwarfism. The inherent anatomical abnormalities of the spine present in achondroplastic dwarfism predispose these patients to an increased incidence of spinal deformity as well as neurogenic claudication and potential radicular symptoms. The risks associated with prolonged general anesthesia and intolerance of significant blood loss in these patients makes them ideal candidates for minimally invasive spinal surgery. The patient in this case was a 51-year-old man with achondroplastic dwarfism who had a history of progressive claudication and radicular pain despite previous extensive lumbar laminectomies. The lateral retroperitoneal transpsoas approach was used for placement of interbody cages at L1/2, L2/3, L3/4, and L4/5, followed by posterior decompression and pedicle screw instrumentation. The patient tolerated the procedure well with no complications. Postoperatively his claudicatory and radicular symptoms resolved and a CT scan revealed solid arthrodesis with no periimplant lucencies. PMID:25415482

  1. Older literature review of increased risk of adjacent segment degeneration with instrumented lumbar fusions

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: Adjacent segment degeneration (ASD) following lumbar spine surgery occurs in up to 30% of cases, and descriptions of such changes are not new. Here, we review some of the older literature concerning the rate of ASD, typically more severe cephalad than caudad, and highly correlated with instrumented fusions. Therefore, for degenerative lumbar disease without frank instability, ASD would be markedly reduced by avoiding instrumented fusions. Methods: In a prior review, the newer literature regarding the frequency of ASD following lumbar instrumented fusions (e.g., transforaminal or posterior lumbar interbody fusions [TLIF/PLIF] fusions or occasionally, posterolateral fusions [PLFs]) was presented. Some studies cited an up to an 18.5% incidence of ASD following instrumented versus noninstrumented fusions/decompressions alone (5.6%). A review of the older literature similarly documents a higher rate of ASD following instrumented fusions performed for degenerative lumbar disease alone. Results: More frequent and more severe ASD follows instrumented lumbar fusions performed for degenerative lumbar disease without instability. Alternatively, this entity should be treated with decompressions alone or with noninstrumented fusions, without the addition of instrumentation. Conclusions: Too many studies assume that TLIF, PLIF, and even PLF instrumented fusions are the “gold standard of care” for dealing with degenerative disease of the lumbar spine without documented instability. It is time to correct that assumption, and reassess the older literature along with the new to confirm that decompression alone and noninstrumented fusion avoid significant morbidity and even potentially mortality attributed to unnecessary instrumentation. PMID:26904370

  2. Anterior Decompression and Shortening Reconstruction with a Titanium Mesh Cage through a Posterior Approach Alone for the Treatment of Lumbar Burst Fractures

    PubMed Central

    Abe, Eiji; Miyakoshi, Naohisa; Murai, Hajime; Kobayashi, Takashi; Abe, Toshiki; Kikuchi, Kazuma; Shimada, Yoichi

    2012-01-01

    Study Design A retrospective study. Purpose To examine the efficacy and safety for a posterior-approach circumferential decompression and shortening reconstruction with a titanium mesh cage for lumbar burst fractures. Overview of Literature Surgical decompression and reconstruction for severely unstable lumbar burst fractures requires an anterior or combined anteroposterior approach. Furthermore, anterior instrumentation for the lower lumbar is restricted through the presence of major vessels. Methods Three patients with an L1 burst fracture, one with an L3 and three with an L4 (5 men, 2 women; mean age, 65.0 years) who underwent circumferential decompression and shortening reconstruction with a titanium mesh cage through a posterior approach alone and a 4-year follow-up were evaluated regarding the clinical and radiological course. Results Mean operative time was 277 minutes. Mean blood loss was 471 ml. In 6 patients, the Frankel score improved more than one grade after surgery, and the remaining patient was at Frankel E both before and after surgery. Mean preoperative visual analogue scale was 7.0, improving to 0.7 postoperatively. Local kyphosis improved from 15.7° before surgery to -11.0° after surgery. In 3 cases regarding the mid to lower lumbar patients, local kyphosis increased more than 10° by 3 months following surgery, due to subsidence of the cages. One patient developed severe tilting and subsidence of the cage, requiring additional surgery. Conclusions The results concerning this small series suggest the feasibility, efficacy, and safety of this treatment for unstable lumbar burst fractures. This technique from a posterior approach alone offers several advantages over traditional anterior or combined anteroposterior approaches. PMID:22708016

  3. Effect of Using Local Intrawound Vancomycin Powder in Addition to Intravenous Antibiotics in Posterior Lumbar Surgery: Midterm Result in a Single-Center Study

    PubMed Central

    Lee, Gun-Ill; Chun, Hyoung-Joon; Choi, Kyu-Sun

    2016-01-01

    Objective We conducted this study to report the efficacy of local application of vancomycin powder in the setting of surgical site infection (SSI) of posterior lumbar surgical procedures and to figure out risk factors of SSIs. Methods From February 2013 to December 2013, SSI rates following 275 posterior lumbar surgeries of which intrawound vancomycin powder was used in combination with intravenous antibiotics (Vanco group) were assessed. Compared with 296 posterior lumbar procedures with intravenous antibiotic only group from February 2012 to December 2012 (non-Vanco group), various infection rates were assessed. Univariate and multivariate analysis to figure out risk factors of infection among Vanco group were done. Results Statistically significant reduction of SSI in Vanco group (5.5%) from non-Vanco group (10.5%) was confirmed (p=0.028). Mean follow-up period was 8 months. Rate of acute staphylococcal SSIs reduced statistically significantly to 4% compared to 7.4% of non-Vanco group (p=0.041). Deep staphylococcal infection decreased to 2 compared to 8 and deep methicillin-resistant Staphylococcus aureus infection also decreased to 1 compared to 5 in non-Vanco group. No systemic complication was observed. Statistically significant risk factors associated with SSI were diabetes mellitus, history of cardiovascular disease, length of hospital stay, number of instrumented level and history of previous surgery. Conclusion In this series of 571 patients, intrawound vancomycin powder usage resulted in significant decrease in SSI rates in our posterior lumbar surgical procedures. Patients at high risk of infection are highly recommended as a candidate for this technique. PMID:27437012

  4. [Anesthetic management of posterior lumbar spinal fusion in a patient suspected of having acute exacerbation of chronic interstitial pneumonia].

    PubMed

    Sakai, Mayuko; Takenami, Tamie; Otsuka, Tomohisa; Hayashi, Norito; Yoshino, Kazuhisa; Matsumoto, Shigehiro; Okamoto, Hirotsugu

    2014-02-01

    A patient complicated with interstitial pneumonia required emergency posterior lumbar spinal fusion. The blood gas analysis showed relatively benign values (PaO2 81 torr, PaCO2 44 torr, under room air), but the honeycombing lungs were noted in the bilateral lung fields on CT, and the KL-6 level was high (1,000 U x ml(-1)), for which the acute exacerbation of interstitial pneumonia was suspected. Sivelestat sodium administration was initiated during the surgery and continued postoperatively. During surgery, setting the FIO2 at 0.34, the P/F ratio and intra-airway pressure could be maintained at 500 and 25 mmHg, respectively. To reduce postoperative respiratory complication, anesthesia was maintained with desflurane, which is dissipated easily, and 0.5% ropivacaine 15 ml was subcutaneously injected to the surgical field at the time of wound closure to reduce the total doses of intraoperative fentanyl and postoperative analgesics. After the completion of surgery, the endotracheal tube was removed with head elevated position, and the patient was transported back to the ward. No acute exacerbation occurred thereafter, and the patient was discharged 67 days after surgery. The prediction of acute exacerbation of interstitial pneumonia is difficult. Moreover, there is no established preventive method, although the mortality is high. Therefore, physicians should be thoroughly informed about the currently available evidence, including developmental factors. PMID:24601111

  5. Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis.

    PubMed

    Caputo, Adam M; Michael, Keith W; Chapman, Todd M; Jennings, Jason M; Hubbard, Elizabeth W; Isaacs, Robert E; Brown, Christopher R

    2013-11-01

    Extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USA) is a minimally invasive lateral transpsoas approach to the thoracolumbar spine. Though the procedure is rapidly increasing in popularity, limited data is available regarding its use in deformity surgery. We aimed to evaluate radiographic correction using XLIF in adults with degenerative lumbar scoliosis. Thirty consecutive patients were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Plain radiographs were obtained on all patients preoperatively, postoperatively, and at most recent follow-up. Plain radiographic measurements of coronal Cobb angle, apical vertebral translation, segmental lordosis, global lordosis, disc height, neuroforaminal height and neuroforaminal width were made at each time point. CT scans were obtained for all patients 1 year after surgery to evaluate for fusion. There was significant improvement in multiple radiographic parameters from preoperative to postoperative. Cobb angle corrected 72.3%, apical vertebral translation corrected 59.7%, neuroforaminal height increased 80.3%, neuroforaminal width increased 7.4%, and disc height increased 116.7%. Segmental lordosis at L4-L5 increased 14.1% and global lordosis increased 11.5%. There was no significant loss of correction from postoperative to most recent follow-up. There was an 11.8% pseudoarthrosis rate at levels treated with XLIF. Complications included lateral incisional hernia (n=1), rupture of anterior longitudinal ligament (n=2), wound breakdown (n=2), cardiac instability (n=1), pedicle fracture (n=1), and nonunion requiring revision (n=1). XLIF significantly improves coronal plane deformity in patients with adult degenerative scoliosis. XLIF has the ability to correct sagittal plane deformity, although it is most effective at lower lumbar levels. PMID:23906522

  6. The VariLift® Interbody Fusion System: expandable, standalone interbody fusion

    PubMed Central

    Emstad, Erik; del Monaco, Diana Cardenas; Fielding, Louis C; Block, Jon E

    2015-01-01

    Intervertebral fusion cages have been in clinical use since the 1990s. Cages offer the benefits of bone graft containment, restored intervertebral and foraminal height, and a more repeatable, stable procedure compared to interbody fusion with graft material alone. Due to concerns regarding postoperative stability, loss of lordosis, and subsidence or migration of the implant, interbody cages are commonly used with supplemental fixation such as pedicle screw systems or anterior plates. While providing additional stability, supplemental fixation techniques increase operative time, exposure, cost, and morbidity. The VariLift® Interbody Fusion System (VariLift® system) has been developed as a standalone solution to provide the benefits of intervertebral fusion cages without the requirement of supplemental fixation. The VariLift® system, FDA-cleared for standalone use in both the cervical and lumbar spine, is implanted in a minimal profile and then expanded in situ to provide segmental stability, restored lordosis, and a large graft chamber. Preclinical testing and analyses have found that the VariLift® System is durable, and reduces stresses that may contribute to subsidence and migration of other standalone interbody cages. Fifteen years of clinical development with the VariLift® system have demonstrated positive clinical outcomes, continued patient maintenance of segmental stability and lordosis, and no evidence of implant migration. The purpose of this report is to describe the VariLift® system, including implant characteristics, principles of operation, indications for use, patient selection criteria, surgical technique, postoperative care, preclinical testing, and clinical experience. The VariLift® System represents an improved surgical option for a stable interbody fusion without requiring supplemental fixation. PMID:26060414

  7. Minimally invasive trans-sacral approach to L5-S1 interbody fusion: Preliminary results from 1 center and review of the literature

    PubMed Central

    Bradley, W. Daniel; Hisey, Michael S.; Verma-Kurvari, Sunita; Ohnmeiss, Donna D.

    2012-01-01

    Background Lumbar interbody fusion has long been used for the treatment of painful degenerative spinal conditions. The anterior approach is not feasible in some patients, and the posterior approach is associated with a risk of neural complications and possibly muscle injury. A trans-sacral technique was developed that allows access to the L5-S1 disc space. The purposes of this study were to investigate the clinical outcome of trans-sacral interbody fusion in a consecutive series of patients from 1 center and to perform a comprehensive review of the literature on this procedure. Methods A literature search using PubMed was performed to identify articles published on trans-sacral axial lumbar interbody fusion (AxiaLIF). Articles reviewed included biomechanical testing, feasibility of the technique, and clinical results. The data from our center were collected retrospectively from charts for the consecutive series, beginning with the first case, of all patients undergoing fusion using the AxiaLIF technique. In most cases, posterior instrumentation was also used. A total of 41 patients with at least 6 months’ follow-up were included (mean follow-up, 22.2 months). The primary clinical outcome measures were visual analog scales separately assessing back and leg pain and the Oswestry Disability Index. Radiographic assessment of fusion was also performed. Results In the group of 28 patients undergoing single-level AxiaLIF combined with posterior fusion, the visual analog scale scores assessing back and leg pain and mean Oswestry Disability Index scores improved significantly (P < .01). In the remaining 13 patients, back pain improved significantly with a trend for improvement in leg pain. Reoperation occurred in 19.5% of patients; in half of these, reoperation was not related to the anterior procedure. Conclusions A review of the literature found that the AxiaLIF technique was similar to other fusion techniques with respect to biomechanical properties and produced

  8. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization

    PubMed Central

    Yaldiz, Can; Yaldiz, Mahizer; Ceylan, Nehir; Kacira, Ozlem Kitiki; Ceylan, Davut; Kacira, Tibet; Kizilcay, Gokhan; Tanriverdi, Taner

    2015-01-01

    Abstract Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs. PMID:26200620

  9. Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report.

    PubMed

    Tamaki, Yasuaki; Sakai, Toshinori; Miyagi, Ryo; Nakagawa, Takefumi; Shimakawa, Tateaki; Sairyo, Koichi; Chikawa, Takashi

    2015-09-01

    A 64-year-old man was referred to the authors with low-back pain (LBP) and right leg pain with a history of previously diagnosed lumbar disc herniation (LDH) at L4-5. He had undergone 2 percutaneous endoscopic lumbar discectomies (PELDs) for the herniation at another institution, and according to the surgical record of the second surgery, a dural tear occurred intraoperatively but was not repaired. Postoperative conservative treatments such as an epidural block and blood patch had not relieved his persistent LBP or right leg pain. Upon referral to the authors, MRI and myelography revealed an intradural LDH. The herniated mass was removed by durotomy, and posterior lumbar interbody fusion was performed. His symptoms were partially improved after surgery. Primary suture is technically difficult when a dural tear occurs during PELD. Therefore, close attention should be paid to avoiding such tears, and surgeons should increase their awareness of intradural LDH as a possible postoperative complication of PELD. PMID:26068274

  10. A rare cause of ureteral injuries; simultaneous common iliac artery and ureter injury during posterior lumbar disc surgery

    PubMed Central

    Başer, Aykut; Alkış, Okan; Toktaş, Cihan; Zümrütbaş, Ali Ersin

    2016-01-01

    Major vascular injuries during lumbar disc surgery are rare but well-recognized complications. However, vascular injuries of the branches of the aorta and ureteral injuries are very rare. Although its incidence is not known definitely, it is estimated to be 1/1000. Ureteral injuries comprise less than 1% of all genitourinary traumas. In this article, we report clinical progress of a patient who had simultaneous internal iliac artery and ureteral injury during lumbar discectomy. The patient was managed with primary ureteroureterostomy. To our knowledge, this is the first case reported with simultaneous ureter and iliac artery trauma during lumbar disc surgery. PMID:27274898

  11. Clinical and Radiological Comparison of Semirigid (WavefleX) and Rigid System for the Lumbar Spine

    PubMed Central

    Kim, Do-Keun; Lim, Hyunkeun; Oh, Chang Hyun

    2016-01-01

    Objective Spinal fusion operation is an effective treatment in the spinal pathology, but it could change the physiological distribution of load at the instrumented and adjacent segments. This retrospective study compared the radiological and clinical outcomes of patients undergoing lumbar fusion with semirigid rods versus rigid rods system. Methods Using transpedicular fixation and posterior lumbar interbody fusion at the level of L4/L5, 20 patients were treated with semirigid rods (WavefleX, SR group), and 20 patients with rigid rods (titanium, RR group). Clinical and radiological outcomes were evaluated, including visual analog score for lower back pain and leg pain, Prolo functional and economic scores, statues of implanted instruments, fusion rate, and complications during 24-month follow-up. Results Clinical scores were significantly improved until postoperative 24-month follow-up as compared with preoperative scores in both groups (p<0.05), with similar levels of improvement observed at the same time points postoperatively between the 2 groups. Prolo economic scores were significantly improved in SR group compared to RR until 12 months, but this improvement became similar after 18 months. The overall fusion rate was 94.1% until the 24-month follow-up for both groups. No significant complication was observed in both groups. Conclusion The results of the present study indicate that semirigid rods system with posterior lumbar interbody fusion showed similar clinical and radiological result with rigid rods system until 2 years after instrumentation. The WavefleX rods system, as a semirigid rods with unique characteristics, may be an effective alternative treatment for patients in lumbar fusion. PMID:27437014

  12. Operative treatment of isthmic spondylolisthesis with posterior stabilization and ALIF. Cages versus autogenous bone grafts.

