ABSTRACT
Background: This retrospective study was performed toassess the radiological and clinical outcome of patients whounderwent transforaminal lumbar interbody fusion (TLIF) withan interbody cage for spondylolisthesis.Methods: Forty five consecutive patients of spondylolisthesiswho underwent transforaminal lumbar interbody fusion (TLIF)during the period from July 2016 to June 2018 were reviewedretrospectively. Clinical data and radiological data werecollected and analysed. Twenty seven male and eighteenfemale patients underwent the TLIF procedure with a meanage of 48.6 years (24–66 years). The primary pathology was alytic listhesis in 28 patients and degenerative listhesis in 17.There was no multilevel fixation. Two cases were revisionsurgery. The mean blood loss was 290 ml and mean operativetime 160 minutes. No patient need to stay in ICU or HDU.Hospital stay was 4-5 days. Radiological outcome wasassessed by observing the presence of fusion mass at biplanarradiography whereas clinical outcomes were assessed bymeans of the Parker Visual Analog scale (VAS).Results wereclassified into three categories (excellent and good, fair, andpoor) using the Parker criteria. Pain was recorded by usingVisual Analog Scale.Results: There were no intra-operative complications. Twopatients developed neurological deficit in the form of partial footdrop. There were statistically significant improvements frompreoperative VAS to post-operative VAS. Fusion couldbe assessed in all patients. Anterior interbody fusion wasachieved in 78.3% of cases and posterior lateral fusion wasachieved in 69.6%.Four patients showed no fusion at the endof 6 months post operatively.Conclusions: Transforaminal lumbar interbody fusion is a safeand effective method to achieve circumferential fusion. It istechnically challenging and needs to be proficient in thetechnique to avoid catastrophic complications. Clinical scoringconfirmed that satisfactory overall outcome. Complicationsresulting from the procedure is uncommon and generally minorand transient.
ABSTRACT
BACKGROUND: Anterior interbody fusion has previously been demonstrated to increase neuroforaminal height in a cadaveric model using cages. No prior study has prospectively assessed the relative change in magnetic resonance imaging (MRI) demonstrated neuroforaminal dimensions at the index and supradjacent levels, after anterior interbody fusion with a corticocancellous allograft in a series of patients without posterior decompression. The objective of this study was to determine how much foraminal dimension can be increased with indirect foraminal decompression alone via anterior interbody fusion, and to determine the effect of anterior lumbar interbody fusion on the dimensions of the supradjacent neuroforamina. METHODS: A prospective study comparing pre- and postoperative neuroforaminal dimensions on MRI scan among 26 consecutive patients undergoing anterior lumbar interbody fusion without posterior decompression was performed. We studies 26 consecutive patients (50 index levels) that had undergone anterior interbody fusion followed by posterior pedicle screw fixation without distraction or foraminotomy. We used preoperative and postoperative MRI imaging to assess the foraminal dimensions at each operated level on which the lumbar spine had been operated. The relative indirect foraminal decompression achieved was calculated. The foraminal dimension of the 26 supradjacent untreated levels was measured pre- and postoperatively to serve as a control and to determine any effects after anterior interbody fusion. RESULTS: In this study, 8 patients underwent 1 level fusion (L5-S1), 12 patients had 2 levels (L4-S1) and 6 patients had 3 levels (L3-S1). The average increase in foraminal dimension was 43.3% (p 0.05). CONCLUSIONS: Anterior interbody fusion with a coriticocancellous allograft can significantly increase neuroforaminal dimension even in the absence of formal posterior distraction or foraminotomy; anterior interbody fusion with a coriticocancellous allograft has little effect on supradjacent neuroforaminal dimensions.
