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OBJECTIVE@#To investigate possible causes and preventive measures for asymptomatic pain in the limbs after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF).@*METHODS@#Clinical data from 50 patients with lumbar degenerative disease who underwent MIS-TLIF between January 2019 and September 2020 were retrospectively analyzed. The group included 29 males and 21 females aged from 33 to 72 years old, with an average age of (65.3±7.13) years. Twenty-two patients underwent unilateral decompression, and 28 underwent bilateral decompression. The side(ipsilateral or contralateral) and site(low back, hip, or leg) of the pain were recorded before surgery, 3 days after surgery, and 3 months after surgery. The pain degree was evaluated using the visual analogue scale(VAS) at each time point. The patients were further grouped based on whether contralateral pain occurred postoperatively (8 cases in the contralateral pain group and 42 in the no contralateral pain group), and the causes and preventive measures of pain were analyzed.@*RESULTS@#All surgeries were successful, and the patients were followed up for at least 3 months. Preoperative pain on the symptomatic side improved significantly, with the VAS score decreasing from (7.00±1.79) points preoperatively to (3.38±1.32) points at 3 days postoperatively and (3.98±1.17) points at 3 months postoperatively. Postoperative asymptomatic side pain (contralateral pain) occurred in 8 patients within 3 days after surgery, accounting for 16% (8/50) of the group. The sites of contralateral pain included the lumbar area (1 case), hip(6 cases), and leg (1 case). The contralateral pain was significantly relieved 3 months after surgery.@*CONCLUSION@#More cases of contralateral limb pain occur after unilateral decompression MIS-TLIF, and the reason may include contralateral foramen stenosis, compression of medial branches, and other factors. To reduce this complication, the following procedures are recommended: restoring intervertebral height, inserting a transverse cage, and withdrawing screws minimally.
Subject(s)
Male , Female , Humans , Middle Aged , Aged , Adult , Retrospective Studies , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Minimally Invasive Surgical Procedures/methods , Pain, Postoperative , Treatment OutcomeABSTRACT
OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.
Subject(s)
Male , Female , Humans , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Spinal Stenosis/surgery , Blood Loss, Surgical , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Treatment Outcome , Pain, Postoperative , Muscles , Minimally Invasive Surgical Procedures/methodsABSTRACT
OBJECTIVE@#To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.@*METHODS@#Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI.@*RESULTS@#The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697).@*CONCLUSION@#UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.
Subject(s)
Humans , Imaging, Three-Dimensional , Lumbar Vertebrae/surgery , Minimally Invasive Surgical Procedures , Pedicle Screws , Retrospective Studies , Spinal Fusion , Surgery, Computer-Assisted , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
OBJECTIVE@#To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation.@*METHODS@#A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score).@*RESULTS@#Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences ( P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). And there was no significant difference between the two groups at each time point after operation ( P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months ( P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group ( P<0.05).@*CONCLUSION@#For the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.