    PubMed

    Pankowski, Rafal; Smoczynski, Andrzej; Roclawski, Marek; Ceynowa, Marcin; Kloc, Wojciech; Wasilewski, Wojciech; Jende, Piotr; Liczbik, Wieslaw; Beldzinski, Piotr; Libionka, Witold; Pierzak, Olaf; Adamski, Stanislaw; Niedbala, Miroslaw

    2012-01-01

    In the following study the use of cages and autogenous bone grafts were compared in the operative treatment of isthmic spondylolisthesis with the posterior stabilization and Anterior Lumbosacral Interbody Fusion (ALIF). 55 patients were divided into two groups. Autogenous bone grafts were used in the first group (34 patients) and titanium interbody implants (cages) in the second group (21 patients). The mean follow up period in the first group was 8.6 years and 3.4 years in the second group. The radiological outcome was based upon the evaluation of the degree of spondylolisthesis, the angle of the lumbar lordosis, the height of the interbody space and intervertebral foramen and the evaluation of the spinal fusion. The objective clinical outcome assessment was based on Oswestry Disability Index. Subjective clinical evaluation was performed with the use of Visual Analog Pain Score (VAS) and the two questions concerning the evaluation of success of the operative treatment and a possible agreement to the following operation if necessary. The use of autogenous bone grafts alone in ALIF was related to the significant loss of achieved segmental spine anatomy restoration. The implantation of the cages prevented the loss of slippage correction, permanently reconstructed the anatomical conditions in the area of the operated spinal segment. PMID:22744517

  13. Long-term Follow-up (Minimum 5 Years) Study of Single-level Posterior Dynamic Stabilization in Lumbar Degenerative Disease; 'Interspinous U' & 'DIAM'

    PubMed Central

    Kim, Yeon Joon; Park, Chan Woo; Son, Seong; Kim, Woo Kyung

    2012-01-01

    Objectives Recently posterior dynamic stabilizations (PDS) are increased in degenerative lumbar disease. But, some previous studies had doubts its long term prognosis. Long term clinical and radiological results of PDS using interspinous device (Interspinous U, DIAM) were analyzed. Methods We have used the 'interspinous U' and 'DIAM' for patients with lumbar spinal stenosis. We included single level lumbar spinal stenosis patients who completed minimum 60 months follow-up evaluation. All patients checked plain lateral and flexion-extension views at immediately after the surgery and each follow-up. The clinical outcome was measured by Odom's criteria. Complications including post operative infection, bony erosion, device fracture, device malformations, and instabilities were surveyed. Results We included 18 for 'Interspinous U' and 7 patients 'DIAM' groups. Mean follow-up durations for 'Interspinous U' and 'DIAM' were 74.6 and 62.6 months, respectively. Satisfactory groups were 50.0% and 42.9 % for 'Interspinous U' and 'DIAM' groups. In 'Interspinous U' group disc height ratio increased transiently in immediate postoperative period (from 0.18 to 0.21) and then, decreased significantly in last follow-up (0.18). In 'DIAM' group, disc height ratio increased transiently in immediate postoperative period (from 0.18 to 0.19), and then decreased significantly in the last follow-up (0.16). Three (16.7%) and two (28.6%) patients undergo on a re-operation due to severe back pain in 'Interspinous U' and 'DIAM' groups. Conclusion Long term follow up 'Interspinous U' and 'DIAM' group showed low patient satisfaction and poor radiological outcomes. To ascertain the benefit of PDS compare with posterior screw fixation, prospective analysis with larger population and multi-center study will be needed. PMID:25983797

  14. Stage I posterior osteotomy and instrumentation and stage II anterior debridement and bone grafting for lumbar spinal tuberculosis with severe kyphosis

    PubMed Central

    Deng, Qiang; Zhang, Yalou; Sheng, Weibin

    2015-01-01

    The purpose of this study was to determine the efficacy of stage I posterior osteotomy and instrumentation followed by stage II anterior debridement and bone grafting in patients with lumbar spinal tuberculosis (TB) with severe kyphosis. The records of patients with lumbar spinal TB and severe kyphosis treated with 2-stage surgery at our hospital from 2005 to 2010 were retrospectively reviewed. Outcome measures were kyphosis correction rate, visual analogue scale (VAS) pain scores, and American Spinal Injury Association (ASIA) spinal cord injury and sensation function scores. A total of 53 patients (34 male, 19 female; mean age 32 years) were included. The number of involved kyphosis segments ranged from 7 to 14, and the average preoperative kyphosis angle was 107.3 ± 18.1°. All procedures were performed without serious complications. The average follow-up time was 42 months. Bone fusion occurred at a range of 6 to 9 months after surgery, and none of the patients had internal fixation failure, position change, or pseudoarthrosis. The mean postoperative kyphosis angle was 29.4 ± 12.4°, with a mean improvement of 77.9°, and the correction rate was 72.6% (P < 0.001). At final follow-up, average correction loss was 1.35°. The mean postoperative VAS pain score was 2.4 ± 0.8, and the change from the preoperative value was significant (P < 0.001). ASIA spinal injury scores were increased postoperatively. Stage I posterior osteotomy and instrumentation followed by stage II anterior debridement and bone grafting can achieve good results in patients with lumbar TB and severe kyphosis. PMID:26885015

  15. Biomechanical comparison between lumbar disc arthroplasty and fusion.

    PubMed

    Chen, Shih-Hao; Zhong, Zheng-Cheng; Chen, Chen-Sheng; Chen, Wen-Jer; Hung, Chinghua

    2009-03-01

    The artificial disc is a mobile implant for degenerative disc replacement that attempts to lessen the degeneration of the adjacent elements. However, inconsistent biomechanical results for the neighboring elements have been reported in a number of studies. The present study used finite element (FE) analysis to explore the biomechanical differences at the surgical and both adjacent levels following artificial disc replacement and interbody fusion procedures. First, a three-dimensional FE model of a five-level lumbar spine was established by the commercially available medical imaging software Amira 3.1.1, and FE software ANSYS 9.0. After validating the five-level intact (INT) model with previous in vitro studies, the L3/L4 level of the INT model was modified to either insert an artificial disc (ProDisc II; ADR) or incorporate bilateral posterior lumbar interbody fusion (PLIF) cages with a pedicle screw fixation system. All models were constrained at the bottom of the L5 vertebra and subjected to 150N preload and 10Nm moments under four physiological motions. The ADR model demonstrated higher range of motion (ROM), annulus stress, and facet contact pressure at the surgical level compared to the non-modified INT model. At both adjacent levels, ROM and annulus stress were similar to that of the INT model and varied less than 7%. In addition, the greatest displacement of posterior annulus occurred at the superior-lateral region. Conversely, the PLIF model showed less ROM, less annulus stress, and no facet contact pressure at the surgical level compared to the INT model. The adjacent levels had obviously high ROM, annulus stress, and facet contact pressure, especially at the adjacent L2/3 level. In conclusion, the artificial disc replacement revealed no adjacent-level instability. However, instability was found at the surgical level, which might accelerate degeneration at the highly stressed annulus and facet joint. In contrast to disc replacement results, the posterior

  16. Repeated microendoscopic discectomy for recurrent lumbar disk herniation

    PubMed Central

    Hou, Tianyong; Zhou, Qiang; Dai, Fei; Luo, Fei; He, Qingyi; Zhang, Jinsong; Xu, Jianzhong

    2015-01-01

    OBJECTIVES: To explore the microendoscopic discectomy technique and inclusion criteria for the treatment of recurrent lumbar disc herniation and to supply feasible criteria and technical notes to avoid complications and to increase the therapeutic effect. METHODS: A consecutive series of 25 patients who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. The inclusion criteria were as follows: no severe pain in the lumbar region, no lumbar instability observed by flexion-extension radiography and no intervertebral discitis or endplate damage observed by magnetic resonance imaging. All patients were diagnosed by clinical manifestations and imaging examinations. RESULTS: Follow-up visits were carried out in all cases. Complications, such as nerve injuries, were not observed. The follow-up outcomes were graded using the MacNab criteria. A grade of excellent was given to 12 patients, good to 12 patients and fair to 1 patient. A grade of excellent or good occurred in 96% of cases. One patient relapsed 3 months after surgery and then underwent lumbar interbody fusion and inner fixation. The numerical rating scale of preoperative leg pain was 7.4± 1.5, whereas it decreased to 2.1±0.8 at 7 days after surgery. The preoperative Oswestry disability index of lumbar function was 57.5±10.0, whereas it was 26.0±8.5 at 7 days after surgery. CONCLUSION: In these cases, microendoscopic discectomy was able to achieve satisfactory clinical results. Furthermore, it has advantages over other methods because of its smaller incision, reduced bleeding and more efficient recovery. PMID:25789521

  17. Global and segmental kinematic changes following sequential resection of posterior osteoligamentous structures in the lumbar spine: An in vitro biomechanical investigation using pure moment testing protocols.

    PubMed

    Chamoli, Uphar; Korkusuz, Mert H; Sabnis, Ashutosh B; Manolescu, Andrei R; Tsafnat, Naomi; Diwan, Ashish D

    2015-11-01

    Lumbar spinal surgeries may compromise the integrity of posterior osteoligamentous structures implicating mechanical stability. Circumstances necessitating a concomitant surgery to achieve restabilisation are not well understood. The main objective of this in vitro study was to quantify global and segmental (index and adjacent levels) kinematic changes in the lumbar spine following sequential resection of the posterior osteoligamentous structures using pure moment testing protocols. Six fresh frozen cadaveric kangaroo lumbar spines (T12-S1) were tested under a bending moment in flexion-extension, bilateral bending, and axial torsion in a 6-degree-of-freedom Kinematic Spine Simulator. Specimens were tested in the following order: intact state (D0), after interspinous and supraspinous ligaments transection between L4 and L5 (D1), further after a total bilateral facetectomy between L4 and L5 (D2). Segmental motions at the cephalad, damaged, and caudal levels were recorded using an infrared-based motion tracking device. Following D1, no significant change in the global range of motion was observed in any of the bending planes. Following D2, a significant increase in the global range of motion from the baseline (D0) was observed in axial torsion (median normalised change +20%). At the damaged level, D2 resulted in a significant increase in the segmental range of motion in flexion-extension (+77%) and axial torsion (+492%). Additionally, a significant decrease in the segmental range of motion in axial torsion (-35%) was observed at the caudal level following D2. These results suggest that a multi-segment lumbar spine acts as a mechanism for transmitting motions, and that a compromised joint may significantly alter motion transfer to adjacent segments. We conclude that the interspinous and supraspinous ligaments play a modest role in restricting global spinal motions within physiologic limits. Following interspinous and supraspinous ligaments transection, a total

  18. The anatomic rationale for transforaminal endoscopic interbody fusion: a cadaveric analysis.

    PubMed

    Hardenbrook, Mitchell; Lombardo, Sergio; Wilson, Miles C; Telfeian, Albert E

    2016-02-01

    OBJECTIVE The authors describe a cadaveric analysis to determine the ideal dimensions and trajectory for considering endoscopic transforaminal interbody implantation. METHODS The soft tissues of 8 human cadavers were removed from L-1 to the sacrum, exposing the posterior bony elements. Facetectomies were performed bilaterally at each lumbar level with resection of the pars interarticularis, revealing the pedicles, nerve roots, and interbody disc space. Each level was digitally photographed with a marker for scale and evaluated with digital analysis software. The traversing and exiting nerve roots and pedicle margins were identified, and the distances between these structures and their relationships to the surrounding structures were documented. RESULTS The dimensions of 2 areas were measured: the working triangle and safe zone. The working triangle is the triangle between the exiting and traversing nerve roots above the superior margin of the inferior pedicle. The safe zone is the trapezoid bounded by the widths of the superior and inferior pedicles between the exiting and traversing nerve roots. The mean surface area for the working triangle was 1.83 cm(2), with L5-S1 having the largest area at 2.19 cm(2). The mean surface area of the safe zone was 1.19 cm(2), with L5-S1 having the largest area at 1.26 cm(2). At the medial border of the pedicle extending superiorly, there were no nerve structures within 1.19 cm at any level. On the lateral border of the pedicle, the exiting nerve root was closer superiorly, with the closest being 0.3 cm. CONCLUSIONS The working triangle is a relatively large area. The safe zone, just superior to the pedicle, is free of nerve structures. By utilizing the superior border of the pedicle, the disc space can be accessed within this safe zone without risk of injury to the nerves. A thorough understanding of foraminal anatomy is fundamental for considering how to safely access the disc space, thereby utilizing less invasive endoscopic

  19. Flexible Stabilisation of the Degenerative Lumbar Spine Using PEEK Rods

    PubMed Central

    Benezech, Jacques; Garlenq, Bruno; Larroque, Gilles

    2016-01-01

    Posterior lumbar interbody fusion using cages, titanium rods, and pedicle screws is considered today as the gold standard of surgical treatment of lumbar degenerative disease and has produced satisfying long-term fusion rates. However this rigid material could change the physiological distribution of load at the instrumental and adjacent segments, a main cause of implant failure and adjacent segment disease, responsible for a high rate of further surgery in the following years. More recently, semirigid instrumentation systems using rods made of polyetheretherketone (PEEK) have been introduced. This clinical study of 21 patients focuses on the clinical and radiological outcomes of patients with lumbar degenerative disease treated with Initial VEOS PEEK®-Optima system (Innov'Spine, France) composed of rods made from PEEK-OPTIMA® polymer (Invibio Biomaterial Solutions, UK) without arthrodesis. With an average follow-up of 2 years and half, the chances of reoperation were significantly reduced (4.8%), quality of life was improved (ODI = 16%), and the adjacent disc was preserved in more than 70% of cases. Based on these results, combined with the biomechanical and clinical data already published, PEEK rods systems can be considered as a safe and effective alternative solution to rigid ones. PMID:26981285

  20. The immediate and 24-hour follow-up effect of unilateral lumbar Z-joint mobilisation on posterior chain neurodynamics.

