Radiographic and Clinical Outcomes of Posterior Interbody Fusion for High-Grade Spondylolisthesis

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the clinical and radiological outcomes of posterior interbody fusion using pedicle screw fixation after posterior decompression for high-grade spondylolisthesis. SUMMARY OF LITERATURE REVIEW: The surgical treatment of high-grade spondylolisthesis has been controversial. However, few reports on the results of reduction and posterior interbody fusion after posterior decompression have been published. MATERIALS AND METHODS: Thirteen patients with L5-S1 high-grade spondylolisthesis (Meyerding grade III, IV) who underwent reduction and posterior interbody fusion were analyzed with at least 2 years of follow-up. The mean age of the patients (male 2, female 11) was 51 years. Classified by the type of spondylolisthesis, 10 cases were isthmic, 2 cases dysplastic, and 1 case degenerative. A visual analogue scale (VAS), the Oswestry Disability Index (ODI) score, bone union, anterior slippage, and slip angle were used in comparing clinical and radiographic outcomes. RESULTS: All cases showed improvement of preoperative symptoms. The VAS and ODI score improved from a mean of 8.9 points and 36.2 points preoperatively to 2.1 points and 10.2 points, respectively, at last follow-up. The degree of anterior slippage measured by Taillard's method was improved from a mean of 57.7% before surgery to mean of 14.6% at last follow-up. The slip angle also changed from a mean of 2.4° kyphosis before surgery to a mean of 7.6°C lordosis at last follow-up. There were two complications: infection and new radiating pain. CONCLUSIONS: Reduction and posterior interbody fusion using pedicle screw fixation after posterior decompression was a useful surgical method for high-grade spondylolisthesis that corrected lumbosacral kyphosis, filled the structural space of the anterior column, and acheived fusion of interbody movement.

Clinical and Radiological Comparison of Posterolateral Fusion and Posterior Interbody Fusion Techniques for Multilevel Lumbar Spinal Stabilization In Manual Workers

STUDY DESIGN: Eighty-four patients who had been treated for degenerative spinal diseases between January 2006 and June 2009 were reviewed retrospectively. PURPOSE: We aimed to compare the clinical and radiologic findings of manual workers who underwent posterolateral fusion (PLF) or posterior interbody fusion (PLIF) involving fusion of 3 or more levels of the spine. OVERVIEW OF LITERATURE: Previous studies have concluded that there is no significant difference between the clinical outcome of PLF and PLIF techniques. METHODS: After standard decompression, 42 patients underwent PLF and the other 42 patients underwent PLIF. Radiologic findings, Oswestry disability index (ODI) scores, and visual analogue scale (VAS) scores were assessed preoperatively and at 6-month intervals postoperatively and return to work times/rates were assessed for 48 months. RESULTS: Patients who underwent PLF had significantly shorter surgical time and less blood loss. According to the 48-month clinical results, ODI and VAS scores were reduced significantly in the two groups, but the PLIF group showed better results than the PLF group at the last follow-up. Return to work rate was 63% in the PLF group and 87% in the PLIF group. Union rates were found to be 81% and 89%, respectively, after 24 months (p=0.154). CONCLUSIONS: PLIF is a preferable technique with respect to stability and correction, but the result does not depend on only the fusion rates. Discectomy and fusion mass localization should be considered for achieving clinical success with the fusion technique. Before performing PLIF, the association of the long operative time and high blood loss with mortality and morbidity should be taken into consideration, particularly in the elderly and disabled patients.

Clinical effects of transforaminal decompression posterior interbody fusion internal fixation for treating upper protrusion of lumbar intervertebral disc / 重庆医学

Objective To evaluate the clinical effect of transforaminal decompression posterior interbody fusion internal fixation in the treatment of upper protrusion of lumbar intervertebral disc .Methods 11 patients with upper protrusion of lumbar interverte-bral disc were given transforaminal decompression posterior interbody fusion internal fixation .The operation time and bleeding a-mount were recorded ,and the clinical effects were evaluated .Results The operation time and bleeding amount during operation were (132 .0 ± 37 .0)min and (320 .1 ± 56 .8)mL ,respectively .The lumbar function scoring of Japanese Orthopedic Association (JOA) after operation was (22 .9 ± 2 .3) points ,which was significantly higher than (11 .2 ± 3 .1) points before operation ;The postoperative recovery excellent rate was 90 .9% .All of the patients successfully finished posterior interbody fusion .Conclusion Transforaminal decompression posterior interbody fusion internal fixation in the treatment of upper protrusion of lumbar interverte-bral disc has the advantages of sufficient exposure ,safe operation and significant therapeutic effects .