Subject(s)
Humans , Spinal Stenosis/surgery , Low Back Pain/surgery , Blood Loss, Surgical , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Retrospective Studies , Spinal FusionABSTRACT
【Objective】 To compare the clinical effects and screw placement accuracy for treating lumbar disc herniation between robot-assisted minimal invasive transforaminal lumbar interbody fusion (RA-MIS-TLIF) and minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF). 【Methods】 We retrospectively recruited 69 patients with single segment lumbar disc herniation treated between January 2018 and August 2019 at Honghui Hospital of Xi’an Jiaotong University. There were cases of 33 RA-MIS-TLIF (RA group) and 36 MIS-TLIF (MIS-TLIF group). Subsequently, the patients’ baseline characteristics were collected, including age, gender, body mass index, complication with diabetes, duration of symptoms, operated segment, and follow-up time. We also collected perioperative parameters such as operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, screw placement accuracy, wound drainage, hospitalization duration, postoperative complicatins, and fusion rate. Lower back pain, lower extremity pain visual analogue score (VAS), and lumbar Japanese Orthopaedic Association Scores (JOA) were obtained preoperatively, postoperative 3 days/6 months/12 months, and the last follow-up. 【Results】 All the procedures were successfully completed and the follow-up time was 14.82±1.83 (RA group) and 15.11±1.62 (MIS-TLIF group) months, without significant difference (P>0.05). Compared with MIS-TLIF group, RA group had less intraoperative blood loss [(116.67±18.48) min vs. (128.06±22.53) min], fluoroscopy frequency [(12.42±2.28) vs. (15.67±2.46)], screw placement accuracy (93.18% vs. 84.03%), postoperative drainage [(73.03±23.52) mL vs. (88.33±28.54) mL], and shorter hospitalization stay [(6.45±1.52)d vs. (7.69±1.85) d] (all P0.05). The VAS of lower back pain and lower extremity pain, and lumbar JOA were significantly improved after the operation (P0.05). Meanwhile, fusion rate and incidence of complications did not significantly differ between the two groups (P>0.05). 【Conclusion】 Both robot-assisted MIS-TLIF and MIS-TLIF can achieve excellent clinical effects in treating single-segment lumbar disc herniation. However, the former can improve the accuracy of screw placement and reduce intraoperative blood loss, fluoroscopy frequency, postoperative drainage and hospitalization time, which indicates a promising application.
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Objective To analyze the biomechanical characteristics of lumbar fusion by 3 internal fixation methods using three-dimensional (3D) finite element (FE) method. Methods The FE fixation models of physiological L4-5, unfixed fusion L4-5, translaminar facet screw (TLFS), lumbar pedical screw+translaminar facet screw (LPS+TLFS), bilateral pedical screw (BPS) with complete osteotomy or partial osteotomy of facet joint were established, respectively. The biomechanical characteristics of L4 centrum and implants under six motion states (spinal flexion, extension, lateral bending and axial rotation) in L4-5 fusion model and three fixation models were compared by FE analysis. Results The average maximal displacements of L4 centrum in L4-5 unfixed fusion model, TLFS model, TLFS+LPS model, BPS model were 1.410 8, 0.629 8, 0.336 9, 0.252 8 mm (complete osteotomy of facet joint) and 1.296 7, 0.844 9, 0.340 9, 0.273 8 mm (partial osteotomy of facet joint); the average maximal displacements of cage were 0.479 9, 0.319 5, 0.167 6, 0.126 4 mm (complete osteotomy of facet joint) and 0.378 7, 0.348 4, 0.183 5, 0.137 2 mm (partial osteotomy of facet joint)；the average maximum stresses of screws and rods during 6 motions in TLFS model, TLFS+LPS model, BPS model were 178.34, 79.55, 56.33 MPa (complete osteotomy of facet joint) and 142.29, 103.02, 59.69 MPa (partial osteotomy of facet joint). Conclusions In percutaneous transforaminal lumbar interbody fusion, the fixation effect of BPS model was similar to that of LPS+TLFS model. BPS model could achieve the best spinal stability, and LPS+TLFS model was also a good fixation method. The stability of TLFS model alone was relatively poor, but it was still better than that of cage bone graft without internal fixation. In the absence of internal fixation, preservation of the articular process significantly increased stability of the spine.
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【Objective】 To compare the short-term clinical effects of oblique lateral interbody fusion （OLIF） and transforaminal lumbar interbody fusion （TLIF） for treating single-segment lumbar spondylolisthesis. 【Methods】 We retrospectively analyzed the data of 68 patients with single-segment degenerative lumbar spondylolisthesis from January 2019 to February 2020. According to different surgical methods， the patients were divided into OLIF+ anterior screw fixation group （33 cases） and TLIF + posterior pedicle screw fixation group （35 cases）. The operation time， intraoperative blood loss， postoperative drainage， postoperative hospital stay and complication rate were compared between the two groups of patients. The disc height （DH）， lumbar lordosis （LL）， fused segmental lordosis （FSL）， foraminal height （FH）， and spondylolisthesis angle （SA） were measured before and after surgery and during follow-up. The visual analogue scale （VAS） of waist pain and the Oswestry disability index （ODI） were used to evaluate the short-term clinical efficacy. 【Results】 The operation time， intraoperative blood loss， postoperative drainage， and postoperative hospital stay were less in OLIF group than in TLIF group （all P0.05）. The two groups had statistically significant differences in DH and FH after surgery （P0.05）. There were six （18.2%） and five （14.3%） cases of complications in OLIF group and TLIF group， respectively， with no significant difference （P>0.05）. 【Conclusion】 OLIF and TLIF are equally safe and effective in treating single-segment lumbar spondylolisthesis. However， OLIF combined with anterior screw fixation has the advantages of less surgical trauma， less blood loss， shorter operation time， reduced postoperative hospital stay and shorter recovery time. Therefore， it is a more minimally invasive surgical option.