    PubMed

    Shankar Ganesh, G; Mohanty, Patitapaban; Smita Pattnaik, Swati

    2015-04-01

    Few studies have reported the effects of lumbar spine mobilization on neurodynamics. In a recent study, Szlezak et al. (2011) reported immediate improvement of posterior chain neurodynamics [range of passive straight leg raise (SLR)] following ipsilateral lumbar spine zygopophyseal (Z) joint mobilization. We re-duplicated the study with a 24 h follow-up measurement. Sixty healthy college students were assigned to two groups, mobilization and control. The mobilization group received ipsilateral grade 3 Maitland mobilizations to Z joint at a frequency of 2 MHz for 3 min and the control group received no treatment. The SLR was measured before and after the intervention for both the groups on the day of testing and 24-h later. Repeated measures ANOVA showed statistically significant pre to post improvement in SLR range after mobilization. The improvement was retained at 24-h. The results of the study are consistent with Szlezak et al. (2011). PMID:25892376

  1. Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems

    PubMed Central

    Ilharreborde, Brice; Shaw, Miranda N.; Berglund, Lawrence J.; Zhao, Kristin D.; An, Kai-Nan

    2010-01-01

    Treatment of chronic low back pain due to degenerative lumbar spine conditions often involves fusion of the symptomatic level. A known risk of this procedure is accelerated adjacent level degeneration. Motion preservation devices have been designed to provide stabilization to the symptomatic motion segment while preserving some physiologic motion. The aim of this study was to compare the changes in relative range of motion caused as a result of application of two non-fusion, dynamic stabilization devices: the Universal Clamp (UC) and the Wallis device. Nine fresh, frozen human lumbar spines (L1–Sacrum) were tested in flexion–extension, lateral bending, and axial rotation with a custom spine simulator. Specimens were tested in four conditions: (1) intact, (2) the Universal Clamp implanted at L3–4 (UC), (3) the UC with a transverse rod added (UCTR), and (4) the Wallis device implanted at L3–4. Total range of motion at 7.5 N-m was determined for each device and compared to intact condition. The UC device (with or without a transverse rod) restricted motion in all planes more than the Wallis. The greatest restriction was observed in flexion. The neutral position of the L3–4 motion segment shifted toward extension with the UC and UCTR. Motion at the adjacent levels remained similar to that observed in the intact spine for all three constructs. These results suggest that the UC device may be an appropriate dynamic stabilization device for degenerative lumbar disorders. PMID:21132335

  2. A review: Reduced reoperation rate for multilevel lumbar laminectomies with noninstrumented versus instrumented fusions

    PubMed Central

    Epstein, Nancy Ellen

    2016-01-01

    Background: The reoperation rate, including for adjacent segment disease (ASD), is lower following multilevel lumbar laminectomy with noninstrumented versus instrumented fusions. Methods: This study reviews selected literature focusing on the reoperation rate, including for ASD, following multilevel laminectomies with noninstrumented versus instrumented fusions. Several prior studies document a 1.3–5.6% reoperation rate following multilevel laminectomy with/without noninstrumented fusions. Results: The reoperation rates for instrumented fusions, including for ASD, are substantially higher. One study cited a 12.2–18.5% frequency for reoperation following instrumented transforaminal lumbar and posterior lumbar interbody fusions (TLIF and PLIFs) at an average of 164 postoperative months. Another study cited a 9.9% reoperation rate for ASD 1 year following PLIF; this increased to 80% at 5 postoperative years. A further study compared 380 patients variously undergoing laminectomies/noninstrumented posterolateral fusions, laminectomies with instrumented fusions (PLFs), and laminectomies with instrumented PLF plus an interbody fusions; this study documented no significant differences in outcomes for any of these operations at 4 postoperative years. Furthermore, other series showed fusion rates for 1–2 level procedures which were often similar with or without instrumentation, while instrumentation increased reoperation rates and morbidity. Conclusions: Many studies document no benefit for adding instrumentation to laminectomies performed for degenerative disease, including spondylolisthesis. Reoperation rates for laminectomy alone/laminectomy with noninstrumented fusions vary from 1.3% to 5.6% whereas reoperation rates for ASD after instrumented PLIF was 80% at 5 postoperative years. This review should prompt spinal surgeons to reexamine when, why, and whether instrumentation is really necessary, particularly for treating degenerative lumbar disease. PMID:27274408

  3. Prone Position-Related Meralgia Paresthetica after Lumbar Spinal Surgery : A Case Report and Review of the Literature

    PubMed Central

    Lee, Ho Jun

    2008-01-01

    Lateral femoral cutaneous neuropathy occurring during spinal surgery is frequently related to iliac bone graft harvesting, but meralgia paresthetica (MP) can result from the patient being in the prone position. Prone position-related MP is not an uncommon complication after posterior spine surgery but there are only few reports in the literature on this subject. It is usually overlooked because of its mild symptoms and self-limiting course, or patients and physicians may misunderstand the persistence of lower extremity symptoms in the early postoperative period to be a reflection of poor surgical outcome. The authors report a case of prone position-related MP after posterior lumbar interbody fusion at the L3-4 and reviewed the literature with discussion on the incidence, pathogenesis, and possible risk factors related to this entity. PMID:19137086

  4. Staged treatment of thoracic and lumbar spinal tuberculosis with flow injection abscess.

    PubMed

    Zeng, Hao; Zhang, Yupeng; Shen, Xiongjie; Luo, Chengke; Xu, Zhengquan; Liu, Zheng; Liu, Xiangyang; Wang, Xiyang

    2015-01-01

    The study was to investigate the feasibility and effectiveness of posterior-only approach combining with puncture drainage under CT-guide in staged treatment of thoracic and lumbar spinal tuberculosis with flow injection abscess. We retrospectively analyzed 15 patients (came from 72 cases with thoracic and lumbar spinal tuberculosis) with flow injection abscesses underwent surgery from January 2007 to February 2009, and evaluated the American Spinal Injury Association (ASIA) scoring system of nerve function, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), abscess absorption time and the Oswestry Disability Index (ODI), preoperatively and postoperatively. 15 patients were followed up for 13-37 months, no recurrence of tuberculosis, no fixation loosening and neurologic symptoms aggravated. The flow injection abscesses are absorbed within 3-6 months postoperative operation. In final follow-up, ESR went down to 5.2±2.1 mm/h from preoperative 79.6±14.8 mm/h, CRP decreased from preoperative 49.3±7.5 mg/L to 1.8±0.7 mg/L, ODI changed from 75.13±20.15 to 16.72±8.62, all of them changed significantly (P<0.05). In conclusions, one-stage posterior debridement, interbody fusion, pedicle screw fixation and two-stage CT-guided interventional therapy were safe and effective in treatment of the thoracic and lumbar spinal tuberculosis with flow injection abscess. PMID:26770442

  5. Staged treatment of thoracic and lumbar spinal tuberculosis with flow injection abscess

    PubMed Central

    Zeng, Hao; Zhang, Yupeng; Shen, Xiongjie; Luo, Chengke; Xu, Zhengquan; Liu, Zheng; Liu, Xiangyang; Wang, Xiyang

    2015-01-01

    The study was to investigate the feasibility and effectiveness of posterior-only approach combining with puncture drainage under CT-guide in staged treatment of thoracic and lumbar spinal tuberculosis with flow injection abscess. We retrospectively analyzed 15 patients (came from 72 cases with thoracic and lumbar spinal tuberculosis) with flow injection abscesses underwent surgery from January 2007 to February 2009, and evaluated the American Spinal Injury Association (ASIA) scoring system of nerve function, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), abscess absorption time and the Oswestry Disability Index (ODI), preoperatively and postoperatively. 15 patients were followed up for 13-37 months, no recurrence of tuberculosis, no fixation loosening and neurologic symptoms aggravated. The flow injection abscesses are absorbed within 3-6 months postoperative operation. In final follow-up, ESR went down to 5.2±2.1 mm/h from preoperative 79.6±14.8 mm/h, CRP decreased from preoperative 49.3±7.5 mg/L to 1.8±0.7 mg/L, ODI changed from 75.13±20.15 to 16.72±8.62, all of them changed significantly (P<0.05). In conclusions, one-stage posterior debridement, interbody fusion, pedicle screw fixation and two-stage CT-guided interventional therapy were safe and effective in treatment of the thoracic and lumbar spinal tuberculosis with flow injection abscess. PMID:26770442

  6. A new lumbar posterior fixation system, the memory metal spinal system: an in-vitro mechanical evaluation

    PubMed Central

    2013-01-01

    Background Spinal systems that are currently available for correction of spinal deformities or degeneration such as lumbar spondylolisthesis or degenerative disc disease use components manufactured from stainless steel or titanium and typically comprise two spinal rods with associated connection devices (for example: DePuy Spines Titanium Moss Miami Spinal System). The Memory Metal Spinal System of this study consists of a single square spinal rod made of a nickel titanium alloy (Nitinol) used in conjunction with connecting transverse bridges and pedicle screws made of Ti-alloy. Nitinol is best known for its shape memory effect, but is also characterized by its higher flexibility when compared to either stainless steel or titanium. A higher fusion rate with less degeneration of adjacent segments may result because of the elastic properties of the memory metal. In addition, the use of a single, unilateral rod may be of great value for a TLIF procedure. Our objective is to evaluate the mechanical properties of the new Memory Metal Spinal System compared to the Titanium Moss Miami Spinal System. Methods An in-vitro mechanical evaluation of the lumbar Memory Metal Spinal System was conducted. The test protocol followed ASTM Standard F1717-96, “Standard Test Methods for Static and Fatigue for Spinal Implant Constructs in a Corpectomy Model.” 1. Static axial testing in a load to failure mode in compression bending, 2. Static testing in a load to failure mode in torsion, 3. Cyclical testing to estimate the maximum run out load value at 5.0 x 10^6 cycles. Results In the biomechanical testing for static axial compression bending there was no statistical difference between the 2% yield strength and the stiffness of the two types of spinal constructs. In axial compression bending fatigue testing, the Memory Metal Spinal System construct showed a 50% increase in fatigue life compared to the Titanium Moss Miami Spinal System. In static torsional testing the Memory Metal

  7. An assessment of exposure indices in computed radiography for the posterior-anterior chest and the lateral lumbar spine.

    PubMed

    Warren-Forward, H; Arthur, L; Hobson, L; Skinner, R; Watts, A; Clapham, K; Lou, D; Cook, A

    2007-01-01

    Studies have indicated that computed radiography (CR) can increase radiation dose to the patient, leading to potential biological effects. Although manufacturers have set parameters to safeguard against overexposure, it is unclear whether these are being used by radiographers or if their recommended values are consistent with the ALARA principle. The research aims are to investigate (i) whether radiographers are producing images with exposure indices within the manufacturers recommended range (MRR); (ii) the phenomenon of exposure creep, and (iii) the relationship between exposure indices (EIs) and radiation dose. A retrospective analysis of exposure indices over an 18-month period for the posteroanterior (PA) chest and lateral (LAT) lumbar spine at two centres using Kodak 800 and 850 CR systems was conducted. A phantom study was performed to assess the relationship between EI and entrance surface dose (ESD) for fixed and varying tube potentials. Kodak recommends that images have EIs between 1700 and 1900. Thirty percent of LAT lumbar spine examinations at hospital B and 38% of PA chest examinations at hospital A were produced with EIs below 1700. In the phantom study, when using a varied tube potential (70-125 kVp) and maintaining a constant EI of 1550, ESD was reduced by 56%. All clinical and phantom images were assessed to be of a diagnostic quality. The retrospective results indicate that there is a potential to reduce the MRR and optimize patient dose. There is also evidence to suggest that EI is not a reliable indicator of patient dose. The authors recommend that staff training is essential on these newer systems. PMID:16916804

  8. [The comparison of the use of cages with the use of autogenous bone grafts in the operative treatment of the isthmic spondylolisthesis by the posterior stabilisation and ALIF].

    PubMed

    Pankowski, Rafał; Smoczyński, Andrzej; Jaskólski, Dawid; Rocławski, Marek; Samson, Lucjan; Piotrowski, Maciej

    2009-01-01

    In the following study the use of cages and autogenous bone grafts were comparised in the operative treatment of isthmic spondylolisthesis by the posterior stabilization and anterior lumbosacral interbody fusion. 55 patients were divided into two groups. Patients underwent ALIF with the use of autogenous bone grafts in the first group (34) and with the use of titanium interbody implants (cages) in the second group (21). The mean follow up period in the first group was 8.6 years and in the second group was 3.4 years. The objective clinical outcome assessment was based on Oswestry disability questionnaire. Subjective clinical evaluation was conducted with the use of visual analog pain score and two questions concerning the evaluation of success of the operative treatment and a possible agreement to the following operation if necessary. The radiological results were based upon the evaluation of the degree of spondylolisthesis, the angle of the lumbar lordosis, the height of the interbody space and intervertebral foramen and the evaluation of the spinal fusion. The usage of autogenous bone grafts alone in ALIF was related to the significant loss of achieved segmental spine anatomy restoration. The implantation of the cages prevented the loss of slippage correction, permanently reconstructed the anatomical conditions in the area of the operated spinal segment. PMID:19514478

  9. Magnetoneurographic registration of propagating magnetic fields in the lumbar spine after stimulation of the posterior tibial nerve

    NASA Astrophysics Data System (ADS)

    Klein, Anita; van Leeuwen, Peter; Hoormann, Jörg; Grönemeyer, Dietrich

    2006-06-01

    Stimulation of the posterior tibial nerve has been associated with different somatosensory evoked potentials (SEP) recorded along the spine and thorax. The aim of this study was to register and describe the magnetic fields corresponding to different components of spinal SEP after stimulation of tibial nerves. In nine healthy subjects, right and left posterior tibial nerves were transcutaneously electrostimulated at the ankles. Neuromagnetic fields were registered over a circular 800 cm2 area of the lumbosacral spine using a 61-channel biomagnetometer. Magnetic field maps were constructed and examined visually for dipolar patterns. Equivalent current dipoles (ECD) were calculated for each somatosensory evoked field (SEF) using a least-squares fit in a spherical model. In seven subjects dipolar SEF were detected over the lower back at two separate latencies and locations and propagating ECD could be localized. Both the first and second components found agreed anatomically and functionally with respect to propagation in the underlying nerve fibers. It was possible to record and identify SEF which correspond to the SEP described in the literature. Dipole localization based on an equivalent current dipole model allowed a basic evaluation of the plausibility of the measurements with respect to the processes being examined.