Subject(s)
Female , Humans , Male , Intervertebral Disc Degeneration/diagnosis , Lumbar Vertebrae , Magnetic Resonance Imaging , Prospective Studies , Spinal FusionABSTRACT
STUDY DESIGN: Retrospective study. OBJECTIVES: To demonstrate the fusion rate, degree of subsidence and donor site morbidity of anterior cervical interbody fusion with autogenous bicortical iliac bone graft and anterior cervical locking plate. SUMMARY OF THE LITERATURE REVIEW: In anterior cervical discectomy and fusion with autogenous tricortical iliac bone graft, a large percentage of patients report chronic donor site pain. MATERIALS AND METHODS: Retrospective research was done for 39 patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft, from January 2006 to July 2011, with a follow up period of longer than 1 year. Fusion rates and subsidece of the graft is estimated with radiographs. Neck pain and donor site pain was estimated with visual analogue scale (VAS) and dysfunction was estimated with the neck disability index (NDI). RESULTS: A 95% of patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft revealed definitive fusion with little amount of subsidence. The mean VAS score was 0.7 on the donor site and the mean NDI score was 3.8 at the final visit. There was excellent clinical outcome without complication at the donor site or the recipient site. CONCLUSIONS: Anterior cervical interbody fusion with autogenous bicortical iliac bone graft showed high fusion rates and minimal subsidence with excellent clinical outcomes. Therefore, bicortical iliac bone graft is an effective operational procedure in anterior cervical interbody fusion.
Subject(s)
Humans , Diskectomy , Follow-Up Studies , Neck , Neck Pain , Retrospective Studies , Tissue Donors , TransplantsABSTRACT
OBJECTIVE: To document lumbar lordosis (LL) of the spine and its change during surgeries with the different height but the same angle setting of the anterior cage. Additionally, we attempted to determine if sufficient LL is achieved at different cage heights and to quantify the change in LL during multi-level anterior lumbar interbody fusion (ALIF). METHODS: The medical records and radiographs of 42 patients who underwent more than 2 level ALIFs between 2008 and 2009 were retrospectively reviewed. We evaluated 3 parameters seen on lateral whole spine radiographs : LL, pelvic incidence (PI), and sagittal vertical axis (SVA). The mean follow-up time was 28.1 months and the final follow-up radiographs of all patients were reviewed at least 2 years after surgery. Statistical analysis was performed using the paired t-tests. RESULTS: Lumbar lordosis had changed up to 30 degrees immediately and 2 years after surgery (preoperative mean LL, SVA : 22.45 degrees, 112.31 mm; immediate postoperative mean LL, SVA : 54.45 degrees, 37.36 mm; final follow-up mean LL, SVA : 49.56 degrees, 26.95 mm). Our goal of LL is to obtain as much PI as possible, preoperative mean PI value was 55.38+/-3.35. The pre-operative and two year post-surgery follow-up mean of the Japanese Orthopedic Association score were 9.2+/-0.6 and 13.2+/-0.6 (favorable outcome rate : 95%), respectively. In addition, we were able to obtain good clinical outcomes and sagittal balance with a subsidence rate of 22.7%. CONCLUSION: We were able to achieve sufficient LL, such that it was similar to the PI, utilizing multi-level ALIF with the use of a tall cage with the same angle setting of the cage. We have found out that achieving sufficient lumbar lordosis and sagittal balance require an anterior lumbar cage with high angle and height.