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@#OBJECTIVE: The main objective of this study was to evaluate clinical and radiographic outcomes of computer minimally invasive transforaminal lumbar interbody fusion (CNMIS TLIF). METHODS: Blood loss, operating time, complications, and hospital stay were identified through chart review. Numeric rating scale (NRS) scores for pain were taken during recent follow-ups, and these were compared to the pre-operative scores. Three different examiners assessed the pre-operative lumbosacral spine radiographs. At a 2-years follow-up, the patients were evaluated with NRS and the radiographs reassessed by three other examiners. RESULTS: Seventy-four patients with a mean age of 54 years underwent CNMIS TLIF. Average blood loss was 300 mL, operative time was 4.5 hours, and the average length of hospital stay was 8.5 days. A total of four complications were noted in our study. There was an improvement of mean local lordosis and regional lordosis. The paired-sample t-test showed that the anterior, middle, and posterior disc heights at the cage level were significantly increased compared to the pre-operative values. CONCLUSION: CNMIS TLIF is a safe and efficient method to achieve spinal fusion. There was a significant improvement in clinical outcomes in terms of pain relief. Radiologic parameters such as local lordosis, regional lordosis, and anterior, middle, and posterior disc heights showed significant improvements at 2-years follow-up.
Subject(s)
Spinal Fusion , Minimally Invasive Surgical Procedures , ComputersABSTRACT
BACKGROUND: More and more studies have shown that lumbar-pelvic parameters are closely related to the clinical effect and adjacent segment degeneration after lumbar fusion, but the effect of minimally invasive transforaminal interbody fusion on lumbar-pelvic parameters is not clear. OBJECTIVE: To evaluate the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on the lumbar-pelvic imaging parameters in patients with single-segment lumbar spinal stenosis. METHODS: The clinical data of 85 patients with single-segment lumbar spinal stenosis treated by MIS-TLIF and open-TLIF in the First Affiliated Hospital of Dali University from January 2015 to January 2017 were retrospectively analyzed, including 39 cases of MIS-TLIF operation (MIS-TLIF group) and 46 cases of open-TLIF operation (open-TLIF group). On the standing lateral lumbar X-ray containing bilateral femoral heads: lumbar lordosis, segmental lordosis, height of the intervertebral disc, the L1 axis and S1 distance, pelvic incidence, pelvic tilt, and sacral slope were measured, and the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were calculated. RESULTS AND CONCLUSION: (1) During the last follow-up, lumbar lordosis, height of the intervertebral disc, and sacral slope were increased in both groups compared with preoperative parameters, but pelvic tilt was decreased compared with preoperatively, and the difference was significant (P 0.05). (2) During the last follow-up, lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope, and the L1 axis and S1 distance were not significantly different compared with preoperative parameters (P > 0.05). (3) The difference between pelvic incidence−lumbar lordosis was significantly decreased at the last follow-up compared with preoperative parameters in the two groups (P 0.05). (4) Above results indicated that for single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open-TLIF in recovery of lumbar lordosis, intervertebral height, and improving lumbar-pelvic balance.
