Anterior Lumbar Interbody Fusion Using BAK Cage for Treatment of Failed Back Surgery Syndrome

OBJECTIVE: To evaluate the role of anterior lumbar interbody fusion in treatment of failed back surgery syndrome, the authors present a retrospectively analysis of the clinical & radiological results of anterior lumbar interbody fusion. METHODS: Between September 2000 and September 2001, twenty two patients underwent anterior lumbar interbody fusion for treatment of failed back surgery syndrome. We analyzed clinical & radiological changes. The mean follow-up period was 19 months. RESULTS: Overall satisfactory outcome was 90%. The mean VAS was changed from 8.3 to 3.7. The mean Oswestry Disability Index(%) was changed from 70 to 33. The fusion rate was 86%. There were 2 complications; wound infection, sympathetic dysfunction. CONCLUSION: We conclude that the anterior lumbar interbody fusion seems to be a safe and favorable method in treating selective patients with failed back surgery syndrome.

Comparative Study of Laparoscopic L5-S1 Fusion versus Open Mini-Anterior Lumbar Interbody Fusion

OBJECTIVE: To investigate the effectiveness and safety of the laparoscopic L5-S1 fusion, its perioperative parameters and long-term outcome are compared with those of open anterior surgical approach. METHODS: Data of 54 consecutive patients who underwent anterior approach for L5-S1 fusion either by laparoscopic or open mini-anterior lumbar interbody fusion(ALIF) from 1997 to 1999 were analyzed. Among them, 47 cases were available with more than 2-years follow-up data. In all cases, carbon cage and autologous bone graft were used. RESULTS: Twenty five patients underwent a laparoscopic procedure and twenty two a open mini-ALIF. Three laparoscopic procedures were converted to open ones. For perioperative parameter, only the operative time was statistically different(p=0.001) while length of postoperative hospital stay and blood loss were not. The incidence of operative complication was three in laparoscopic group and two in open mini-ALIF group. After the follow-up of at least two years, the two groups showed no statistical difference in visual analog scale for pain, Oswestry disability index, and patient satisfaction index. The fusion rate was 91% in each group. CONCLUSION: The findings of this study suggest that laparoscopic ALIF has similar effectiveness and safety with open mini-ALIF. However, the advantage of laparoscopic approach as a minimally invasive surgery should be reconsidered because no objective additional benefit was found.

Anterior Lumbar Interbody Fusion for Focal Type of Degenerative Flat Back: Preliminary Report

OBJECTIVE: The purpose of this study is to determine the efficacy of anterior lumbar interbody fusion(ALIF) for the patients with focal type of degenerative flat back. METHODS: The authors reviewed clinical and radiologic data of 16 patients with focal type of degenerative flat back who underwent ALIF during the period between December 1999 and November 2000. The operation procedure was ALIF using titanium or carbon fiber cages of lordotic angle, which were filled with allograft or autograft mixed with allograft through minilaparotomy. RESULTS: The majority of the patients were female(15 female: 1 male) and the mean age was 60.1 years. Six patients were operated on one level, ten on two levels. The mean follow up period was 10.7 months. The mean operation time was 131minutes and the average estimated blood loss was 133ml. Transfusion was not needed in any case. The mean preoperative lumbar lordotic angle was 4.1 degree(-7.4-41.6) and improved to 17.5 degree(-4.5-41.9) postoperatively. Radiological fusion was achieved in 13 patients(81%). The Oswestry disability index score improved from 62.5% to 23.9% and the patient's subjective improvement rate was 80%. Complications were infection in one patient, incisional hernia in one, symptomatic pseudoarthrosis in one and transient sympathetic disturbance in left leg in three. CONCLUSION: In a subset of the patients with degenerative flat back who showed disc degeneration in one or two levels, ALIF using cages improved patient's symptoms effectively. It seems that ALIF through minilaparotomy can be one of the surgical options in the treatment of the focal type of degenerative flat back.

The Efficacy of Anterior Lumbar Interbody Fusion in Degenerative Disc Disease and Degenerative Spondylolisthesis: Comparative Review of 44 Single-Level Cases

