Lateral lumbar interbody fusion for the correction of spondylolisthesis and adult degenerative scoliosis in high-risk patients: early radiographic results and complications (original) (raw)
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Asian Spine Journal, 2015
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.
Journal of Spine Surgery
Background: Surgical treatment for adult degenerative scoliosis (ADS) is a complex undertaking and is associated with a high complication rate. Our aim was to evaluate the clinical and radiological outcomes, mortality and morbidity of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment in ADS based on the experience of a single tertiary referral center for spinal surgery. Methods: We performed a retrospective analysis of prospectively collected data of consecutive patients who had undergone multi-level posterior interbody fusion for degenerative scoliosis. We prospectively recorded patients' demographics, co-morbidities; coronal and sagittal plane deformity assessment and surgical details: number of instrumented levels, and intra-operative and postoperative complications. Functional outcomes and patient-reported complications were entered in our local spine surgery database (part of the Eurospine Spine Tango Registry) and used to collect data on functional scores and patient-reported complications preoperatively and at 6, 12 and 24 months' follow-up. Results: Our study involved 13 males and 51 females with a mean age of 70.26 (range 49-90, SD 8.9). MPLIF was performed at five levels in one patient, four levels in 29 patients, three levels in 20 patients, and two levels in 14 patients. There were a total of 14 (21.87%) major, minor and mechanical complications. There were no procedure-related mortalities. The average COMI and Eq5d scores improved significantly post-surgery, and this improvement was maintained at a mean follow-up of up to two years. Conclusions: Multilevel posterior interbody fusion is a safe procedure, and in selected cases can result in good clinical and radiological outcomes with improvement in patient quality of life.
Journal of Neurosurgery: Spine, 2007
Object The purpose of this study was to compare the imaging and clinical outcomes obtained in patients with lumbar spondylolisthesis who have undergone either instrumented anterior lumbar interbody fusion (ALIF) or instrumented posterior LIF (PLIF), especially with regard to the development of adjacent-segment degeneration (ASD). Methods Forty-eight patients with preoperative spondylolisthesis and minimal ASD who underwent instrumented L4–5 fusion were divided into two groups according to the surgical approach. After ensuring the two groups' comparability, the following variables were evaluated: postoperative segmental and lumbar lordosis, postoperative percentage of vertebral slippage, reduction rate, incidence of ASD, and clinical outcomes. Results Adjacent-segment degeneration was found in 44.0% of the patients in the ALIF group and in 82.6% of those in the PLIF group (p = 0.008). Clinical success rates were 92.0 and 87.0% in the ALIF and PLIF groups, respectively. There were...
Bratislavské lekárske listy, 2021
BACKGROUND: Lumbar spondylolisthesis is a relatively common cause of low back and lower extremity pain. The most common type, degenerative lumbar spondylolisthesis (DLS), is a disease that causes stenosis of the spinal canal. Two surgical methods of treatment are widely accepted, namely posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). MATERIALS AND METHODS: Between 2015 and 2017, the fi ndings of 333 consecutive DLS patients who underwent surgical decompression with instrumented fusion were analyzed in a prospective study at the
Journal of Neurological Disorders, 2015
Objectives: The present study aims to assess the results of extended Transforaminal Lumbar Interbody Fusion (TLIF) for a two-surgeon, single institution series. Methods: 57 cases of extended TLIF with bilateral decompression were performed. Pain, ASIA scores, patient demographics, BMI, perioperative indices and radiographic measurements were recorded and analysed. Results: 57 operations were performed between February 2011 and January 2014, there were 38 female and 19 male patients. Mean patient age was 62.86 years, mean BMI was 30.31 kg/m2. In 49 patients spondylolisthesis was the primary indication. The mean intraoperative time was 284.65 min, this decreased as the series progressed. The median length of stay was 5 days, ranging from 2 to 9 days. The surgical complication rate was 22.8%. Two patients died from cardiopulmonary complications. 78.9% of the cohort had single-level TLIF, L4/5 was the most commonly fused level. Significant pain reduction was achieved from a mean Pre-operative VAS of 8.28 1.39 to post-op VAS of 1.501.05 at 12 months. No patients deteriorated neurologically. Spondylolisthesis was significantly corrected from a pre-operative mean of 6.82 mm to 2.80 mm post-operatively. There is a learning curve associated with the procedure. Discussion: TLIF with bilateral facet joint removal and decompression appeared to be a safe and effective alternative to other fusion techniques, and is comparable to other published case series. Stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life.