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BACKGROUND: In the elderly patients with degenerative lumbar spinal stenosis, bilateral nerve root canal stenosis commonly shows only one side of symptoms. There is still controversy about whether or not decompression is needed on the side without symptoms or with less symptoms and how to operate. OBJECTIVE: To explore the safety and efficacy of robot-assisted unilateral-decompression using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique by investigating a series of cases with the radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms and by comparing clinical decompression effect and imaging changes before and after operation. METHODS: Cases with radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms subjected to unilateral decompression on the affected side, interbody fusion and bilateral fixation after robot-assisted MIS-TLIF in the same treatment group were retrospectively analyzed. Operation time, intraoperative blood loss and complications were recorded. The vertebral canal cross-sectional area, intervertebral foramen height, intervertebral space height, and lumbar lordosis angle were examined before and after surgery. Visual analogue scale scores for low back pain and leg pain were assessed before and after surgery. Oswestry disability index was used to assess lumbar function before and after surgery. Macnab criteria were used to evaluate the efficacy at the final follow-up after surgery. RESULTS AND CONCLUSION: (1) Operation time was 110-235 minutes, averagely 169.4 minutes. Intraoperative blood loss was 70-180 mL, averagely 112.4 mL. (2) After 3-8 months of follow-up, the visual analogue scale scores of low back pain and lower extremity pain 1 month after surgery and in final follow-up were significantly lower than those before operation (both P 0.05). (6) It is concluded that robot-assisted unilateral-decompression MIS-TLIF obtained satisfactory effect in bilateral lumbar canal stenosis patients presenting with unilateral symptoms.
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BACKGROUND: Decompression-fixation-fusion is the key to spinal surgery since early effective fixation to achieve intervertebral fusion can restore spinal stability in lumbar degenerative disease. OBJECTIVE: To compare biomechanical stability of fusion segment and adjacent segments of bilateral pedicle screw fixation, unilateral pedicle screw fixation and unilateral pedicle screw combined with contralateral translaminar facet screw fixation under transforaminal lumbar interbody fusion. METHODS: Eighteen fresh calf L3-5 specimens were selected. Different forms of fixation were conducted under transforaminal lumbar interbody fusion. The specimens were divided into group A (complete specimens) and group B (bilateral pedicle screws), group C (unilateral pedicle screws), and group D (unilateral pedicle screw combined with contralateral translaminar facet screw). The range of motion of adjacent segment L3-4 and fusion segment L4-5 in six directions of backward extension, forward bending, left bending, right bending, left rotation and right rotation and the stiffness of fusion segment L4-5 were tested. RESULTS AND CONCLUSION: (1) For the range of motion of fusion segment L4-5, the stability was highest in the group B in six directions, followed by group D, which showed similar results in rotation in the group B (P > 0.05). The stability of right curvature and left rotation in group C was insufficient, and there was no significant difference in range of motion between group A and group C (P > 0.05). The range of motion in group A was largest and the stability was worst in the six motion directions. (2) For the stiffness value of fusion segment L4-5, the stiffness value of group B was largest in six directions, which was significantly different from other groups (P 0.05). There was no significant difference between group C and group A in the range of motion of six directions (P > 0.05). (4) The results showed that the motion ramge of unilateral pedicle screw fixation in the right and left rotation directions was large in the early stage, which was close to that of the complete specimen group. There is a shortage of stability, so we need to use it carefully and grasp the indications strictly. Unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation improves the disadvantages of asymmetric fixation of unilateral pedicle screw, increases the stability of rotation and lateral bending, and avoids the influence of bilateral pedicle screw fixation on adjacent segments, thus becoming an effective clinical surgical treatment.