One-Stage Posterior Debridement, Interbody Fusion and Instrumentation in the Treatment of Pyogenic Lumbar Spondylodiscitis

STUDY DESIGN: A retrospective study on the outcomes of surgical treatment for pyogenic lumbar spondylodiscitis. OBJECTIVES: To report the clinical outcomes of the surgical treatment of pyogenic lumbar spondylodiscitis using a one stage posterior approach. SUMMARY OF LITERATURE REVIEW: There are few reports on the treatment of pyogenic lumbar spondylodiscitis through a one stage posterior approach. MATERIALS AND METHODS: Between June 1999 and June 2005, this study examined the history of 12 patients with pyogenic lumbar spondylodiscitis treated by simultaneous posterior debridement, autogenous iliac bone graft and pedicle screw fixation. The clinical outcomes were evaluated in terms of the pain level, neurological status, hematological parameters and radiology findings. RESULTS: The clinical symptoms improved in all cases after surgery. There was no case of the infection recurring. The mean time for postoperative antibiotics and hospitalization was 6 weeks and 41.6 days, respectively. Radiological bony fusion was observed at 5.5 months on average. The mean preoperative, immediate postoperative and final follow-up sagittal angles were 4.6, 8.6 and 6.9degrees. CONCLUSION: One stage posterior interbody fusion and instrumentation for the treatment of pyogenic lumbar spondylodiscitis can provide radical debridement, bone graft and immediate stability without prohibiting the control of infection. Therefore, it can be used in selected cases.

Management of Lumbar Pyogenic Spondylitis with Posterior Decompression and Interbody Fusion Using Transpedicular Screws / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to assess the efficacy of posterior decompression and interbody fusion with posterior instrumentation in treating lumbar pyogenic spondylitis. MATERIALS AND METHODS: Twenty-one patients with lumbar pyogenic spondylitis who underwent posterior decompression and lumbar interbody fusion with posterior fixation were reviewed. Clinically infection control (CRP normalization time) and rehabilitation were investigated. And radiologically, timing of achievement of fusion and changes of sagittal alignment were investigated. RESULTS: Infection was controlled successfully without any recurrence and breakage of instrument. Stable interbody fusion was achieved in all cases within 6 months. Postoperative interval to achieve normal CRP was 28.7 (10-64) days. Ambulation was started on 5.8th (2-19) day. Sagittal angle was 12.3 degrees before operation, became more lordotic to 16.4 degrees, but decreased to 11 degrees at final follow-up. Final sagittal alignment was almost same with the preoperative status. CONCLUSION: By achieving favorable results clinically and radiologically, posterior decompression and interbody fusion seemed to be an effective method in management of lumbar pyogenic spondylitis.

Analysis of neurologic complications after posterior lumbar interbody fusion / 中国脊柱脊髓杂志

Objective:To evaluate the neurologic complications associated with posterior lumbar interbody fusion (PLIF).Method:From March 2003 to May 2008,a total of 178 patients experienced PLIF procedure due to lumbar disease.Of these,forty two had lumbar disc herniation,39 had lumbar spine stenosis,61 had degenerative spondylolisthesis, 22 had isthmic spondylolisthesis and 14 had post-laminectomy/discectomy syndrome. One hundred and thirty patients had single level fused,of these,8 at L3/4.64 at L4/5 and 58 at L5/S1.Forty six cases had two levels fused,of these, 19 at L3/4 and L4/5,27 at L4/5 and L5/Sl.Two patients had three levels fused,all at the L3/4.L4/5 and L5/S1.A11 causes possibly related to the neurologic complications were documented.Result: 13 cases(7.3%) were noted to have neurologic complications,of these,one at L4,7 at L5 and 5 at S1.6 cases had nerve root stretch injury,3 cases had nerve root injury from instrument maneuver, 1 case had nerve root deformity, 1 case had developed epidural hematoma, 1 case had nerve root injury from pedicle fracture and 1 case had secondary lateral recess stenosis.2 cases had complete neurological injury,and 11 cases had incomplete injury.According to American Spinal Injury Association (ASIA) criteria,there was complete recovery of neurologic function in 7 cases, incomplete recovery in 4 cases and no change in 2 cas-es.Conclusion: Many causes may be associated with the neurologic complications due to posterior lumbar interbody fusion,nerve root stretch injury is the most common.