Subject(s)
Animals , Humans , Asian People , Axis, Cervical Vertebra , Follow-Up Studies , Incidence , Lordosis , Medical Records , Orthopedics , Osteotomy , Retrospective Studies , SpineABSTRACT
STUDY DESIGN: A prospective radiological assessment. OBJECTIVES: Changes in the height, area, and width--captured using computed tomography (CT)--of the neural foramen with respect to changes in the intervertebral disc height, after undergoing an anterior cervical disc removal and fusion procedure. SUMMARY OF LITERATURE REVIEW: The multiple authors of this study, by obtaining central canal and area of neural foramen by increasing the disc spacing height and area of the neural foramen, attempted to assess the height increase of disc spacing. It is necessary to consider the synergistic effects of decompression through dissection of the posterior longitudinal ligament (PLL). MATERIALS AND METHODS: The authors studied 17 patient cases that underwent one segment anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease from June 2006 to March 2007. All patient cases underwent autogenous iliac bone graft or cage insertion with plate fixation procedure. We measured the areas of the neural foramen, heights of the vertebra body above and below the removed intervertebral disc with CT before and after ACDF. Radiographic measurements were averaged. RESULTS: Among the 17 cases, the height of the cervical disc increased in 15 cases and decreased in 2 cases. The heights of the neural foramen increased in 19 cases and showed no changes in 13 cases. The areas of the neural foramen increased in 23 cases and decreased in 6 cases. The heights of vertebral body above and below the removed disc increased by 5.4% (p=0.734), and the heights of the neural foramen increased by 13.3% (p=0.002). The area of the neural foramen increased by 13.6% (p=0.192). The widths of the neural foramen increased by 2.3% (p=0.586). The intervertebral disc height, neural foramen height, and neural foramen area increased by 39.6%, 8.4%, and 17.9%, respectively, after a 2mm lengthening of bone transplant. The intervertebral disc height, neural foramen height, and neural foramen area increased by 59.8%, 22.9%, and 10.3%, respectively, after a 3mm lengthening of bone transplant. The height and area of neural foramen increased by 18.3% and 18.2%, respectively, after the PLL removal and dissection. CONCLUSIONS: The follow-up observations of the intervertebral disc height, neural foramen height, and neural foramen area showed increases after one segment ACDF in cervical disease cases, when compared to the preoperative radiographic findings. As the height of bone transplant increased, the intervertebral disc height, neural foramen height, and neural foramen area increased. The neural foramen height and neural foramen area significantly increased, when PLL was dissected.
Subject(s)
Humans , Decompression , Diskectomy , Follow-Up Studies , Intervertebral Disc , Longitudinal Ligaments , Prospective Studies , Spine , TransplantsABSTRACT
STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to evaluate the effectiveness and safety of a PEEK cage filled with DBM in patients with a distractive flexion injury of the cervical spine. SUMMARY OF LITERATURE REVIEW: AIF of the cervical spine using an autoiliac bone graft and plate fixation is known to be an effective treatment for traumatic injuries. However, the complications arising from the donor site are troublesome, and so fusion with cage is an alternative treatment. MATERIALS AND METHODS: We analyzed 32 cases (22 males and 10 females) with distractive flexion injury of the cervical spine. They underwent anterior decompression and interbody fusion with a PEEK cage and anterior plate fixation. In 18 patients, the cage was filled with autogenous iliac bone (Group I), and for the other 10 the cages were filled with DBM (Group II). RESULTS: All the cases in Group I and Group II achieved fusion except for one case of nonunion in group II. The anterior and posterior vertebral heights of the fused segments of group II were decreased more than those of group I, resulting a statistical difference (p=0.003). The changes of segmental lordosis (p=0.69) and the neurologic status (p=0.22) showed no statistical difference between the two groups. CONCLUSIONS: AIF using a PEEK cage filled with DBM and plate fixation showed no significant clinical differences compared to the case of iliac bone autografting. However, from a radiologic perspective, the time to achieve union was extensive and a case of nonunion was also observed. Therefore, many considerations are necessary when using DBM as a replacement for iliac bone autografting and further research should be done on this subject.