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Objective: To analyze the restoration of intervertebral height and lordosis of fusion segment after open-transforaminal lumbar interbody fusion (Open-TLIF) and minimally invasive-TLIF (MIS-TLIF). Methods: Between January 2013 and February 2016, patients who treated with TLIF due to lumbar degenerative diseases and met the selection criteria were selected as the study objects. Among them, 41 patients were treated with open-TLIF (Open-TLIF group), 34 patients were treated with MIS-TLIF (MIS-TLIF group). There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, disease type, disease duration, pathological segment, and other general data. The intraoperative bleeding volume, hospital stay, visual analogue scale (VAS) score of waist and leg, and Oswestry disability index (ODI) were recorded before and after operation. The anterior disc height (ADH), posterior disc height (ADH), and segmental lordosis (SL) of fusion segment were measured by X-ray film before and at 6 months after operation. The differences of ADH, PDH, and SL between pre- and post-operation were calculated. Results: The intraoperative bleeding volume and hospital stay in Open-TLIF group were significantly higher than those in MIS-TLIF group ( t=14.619, P=0.000; t=10.021, P=0.000). All incisions healed by first intention without early complications. All patients were followed up 6-24 months (mean, 12.6 months) in Open-TLIF group and 6-24 months (mean, 11.5 months) in MIS-TLIF group. The preoperative VAS scores of waist and leg and ODI of the two groups significantly improved ( P0.05). Imaging examination showed the good intervertebral fusion. There was no significant difference in ADH, PDH, and SL between the two groups before operation and at 6 months after operation ( P>0.05). The differences of ADH, PDH, and SL between the two groups were not significant ( P>0.05). The ADH, PDH, and SL after operation significantly increased in the two groups ( P<0.05). Conclusion: Open-TLIF and MIS-TLIF show similar effectiveness and radiological change in the treatment of single lumbar degenerative diseases and the improved intervertebral height and lordosis, but MIS-TLIF can significantly reduce hospital stay and intraoperative blood loss.
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Objective: To compare the effectiveness of modified transforaminal lumbar interbody fusion (modified-TLIF) and posterior lumbar interbody fusion (PLIF) for mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. Methods: The clinical data of 106 patients with mild to moderate lumbar spondylolisthesis (Meyerding classification≤Ⅱ degree) who met the selection criteria between January 2015 and January 2017 were retrospectively analysed. All patients were divided into modified-TLIF group (54 cases) and PLIF group (52 cases) according to the different surgical methods. There was no significant difference in preoperative clinical data of gender, age, disease duration, sliding vertebra, Meyerding grade, and slippage type between the two groups ( P>0.05). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, hospital stay, and complications of the two groups were recorded and compared. The improvement of pain and function were evaluated by the visual analogue scale (VAS) score and Japanese Orthopedic Association (JOA) score at preoperation, 1 week, and 1, 6, 12 months after operation, and last follow-up, respectively. The effect of slip correction was evaluated by slip angle and intervertebral altitude at preoperation and last follow-up, and the effectiveness of fusion was evaluated according to Suk criteria. Results: All patients were followed up, the modified-TLIF group was followed up 25-36 months (mean, 32.7 months), the PLIF group was followed up 24-38 months (mean, 33.3 months). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, and hospital stay of the modified-TLIF group were significantly less than those of the PLIF group ( P0.05). At last follow-up, the fusion rate of the modified-TLIF group and the PLIF group was 96.3% (52/54) and 98.1% (51/52), respectively, and no significant difference was found between the two groups ( χ2=0.000, P=1.000). About complications, there was no significant difference between the two groups in nerve injury on the opposite side within a week, incision infection, and pulmonary infection ( P>0.05). No case of nerve injury on the operation side within a week or dural laceration occurred in the modified-TLIF group, while 8 cases (15.4%, P=0.002) and 4 cases (7.7%, P=0.054) occurred in the PLIF group respectively. Conclusion: Modified-TLIF and PLIF are effective in the treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. However, modified-TLIF has relatively less trauma, lower blood loss, lower drainage volume, lower incidence of dural laceration and nerve injury, which promotes enhanced recovery after surgery.
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Objective@#We aimed to compare the clinical and radiological outcomes of midline lumbar fusion (MIDLF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.@*Methods@#Consecutively treated patients with lumbar pathology who underwent MIDLF ( @*Results@#The mean operative time and hematocrit (HCT, Day 1) were significantly shorter and lower in MIDLF cases (174 min @*Conclusion@#MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates, and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Lumbar Vertebrae/surgery , Retrospective Studies , Spinal Fusion/methods , Treatment OutcomeABSTRACT
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.