  10. Biomechanical comparison of three stand-alone lumbar cages — a three-dimensional finite element analysis

    PubMed Central

    2013-01-01

    Background For anterior lumbar interbody fusion (ALIF), stand-alone cages can be supplemented with vertebral plate, locking screws, or threaded cylinder to avoid the use of posterior fixation. Intuitively, the plate, screw, and cylinder aim to be embedded into the vertebral bodies to effectively immobilize the cage itself. The kinematic and mechanical effects of these integrated components on the lumbar construct have not been extensively studied. A nonlinearly lumbar finite-element model was developed and validated to investigate the biomechanical differences between three stand-alone (Latero, SynFix, and Stabilis) and SynCage-Open plus transpedicular fixation. All four cages were instrumented at the L3-4 level. Methods The lumbar models were subjected to the follower load along the lumbar column and the moment at the lumbar top to produce flexion (FL), extension (EX), left/right lateral bending (LLB, RLB), and left/right axial rotation (LAR, RAR). A 10 Nm moment was applied to obtain the six physiological motions in all models. The comparison indices included disc range of motion (ROM), facet contact force, and stresses of the annulus and implants. Results At the surgical level, the SynCage-open model supplemented with transpedicular fixation decreased ROM (>76%) greatly; while the SynFix model decreased ROM 56-72%, the Latero model decreased ROM 36-91%, in all motions as compared with the INT model. However, the Stabilis model decreased ROM slightly in extension (11%), lateral bending (21%), and axial rotation (34%). At the adjacent levels, there were no obvious differences in ROM and annulus stress among all instrumented models. Conclusions ALIF instrumentation with the Latero or SynFix cage provides an acceptable stability for clinical use without the requirement of additional posterior fixation. However, the Stabilis cage is not favored in extension and lateral bending because of insufficient stabilization. PMID:24088294

  11. The Extended Posterior Circumferential Decompression Technique in the Management of Tubercular Spondylitis with and without Paraplegia

    PubMed Central

    Rathinavelu, Barani; Krishnan, Venkatesh; Amritanand, Rohit; Sundararaj, Gabriel David

    2014-01-01

    Study Design Retrospective clinical series. Purpose To study the clinical, functional and radiological results of patients with tuberculous spondylitis with and without paraplegia, treated surgically using the "Extended Posterior Circumferential Decompression (EPCD)" technique. Overview of Literature With the increasing possibility of addressing all three columns by a single approach, posterior and posterolateral approaches are gaining acceptance. A single exposure for cases with neurological deficit and kyphotic deformity requiring circumferential decompression, anterior column reconstruction and posterior instrumentation is helpful. Methods Forty-one patients with dorsal/dorsolumbar/lumbar tubercular spondylitis who were operated using the EPCD approach between 2006 to 2009 were included. Postoperatively, patients were started on nine-month anti-tuberculous treatment. They were serially followed up to thirty-six months and both clinical measures (including pain, neurological status and ambulatory status) and radiological measures (including kyphotic angle correction, loss of correction and healing status) were used for assessment. Results Disease-healing with bony fusion (interbody fusion) was seen in 97.5% of cases. Average deformity (kyphosis) correction was 54.6% in dorsal spine and 207.3% in lumbar spine. Corresponding loss of correction was 3.6 degrees in dorsal spine and 1.9 degrees in the lumbar spine. Neurological recovery in Frankel B and C paraplegia was 85.7% and 62.5%, respectively. Conclusions The EPCD approach permits all the advantages of a single or dual session anterior and posterior surgery, with significant benefits in terms of decreased operative time, reduced hospital stay and better kyphotic angle correction. PMID:25558312

  12. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion.

    PubMed

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Yang, Sidong; Wang, Yanhong; Wang, Qian; Zhang, Feng; Ding, Wenyuan

    2016-08-01

    The aim of this study was to identify the prevalence of proximal junctional kyphosis (PJK) in degenerative lumbar scoliosis (DLS) following long instrumented posterior spinal fusion, and to search for predictable risk factors for the progression of junctional kyphosis.In total 98 DLS patients with a minimum 2-year follow-up were reviewed prospectively. According to the occurrence of PJK at the last follow-up, patients were divided into 2 groups: PJK group and non-PJK group. To investigate risk values for the progression of PJK, 3 categorized factors were analyzed statistically: patient characteristics-preoperative data of age, sex, body mass index (BMI), bone mineral density (BMD) were investigated; surgical variables-the most proximal and distal levels of the instrumentation, the number of instrumented levels; pre- and postoperative radiographic parameters include the scoliotic angle, sagittal vertical axis, thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope.PJK was developed in 17 of 98 patients (17.3%) until to the final follow-up and were enrolled as the PJK group, and 81 patients without PJK at final follow-up were enrolled as the non-PJK group. There was no statistically significant difference between the 2 groups in age at operation (P = 0.900). The patient's sex was excluded in statistical analysis because of the predominance of female patients. There were statistically significant difference between the 2 groups in BMI ([25.5 ± 1.7] kg/m in the PJK group and [23.6 ± 1.9] kg/m in the non-PJK group, P < 0.001) and BMD ([-1.4 ± 0.8] g/cm in the PJK group and [-0.7 ± 0.3] g/cm in the non-PJK group, P < 0.001). No specific surgery-related variables were found to be associated with an increased risk of developing PJK, except when the most proximal instrumented vertebrae stopped at thoracolumbar junction (T11-L1). The upper instrumentation vertebrae (UIV) at

  13. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion

    PubMed Central

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Yang, Sidong; Wang, Yanhong; Wang, Qian; Zhang, Feng; Ding, Wenyuan

    2016-01-01

    Abstract The aim of this study was to identify the prevalence of proximal junctional kyphosis (PJK) in degenerative lumbar scoliosis (DLS) following long instrumented posterior spinal fusion, and to search for predictable risk factors for the progression of junctional kyphosis. In total 98 DLS patients with a minimum 2-year follow-up were reviewed prospectively. According to the occurrence of PJK at the last follow-up, patients were divided into 2 groups: PJK group and non-PJK group. To investigate risk values for the progression of PJK, 3 categorized factors were analyzed statistically: patient characteristics—preoperative data of age, sex, body mass index (BMI), bone mineral density (BMD) were investigated; surgical variables—the most proximal and distal levels of the instrumentation, the number of instrumented levels; pre- and postoperative radiographic parameters include the scoliotic angle, sagittal vertical axis, thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope. PJK was developed in 17 of 98 patients (17.3%) until to the final follow-up and were enrolled as the PJK group, and 81 patients without PJK at final follow-up were enrolled as the non-PJK group. There was no statistically significant difference between the 2 groups in age at operation (P = 0.900). The patient's sex was excluded in statistical analysis because of the predominance of female patients. There were statistically significant difference between the 2 groups in BMI ([25.5 ± 1.7] kg/m2 in the PJK group and [23.6 ± 1.9] kg/m2 in the non-PJK group, P < 0.001) and BMD ([–1.4 ± 0.8] g/cm2 in the PJK group and [−0.7 ± 0.3] g/cm2 in the non-PJK group, P < 0.001). No specific surgery-related variables were found to be associated with an increased risk of developing PJK, except when the most proximal instrumented vertebrae stopped at thoracolumbar junction (T11-L1). The upper

  14. Percutaneous Transpedicular Interbody Fusion Technique in Percutaneous Pedicle Screw Stabilization for Pseudoarthrosis Following Pyogenic Spondylitis.

    PubMed

    Ikuta, Ko; Masuda, Keigo; Yonekura, Yutaka; Kitamura, Takahiro; Senba, Hideyuki; Shidahara, Satoshi

    2016-04-01

    This report introduces a percutaneous transpedicular interbody fusion (PTPIF) technique in posterior stabilization using percutaneous pedicle screws (PPSs). An 81-year-old man presented with pseudoarthrosis following pyogenic spondylitis 15 months before. Although no relapse of infection was found, he complained of obstinate low back pain and mild neurological symptoms. Radiological evaluations showed a pseudoarthrosis following pyogenic spondylitis at T11-12. Posterior stabilization using PPSs from Th9 to L2 and concomitant PTPIF using autologous iliac bone graft at T11-12 were performed. Low back pain and neurological symptoms were immediately improved after surgery. A solid interbody fusion at T11-12 was completed 9 months after surgery. The patient had no restriction of daily activity and could play golf at one year after surgery. PTPIF might be a useful option for perform segmental fusion in posterior stabilization using PPSs. PMID:27114777

  15. Percutaneous Transpedicular Interbody Fusion Technique in Percutaneous Pedicle Screw Stabilization for Pseudoarthrosis Following Pyogenic Spondylitis

    PubMed Central

    Masuda, Keigo; Yonekura, Yutaka; Kitamura, Takahiro; Senba, Hideyuki; Shidahara, Satoshi

    2016-01-01

    This report introduces a percutaneous transpedicular interbody fusion (PTPIF) technique in posterior stabilization using percutaneous pedicle screws (PPSs). An 81-year-old man presented with pseudoarthrosis following pyogenic spondylitis 15 months before. Although no relapse of infection was found, he complained of obstinate low back pain and mild neurological symptoms. Radiological evaluations showed a pseudoarthrosis following pyogenic spondylitis at T11–12. Posterior stabilization using PPSs from Th9 to L2 and concomitant PTPIF using autologous iliac bone graft at T11–12 were performed. Low back pain and neurological symptoms were immediately improved after surgery. A solid interbody fusion at T11–12 was completed 9 months after surgery. The patient had no restriction of daily activity and could play golf at one year after surgery. PTPIF might be a useful option for perform segmental fusion in posterior stabilization using PPSs. PMID:27114777

  16. Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up.

    PubMed

    Fritzell, Peter; Berg, Svante; Borgström, Fredrik; Tullberg, Tycho; Tropp, Hans

    2011-07-01

    This randomized controlled health economic study assesses the cost-effectiveness of the concept of total disc replacement (TDR) (Charité/Prodisc/Maverick) when compared with the concept of instrumented lumbar fusion (FUS) [posterior lumbar fusion (PLF) /posterior lumbar interbody fusion (PLIF)]. Social and healthcare perspectives after 2 years are reported. In all, 152 patients were randomized to either TDR (n = 80) or lumbar FUS (n = 72). Cost to society (total mean cost/patient, Swedish kronor = SEK, standard deviation) for TDR was SEK 599,560 (400,272), and for lumbar FUS SEK 685,919 (422,903) (ns). The difference was not significant: SEK 86,359 (-45,605 to 214,332). TDR was significantly less costly from a healthcare perspective, SEK 22,996 (1,202 to 43,055). Number of days on sick leave among those who returned to work was 185 (146) in the TDR group, and 252 (189) in the FUS group (ns). Using EQ-5D, the total gain in quality adjusted life years (QALYs) over 2 years was 0.41 units for TDR and 0.40 units for FUS (ns). Based on EQ-5D, the incremental cost-effectiveness ratio (ICER) of using TDR instead of FUS was difficult to analyze due to the "non-difference" in treatment outcome, which is why cost/QALY was not meaningful to define. Using cost-effectiveness probabilistic analysis, the net benefit (with CI) was found to be SEK 91,359 (-73,643 to 249,114) (ns). We used the currency of 2006 where 1 EURO = 9.26 SEK and 1 USD = 7.38 SEK. It was not possible to state whether TDR or FUS is more cost-effective after 2 years. Since disc replacement and lumbar fusion are based on different conceptual approaches, it is important to follow these results over time. PMID:21053028

  17. Lymphopenia and Elevated Blood C-Reactive Protein Levels at Four Days Postoperatively Are Useful Markers for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

    PubMed Central

    Shigematsu, Hideki; Koizumi, Munehisa; Nakajima, Hiroshi; Okuda, Akinori; Morimoto, Yasuhiko; Masuda, Keisuke; Tanaka, Yasuhito

    2016-01-01

    Study Design Case-control study. Purpose To identify the characteristics of candidate indexes for early detection of surgical site infection (SSI). Overview of Literature SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial for the welfare of the patient postoperation. Methods We retrospectively reviewed laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spine disease. The sensitivity and specificity of six laboratory markers for early detection of SSI were calculated: greater elevation of the white blood cell count at day 7 than at day 4 postoperatively, greater elevation of the C-reactive protein (CRP) level at day 7 than at day 4 postoperatively, a CRP level of >10 mg/dL at 4 days postoperatively, neutrophil percentage of >75% at 4 days postoperatively, a lymphocyte percentage of <10% at 4 days postoperatively, and a lymphocyte count of <1,000/µL at 4 days postoperatively. Statistical analysis was via Fisher's exact test and a p-value of <0.05 was considered significant. Results In total, 85 patients were enrolled. Of these, five patients developed deep SSI. The sensitivity and specificity of each index were as follows: index 1, 20.0% and 77.5%; index 2, 20.0% and 83.8%; index 3, 40.0% and 97.5%; index 4, 40.0% and 86.3%; index 5, 0% and 96.3%; and index 6, 80.0% and 80.0%. A significant difference was noted for indexes 3 and 6. Conclusions A CRP level of >10 mg/dL at 4 days postoperatively would be useful for definitive diagnosis of SSI, and a lymphocyte count of <1,000/µL at 4 days postoperatively would be a useful screening test for SSI. Although laboratory markers for early detection of SSI have been frequently reported, we believe that it is important to understand the characteristics of each index for a precise diagnosis. PMID:27114760

  18. Long-Term Objective Physical Activity Measurements using a Wireless Accelerometer Following Minimally Invasive Transforaminal Interbody Fusion Surgery

    PubMed Central

    Mobbs, Ralph J.

    2016-01-01

    We report on a case of a patient who underwent minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) with objective physical activity measurements performed preoperatively and postoperatively at up to 12-months using wireless accelerometer technology. In the first postoperative month following surgery, the patient had reduced mobility, taking 2,397 steps over a distance of 1.8 km per day. However, the number of steps taken and distance travelled per day had returned to baseline levels by the second postoperative month. At one-year follow-up, the patient averaged 5,095 steps per day in the month over a distance of 3.8 km; this was a 60% improvement in both steps taken and distance travelled compared to the preoperative status. The use of wireless accelerometers is feasible in obtaining objective physical activity measurements before and after lumbar interbody fusion and may be applicable to other related spinal surgeries as well. PMID:27114781

  19. PEEK-Halo effect in interbody fusion.

    PubMed

    Phan, Kevin; Hogan, Jarred A; Assem, Yusuf; Mobbs, Ralph J

    2016-02-01

    Recent developments have seen poly[aryl-ether-ether-ketone] (PEEK) being increasingly used in vertebral body fusion. More novel approaches to improve PEEK have included the introduction of titanium-PEEK (Ti-PEEK) composites and coatings. This paper aims to describe a potential complication of PEEK based implants relating to poorer integration with the surrounding bone, producing a "PEEK-Halo" effect which is not seen in Ti-PEEK composite implants. We present images from two patients undergoing anterior lumbar interbody fusion (ALIF). The first patient underwent an L5/S1 ALIF using a PEEK implant whilst the second patient underwent L4/L5 ALIF using a Ti-PEEK composite implant. Evidence of osseointegration was sought using CT imaging and confirmed using histological preparations of a sheep tibia model. The PEEK-Halo effect is demonstrated by a halo effect between the PEEK implant and the bone graft on CT imaging. This phenomenon is secondary to poor osseointegration of PEEK implants. The PEEK-Halo effect was not demonstrated in the second patient who received a Ti-PEEK composite graft. Histological analysis of graft/bone interface surfaces in PEEK versus Ti-PEEK implants in a sheep model further confirmed poorer osseointegration of the PEEK implant. In conclusion, the PEEK-Halo effect is seen secondary to minimal osseointegration of PEEK at the adjacent vertebral endplate following a PEEK implant insertion. This effect is not seen with Ti-PEEK implants, and may support the role of titanium in improving the bone-implant interface of PEEK substrates. PMID:26474500

  20. [Ultrasound-assisted neuraxial anesthesia in a patient with previous lumbar laminectomy and fusion: a case report].