Subject(s)
Animals , Humans , Male , Bone Matrix , Decompression , Ketones , Lordosis , Polyethylene Glycols , Retrospective Studies , Spine , Tissue Donors , Transplantation, Autologous , TransplantsABSTRACT
STUDY DESIGN: This is a retrospective study OBJECTIVES: We wanted to evaluate the effectiveness and safety of anterior interbody fusion (AIF) using cage and plate fixation for treating distractive flexion injury of the cervical spine according to the radiological and clinical outcomes. SUMMARY OF THE LITERATURE REVIEW: AIF of the cervical spine using autoiliac bone and plate fixation is known as an effective method for treating not only degenerative disease, but also trauma as well. However, the problem lies in the complications that occur at the donor site. To avoid these complications, the fusion method using a cage is becoming more frequently used, but there are not many reports on using a cage and plate for treating trauma in the cervical spine. MATERIALS AND METHODS: We retrospectively analyzed 47 patients with distractive flexion injury of the cervical spine and who underwent anterior decompression and interbody fusion with a autoiliac bone graft and plate fixation (Group I, 32 patients) or who underwent anterior decompression and interbody fusion with cage and plate fixation (Group II, 15 patients). We statistically analyzed the changes of the segmental lordosis, the fused segmental body height, the fusion rate on plain radiography and the neurologic recovery with using an ASIA scoring system. RESULTS: All the cases were fused by 12.6+/-2.5weeks after operation. The changes of segmental lordosis shows no statistical difference between the two groups (p=0.69). The anterior and posterior vertebral heights of the fused segments of Group I were more decreased than those of Group II, and there was a statistical difference between the two groups (p=0.03, 0.04). The initial and last follow up neurologic statuses were not statistically difference between the two groups (p=0.11) CONCLUSIONS: For the treatment of fracture-dislocation injury in the cervical spine, AIF using a PEEK cage filled with autoiliac bone and plate fixation is an effective method with the least possibility of complications at the donor site, and at the same time, this surgical method shows equally satisfactory results, both radiologically and clinically, as fusion with using a tricortical autoiliac bone graft.
Subject(s)
Animals , Humans , Asia , Body Height , Decompression , Follow-Up Studies , Ketones , Lordosis , Polyethylene Glycols , Retrospective Studies , Spine , Tissue Donors , TransplantsABSTRACT
STUDY DESIGN: This is a retrospective study. OBJECTIVES: We analyzed the radiological and clinical results to verify the efficacy of anterior interbody fusion with using cages gradually increases in the treatment of cervical radiculopathy. SUMMARY OF LITERATURE REVIEW: Anterior cervical decompression and fusion is well accepted treatments for cervical radiculopathy. Performing anterior interbody fusion using cages has recently gradually increased to minimize the extent of surgery. While there are numerous reports on the primary stabilizing effects of the cervical cages, little is known about the subsidence behavior of such cages in vivo. MATERIALS AND METHODS: We retrospectively analyzed 38 patients with cervical disc herniation who underwent anterior decompression and interbody fusion with autoiliac bone graft and plate fixation (Group I, 21 patients) or who underwent with standalone cage (Group II, 17 patients). We statistically analyzed the changes of the cervical lordosis, the segmental lordosis, the vertebral body height, the fusion rate on the plain x-ray and the clinical results with using a pain visual analogue scale. RESULTS: All the cases were fused by 11.2+/-2.7 weeks after operation. The changes of the cervical lordosis and segmental lordosis show no statistically significant difference between the two groups (p=0.07, 0.66). The anterior and posterior vertebral heights of the fused segments of group II were more decreased than those of group I, but there was no statistically difference between the two groups (p=0.06, 0.30). The clinical results were not statistically difference between the two groups (p=0.64, 0.45). CONCLUSIONS: Implantation of autoiliac cancellous bone impacted stand-alone cages or on a tricortical iliac crest autograft after anterior decompression was safe and reliable options for the treatment of cervical disc herniation that causes single level radiculopathy. Both procedures produced equally satisfying clinical and radiological results, leading to a high fusion rate and they maintained the intervertebral height.