BMC surgery, 2015
Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches. Most patients are treated with posterior-only approaches because the high complication rate of anterior approach. Our purpose is to compare and assess outcomes of combined anterior lumbar interbody fusion and instrumented posterolateral fusion with posterior alone approach for degenerative lumbar scoliosis with spinal stenosis. Between November 2002 and November 2011, a total of 110 patients with degenerative spinal deformity and curves measuring over 30°were included. Of the 110 patients who underwent surgery, 56 underwent the combined anterior and posterior approach and 54 underwent posterior surgery at our institution. The following were the indications of anterior lumbar interbody fusion: (1) rigid or frank lumbar kyphosis, (2) anterior or lateral bridged traction osteophytes, (3) gross coronal and sagittal deformity or imbalance, a...
Global Spine Journal, 2015
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 ¼ 50) or LLIF (n ¼ 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. Patientreported 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 ¼ 0.1948). ALIF added 6degreesoflordosisand3mmofheight,primarilymeasuredatL5−S1,andLLIFadded6 degrees of lordosis and 3 mm of height, primarily measured at L5-S1, and LLIF added 6degreesoflordosisand3mmofheight,primarilymeasuredatL5−S1,andLLIFadded3 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.
Journal of Applied Life Sciences International
Background data: The degenerative lumbar diseases form a burden on both the patients and the society. The development of the degenerative process is highly linked to the aging process as discussed by Kirkandly Willis where the degenerative spine passes through 3 phases of process that results in the degenerative diseases. The management of the degenerative spine deformities varies and depends on various factors. Traditional surgical management involves instrumentation, decompression and fusion processes. Oblique Lumbar interbody fusion ‘OLIF’ is a novel technique when used alone as in stand-alone OLIF ‘SA-OLIF’ it could achieve degenerative deformity correction along with neural decompression, however, the final aim of SA OLIF where solid fusion is required still is under evaluation and literature lacks the essential data for this approach. This study aims to assess the fusion of the SA-OLIF in the management of degenerative lumbar scoliosis. Study Design: A Prospective clinical cas...
Journal of Spine Surgery, 2020
Background: High-grade spondylolisthesis (>50% slippage) is infrequently encountered in adults and frequently requires surgical treatment. The optimal surgical treatment is controversial with limited literature guidance as to optimal approach to treatment. An observational study to examine the technique and radiographic outcomes of adult patients treated with anterior lumbar interbody fusion (ALIF) and posterior percutaneous instrumentation for high-grade spondylolisthesis. Methods: ALIF was performed in 5 consecutive patients (3/5 female, 2/5 male) aged 29-67 years old who presented with low back pain and L5 radiculopathy. All patients failed conservative treatment and were treated with L4-5 and L5-S1 ALIF followed by posterior percutaneous L4-S1 pedicle screw and rod fixation. Pre-and postoperative clinical data was collected including L5-S1 posterior disk height in millimeters, millimeters of spondylolisthesis at L5-S1, degrees of segmental lordosis (L4-S1), lumbar lordosis (L1-S1), and lumbar lordosis pelvic incidence (LL-PI) mismatch. Results: Six weeks following surgery, no patient reported residual L5 radicular symptoms. At last follow up, patient satisfaction, according to Modified Macnab Criteria, was excellent in 4/5 patients and good in 1/5 patient. In the 4 patients with greater than 1 year radiographic follow up, fusion rate was 100% on computed tomography (CT). Mean increase in posterior disk height was 12.5 mm (range, 11.4-13.5 mm). Mean reduction in spondylolisthesis was 58.7% (range, 20.2-100%). Mean segmental (L4-S1) and overall (L1-S1) lumbar lordosis increased by 23.6% (range, 6.5-41.7%) and 16.6% (2.5-31.5%), respectively. Following surgery, LL-PI mismatch decreased from a mean of 16.4 to 10.2 degrees. Conclusions: ALIF with posterior percutaneous instrumentation is a safe and effective treatment for highgrade lumbosacral spondylolisthesis in properly selected adults. This technique improves lumbar sagittal parameters and reduces spondylolisthesis. The indirect neural decompression from simultaneous disk height restoration and spondylolisthesis reduction may be associated with lower neurological injury rate compared to posterior-only. Future prospective study is needed to validate this hypothesis.
Instrumented Posterior Lumbar Interbody Fusion in Adult Spondylolisthesis
Clinical Orthopaedics & Related Research, 2008
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.