    PubMed

    Geng, J; Li, M

    2016-02-18

    A patient with previous L3-4 posterior lumbar interbody fusion, pedicle screws instrumentation and L3-4 decompression, was scheduled for left total hip arthroplasty. Two years ago, due to poor landmarks palpation, the patient experienced a failed lumbar puncture after multiple attempts before herniorrhaphy. His plain radiography showed bilateral partial laminectomy at L3-4 level, and between L3 and L4, two posterior pedicle screws connected by metal rods on both sides. This time, we used ultrasound to locate L4-5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture. According to this information, L4-5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid, 15 mg hyperbaric bupivicaine was injected into intrathecal space. An epidural catheter was then inserted into the epidural space. The sensory block level was fixed at T10 to S within 10 minutes. Intraoperatively, the patient received 10 mL 2% (mass fraction) lidocaine through the epidural catheter in total. The surgery was uneventful. No neurologic complication was observed after the surgery. This case report demonstrates that ultRASound imaging can provide useful information for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine. PMID:27538165

  1. Replacement of Vertebral Lamina (Laminoplasty) in Surgery for Lumbar Isthmic Spondylolisthesis: 5-Year Follow-Up Results

    PubMed Central

    2016-01-01

    Study Design A review of clinical and radiological outcomes of lumbar laminoplasty (LL) for the treatment of isthmic spondylolisthesis (ISL). Purpose The single session performance of posterior lumbar interbody fusion with allograft in the anterior column and providing the realignment of the vertebrae was presented as a preliminary report earlier. Overview of Literature Long-term surgical outcome of cervical laminoplasty in patients has been reported. But, outcome of LL in patients is unclear. Methods The long-term (5 years) year follow-up results of the LL technique are reported in this retrospective study. All patients underwent preoperative and postoperative direct X-ray, computed tomography, and magnetic resonance imaging. The patients that did not respond to conservative treatment were operated. Twenty-one (52.5%) female and 19 (47.5%) male patients were included. Results Mean age was 43,5 years (ranges, 22–57 years). The most common symptoms were low back pain (89%), pelvic and leg pain (69%) and reduction in walking distance (65%). A total of 180 pedicle screws were inserted in 40 patients; posterior lumbar interbody fusion and laminoplasty with reduction was performed in 20 patients for L4–L5, 12 patients for L5–S1, 4 patients for L3–L4–L5 and 4 patients for L4–L5-S1. Ten (25%) patients with ILL had accompanying spinal stenosis. The difference between preoperative and postoperative sagittal plane rotation and dislocation degrees and disc space heights were statistically significant in all patients (p<0.05). Solid grade 4 fusion was observed in 38 patients; in only 2 patients grade 2 pseudoarthrosis developed (5%), but these patients were asymptomatic. Visual analog scale, Prolo economical and functional scale was examined with an average follow-up 5.5 years. Conclusions LL technique has the advantages of shorter duration of operation, lack of graft donor site complications, protection of posterior column osseoligamentous structures and

  2. A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine.

    PubMed

    Street, John T; Andrew Glennie, R; Dea, Nicolas; DiPaola, Christian; Wang, Zhi; Boyd, Michael; Paquette, Scott J; Kwon, Brian K; Dvorak, Marcel F; Fisher, Charles G

    2016-09-01

    OBJECTIVE The objective of this study was to determine if there is a significant difference in surgical site infection (SSI) when comparing the Wiltse and midline approaches for posterior instrumented interbody fusions of the lumbar spine and, secondarily, to evaluate if the reoperation rates and specific causes for reoperation were similar for both approaches. METHODS A total of 358 patients who underwent 1- or 2-level posterior instrumented interbody fusions for degenerative lumbar spinal pathology through either a midline or Wiltse approach were prospectively followed between March 2005 and January 2011 at a single tertiary care facility. A retrospective analysis was performed primarily to evaluate the incidence of SSI and the incidence and causes for reoperation. Secondary outcome measures included intraoperative complications, blood loss, and length of stay. A matched analysis was performed using the Fisher's exact test and a logistic regression model. The matched analysis controlled for age, sex, comorbidities, number of index levels addressed surgically, number of levels fused, and the use of bone grafting. RESULTS All patients returned for follow-up at 1 year, and adverse events were followed for 2 years. The rate of SSI was greater in the midline group (8 of 103 patients; 7.8%) versus the Wiltse group (1 of 103 patients; 1.0%) (p = 0.018). Fewer additional surgical procedures were performed in the Wiltse group (p = 0.025; OR 0.47; 95% CI 0.23-0.95). Proximal adjacent segment failure requiring reoperation occurred more frequently in the midline group (15 of 103 patients; 14.6%) versus the Wiltse group (6 of 103 patients; 5.8%) (p = 0.048). Blood loss was significantly lower in the Wiltse group (436 ml) versus the midline group (703 ml); however, there was no significant difference between the 2 groups in intraoperative complications or length of stay. CONCLUSIONS The patients who underwent the Wiltse approach had a decreased risk of wound breakdown and

  3. Spine interbody implants: material selection and modification, functionalization and bioactivation of surfaces to improve osseointegration.

    PubMed

    Rao, Prashanth J; Pelletier, Matthew H; Walsh, William R; Mobbs, Ralph J

    2014-05-01

    The clinical outcome of lumbar spinal fusion is correlated with achievement of bony fusion. Improving interbody implant bone on-growth and in-growth may enhance fusion, limiting pseudoarthrosis, stress shielding, subsidence and implant failure. Polyetheretherketone (PEEK) and titanium (Ti) are commonly selected for interbody spacer construction. Although these materials have desirable biocompatibility and mechanical properties, they require further modification to support osseointegration. Reports of extensive research on this topic are available in biomaterial-centric published reports; however, there are few clinical studies concerning surface modification of interbody spinal implants. The current article focuses on surface modifications aimed at fostering osseointegration from a clinician's point of view. Surface modification of Ti by creating rougher surfaces, modifying its surface topography (macro and nano), physical and chemical treatment and creating a porous material with high interconnectivity can improve its osseointegrative potential and bioactivity. Coating the surface with osteoconductive materials like hydroxyapatite (HA) can improve osseointegration. Because PEEK spacers are relatively inert, creating a composite by adding Ti or osteoconductive materials like HA can improve osseointegration. In addition, PEEK may be coated with Ti, effectively bio-activating the coating. PMID:24890288

  4. Intervertebral Fusion with Mobile Microendoscopic Discectomy for Lumbar Degenerative Disc Disease.

    PubMed

    Xu, Bao-Shan; Liu, Yue; Xu, Hai-Wei; Yang, Qiang; Ma, Xin-Long; Hu, Yong-Cheng

    2016-05-01

    The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy (MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion. PMID:27384734

  5. Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging

    PubMed Central

    Ohtori, Seiji; Suzuki, Munetaka; Oikawa, Yasuhiro; Yamanaka, Hajime; Tamai, Hiroshi; Kobayashi, Tatsuya; Orita, Sumihisa; Yamauchi, Kazuyo; Suzuki, Miyako; Aoki, Yasuchika; Watanabe, Atsuya; Kanamoto, Hirohito; Takahashi, Kazuhisa

    2016-01-01

    Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis. PMID:26949473

  6. Titanium mesh cage fracture after lumbar reconstruction surgery: a case report and literature review

    PubMed Central

    Wang, Shan-Jin; Liu, Xiao-Ming; Zhao, Wei-Dong; Wu, De-Sheng

    2015-01-01

    Titanium mesh cage (TMC) was introduced recently to provide anterior structural support and interbody fusion without the need to harvest bone from the iliac crest. Because of its good mechanical behavior and satisfactory clinical outcomes, TMC is commonly used for lumbar burst fractures. Here, we present a female patient who underwent a posterior-anterior L4 corpectomy with TMC placement and developed a cage fracture after 42 months. The patient refused the revision surgery and asked for conservative treatment. At the 3-month follow-up, she reported doing well, with no complaints of back pain or leg pain. There were three cases of TMC fracture have been previously reported in the literature. Only one patient performed a revision surgery with an expandable titanium cage, and all this three patients experienced a good outcome during the follow-up period. TMC fracture is a rare complication of spinal surgery. Close observation or surgical treatment should be considered to improve patient outcomes. Although cage placement, instability, subsidence, and both stress shielding and necrotic bone in the cage appear to play key roles in the pathogenesis of this rare complication, the exact mechanism of this condition remains undetermined. PMID:26131138

  7. Laparoscopic total extraperitoneal repair of lumbar hernia

    PubMed Central

    Lim, Man Sup; Lee, Hae Wan; Yu, Chang Hee

    2011-01-01

    Lumbar hernia is a rare surgical entity without a standard method of repair. With advancements in laparoscopic techniques, successful lumbar herniorrhaphy can be achieved by the creation of a completely extraperitoneal working space and secure fixation of a wide posterior mesh. We present a total extraperitoneal laparoendoscopic repair of lumbar hernia, which allowed for minimal invasiveness while providing excellent anatomical identification, easy mobilization of contents and wide secure mesh fixation. A total extraperitoneal method of lumbar hernia repair by laparoscopic approach is feasible and may be an ideal option. PMID:22111086

  8. [Lumbar hernia].

    PubMed

    Teiblum, Sandra Sofie; Hjørne, Flemming Pii; Bisgaard, Thue

    2010-03-22

    Lumbar hernia is a rare condition. Lumbar hernia should be considered a rare differential diagnosis to unexplained back pain. Symptoms are scarce and diffuse and can vary with the size and content of the hernia. As there is a 25% risk of incarceration, operation is indicated even in asymptomatic hernias. We report a case of lumbar hernia in a woman with a slow growing mass in the lumbar region. She presented with pain and a computed tomography confirmed the diagnosis. She underwent open surgery and fully recovered with recurrence within the first half year. PMID:20334799

  9. Single-level transforaminal interbody fusion for traumatic lumbosacral fracture-dislocation: a case report.

    PubMed

    Herrera, Anthony J; Berry, Chirag A; Rao, Raj D

    2013-02-01

    L5S1 fracture-dislocations are rare three-column injuries. The infrequency of this injury has led to a lack of a universally accepted treatment strategy. Transforaminal lumbar interbody fusion (TLIF) has been shown to be an effective approach for interbody fusion in degenerative indications, but has not been previously reported in the operative management of traumatic lumbosacral dislocation. The authors report a case of traumatic L5S1 fracture-dislocation in a 30-year-old male, presenting with a right-sided L5 neurologic deficit, following a street sweeper accident. Imaging revealed an L5S1 fracture-dislocation with fracture of the S1 body. Open reduction with TLIF and L5S1 posterolateral instrumented fusion was carried out within 24 hours of injury. Excellent reduction was obtained, and maintained at long-term follow-up, with complete resolution of pain and neurologic deficit. In this patient, L5S1 fracture-dislocation was treated successfully, with an excellent outcome, with a single level TLIF and instrumented posterolateral fusion at L5S1. PMID:23547528

  10. Evaluation of a Hybrid Dynamic Stabilization and Fusion System in the Lumbar Spine: A 10 Year Experience

    PubMed Central

    Kashkoush, Ahmed; Agarwal, Nitin; Paschel, Erin; Goldschmidt, Ezequiel

    2016-01-01

    Introduction: The development of adjacent-segment disease is a recognized consequence of lumbar fusion surgery. Posterior dynamic stabilization, or motion preservation, techniques have been developed which theoretically decrease stress on adjacent segments following fusion. This study presents the experience of using a hybrid dynamic stabilization and fusion construct for degenerative lumbar spine pathology in place of rigid arthrodesis. Methods: A clinical cohort investigation was conducted of 66 consecutive patients (31 female, 35 male; mean age: 53 years, range: 25 – 76 years) who underwent posterior lumbar instrumentation with the Dynesys Transition Optima (DTO) implant (Zimmer-Biomet Spine, Warsaw, IN) hybrid dynamic stabilization and fusion system over a 10-year period. The median length of follow-up was five years. DTO consists of pedicle screw fixation coupled to a rigid rod as well as a flexible longitudinal connecting system. All patients had symptoms of back pain and neurogenic claudication refractory to non-surgical treatment. Patients underwent lumbar arthrodesis surgery in which the hybrid system was used for stabilization instead of arthrodesis of the stenotic adjacent level. Results: Indications for DTO instrumentation were primary degenerative disc disease (n = 52) and failed back surgery syndrome (n = 14). The most common dynamically stabilized and fused segments were L3-L4 (n = 37) and L5-S1 (n = 33), respectively. Thirty-eight patients (56%) underwent decompression at the dynamically stabilized level, and 57 patients (86%) had an interbody device placed at the level of arthrodesis. Complications during the follow-up period included a single case of screw breakage and a single case of pseudoarthrosis. Ten patients (15%) subsequently underwent conversion of the dynamic stabilization portion of their DTO instrumentation to rigid spinal arthrodesis. Conclusion: The DTO system represents a novel hybrid dynamic stabilization and fusion construct

  11. [Lumbar spinal angiolipoma].

    PubMed

    Isla, Alberto; Ortega Martinez, Rodrigo; Pérez López, Carlos; Gómez de la Riva, Alvaro; Mansilla, Beatriz

    2016-01-01

    Spinal angiolipomas are fairly infrequent benign tumours that are usually located in the epidural space of the thoracic column and represent 0.14% to 1.3% of all spinal tumours. Lumbar angiolipomas are extremely rare, representing only 9.6% of all spinal extradural angiolipomas. We report the case of a woman who complained of a lumbar pain of several months duration with no neurological focality and that had intensified in the last three days without her having had any injury or made a physical effort. The MR revealed an extradural mass L1-L2, on the posterior face of the medulla, decreasing the anteroposterior diameter of the canal. The patient symptoms improved after surgery. Total extirpation of the lesion is possible in most cases, and the prognosis is excellent even if the lesion is infiltrative. For this reason, excessively aggressive surgery is not necessary to obtain complete resection. PMID:27263067

  12. Anterior column realignment following lateral interbody fusion for sagittal deformity correction.

    PubMed

    Pimenta, Luiz; Fortti, Fernanda; Oliveira, Leonardo; Marchi, Luis; Jensen, Rubens; Coutinho, Etevaldo; Amaral, Rodrigo

    2015-07-01

    Degenerative and iatrogenic diseases may lead to loss of lordosis or even kyphotic thoracolumbar deformity and sagittal misalignment. Traditional surgery with three-column osteotomies is associated with important neurologic risks and postoperative morbidity. In a novel technique, the lateral transpsoas interbody fusion (LTIF) is complemented with the sacrifice of the anterior longitudinal ligament and anterior portion of the annulus followed by the insertion of a hyperlordotic interbody cage. This is a less invasive lateral technique named anterior column realignment (ACR) and aims to correct sagittal misalignment in adult spinal deformity (ASD), with or without the addition of minor posterior osteotomies. In this article, we provide an account of the evolution to the ACR technique, the literature, and the Brazilian experience in the treatment of adult spinal deformity with this novel advanced application of LTIF. In the presence of ASD, the risk-to-benefit ratio of a surgical correction must be evaluated. Less invasive surgical strategies can be alternatives to treat the deformity and provide better quality of life to the patient. ACR is an advanced application of lateral transpsoas approach, up to date has shown to be reliable and effective when used for ASD, and may minimize complications and morbidity from traditional surgical procedures. Long-term follow-up and comparative studies are needed to evaluate real benefit. PMID:25971442

  13. Progression of a lumbar disc extrusion.

    PubMed

    Crowell, Michael S; Alitz, Curtis

    2014-11-01

    The patient was a 34-year-old woman who was referred to a physical therapist for a chief complaint of progressively worsening right buttock pain with paresthesias of the right posterior thigh and calf. Prior magnetic resonance imaging of the patient's lumbar spine revealed a large left paracentral disc extrusion at L5-S1. Following physical therapist intervention, the patient reported a new onset of left posterior thigh pain, with paresthesias of the dorsolateral aspect of the left foot. Repeat magnetic resonance imaging of the patient's lumbar spine revealed an increase in the size of the disc extrusion at L5-S1. PMID:25361862

  14. A 10-year follow-up of transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or intervertebral B-Twin system in failed back surgery syndrome

    PubMed Central

    Cincu, Rafael; Lorente, Francisco de Asis; Gomez, Joaquin; Eiras, Jose; Agrawal, Amit

    2015-01-01

    Background: The spine surgeons have been combining anterior and posterolateral fusion (circumferential fusion) as the final solution to treat spinal disorders and many have been using it to treat failed back surgery syndrome (FBSS). In present study, we analyzed and compared the clinical and radiological outcomes in patients with transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or in patients with transpedicular screw fixation and intervertebral B-Twin system for FBSS with a follow-up period of 10 years after the surgery. Materials and Methods: This study was a retrospective case study performed on 55 patients with FBSS. Clinical and radiological changes were compared between the two groups of patients on the basis of improvement of back pain, radicular pain, and work capacity. Outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year from before surgery until 2012. We analyzed the evolution of 55 cases of FBSS those underwent segmental circumferential posterior fusions from June 2001 to February 2003, operated by a single surgeon and followed up during 10 years until February 2012. The patients were divided into 2 groups: In 25 patients, posterolateral fusions with Legacy™ (Medtronic, Inc. NYSE: MDT) screws and intersomatic autogenous posterior iliac crest bone graft was performed, and, in 30 patients, posterolateral fusions with the same screws and intersomatic fusion B-Twin (Biomet Spain Orthopaedics, S.L.) system was performed. In all cases, we used posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) approach for intervertebral graft, and the artrodesis was supplemented at intertransverse level with Autologus Growth Factor (AGF-MBA INCORPORADO, S.A.). The outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year and compared

  15. Clinical outcomes following sublaminar decompression and instrumented fusion for lumbar degenerative spinal pathology.