Subject(s)
Animals , Humans , Body Height , Decompression , Lordosis , Radiculopathy , Retrospective Studies , TransplantsABSTRACT
STUDY DESIGN: A prospective radiological assessment was performed using computerized tomography measurements. OBJECTIVES: The aim of this study was to assess the changes in the dimensions of the neural foramen after anterior interbody fusion with posterior fixation in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Anterior lumbar interbody fusion distracts the height and width of the neural foramen. MATERIALS AND METHODS: Anterior interboody fusion with posterior fixation was performed in twenty-five patients. The sagittal parameters were the height and area of the neural foramen. The fused lumbar segments was imaged in the direct sagittal projections in a CT (SOMATOM Senstaion; SIMENS, Germany) and 1-mm slice thickness before surgery and after solid fusion. Computer digitation was used for the measurements independently by three different observers. Statistical analysis was performed using a Wilcoxon signed test and a paired T-test to determine the correlation between the measurements, and Pearson correlation to determine the level of interobserver and intraobserver agreement. RESULTS: After anterior interbody fusion and posterior fixation, the height and the area of the neural foramen had increased significantly by 15.5+/-14.0%(p.0.001) and 23.2+/-17.7%(p.0.001). There was a significant confidence in interobserver (0.9466~0.9996) and intraobserver(0.8896~0.9991) agreement. CONCLUSIONS: Anterior interbody fusion significantly increased the changes in the dimensions of the neural foramen. Anterior distraction and decompression with anterior interbody fusion increased the area of the neural foramen This study shows that anterior interbody fusion can be used to decompress the neural foramen in the spondylolisthesis.
Subject(s)
Humans , Decompression , Prospective Studies , SpondylolisthesisABSTRACT
STUDY DESIGN: A prospective radiologic assessment. OBJECTIVES: To compare the changes of dimensions of the intervertebral disc and neural foramen between the anterior lumbar interbody fusion and the posterolateral fusion in the lumbar spine. SUMMARY OF LITERATURE REVIEW: There are few reports comparing an anterior lumbar interbody fusion with pedicle screw fixation and a posterolateral fusion with pedicle screw fixation. MATERIALS AND METHODS: We studied 62 patients with degenerative lumbar diseases who underwent minimal anterior lumbar interbody fusion with pedicle screw fixation (group I, 40 patients) or who underwent posterolateral fusion with pedicle screw fixation (group II, 22 patients). We measured the height of disc and the height, width, and area of the neural foramen measured in 1-mm reconstructive sagittal images of computed tomography before and 6 months after the operation. The factors were independently measured by three different observers. RESULTS: Disc height was increased by a mean of 39.1+/-3.28% in group I and 3.1+/-2.99% in group II. The height of the neural foramen was increased by a mean of 18.7+/-4.21% in I and 1.0+/-2.34% in II. The area of neural foramen was increased by a mean of 21.5+/-3.50% in I and -2.1+/-4.39% in II, with significant differences between groups in all parameters. CONCLUSION: The minimal anterior lumbar interbody fusion with pedicle screw fixation was superior to posterolateral fusion with pedicle screw fixation for increasing disc height and the height and area of neural foramen.
Subject(s)
Humans , Intervertebral Disc , Prospective Studies , SpineABSTRACT
STUDY DESIGN: A retrospective study. PURPOSE: We evaluated the results of the use of anterior debridement and interbody fusion followed by posterior spinal instrumentation. OVERVIEW OF LITERATURE: An early diagnosis of pyogenic spondylitis is difficult to obtain. The disease can be treated with various surgical methods (such as anterior debridement and bone graft, anterior instrumentation, and posterior instrumentation). METHODS: This study included 20 patients who received anterior debridement and interbody fusion with strut bone graft followed by posterior spinal fusion for pyogenic spondylitis between 1996 and 2005. We analyzed the culture studies, the correction of the kyphotic angle, blood chemistry, the bony union period, and the amount of symptom relief. RESULTS: In terms of clinical symptoms relief, eight patients were grouped as "excellent", eleven patients as "good", and one patient as "fair". The vertebral body cultures were positive in 14 patients showing coagulase (-) streptococcus and S. aureus. The average times for normalization of the erythrocyte sedimentation rate and C-reactive protein level were 3.3 and 1.9 months, respectively. Four months was required for bony union. For complications, meralgia paresthetica was found in two cases. CONCLUSIONS: Due to early ambulation and the correction of the kyphotic angle, anterior interbody fusion with strut bone graft and posterior instrumentation could be another favorable method for the treatment of pyogenic spondyulitis.