Comparison of short term outcome in the treatment of degenerative lumbar stenosis with Coflex implant versus laminectomy and posterior interbody fusion along with pedicle screw system / 中国矫形外科杂志

[Objective]To compare the short term outcome in treatment of degenerative lumbar stenosis with Coflex implant versus laminectomy and posterior interbody fusion along with pedicle screw system. [Methods]Thirty patients with degenerative lumbar stenosis were randomly divided into two groups.Fifteen patients in the control group were treated with laminectomy and posterior interbody fusion along with pedicle screw system. The other 15 patients in the experiment group were treated with Coflex implant. The parameters for assessment included operation time,intraoperative blood loss,hospital stay,pre- and postoperative JOA score,improvement rate and complication rate.[Results]Compared to the control,significant reduction was found in terms of operation time,intraoperative blood loss,and hospital stay in the experiment group.No significant difference was found regard to the improvement rate and postoperative JOA score. In addition ,there was no complication in the Coflex group during the follow-up.[Conclusion]Coflex implant is an effective,save and minimally invasive surgical method for the treatment of degenerative lumbar stenosis.

Posterior interbody fusion with circular saw for treatment of lumbar spondylolisthesis / 中国矫形外科杂志

[Objective]To modify posterior lumbar interbody fusion for improvement of convenient manipulation and safety in the operation,and solid fusion. [Methods]After total decompression of the spinal nerve through posterior medline approach,discectomy of the slipping segment was performed with a circular saw with diameter of 1.0 centmeter.Under direct visualization through the hole of the circular saw,the disc tissue including cartilage of upper and lower end plates was removed with a long handle curette.After pedicle screw and rod system was placed,a bone block harvested from the posterosuperior iliac with a circular saw with diameter of 1.2 centmeter was implanted into the intervertebral space.Then compression of the intervertebral space to catch the bone lock firmly was conducted by regulating and fixing the the pedicle screw and rod system.[Results]Forty-eight patients in this report were followed up from 6 to 24 months.Based on JOA low back pain score,there were 36 patients was in excellent result,8 in good and 4 in fair,the satisfactory rate was 91.67% and effective rate was 100%.[Conclusion]Using circular saws in posterior lumbar interbody fusion has advantagas of good visualization profit removing disc tissue,preventing neurovascular injuries,and making good bone grafting bed.Convenient and secure bone harvesting decrease blood loss,time consume during the operation and prevent donor site complication.Futhermore,follow up results of the patients in this report demonstrate that posterior interbody fusion with circular saw for treatment of lumbar spondylolisthesis have satisfactory outcome and high fusion rate.

Clinical outcome of two operation methods in the treatment of degenerative spondylolisthesis / 中国矫形外科杂志

0.05);the better result was obtained including low back pain,Taillard index and relative disc height at the end of follow-up in POLA.[Conclusion]Posterior oblique lumbar arthrodeses is better ideal method in the treatment of degenerative spondylolisthesis.

Posterior Interbody Fusion using Cage for T4 Bursting Fracture

We report a case of T4 bursting fracture with paraparesis that recovered by posterior approach. A 47-year-old man presented with paraparesis (gradeIII) which had progressed rapidly after motor cycle accident. After sacrificing the T4 nerve root (right), posterior interbody fusion using cage following T4 corpectomy and T3-4, T4-5 discectomy was performed. After operation, lower extremities motor power improved and he could walk after one month. And this is the first report of posterior approach using cage by corpectomy and two level discectomy in case of upper thoracic burst fracture in Korea.