    PubMed

    Peddada, Kranti; Elder, Benjamin D; Ishida, Wataru; Lo, Sheng-Fu L; Goodwin, C Rory; Boah, Akwasi O; Witham, Timothy F

    2016-08-01

    Traditional treatment for lumbar stenosis with instability is laminectomy and posterolateral arthrodesis, with or without interbody fusion. However, laminectomies remove the posterior elements and decrease the available surface area for fusion. Therefore, a sublaminar decompression may be a preferred approach for adequate decompression while preserving bone surface area for fusion. A retrospective review of 71 patients who underwent sublaminar decompression in conjunction with instrumented fusion for degenerative spinal disorders at a single institution was performed. Data collected included demographics, preoperative symptoms, operative data, and radiographical measurements of the central canal, lateral recesses, and neural foramina, and fusion outcomes. Paired t-tests were used to test significance of the outcomes. Thirty-one males and 40 females with a median age 60years underwent sublaminar decompression and fusion. A median of two levels were fused. The mean Visual Analog Scale pain score improved from 6.7 preoperatively to 2.9 at last follow-up. The fusion rate was 88%, and the median time to fusion was 11months. Preoperative and postoperative mean thecal sac cross-sectional area, right lateral recess height, left lateral recess height, right foraminal diameter, and left foraminal diameter were 153 and 209mm(2) (p<0.001), 5.9 and 5.9mm (p=0.43), 5.8 and 6.3mm (p=0.027), 4.6 and 5.2mm (p=0.008), and 4.2 and 5.2mm (p<0.001), respectively. Sublaminar decompression provided adequate decompression, with significant increases in thecal sac cross-sectional area and bilateral foraminal diameter. It may be an effective alternative to laminectomy in treating central and foraminal stenosis in conjunction with instrumented fusion. PMID:27056673

  16. Automatic Lumbar Spondylolisthesis Measurement in CT Images.

    PubMed

    Liao, Shu; Zhan, Yiqiang; Dong, Zhongxing; Yan, Ruyi; Gong, Liyan; Zhou, Xiang Sean; Salganicoff, Marcos; Fei, Jun

    2016-07-01

    Lumbar spondylolisthesis is one of the most common spinal diseases. It is caused by the anterior shift of a lumbar vertebrae relative to subjacent vertebrae. In current clinical practices, staging of spondylolisthesis is often conducted in a qualitative way. Although meyerding grading opens the door to stage spondylolisthesis in a more quantitative way, it relies on the manual measurement, which is time consuming and irreproducible. Thus, an automatic measurement algorithm becomes desirable for spondylolisthesis diagnosis and staging. However, there are two challenges. 1) Accurate detection of the most anterior and posterior points on the superior and inferior surfaces of each lumbar vertebrae. Due to the small size of the vertebrae, slight errors of detection may lead to significant measurement errors, hence, wrong disease stages. 2) Automatic localize and label each lumbar vertebrae is required to provide the semantic meaning of the measurement. It is difficult since different lumbar vertebraes have high similarity of both shape and image appearance. To resolve these challenges, a new auto measurement framework is proposed with two major contributions: First, a learning based spine labeling method that integrates both the image appearance and spine geometry information is designed to detect lumbar vertebrae. Second, a hierarchical method using both the population information from atlases and domain-specific information in the target image is proposed for most anterior and posterior points positioning. Validated on 258 CT spondylolisthesis patients, our method shows very similar results to manual measurements by radiologists and significantly increases the measurement efficiency. PMID:26849859

  17. Lumbar spine CT scan

    MedlinePlus

    CAT scan - lumbar spine; Computed axial tomography scan - lumbar spine; Computed tomography scan - lumbar spine; CT - lower back ... stopping.) A computer creates separate images of the spine area, called slices. These images can be stored, ...

  18. Lumbar pseudarthrosis: a review of current diagnosis and treatment.

    PubMed

    Chun, Danielle S; Baker, Kevin C; Hsu, Wellington K

    2015-10-01

    OBJECT Failed solid bony fusion, or pseudarthrosis, is a well-known complication of lumbar arthrodesis. Recent advances in radiographic technology, biologics, instrumentation, surgical technique, and understanding of the local biology have all aided in the prevention and treatment of pseudarthrosis. Here, the current literature on the diagnosis and management of lumbar pseudarthroses is reviewed. METHODS A systematic literature review was conducted using the MEDLINE and Embase databases in order to search for the current radiographie diagnosis and surgical treatment methods published in the literature (1985 to present). Inclusion criteria included: 1) published in English; 2) level of evidence I-III; 3) diagnosis of degenerative lumbar spine conditions and/or history of lumbar spine fusion surgery; and 4) comparative studies of 2 different surgical techniques or comparative studies of imaging modality versus surgical exploration. RESULTS Seven studies met the inclusion criteria for current radiographie imaging used to diagnose lumbar pseudarthrosis. Plain radiographs and thin-cut CT scans were the most common method for radiographie diagnosis. PET has been shown to be a valid imaging modality for monitoring in vivo active bone formation. Eight studies compared the surgical techniques for managing and preventing failed lumbar fusion. The success rates for the treatment of pseudarthrosis are enhanced with the use of rigid instrumentation. CONCLUSIONS Spinal fusion rates have improved secondary to advances in biologies, instrumentation, surgical techniques, and understanding of local biology. Treatment of lumbar pseudarthrosis includes a variety of surgical options such as replacing loose instrumentation, use of more potent biologies, and interbody fusion techniques. Prevention and recognition are important tenets in the algorithm for the management of spinal pseudarthrosis. PMID:26424334

  19. Operative Management of Lumbar Degenerative Disc Disease

    PubMed Central

    Lee, Yu Chao; Osti, Orso Lorenzo

    2016-01-01

    Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term. PMID:27559465

  20. Operative Management of Lumbar Degenerative Disc Disease.

    PubMed

    Lee, Yu Chao; Zotti, Mario Giuseppe Tedesco; Osti, Orso Lorenzo

    2016-08-01

    Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term. PMID:27559465

  1. A minimally invasive technique for percutaneous lumbar facet augmentation: Technical description of a novel device

    PubMed Central

    Smith, Zachary A.; Armin, Sean; Raphael, Dan; Khoo, Larry T.

    2011-01-01

    Background: We describe a new posterior dynamic stabilizing system that can be used to augment the mechanics of the degenerating lumbar segment. The mechanism of this system differs from other previously described surgical techniques that have been designed to augment lumbar biomechanics. The implant and technique we describe is an extension-limiting one, and it is designed to support and cushion the facet complex. Furthermore, it is inserted through an entirely percutaneous technique. The purpose of this technical note is to demonstrate a novel posterior surgical approach for the treatment of lumbar degenerative. Methods: This report describes a novel, percutaneously placed, posterior dynamic stabilization system as an alternative option to treat lumbar degenerative disk disease with and without lumbar spinal stenosis. The system does not require a midline soft-tissue dissection, nor subperiosteal dissection, and is a truly minimally invasive means for posterior augmentation of the functional facet complex. This system can be implanted as a stand-alone procedure or in conjunction with decompression procedures. Results: One-year clinical results in nine individual patients, all treated for degenerative disease of the lower lumbar spine, are presented. Conclusions: This novel technique allows for percutaneous posterior dynamic stabilization of the lumbar facet complex. The use of this procedure may allow a less invasive alternative to traditional approaches to the lumbar spine as well as an alternative to other newly developed posterior dynamic stabilization systems. PMID:22145084

  2. Lumbar paraspinal muscle morphometry and its correlations with demographic and radiological factors in adult isthmic spondylolisthesis: a retrospective review of 120 surgically managed cases.

    PubMed

    Thakar, Sumit; Sivaraju, Laxminadh; Aryan, Saritha; Mohan, Dilip; Sai Kiran, Narayanam Anantha; Hegde, Alangar S

    2016-05-01

    OBJECTIVE The objective of this study was to assess the cross-sectional areas (CSAs) of lumbar paraspinal muscles in adults with isthmic spondylolisthesis (IS), to compare them with those in the normative population, and to evaluate their correlations with demographic factors and MRI changes in various spinal elements. METHODS The authors conducted a retrospective study of patients who had undergone posterior lumbar interbody fusion for IS, and 2 of the authors acting as independent observers calculated the CSAs of various lumbar paraspinal muscles (psoas, erector spinae [ES], multifidus [MF]) on preoperative axial T2-weighted MR images from the L-3 to L-5 vertebral levels and computed the CSAs as ratios with respect to the corresponding vertebral body areas. These values were then compared with those in an age- and sex-matched normative population and were analyzed with respect to age, sex, duration of symptoms, grade of listhesis, and various MRI changes at the level of the listhesis (pedicle signal change, disc degeneration, and facetal arthropathy). RESULTS Compared with values in normative controls, the mean CSA value for the ES muscle was significantly higher in the study cohort of 120 patients (p = 0.002), whereas that for the MF muscle was significantly lower (p = 0.009), and more so in the patients with PSC (p = 0.002). Magnetic resonance imaging signal change in the pedicle was seen in half of the patients, all of whom demonstrated a Type 2 change. Of the variables tested in a multivariate analysis, age independently predicted lower area values for all 3 muscles (p ≤ 0.001), whereas female sex predicted a lower mean psoas area value (p < 0.001). None of the other variables significantly predicted any of the muscle area values. A decrease in the mean MF muscle area value alone was associated with a significantly increased likelihood of a PSC (p = 0.039). CONCLUSIONS Compared with normative controls, patients with IS suffer selective atrophy of their MF

  3. Lumbar Osteotomy.

    PubMed

    Wood, Kirkham B

    2016-04-01

    When a patient presents with spine problems, the spine surgeon would do well to avoid use of, reliance on, and acceptance of radiographs as the sole or primary source of information. Measurement of pelvic incidence and lumbar lordosis, although crucial, does not take into account the effort the patient must make to move, the level of involvement of other parts of the body, and the history of previous procedures and outcomes. Radiographs may show pathology that is not consistent with the appearance of the patient. How should we assess this situation? PMID:27015064

  4. Biomechanical effects of polyaxial pedicle screw fixation on the lumbosacral segments with an anterior interbody cage support

    PubMed Central

    Chen, Shih-Hao; Mo Lin, Ruey; Chen, Hsiang-Ho; Tsai, Kai-Jow

    2007-01-01

    Background Lumbosacral fusion is a relatively common procedure that is used in the management of an unstable spine. The anterior interbody cage has been involved to enhance the stability of a pedicle screw construct used at the lumbosacral junction. Biomechanical differences between polyaxial and monoaxial pedicle screws linked with various rod contours were investigated to analyze the respective effects on overall construct stiffness, cage strain, rod strain, and contact ratios at the vertebra-cage junction. Methods A synthetic model composed of two ultrahigh molecular weight polyethylene blocks was used with four titanium pedicle screws (two in each block) and two rods fixation to build the spinal construct along with an anterior interbody cage support. For each pair of the construct fixed with polyaxial or monoaxial screws, the linked rods were set at four configurations to simulate 0°, 7°, 14°, and 21° lordosis on the sagittal plane, and a compressive load of 300 N was applied. Strain gauges were attached to the posterior surface of the cage and to the central area of the left connecting rod. Also, the contact area between the block and the cage was measured using prescale Fuji super low pressure film for compression, flexion, lateral bending and torsion tests. Results Our main findings in the experiments with an anterior interbody cage support are as follows: 1) large segmental lordosis can decrease the stiffness of monoaxial pedicle screws constructs; 2) polyaxial screws rather than monoaxial screws combined with the cage fixation provide higher compression and flexion stiffness in 21° segmental lordosis; 3) polyaxial screws enhance the contact surface of the cage in 21° segmental lordosis. Conclusion Polyaxial screws system used in conjunction with anterior cage support yields higher contact ratio, compression and flexion stiffness of spinal constructs than monoaxial screws system does in the same model when the spinal segment is set at large lordotic

  5. Lumbar paraganglioma.

    PubMed

    Dillard-Cannon, Erika; Atsina, Kofi-Buaku; Ghobrial, George; Gnass, Esteban; Curtis, Mark T; Heller, Joshua

    2016-08-01

    Spinal paragangliomas (SP) are benign and overall rare extra-adrenal neuroendocrine tumors often diagnosed during workup for lower back pain. Complete surgical resection achieves both symptomatic relief and cure. We present a 32-year-old man with a longstanding history of lumbago and bilateral lower extremity pain found to have a lumbar paraganglioma at the level of the L3 vertebrae. The clinical, histopathological, and radiological characteristics are described, including the rare finding of superficial siderosis on MRI of the brain. A laminectomy with microscopic dissection of the intradural mass achieved complete debulking without evidence of residual tumor. Excellent prognosis can be achieved with complete surgical resection of SP without the need for adjuvant therapy. Therefore, care should be taken to distinguish these spinal tumors from those that appear similar but are more aggressive. As such, the radiological finding of superficial siderosis should raise the suspicion for SP when a vascular intradural extramedullary spinal tumor is observed. PMID:27032749

  6. The microendoscopic decompression of lumbar stenosis: a review of the current literature and clinical results.

    PubMed

    Wong, Albert P; Smith, Zachary A; Lall, Rohan R; Bresnahan, Lacey E; Fessler, Richard G

    2012-01-01

    Lumbar stenosis is a well-defined pathologic condition with excellent surgical outcomes. Empiric evidence as well as randomized, prospective trials has demonstrated the superior efficacy of surgery compared to medical management for lumbar stenosis. Traditionally, lumbar stenosis is decompressed with open laminectomies. This involves removal of the spinous process, lamina, and the posterior musculoligamentous complex (posterior tension band). This approach provides excellent improvement in symptoms, but is also associated with potential postoperative spinal instability. This may result in subsequent need for spinal fusion. Advances in technology have enabled the application of minimally invasive spine surgery (MISS) as an acceptable alternative to open lumbar decompression. Recent studies have shown similar to improved perioperative outcomes when comparing MISS to open decompression for lumbar stenosis. A literature review of MISS for decompression of lumbar stenosis with tubular retractors was performed to evaluate the outcomes of this modern surgical technique. In addition, a discussion of the advantages and limitations of this technique is provided. PMID:22900163

  7. The Microendoscopic Decompression of Lumbar Stenosis: A Review of the Current Literature and Clinical Results

    PubMed Central

    Wong, Albert P.; Smith, Zachary A.; Lall, Rohan R.; Bresnahan, Lacey E.; Fessler, Richard G.