Subject(s)
Humans , Blood Sedimentation , C-Reactive Protein , Chemistry , Coagulase , Debridement , Early Ambulation , Early Diagnosis , Retrospective Studies , Spinal Fusion , Spondylitis , Streptococcus , TransplantsABSTRACT
STUDY DESIGN: This was a retrospective study to evaluate anterior cervical interbody fusion with plates. OBJECTIVE: To examine the degree of angulation and translation after an anterior interbody fusion, using anterior plate fixation, upon the fusion rate and clinical outcome. SUMMARY OF LITERATURE REVIEW: Anterior cervical interbody fusion with plate allows immediate rigid internal fixation after decompression and bone grafting. MATERIALS AND METHODS: 65 cases had an anterior interbody fusion on the cervical spine, using an anterior approach and Smith-Robinson's method, between January 1998 and August 2003. Of these, 41 cases, which could be followed up for at least one year, were selected. There were 26 and 15 males and females, respectively, with an average age of 43.5 and mean follow up period of 2.1 years. 15 cases underwent an operation due to dislocation or fracture of the cervical spine due to trauma, and 26 due to cervical diseases. The angulation and translation of the plate was measured by postoperative X-rays. The fusion rate was also determined by the follow up X-rays. The Chi-squared test was used to analyze the data. RESULTS: Bony fusion was obtained in all cases. Two patients developed hoarseness and one showed torticollis, but all had recovered by the follow up. The average angulation of the plate and translation were 6.2 degrees and 3.21mm, respectively, but there was no significant difference of the interbody fusion period due to angulation and translation of the plate or in the improvement of the clinical outcomes. CONCLUSION: In the cases of anterior interbody fusion of the cervical spine, the angulation and translation of the plate had no influence on the fusion time and clinical outcomes. Long term studies and research will be needed to bring about clinically more valuable data.
Subject(s)
Female , Humans , Male , Bone Transplantation , Decompression , Joint Dislocations , Follow-Up Studies , Hoarseness , Retrospective Studies , Spine , TorticollisABSTRACT
Objective To evaluate the long term results of coral bone used in anterior cervical interbody fusion. Methods The 180 patients (126 males and 54 females) who had undergone anterior interbody fusion in our hospital were followed up for 6 years. Their long-term imageological data, including changes in interbody height, interbody angle and range of movement, were analyzed and compared. Results In all the cases a solid fusion was achieved between coral reef and vertebra. The fusion was evaluated as successful in all the 180 patients. Conclusion The coral bone spacer provides the same solid fusion as autografting with iliac crest does.
ABSTRACT
STUDY DESIGN: A prospective radiological assessment was conducted. OBJECTIVES: To analyze the changes in the height of the intervertebral disc, the slippage, slip angle, lumbar lordotic angle and sacral inclination after anterior lumbar interbody fusion and posterior pedicle screw fixation in a lumbar spondylolisthesis. SUMMARY OF LITERATURE REVIEW: The anterior lumbar interbody fusion causes changes in the lumbar sagittal alignment. METHODS: The mini-open anterior lumbar interbody fusion and pedicle screw fixation was undertaken in 33 cases from April 1995 to November 2003. MRI was done before and 6 months after surgery. The measuring factors were the heights of the intervertebral disc, slippage, slip angle, lumbar lordotic angle and sacral inclination. The measuring factors were independently assessed three times by three different orthopedic surgeons. The postoperative changes in measuring the factors were analyzed by a paired t-test statistically. RESULTS: The height of the intervertebral disc was increased by a mean of 14.0%, slippage was reduced by a mean of 2.8%, the slip angle was reduced by a mean of 16.0%, the lumbar lordotic angle was increased by a mean of 15.6% and the scaral inclination was increased by a mean of 3.0%. There was significance in the increase in the disc height, the reduction of slippage and the slip angle, and the increase in lumbar lordotic angle, but there were no significance regarding the changes in sacral inclina-tion. CONCLUSIONS: The anterior lumbar interbody fusion and the pedicle screw fixation significantly improved the height of the intervertebral disc, slippage, slip angle, and lumbar lordotic angle, except sacral inclination.