OBJECTIVE: The authors conduct a retrospective study to evaluate the efficacy of anterior lumbar interbody fusion(ALIF) in treating degenerative disc disease(DDD) and degenerative spondylolisthesis(DS). METHODS: During 1998, eighty-six patients underwent mini-retroperitoneal ALIF with Brantigan carbon cages. Among them, 19 patients were lost during the follow-up period and 23 patients underwent multilevel fusion procedures. The authors evaluated 44 single-level cases(31 with DDD; 13 with DS) with Macnab's criteria for clinical outcomes and the Criteria of Brantigan and Steffee for fusion results. The extent of slippage of patient with DS was not greater than grade 1. The mean follow-up period was 24 months. RESULTS: The overall fusion rate was 88.6%(94% in DDD; 77% in DS). Based on the Macnab's criteria, excellent or good results were achieved in 38 of 44 patients(86.3%). Overall clinical outcome was significantly associated with preoperative diagnosis(p=0.03), radiologically demonstrated fusion(p=0.001), and subsidence of cages(p=0.03). In DDD sub-group, two cases of fusion failure and four of subsidence of cages belonged to excellent or good results. But, in DS sub-group, fusion failure or subsidence rate were significantly high and all three cases with poor result belonged to this sub-group. One of them underwent posterior operation. CONCLUSION: ALIF is considered as a good surgical method for a patient with discogenic back pain caused by degenerative disc disease. But in degenerative spondylolisthesis, considering the comparatively poor clinical and radiological result, it seems that ALIF alone does not provide sufficient strength to overcome the instability. Despite the advantage of minimal invasiveness, more careful application of ALIF is needed in the of degenerative spondylolisthesis.

Thoracoscopic Discectomy of the Herniated Thoracic Discs

No abstract available.

Transthoracic-Extrapleural Approach for Microsurgical Thoracic Discectomy with Video Assistance: Technical Report of Three Cases

No abstract available.

Minimal Invasive Retroperitoneal Anterior Lumbar Interbody Fusion with Video-Assistance

INTRODUCTION: Anterior lumbar interbody fusion with video-assistance has become an increasing popular technique to stabilize the anterior vertebral column disease. A minimally invasive technique with reduced soft tissue dissection allows low morbidity and has cosmetic and functional advantages. METHOD: Fifty patients with chronic degenerative lumbar instability [degenerative disc disease(14), degenerative spondylolisthesis(14), Grade I lytic spondylolisthesis(9) and failed back syndrome(13)] who did not respond to conservative treatment for 6 months underwent minimal invasive retroperitoneal ALIF with video-assistance from Oct. 1996 to Sep. 1997. Access to lumbar disc was achieved through retroperitoneal space with a small vertical 4 to 5 cm incision on the midline after retroperitoneal endoscopic ballooning. After performing complete discectomy under guidance of endoscopic viewing and restoring the narrowed disc height, we stabilized the spine with carbon interbody fusion cages filled with allograft bone. RESULTS: Postoperatively the patients were usually allowed to ambulate on the following day and were discharged within 4 days. There were three major complications; one ureter injury, one retroperitoneal hematoma and one osteomyelitis. With an average 10 months follow up, 42 out of 50 patients(84%) have shown relief of symptomatic back pain. And 27 out of 28 patients with degenerative disc disease and degenerative spondylolisthesis(96%) had successful results. CONCLUSIONS: Minimal invasive retroperitoneal ALIF with video-assistance offers an attractive method to significant decreased postoperative pain and hospital stay compared with conventional anterior approaches. The patients with degenerative disc disease or degenerative spondylolisthesis were more likely to have a successful outcome than those with Grade I lytic spondylolisthesis or failed back syndrome(p=0.02).

Laparoscopic Interbody Fusion in Degenerative Disc Disease of the Lumbosacral Spine

OBJECTIVE: The surgical treatment of symptomatic degenerative disc disease remains one of the most controversial topics among spine surgeons. Recently, advances in many endoscopic surgical techniques have resulted in lowered morbidity, expense, and suffering associated with their open surgery counterparts. The purpose of this study is to evaluate the efficacy of laparoscopic anterior lumbosacral interbody fusion in our patients with symptomatic degenerative disc disease. PATIENTS AND METHODS: We performed laparoscopic anterior interbody fusion for degenerative disc disease at L5-S1 in 26 patients who were unresponsive to conservative treatments for 1 year, from Oct. 1996 to Dec. 1997. This technique consists of a four-puncture laparoscopic approach with a 10mm trocar at the umbilicus for laparoscope, two 5mm trocars at left and right flanks for dissection, and a 15mm trocar at suprapubic area for working port. We performed complete discectomy and stabilized the spine with carbon interbody fusion cages filled with allograft bone. RESULTS: Laparoscopic fusion at L5-S1 was successful in 22 of 26 patients and the remaining four patients were successfully converted to minilaparotomy. The operation time averaged 150 minutes, hospitalization 4.1 days and average blood loss was 90cc. The mean follow-up period was 16.8 months. Radiographic fusion was achieved in 23 of 26 patients(88.5%) and clinical results showed excellent in 11/26, good in 11/26, fair in 3/26, poor in 1/26 according to Macnab's criteria. There were four complications; retroplacement of cages(1), transient dry ejaculation (1), transient urinary bladder dysfunction(1) and malposition of cages(1). CONCLUSION: Laparoscopic fusion at L5-S1 in degenerative disc disease seems to be safe, with satisfactory clinical results. Main advantage are early recovery and short hospitalization time compared with conventional technique.