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OBJECTIVE@#To evaluate the mid-term efficacy of radiofrequency ablation of nucleus pulposus by intervertebral foramen endoscopy BEIS technique in the treatment of lumbar spine surgery failure syndrome over 60 years old.@*METHODS@#The clinical data of 40 patients over 60 years old with lumbar spine surgery failure syndrome admitted from January 2010 to January 2015 were retrospectively analyzed. Among them, there were 34 males and 6 females, aged from 60 to 76 years old with an average of 66 years, the courses of disease ranged from 10 months to 4 years. The patients were divided into two groups (BEIS group and revision group) according to the different surgery. The intervertebral foramen endoscopy BEIS technique and the transforaminal lumbar interbody fusion (TLIF) were performed in BEIS group and revision group respectively. There was no significant difference in general data such as sex, age, course of disease, surgical segment between two groups(>0.05). The operation time, intraoperative bleeding volume, bed rest time after operation and hospitalization time were observed between two groups. At preoperative, postoperative 1 month, 1 year, 3 years, visual analogue scale(VAS) and Japanese Orthopaedic Association Score(JOA) were used to compare the efficacy.@*RESULTS@#The operation time, intraoperative bleeding volume, bed rest time after operation and hospitalization time in BEIS group were (60.2±10.3) min, (60.1±4.5) ml, (2.2±1.5) d, (4.04±1.40) d, respectively, which were significantly lower than those of revision group (<0.05). The VAS and JOA scores of the two groups at different time after operation were significantly improved (<0.05), and there was statistically significant difference between two groups (<0.05).@*CONCLUSIONS@#Radiofrequency ablation of nucleus pulposus by intervertebral foramen endoscopy BEIS technique is more effective than TLIF revision in the treatment of lumbar spine surgery failure syndrome over 60 years old. It has advantages of shorter operation time, less bleeding, shorter bed rest after operation and hospitalization time, and is worthy of clinical promotion.
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Aged , Female , Humans , Male , Middle Aged , Endoscopy , Lumbar Vertebrae , Retrospective Studies , Spinal Fusion , Treatment OutcomeABSTRACT
OBJECTIVE@#To investigate the advantages of minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF) under Quadrant channel in the treatment of grade I and II degree degenerative lumbar spondylolisthesis.@*METHODS@#The clinical data of 100 patients with grade I and II degree degenerative lumbar spondylolisthesis treated from March 2014 to March 2017 were retrospectively analyzed. Among them, 50 patients were treated with MIS-TLIF, including 19 males and 31 females, aged from 44 to 73 years old with an average of (49.83±15.46) years old; course of disease from 6 months to 7 years with the mean of (22.18±4.74) months; L₄ slippage was in 30 cases and L₅ slippage was in 20 cases, the slippage vertebral pedicles were intact; according to Meyerding classification, 29 cases of I degree slip and 21 cases of II degree slip. Other 50 patients were treated with open-transforaminal lumbar interbody fusion(OPEN-TLIF), including 23 males and 27 females, aged from 40 to 77 years old with an average of(50.67±14.36) years old; course of disease from 6 months to 10 years with the mean of (20.56±5.37) months; L₄ slippage was in 33 cases and L₅ slippage was in 17 cases, the slippage vertebral pedicles were intact; according to Meyerding classification, 34 cases of I degree slip and 16 cases of II degree slip. The operation time, length of surgical incision, intraoperative blood loss, postoperative drainage, and serum creatine kinase(CK-MM) levels before surgery and 1 day after surgery were observed. Visual analogue scale(VAS), Japanese Orthopedic Association Score (JOA), and Oswestry dysfunction index (ODI) were compared between the two groups before and after surgery. According to the imaging data, the slip rate, intervertebral space height and slip angle of the two groups before and 12 months (last follow-up) were compared. Intervertebral fusion was evaluated according to lumbar X-ray and CT at 6 and 12 months postoperatively. The clinical effect was evaluated according to the MacNab criteria at 12 months after surgery.