Subject(s)
Intervertebral Disc , Magnetic Resonance Imaging , Orthopedics , Prospective Studies , Spine , SpondylolisthesisABSTRACT
STUDY DESIGN: A prospective radiological assessment was conducted. OBJECTIVES: To analyze the changes in the heights of the intervertebral disc and neural foramen, and the diameters and areas of the dural sac and lateral recess following anterior lumbar interbody fusion and posterior fixation in lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: Anterior lumbar interbody fusion distracts from the height of the intervertebral disc and neural foramen and increase the area of the spinal canal. MATERIALS AND METHODS: A mini-open anterior lumbar interbody fusion and posterior fixation was performed on 40 cases between January 1999 and March 2002. The measured factors included the height of the intervertebral disc and neural foramen, the midsagittal and lateral diameters of the dural sac, the area of the dural sac and the diameter of the lateral recess. These were measured with calipers in 1mm reconstructive computed tomography images before and 6 months after the anterior lumbar interbody fusion. The measured factors were independently taken by three different orthopaedic surgeons. RESULTS: The heights of the intervertebral disc and neural foramen were increased by means of 39.1 and 18.7% respectively. The midsagittal diameter of the dural sac was increased by a mean of 11.6% and that of the lateral dural sac decreased by a mean of 3.7%. The area of the dural sac was increased by a mean of 8.1% and the diameter of lateral recess by a mean of 26.3%. There were statistically significant increases in all the measured factors, with the exception of the lateral diameter of the dural sac. CONCLUSIONS: Anterior lumbar interbody fusion significantly increases the heights of the intervertebral disc and neural foramen, the midsagittal diameter of the dural sac, the area of the dural sac and the diameter of the lateral recess, but not the lateral diameter of the dural sac.
Subject(s)
Intervertebral Disc , Prospective Studies , Spinal Canal , SpineABSTRACT
STUDY DESIGN: A prospective clinical study with radiologic assessment was conducted. OBJECTIVES: To analyze the height changes of the intervertebral disc and neural foramen and width changes of the neural foramen after anterior lumbar interbody fusion and posterior fixation in the lumbar spine. SUMMARY OF LITERATURE REVIEW : Anterior lumbar interbody fusion distracts the height of the intervertebral disc and neural foramen and the width of the neural foramen. MATERIALS AND METHODS: Minimal anterior lumbar interbody fusion and posterior fixation were performed in 20 cases from January 1999 to January 2001. The measuring factors were the height of the anterior and posterior discs, and the height and width of the neural foramen, measured with a caliper in 1mm reconstructive, computed tomography, sagittal images before and 6 months after anterior lumbar interbody fusion. The factors were independently measured by three different persons. RESULTS: The height of the anterior and posterior discs was increased by mean 32.2% and 40.5%, respectively. The height of the right and left neural foramen was increased by mean 15.7% and 18.3%, respectively. The width of the superior, middle and inferior neural foramen was increased by mean 20.6%, 30.3% and 38.6%, respectively. There were significant increases in all measuring factors after minimal anterior lumbar interbody fusion. CONCLUSIONS: Minimal anterior lumbar interbody fusion significantly increased the height of the anterior and posterior intervertebral discs, and the height and width of the neural foramen, and produced neural decompression.
Subject(s)
Humans , Decompression , Intervertebral Disc , Prospective Studies , SpineABSTRACT
PURPOSE: To analyze the characteristics and surgical results in cervical myelopathy patients caused by soft disc herniation. MATERIALS AND METHODS: From June 1997 to August 1998. The authors treated cervical myelopathy patients who had a soft disc herniation. We evaluated the symptoms and signs, simple X-rays, the MRI, the JOA score and Hirabayashi's recovery rate. RESULTS: On simple X-ray, the narrowest A-P diameter was 13 mm, as the average was 14.9 mm, and no bony structural stenosis was found. On MRI, the average of the cord compression was 2.92 mm, and the average A-P compression ratio was 40.2%. An intermediate to high signal change in the cord was found in 8 cases. All patients improved after surgery and the average Hirabayashi's recovery rate was 61.1%. CONCLUSION: If, cord compression due to posterior soft disc herniation is severe, patients can have cervical myelopathy. Lateral disc herniation can also be a cause of cervical myelopathy. Cervical myelopathy due to soft disc herniation can be treated with a good results by using an anterior discectomy and interbody fusion method.