    2012-01-01

    Lumbar stenosis is a well-defined pathologic condition with excellent surgical outcomes. Empiric evidence as well as randomized, prospective trials has demonstrated the superior efficacy of surgery compared to medical management for lumbar stenosis. Traditionally, lumbar stenosis is decompressed with open laminectomies. This involves removal of the spinous process, lamina, and the posterior musculoligamentous complex (posterior tension band). This approach provides excellent improvement in symptoms, but is also associated with potential postoperative spinal instability. This may result in subsequent need for spinal fusion. Advances in technology have enabled the application of minimally invasive spine surgery (MISS) as an acceptable alternative to open lumbar decompression. Recent studies have shown similar to improved perioperative outcomes when comparing MISS to open decompression for lumbar stenosis. A literature review of MISS for decompression of lumbar stenosis with tubular retractors was performed to evaluate the outcomes of this modern surgical technique. In addition, a discussion of the advantages and limitations of this technique is provided. PMID:22900163

  8. Posterior Hip Pain in an Athletic Population

    PubMed Central

    Frank, Rachel M.; Slabaugh, Mark A.; Grumet, Robert C.; Virkus, Walter W.; Bush-Joseph, Charles A.; Nho, Shane J.

    2010-01-01

    Context: Posterior hip pain is a relatively uncommon but increasingly recognized complaint in the orthopaedic community. Patient complaints and presentations are often vague or nonspecific, making diagnosis and subsequent treatment decisions difficult. The purposes of this article are to review the anatomy and pathophysiology related to posterior hip pain in the athletic patient population. Evidence Acquisition: Data were collected through a thorough review of the literature via a MEDLINE search of all relevant articles between 1980 and 2010. Results: Many patients who complain of posterior hip pain actually have pain referred from another part of the body—notably, the lumbar spine or sacroiliac joint. Treatment options for posterior hip pain are typically nonoperative; however, surgery is warranted in some cases. Conclusions: Recent advancements in the understanding of hip anatomy, pathophysiology, and treatment options have enabled physicians to better diagnosis athletic hip injuries and select patients for appropriate treatment. PMID:23015944

  9. Infarction of the unilateral posterior horn and lateral column of the spinal cord with sparing of posterior columns: demonstration by MRI.

    PubMed Central

    Kaneki, M; Inoue, K; Shimizu, T; Mannen, T

    1994-01-01

    Infarction of the spinal cord, particularly in the distribution of the posterior spinal arteries, is rare. Twenty seven cases of posterior spinal artery syndrome have been reported. In all cases, the posterior columns were affected, and in all but two, the lesions were bilateral. Here a 49-year-old woman is reported, who was affected with lumbar cord infarction in the distribution of the posterior spinal arteries, diagnosed by MRI and clinical presentation. This case is of special interest because of sparing of the posterior columns and the unilateral nature of the lesion, even though the infarction occurred in the distribution of the posterior spinal arteries. Images PMID:8201340

  10. Retroperitoneal hematoma after using the extreme lateral interbody fusion (XLIF) approach: Presentation of a case and a review of the literature.

    PubMed

    Peiró-García, A; Domínguez-Esteban, I; Alía-Benítez, J

    2016-01-01

    The transpsoas approach, also known as extreme lateral interbody fusion (XLIF), to the lumbar spine is a novel minimally invasive technique with positive clinical outcomes and a low complication rate. There is a low risk of bleeding, due to this approach causing less soft tissue disruption than traditional spine surgery, but segmental arteries and great vessels can be damaged. Retroperitoneal haematoma is a major complication, with few cases reported. This is the first case reported in a Stand-alone XLIF and also the first case reported with haemorrhagic shock. Non-specific symptoms such tachycardia, hypotension, and anaemia are the most prevalent in this complication. With this case, our aim is to describe serious complications related to XLIF. PMID:25703640

  11. Minimally Invasive Direct Thoracic Interbody Fusion (MIS-DTIF): Technical Notes of a Single Surgeon Study

    PubMed Central

    Abbasi, Hamid

    2016-01-01

    Background Minimally invasive direct thoracic interbody fusion (MIS-DTIF) is a new single surgeon procedure for fusion of the thoracic vertebrae below the scapula (T6/7) to the thoracolumbar junction. In this proof of concept study, we describe the surgical technique for MIS-DTIF and report our experience and the perioperative outcomes of the first four patients who underwent this procedure. Study design/setting In this study we attempt to establish the safety and efficacy of MIS-DTIF. We have performed MIS-DTIF on six spinal levels in four patients with degenerative disk disease or disk herniation. We recorded surgery time, blood loss, fluoroscopy time, complications, and patient-reported pain. Methods Throughout the MIS-DTIF procedure, the surgeon is aided by biplanar fluoroscopic imaging and electrophysiological monitoring. The surgeon approaches the spine with a series of gentle tissue dilations and inserts a working tube that establishes a direct connection from the outside of the skin to the disk space. Through this working tube, the surgeon performs a discectomy and inserts an interbody graft or cage. The procedure is completed with minimally invasive (MI) posterior pedicle screw fixation. Results For the single level patients the mean blood loss was 90 ml, surgery time 43 minutes, fluoroscopy time 293 seconds, and hospital stay two days. For the two-level surgeries, the mean blood loss was 27 ml, surgery time 61 minutes, fluoroscopy time 321 seconds, and hospital stay three days. We did not encounter any clinically significant complications. Thirty days post-surgery, the patients reported a statistically significant reduction of 5.3 points on a 10-point sliding pain scale. Conclusions MIS-DTIF with pedicle screw fixation is a safe and clinically effective procedure for fusions of the thoracic spine. The procedure is technically straightforward and overcomes many of the limitations of the current minimally invasive (MI) approaches to the thoracic spine. MIS

  12. Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis.

    PubMed

    Le Huec, J C; Liu, M; Skalli, W; Josse, L

    2002-04-01

    Many studies have concluded that stand alone cages provide limited stabilization to the spine, and this primary stabilization decreases postoperatively due to various factors. A supplemental fixation may, therefore, be needed to improve the stability. Extensive biomechanical analysis was performed in the present study to further evaluate the stabilization achieved by a laterally inserted cage and the role of an anterior lateral supplemental fixation. Eight human cadaver functional spinal units were subjected sequentially to four different test conditions: (1) intact, (2) instrumented laterally with a long cylindrical threaded cage, (3) the same cage supplemented with a lateral fixation plate, the plate being firmly connected to the cage, and (4) removal of the connection between the plate and the cage. Pure moments were applied to each specimen in a quasi static manner, ranging from -7 Nm to 7 Nm in flexion/extension, lateral bending and axial rotation. Three-dimensional segmental motions were simultaneously recorded under each loading condition. Statistical analysis was carried out on the motion parameters, including the range of motion (ROM) and the neutral zone (NZ). Inter-group comparisons were made using the Friedman test and the Wilcoxon test. The results showed that the stand alone lateral cage provided stabilization by increasing segmental stiffness above that of the intact spine. The stiffness increase ratios were: 1.6 in flexion/extension ( P=0.07), 1.3 in lateral bending ( P=0.4) and 1.0 in axial rotation ( P=0.67). A supplemental plate provided significant reinforcement of the stabilization. The stiffness increase ratios relative to the intact spine were: 3.1 in flexion/extension ( P=0.012), 5.0 in lateral bending ( P=0.012) and 2.3 in axial rotation ( P=0.012). After removal of the connection between the cage and the plate, the stiffness ratios were: 2.7 in flexion/extension ( P=0.027), 4.6 in lateral bending ( P=0.027) and 2.1 in axial rotation ( P=0.027). Globally, the cage alone increased the segmental stiffness above that of the intact spine by a factor of 1.1 ( P=0.39), with the supplemental plate, segmental stiffness increased by a factor of 3.1 ( P<0.01), and the unconnected cage/plate increased stiffness by a factor of 3.0 ( P=0.02). Supplementation of the lateral cage with an anterolateral plate was thus shown to provide significant additional stabilization in all directions, which may potentially compensate for the postoperative decrease in segmental stability. PMID:11956919

  13. Spectrum of magnetic resonance imaging findings in congenital lumbar spinal stenosis

    PubMed Central

    Soldatos, Theodoros; Chalian, Majid; Thawait, Shrey; Belzberg, Alan J; Eng, John; Carrino, John A; Chhabra, Avneesh

    2014-01-01

    AIM: To investigate whether congenital lumbar spinal stenosis (CLSS) is associated with a specific degenerative changes of the lumbar spine. METHODS: The lumbar spine magnetic resonance imaging studies of 52 subjects with CLSS and 48 control subjects were retrospectively evaluated. In each examination, the five lumbar levels were assessed for the presence or absence of circumferential or shallow annular bulges, annular tears, anterior or posterior disc herniations, epidural lipomatosis, Schmorl’s nodes, spondylolisthesis, pars defects, and stress reactions of the posterior vertebral elements. RESULTS: Compared to control individuals, subjects with CLSS exhibited increased incidence of circumferential and shallow annular bulges, annular tears, disc herniations and spondylolisthesis (P < 0.05). CONCLUSION: CLSS is associated with increased incidence of degenerative changes in specific osseous and soft-tissue elements of the lumbar spine. PMID:25516864

  14. Useful Points of Geometry and Topography of the Lumbar Triangle for Transversus Abdominis Plane Block

    PubMed Central

    Ziętek, Zbigniew; Starczewski, Kamil; Sulikowski, Tadeusz; Iwan-Ziętek, Iza; Żukowski, Maciej; Kamiński, Marek; Ziętek-Czeszak, Angelika

    2015-01-01

    Background A new look at the topography of the lumbar triangle becomes a challenge for modern anesthesia. The aim of this study was to redefine the topography of the lumbar triangle for transverse abdominis plane block. Material/Methods We explored 74 lumbar regions in 37 preserved cadavers (17 F and 20 M). Results The lumbar triangle was identified in 66 (89%) out of all explored cadavers’ lumbar regions. The predominant triangle was the acute-angled shaped. It was identified in 39 (59%) out of all explored lumbar regions. The second type of dissected triangles had the obtuse-angled shaped. Most triangles of acute-angled shaped and obtuse-angled shaped (36) had medium surface (range from 3 cm2 to 6 cm2), which accounted for 55% of all dissected lumbar triangles. The mean surface of the lumbar triangle was 3.6±2.2 cm2. Based on other measurements, we demonstrated that the majority of the lumbar triangles (62 triangles) were beyond the posterior axillary line. Conclusions According to the obtained results, the randomized searching for lumbar triangle should be limited to the area situated beyond of the posterior axillary line. The region situated anteriorly to the midaxillary line was defined in the study as the critical area for finding the lumbar triangle. Outcomes from the study revealed that the size and the location of the lumbar triangle as the gate for the transverse abdominal plane block may be responsible for difficulties encountered by anesthetists. Thus, establishing the area with the highest probability of localization of the lumbar triangle can improve both safety and efficiency of transversus abdominis plane block. PMID:26714659

  15. Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain.

    PubMed

    Rosa, Bárbara; Campos, Pedro; Barros, André; Karmali, Samir; Ussene, Esperança; Durão, Carlos; Alves da Silva, João; Coutinho, Nuno

    2016-01-01

    We present a case of a 5th Lumbar Vertebra (L5) spinous process osteochondroma as a rare cause of lumbar pain in an old patient. A 70-year-old male presented with progressive and disabling lower lumbar pain. Tenderness over the central and left paraspinal area of the lower lumbar region and a palpable mass were evident. CT scan showed a mass arising from the spinous process of L5. Marginal resection of the tumor was performed through a posterior approach. The histological study revealed an osteochondroma. After surgery, pain was completely relieved. After one year there was no evidence of local recurrence or symptoms. Osteochondromas rarely involve the spine, but when they do symptoms like pain, radiculopathy/myelopathy, or cosmetic deformity may occur. The imagiologic exam of election for diagnosis is CT scan. When symptomatic the treatment of choice is surgical resection. The most concerning complication of osteochondromas is malignant transformation, a rare event. PMID:27579204

  16. Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain

    PubMed Central

    Rosa, Bárbara; Campos, Pedro; Barros, André; Karmali, Samir; Ussene, Esperança; Alves da Silva, João; Coutinho, Nuno

    2016-01-01

    We present a case of a 5th Lumbar Vertebra (L5) spinous process osteochondroma as a rare cause of lumbar pain in an old patient. A 70-year-old male presented with progressive and disabling lower lumbar pain. Tenderness over the central and left paraspinal area of the lower lumbar region and a palpable mass were evident. CT scan showed a mass arising from the spinous process of L5. Marginal resection of the tumor was performed through a posterior approach. The histological study revealed an osteochondroma. After surgery, pain was completely relieved. After one year there was no evidence of local recurrence or symptoms. Osteochondromas rarely involve the spine, but when they do symptoms like pain, radiculopathy/myelopathy, or cosmetic deformity may occur. The imagiologic exam of election for diagnosis is CT scan. When symptomatic the treatment of choice is surgical resection. The most concerning complication of osteochondromas is malignant transformation, a rare event.

  17. Intradural lumbar disc herniations: report of three cases.

    PubMed

    Prestar, F J; Schattke, H H

    1995-09-01

    Intradural lumbar disc herniation is a rare pathological entity. Three new cases among a series of 5000 lumbar spine operations are added to the about 60 previous case reports in the literature. None of our patients had undergone lumbar spine surgery before. In one patient the location of the free disc fragment was medial within the dural sac; in two patients the free disc fragment had penetrated the dural sac from the axilla of the nerve root. Pathogenesis is discussed (congenital adhesions of the dura mater to the posterior longitudinal ligament at the lower lumbar spine; weakness of the dura mater ventrally and at the axilla of the nerve root). By multiplanar MRI, the free disc hernia within the dural sac may be shown preoperatively. PMID:8542333

  18. A methodology for quantifying seated lumbar curvatures.

    PubMed

    Leitkam, Samuel T; Bush, Tamara Reid; Li, Mingfei

    2011-11-01

    To understand the role seating plays in the support of posture and spinal articulation, it is necessary to study the interface between a human and the seat. However, a method to quantify lumbar curvature in commercially available unmodified seats does not currently exist. This work sought to determine if the lumbar curvature for normal ranges of seated posture could be documented by using body landmarks located on the anterior portion of the body. The development of such a methodology will allow researchers to evaluate spinal articulation of a seated subject while in standard, commercially available seats and chairs. Anterior measurements of boney landmarks were used to quantify the relative positions of the ribcage and pelvis while simultaneous posterior measurements were made of lumbar curvature. The relationship between the anterior and the posterior measures was compared. The predictive capacity of this approach was evaluated by determining linear and second-order regressions for each of the four postures across all subjects and conducting a leave-one-out cross validation. The relationships between the anterior and posterior measures were approximated by linear and second-order polynomial regressions (r(2 ) =  0.829, 0.935 respectively) across all postures. The quantitative analysis showed that openness had a significant relationship with lumbar curvature, and a first-order regression was superior to a second-order regression. Average standard errors in the prediction were 5.9° for the maximum kyphotic posture, 9.9° for the comfortable posture, 12.8° for the straight and tall, and 22.2° for the maximum lordotic posture. These results show predictions of lumbar curvature are possible in seated postures by using a motion capture system and anterior measures. This method of lumbar curvature prediction shows potential for use in the assessment of seated spinal curvatures and the corresponding design of seating to accommodate those curvatures; however

  19. Morphological structure and variations of lumbar plexus in human fetuses.

    PubMed

    Yasar, Soner; Kaya, Serdar; Temiz, Cağlar; Tehli, Ozkan; Kural, Cahit; Izci, Yusuf