Effect of Posterior Lumbar Interbody Fusion for Maintaining the Reduction in Isthmic Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study on the effect of posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis patients. OBJECTIVES: We evaluated the efficacy of performing posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis. SUMMARY OF THE LITERATURE REVIEW: There have been many reports regarding the surgical treatment of spondylolisthesis. Although there are many reports that the clinical results have nothing to do with the reduction, many surgeons have tried to maintain the reduction. However, the question about what kind of fusion modality is the most effective for maintaining the reduction is still controversial. MATERIAL AND METHOD: Between August 2002 and January 2004, 24 patients with isthmic spondylolisthesis were operated on. 14 underwent posterolateral fusion alone (group A) and 10 underwent additional posterior interbody fusion (group B). These two groups were compared in terms of the clinical results, the radiological changes and fusion rates. RESULTS: the reduction rate were 11.81% and 7.32% in the PLF and PLF+PLIF groups, respectively (p>0.05). The reduction losses were 0.19% and 0.35% in the PLF and PLF+PLIF groups, respectively (p>0.05). The changes after fusion were 0.11% and 0.10% in the PLF and PLF+PLIF groups, respectively (p>0.05). There was no case of nonunion. The satisfaction rates were 86% and 83% in the PLF and PLF+PLIF groups, respectively (p>0.05). CONCLUSIONS: In our study, the addition of posterior interbody fusion showed no benefit in maintaining correction. If solid fusion can be obtained, then posterolateral fusion seems to be sufficient enough to maintain correction in isthmic spondylolisthesis. The authors think that further studies are mandatory because of the small number subjects in our study.

Oblique Posterior Interbody Fusion with Bone Plugs by Unilateral Approach for Treatment of Lumbar Instability: Technical Note

A new technical method using bone plugs with oblique posterior interbody fusion(OPIF) was designed to increase the fusion rate. One hundred-seventy-five patients were operated for lumbar instability between November 1990 and December 2000. The L5/S1 segment was affected in 129 cases(74%) of the patients. Oblique posteior interbody fusion with bone plugs by unilateral approach was performed in all patients. Eight-nine percent of these patients showed good surgical results. This stable transplant interbody fusion has the several advantages. Foreign substance is not used and this method increases fusion rate and cost-effective. OPIF using bone plugs along with Oh's screw could provide sufficient stability for segmental instability of the lumbar spine including spondylolisthesis of the lumbar spine, with or without concurrent herniated intervertebral disc or spondylotic narrowing.

Additional Posterior Lumbar Interbody Fusion using Threaded Cage in Spondylolisthesis with Instability / 대한척추외과학회지

STUDY DESIGN: We studied retrospectively the comparison of the clinical and radiologic results of surgical treatment between additional posterior lumbar interbody fusion group and posterolateral fusion with transpedicular screw fixation alone group for spondylolisthesis with segmental instability. OBJECTIVES: To evaluate the efficacy of additional PLIF group using threaded cage in surgical treatment of spondylolisthesis with instability. SUMMARY OF LITERATURE REVIEW: The interbody gap produced by operative reduction of spondylolisthesis is potential risk factors for redisplacement, implant failure and pseudarthrosis. There have been many reports regarding surgical treatment of spondy-lolisthesis for preventing postoperative redisplacement or complication. However, there have been controversies, which was most effective procedure for maintenance of surgical correction of spondylolisthesis. MATERIAL AND METHOD: A fourteen patients with spondylolisthesis who underwent PLIF using threaded cage in addition to PLF from August 1998 to June 1999(Group A) were compared to twenty-one patients who underwent PLF alone from January 1993 to May 1995(Group B). We assessed the radiologic results of slip reduction(SR), sagittal angle correction(SAC) and disc height restoration(DHR) on preoperative, postoperative and last follow-up lumbar sagittal view and clinical outcomes according to Kirkaldy-Willis criteria. RESULTS: The Group A / Group B showed postoperative mean SR 13.2%/9.9%, SAC 3.7 degrees /2.3 degrees and DHR 24.1%/6.3%. At last follow up, the Group A / Group B showed mean SR loss 1.0/7.3%, SAC loss 1.2 degrees /5.4 degrees and DHR loss 1.5%/11% respectively. The clinical results were analyzed as 100%/81%(Group A/B) of excellent to good results. CONCLUSIONS: Additional posterior lumbar interbody fusion with threaded cage was more effective in reduction & maintenance of reduction and showed better clinical results than posterolateral fusion in spondylolisthesis with instability.

Histologically Confirmed Bone Formation in the Carbon Fiber Cage Implant

The authors report the first case of histologically confirmed bone formation in the carbon fiber cage implant which used in posterior lumbar interbody fusion. A case of degenerative lumbar disc desease was treated by posterior lumbar interbody fusion with carbon fiber cage implant and local bone from posterior decompression. One year after the operation the cage was migrated into the spinal canal and compressed dural sac and nerve root. The cage was removed and investigated by light microscope. The histologic examination revealed viable bony traveculae in the cage. This finding suggest autogenous bone in the cage has a biologic bone-growth function after interbody fusion.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.