Subject(s)
Humans , Constriction, Pathologic , Diskectomy , Magnetic Resonance Imaging , Spinal Cord DiseasesABSTRACT
PURPOSE: To evaluate the surgical effect of anterior interbody fusion using a horizontal cylinder cage in a degenerative lumbar spine. MATERIALS AND METHODS: We evaluated 16 patients (at 20 levels) who received anterior interbody fusion using a horizontal cylinder cage in a degenerative lumbar spine or in secondary segmental lumbar instability following decompression at the same level from May 1997 to May 1998. Preoperative, postoperative, and follow-up radiographs were taken to compare the posterior disc height, neuroforaminal area, and the neuroforaminal volume. Fusion rates and clinical results were also reviewed. RESULTS: Posterior disc height (mm), neuroforaminal area (mm2) and neuroforaminal volume (mm3) were increased and maintained during the follow-up period. Radiological fusion was noted in 17 levels (85%) at a postoperative 1 year. Satisfactory clinical results were also obtained in 17 levels (85%). CONCLUSION: Anterior interbody fusion using a horizontal cylinder cage might be an effective method in the surgical treatment of degenerative lumbar spine or secondary segmental lumbar instability.
Subject(s)
Humans , Decompression , Follow-Up Studies , SpineABSTRACT
There have been many reports regarding various operative methods for spondylolytic spondylolisthesis. However, there have been no reports regarding the comparison between posterolateral fusion (PLF) with pedicle screw fixation (PSF) and anterior lumbar interbody fusion (ALIF) with PSF. The purpose of the current study was to compare the clinical outcomes of PLF with PSF and ALIF with PSF, and to help in the selection of treatment options. Fifty-six patients with spondylolytic spondylolisthesis who underwent PLF with PSF (group 1, 35 patients) or who underwent ALIF with PSF (group 2, 21 patients) were studied. Minimum follow-up was 2 years. Demographic variables and disease state were similar for the two groups. We studied operating time, amount of blood loss, duration of hospital stay, clinical outcomes, complications, time at which fusion was complete, fusion rate, and radiological measurements. There were no significant differences between the two groups in terms of the amount of blood loss, duration of hospital stay, back pain, radiating pain, fusion rate, or complication rate. However, in group 2, the operation time and the time at which fusion became complete was longer, and in group 1 there was significant radiological reduction loss. In conclusion, PLF with PSF was just as effective as ALIF with PSF in terms of clinical outcomes, but ALIF with PSF was superior to PLF with PSF in terms of the prevention of reduction loss. Anterior support would be helpful for preventing reduction loss in cases of spondylolytic spondylolisthesis of the lumbar spine.
Subject(s)
Adult , Aged , Female , Humans , Male , Adolescent , Bone Screws , Comparative Study , Middle Aged , Postoperative Complications , Spinal Fusion/methods , Spondylolisthesis/diagnostic imagingABSTRACT
Spondylolisthesis is defined as the anterior slippage of one vertebra on another. Spondylolisthesis is a common painful condition but can also be an incidental radiographic finding in asymptomatic persons. Mild spondylolisthesis predisposes to chronic low back pain. The purpose of surgical treatment are to reduce low back pain and radiating pain, to relieve the neurologic symptoms, and to improve the posture by eliminating the instability of the lumbosacral region. The operative procedures include anterior interbody fusion, posterior fusion, posterolateral fusion, Gill's procedure, and repair of the pars interarticularis. The biomechanics of anterior interbody fusion are based on the restoration of the intervertebral disc space and fusion on the intantaneous axis of ratation of the functional vetebral unit. The advantages of anterior interbody fusion are indirect decompression of the spinal canal, decreased posterior muscle injury, reduced bleeding from the operative site, early postoperative ambulation; reduced hospital days, and high fusion rate.