    2014-04-01

    The objective of this study is to study the anatomy of lumbar plexus on human fetuses and to establish its morphometric characteristics and differences compared with adults. Twenty lumbar plexus of 10 human fetal cadavers in different gestational ages and genders were dissected. Lumbar spinal nerves, ganglions, and peripheral nerves were exposed. Normal anatomical structure and variations of lumbar plexus were investigated and morphometric analyses were performed. The diameters of lumbar spinal nerves increased from L1 to L4. The thickest nerve forming the plexus was femoral nerve, the thinnest was ilioinguinal nerve, the longest nerve through posterior abdominal wall was iliohypogastric nerve, and the shortest nerve was femoral nerve. Each plexus had a single furcal nerve and this arose from L4 nerve in all fetuses. No prefix or postfix plexus variation was observed. In two plexuses, L1 nerve was in the form of a single branch. Also, in two plexuses, genitofemoral nerve arose only from L2 nerve. Accessory obturator nerve was observed in four plexuses. According to these findings, the morphological pattern of the lumbar plexus in the fetus was found to be very similar to the lumbar plexus in adults. PMID:22696243

  20. Do obese patients have worse outcomes after direct lateral interbody fusion compared to non-obese patients?

    PubMed

    Adogwa, Owoicho; Farber, S Harrison; Fatemi, Parastou; Desai, Rupen; Elsamadicy, Aladine; Cheng, Joseph; Bagley, Carlos; Gottfried, Oren; Isaacs, Robert E

    2016-03-01

    Obese patients undergoing lumbar spinal fusion surgery are a challenge to the operating surgeon. Direct lateral interbody fusion (DLIF) has been performed for degenerative disease of the lumbar spine with good outcomes; nevertheless, how obese patients fare compared to non-obese patients after DLIF remains unknown. The primary aim of this study is to compare rates of postoperative complications and long-term outcomes between obese and non-obese patients undergoing DLIF. Sixty-three patients (obese: 29, non-obese: 34) undergoing index DLIF for degenerative disease of the spine between 2010 and 2012 at our institution were retrospectively enrolled. We analyzed data on demographics, postoperative complications, back and leg pain, and functional disability over 2 years. Patients completed the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) back and leg pain numerical rating scores before surgery, then at 12 and 24 months after surgery. Outcomes and complication rates were compared between the cohorts. The cohorts were similar at baseline. Postoperative complications rates were similar between obese and non-obese patients. There was no statistically significant difference in the incidence of durotomy (p=0.91), anterior thigh numbness (p=0.60), cerebrospinal fluid leak (p=0.91), postoperative infection (p=0.37), or bleeding requiring transfusion (p=0.16). No patient experienced a nerve injury or psoas hematoma. Both cohorts had similar 2 year improvement in VAS for back pain, leg pain, and ODI. Our study demonstrates that obese and non-obese patients undergoing DLIF have similar complication profiles; hence, a patient's weight should not be a contraindication to DLIF. PMID:26549673

  1. Footprint mismatch in lumbar total disc arthroplasty.

    PubMed

    Gstoettner, Michaela; Michaela, Gstoettner; Heider, Denise; Denise, Heider; Liebensteiner, Michael; Bach, Christian Michael; Michael, Bach Christian

    2008-11-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening and biomechanical failure due to an incorrect center of rotation. The aim of the present study was to measure the dimensions of lumbar vertebrae based on CT scans and assess the accuracy of match in currently available lumbar disc prostheses. A total of 240 endplates of 120 vertebrae were included in the study. The sagittal and mediolateral diameter of the upper and lower endplates were measured using a digital measuring system. For the levels L4/L5 and L5/S1, an inappropriate size match was noted in 98.8% (Prodisc L) and 97.6% (Charite) with regard to the anteroposterior diameter. Mismatch in the anterior mediolateral diameter was noted in 79.3% (Prodisc L) and 51.2% (Charite) while mismatch in the posterior mediolateral diameter was observed in 91.5% (Prodisc L) and 78% (Charite) of the endplates. Surgeons and manufacturers should be aware of the size mismatch of currently available lumbar disc prostheses, which may endanger the safety and efficacy of the procedure. Larger footprints of currently available total disc arthroplasties are required. PMID:18791748

  2. Footprint mismatch in lumbar total disc arthroplasty

    PubMed Central

    Michaela, Gstoettner; Denise, Heider; Liebensteiner, Michael

    2008-01-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening and biomechanical failure due to an incorrect center of rotation. The aim of the present study was to measure the dimensions of lumbar vertebrae based on CT scans and assess the accuracy of match in currently available lumbar disc prostheses. A total of 240 endplates of 120 vertebrae were included in the study. The sagittal and mediolateral diameter of the upper and lower endplates were measured using a digital measuring system. For the levels L4/L5 and L5/S1, an inappropriate size match was noted in 98.8% (Prodisc L) and 97.6% (Charite) with regard to the anteroposterior diameter. Mismatch in the anterior mediolateral diameter was noted in 79.3% (Prodisc L) and 51.2% (Charite) while mismatch in the posterior mediolateral diameter was observed in 91.5% (Prodisc L) and 78% (Charite) of the endplates. Surgeons and manufacturers should be aware of the size mismatch of currently available lumbar disc prostheses, which may endanger the safety and efficacy of the procedure. Larger footprints of currently available total disc arthroplasties are required. PMID:18791748

  3. Neurological Complications after Lateral Transpsoas Approach to Anterior Interbody Fusion with a Novel Flat-Blade Spine-Fixed Retractor

    PubMed Central

    Nunley, Pierce; Sandhu, Faheem; Frank, Kelly; Stone, Marcus

    2016-01-01

    Introduction. The lateral lumbar interbody fusion (LLIF) surgical approach has potential advantages over other approaches but is associated with some unique neurologic risks due to the proximity of the lumbosacral plexus. The present study analyzed complications following LLIF surgical approach using a novel single flat-blade retractor system. Methods. A retrospective data collection of patients receiving LLIF using a novel single flat-blade retractor system at two institutions in the US. Inclusion criteria were all patients receiving an LLIF procedure with the RAVINE® Lateral Access System (K2M, Inc., Leesburg, VA, USA). There was no restriction on preoperative diagnosis or number of levels treated. Approach-related neurologic complications were collected and analyzed postoperatively through a minimum of one year. Results. Analysis included 253 patients with one to four treated lateral levels. Immediate postoperative neurologic complications were present in 11.1% (28/253) of patients. At one-year follow-up the approach-related neurologic complications resolved in all except 5 patients (2.0%). Conclusion. We observed an 11.1% neurologic complication rate in LLIF procedures. There was resolution of symptoms for most patients by 12-month follow-up, with only 2% of patients with residual symptoms. This supports the hypothesis that the vast majority of approach-related neurologic symptoms are transient. PMID:27294140

  4. Structural and mechanical evaluations of a topology optimized titanium interbody fusion cage fabricated by selective laser melting process.

    PubMed

    Lin, Chia-Ying; Wirtz, Tobias; LaMarca, Frank; Hollister, Scott J

    2007-11-01

    A topology optimized lumbar interbody fusion cage was made of Ti-Al6-V4 alloy by the rapid prototyping process of selective laser melting (SLM) to reproduce designed microstructure features. Radiographic characterizations and the mechanical properties were investigated to determine how the structural characteristics of the fabricated cage were reproduced from design characteristics using micro-computed tomography scanning. The mechanical modulus of the designed cage was also measured to compare with tantalum, a widely used porous metal. The designed microstructures can be clearly seen in the micrographs of the micro-CT and scanning electron microscopy examinations, showing the SLM process can reproduce intricate microscopic features from the original designs. No imaging artifacts from micro-CT were found. The average compressive modulus of the tested caged was 2.97+/-0.90 GPa, which is comparable with the reported porous tantalum modulus of 3 GPa and falls between that of cortical bone (15 GPa) and trabecular bone (0.1-0.5 GPa). The new porous Ti-6Al-4V optimal-structure cage fabricated by SLM process gave consistent mechanical properties without artifactual distortion in the imaging modalities and thus it can be a promising alternative as a porous implant for spine fusion. PMID:17415762

  5. Neurological Complications after Lateral Transpsoas Approach to Anterior Interbody Fusion with a Novel Flat-Blade Spine-Fixed Retractor.

    PubMed

    Nunley, Pierce; Sandhu, Faheem; Frank, Kelly; Stone, Marcus

    2016-01-01

    Introduction. The lateral lumbar interbody fusion (LLIF) surgical approach has potential advantages over other approaches but is associated with some unique neurologic risks due to the proximity of the lumbosacral plexus. The present study analyzed complications following LLIF surgical approach using a novel single flat-blade retractor system. Methods. A retrospective data collection of patients receiving LLIF using a novel single flat-blade retractor system at two institutions in the US. Inclusion criteria were all patients receiving an LLIF procedure with the RAVINE® Lateral Access System (K2M, Inc., Leesburg, VA, USA). There was no restriction on preoperative diagnosis or number of levels treated. Approach-related neurologic complications were collected and analyzed postoperatively through a minimum of one year. Results. Analysis included 253 patients with one to four treated lateral levels. Immediate postoperative neurologic complications were present in 11.1% (28/253) of patients. At one-year follow-up the approach-related neurologic complications resolved in all except 5 patients (2.0%). Conclusion. We observed an 11.1% neurologic complication rate in LLIF procedures. There was resolution of symptoms for most patients by 12-month follow-up, with only 2% of patients with residual symptoms. This supports the hypothesis that the vast majority of approach-related neurologic symptoms are transient. PMID:27294140

  6. Complication with removal of a lumbar spinal locking plate.

    PubMed

    Crawford, Brooke; Lenarz, Christopher; Watson, J Tracy; Alander, Dirk

    2015-01-01

    Introduction. The use of locking plate technology for anterior lumbar spinal fusion has increased stability of the vertebral fusion mass over traditional nonconstrained screw and plate systems. This case report outlines a complication due to the use of this construct. Case. A patient with a history of L2 corpectomy and anterior spinal fusion presented with discitis at the L4/5 level and underwent an anterior lumbar interbody fusion (ALIF) supplemented with a locking plate placed anterolaterally for stability. Fifteen months after the ALIF procedure, he returned with a hardware infection. He underwent debridement of the infection site and removal of hardware. Results. Once hardware was exposed, removal of the locking plate screws was only successful in one out of four screws using a reverse thread screw removal device. Three of the reverse thread screw removal devices broke in attempt to remove the subsequent screws. A metal cutting drill was then used to break hoop stresses associated with the locking device and the plate was removed. Conclusion. Anterior locking plates add significant stability to an anterior spinal fusion mass. However, removal of this hardware can be complicated by the inherent properties of the design with significant risk of major vascular injury. PMID:25838956

  7. Complication with Removal of a Lumbar Spinal Locking Plate

    PubMed Central

    Crawford, Brooke; Lenarz, Christopher; Watson, J. Tracy; Alander, Dirk

    2015-01-01

    Introduction. The use of locking plate technology for anterior lumbar spinal fusion has increased stability of the vertebral fusion mass over traditional nonconstrained screw and plate systems. This case report outlines a complication due to the use of this construct. Case. A patient with a history of L2 corpectomy and anterior spinal fusion presented with discitis at the L4/5 level and underwent an anterior lumbar interbody fusion (ALIF) supplemented with a locking plate placed anterolaterally for stability. Fifteen months after the ALIF procedure, he returned with a hardware infection. He underwent debridement of the infection site and removal of hardware. Results. Once hardware was exposed, removal of the locking plate screws was only successful in one out of four screws using a reverse thread screw removal device. Three of the reverse thread screw removal devices broke in attempt to remove the subsequent screws. A metal cutting drill was then used to break hoop stresses associated with the locking device and the plate was removed. Conclusion. Anterior locking plates add significant stability to an anterior spinal fusion mass. However, removal of this hardware can be complicated by the inherent properties of the design with significant risk of major vascular injury. PMID:25838956

  8. Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

    PubMed Central

    Tuli, Surendra Mohan; Kapoor, Varun; Jain, Anil K; Jain, Saurabh

    2011-01-01

    Background: Iatrogenic instability following laminectomy occurs in patients with degenerative lumbar canal stenosis. Long segment fusions to obviate postoperative instability result in loss of motion of lumbar spine and predisposes to adjacent level degeneration. The best alternative would be an adequate decompressive laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity. We report a retrospective analysis of multilevel lumbar canal stenosis that were operated for posterior decompression and underwent spinaplasty to preserve posterior ligament complex integrity for outcome of decompression and iatrogenic instability. Materials and Methods: 610 patients of degenerative lumbar canal stenosis (n=520) and development spinal canal stenosis (n=90), with a mean age 58 years (33–85 years), underwent multilevel laminectomies and spinaplasty procedure. At followup, changes in the posture while walking, increase in the walking distance, improvement in the dysesthesia in lower limb, the motor power, capability to negotiate stairs and sphincter function were assessed. Forward excursion of vertebrae more than 4 mm in flexion–extension lateral X-ray of the spine as compared to the preoperative movements was considered as the iatrogenic instability. Clinical assessment was done in standing posture regarding active flexion–extension movement, lateral bending and rotations Results: All patients were followed up from 3 to 10 years. None of the patients had neurological deterioration or pain or catch while movement. Walking distance improved by 5–10 times, with marked relief (70–90%) in neurogenic claudication and preoperative stooping posture, with improvement in sensation and motor power. There was no significant difference in the sagittal alignment as well as anterior translation. Two patients with concomitant scoliosis and one with cauda equine syndrome had incomplete recovery. Two patients who developed disc protrusion, underwent

  9. Intradural herniation of lumbar intervertebral discs.

    PubMed

    Hodge, C J; Binet, E F; Kieffer, S A

    1978-12-01

    A case of intradural rupture of a lumbar intervertebral disc is reported, and the literature is reviewed. The majority of intradural disc herniations occur at the L4--5 level. These patients usually have neurologic deficits more severe than those found in the much more common extradural disc herniations. The myelographic picture varies from an irregularly marginated intradural lesion overlying the disc space to a complete block. The common factor allowing intradural disc herniation is probably dense adhesions between the dura and the posterior longitudinal ligament, preventing the more common lateral extradural disc herniation. Intradural disc herniation should be included in the differential diagnosis of lumbar intradural lesions causing nerve root or cauda equina compression. PMID:741242

  10. The Use of Percutaneous Lumbar Fixation Screws for Bilateral Pedicle Fractures with an Associated Dislocation of a Lumbar Disc Prosthesis

    PubMed Central

    Harrison, William D.; Harrison, David J.

    2013-01-01

    Study Design. Case report. Objective. To identify a safe technique for salvage surgery following complications of total disc replacement. Summary of Background Data. Lumbar total disc replacement (TDR) is considered by some as the gold standard for discogenic back pain. Revision techniques for TDR and their complications are in their infancy. This case describes a successful method of fixation for this complex presentation. Methods and Results. A 48-year-old male with lumbar degenerative disc disease and no comorbidities. Approximately two weeks postoperatively for a TDR, the patient represented with acute severe back pain and the TDR polyethylene inlay was identified as dislocated anteriorly. Subsequent revision surgery failed immediately as the polyethylene inlay redislocated intraoperatively. Further radiology identified bilateral pedicle fractures, previously unseen on the plain films. The salvage fusion of L5/S1 reutilized the anterior approach with an interbody fusion cage and bone graft. The patient was then turned intraoperatively and redraped. The percutaneous pedicle screws were used to fix L5 to the sacral body via the paracoccygeal corridor. Conclusion. The robust locking screw in the percutaneous screw allowed a complete fixation of the pedicle fractures. At 3-year followup, the patient has an excellent result and has returned to playing golf. PMID:24294533