@*RESULTS@#All the patients were followed up for 12 months. In MIS-TLIF group, operation time, length of surgical incision, intraoperative blood loss, postoperative drainage were (118.48±21.97) min, (3.74±0.74) cm, (148.78±32.32) ml, (84.85±16.37) ml, respectively, CK-MM level was (72.31±9.79) μ/L before surgery and (415.12±25.89) μ/L at the first day after surgery. In OPEN-TLIF group, operation time, length of surgical incision, intraoperative blood loss, postoperative drainage were (115.40±11.94) min, (8.46±0.69) cm, (219.27±48.33) ml, (157.69±31.61) ml, respectively, CK-MM level was (75.48±10.73) μ/L before surgery and (506.69±37.86) μ/L at the first day after surgery. The intraoperative blood loss, postoperative drainage volume, length of surgical incision, and CK-MM level on the first postoperative day were lower in MIS-TLIF group than in OPEN-TLIF group(0.05). There were no significant differences in ODI, VAS, and JOA scores before surgery(>0.05). The ODI, VAS, and JOA scores were significantly improved after surgery(0.05). There was no significant difference in intervertebral fusion between groups at 6 and 12 months after operation(>0.05). According to the MacNab standard, 40 cases got excellent results, 7 good, 3 fair in MIS-TLIF group, and 35 cases got excellent results, 10 good, 5 fair in OPEN-TLIF group. One patient had incision exudation and delayed healing in MIS-TLIF group. And in OPEN-TLIF group, 1 patient had local muscle necrosis on the right side of L₅ and the bacterial culture of the secretions was negative in the different three times and the right internal fixation device was taken out after the second operation completely debridement, and finally obtained delayed healing.@*CONCLUSIONS@#The MIS-TLIF under Quadrant channel has advantage of minimally invasive trauma, less bleeding, faster function recovery and better effect in surgical treatment of grade I and II degree degenerative lumbar spondylolisthesis.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Lumbar Vertebrae , Minimally Invasive Surgical Procedures , Retrospective Studies , Spinal Fusion , Spondylolisthesis , Treatment OutcomeABSTRACT
Objective To study the biomechanical properties of porous titanium cages used for different lumbar interbody fusion surgeries. Methods The three-dimensional (3D) finite element model of the lumbar spine was constructed, and mechanical parameters of porous materials were obtained by mechanical test. The biomechanical properties of porous titanium cages in anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), direct lateral interbody fusion (DLIF) were compared. Results After lumbar interbody surgery, the predicted range of motion (ROM) and the maximum stress in cage of DLIF model and ALIF model were substantially lower than those of PLIF model and TLIF model. The maximum stress in endplate of DLIF model, ALIF model and TLIF model were obviously lower than that of PLIF model. Conclusions DLIF with the porous cage showed advantages in biomechanical properties, which was simple to operate and suitable for minimally invasive surgery in clinical practice. DLIF performed the superior comprehensive properties.
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Objective: To explore the risk factors of coronal imbalance after posterior long-level fixation and fusion for degenerative lumbar scoliosis. Methods: Retrospectivly analyzed the clinical records of 41 patients with degenerative lumbar scoliosis who had received posterior long-level fixation and fusion with selective transforaminal lumbar interbody fusion (TLIF) accompanied by Ponte osteotomy between August 2011 and July 2016. Patients were divided into imbalance group (group A, 11 cases) and balance group (group B, 30 cases) according to state of coronal imbalance measured at last follow-up. The radiographic parameters at preoperation and last follow-up were measured, and the variance of preoperative and last follow-up parameters were calculated. The radiographic parameters included coronal Cobb angle, coronal balance distance (CBD), apical vertebral translation (AVT), apical vertebral rotation (AVR), Cobb angle of lumbar sacral curve (LSC), and L 5 tilt angle (L 5TA). Univariate analysis was performed for the factors including gender, age, preoperative T value of bone mineral density, number of instrumented vertebra, upper and lower instrumented vertebra, segments of TLIF, decompression, and Ponte osteotomy, as well as the continuous variables of preoperative imaging parameters with significant difference were converted into two-category variables, obtained the influence factors of postoperative coronal imbalance. Multivariate logistic regression analysis was performed to verify the risk factors from the preliminary screened influence factors and the variance of imaging parameters with significant difference between the two groups. Results: The follow-up time of groups A and B was (3.76±1.02) years and (3.56±1.03) years respectively, there was no significant difference between the two groups ( t=0.547, P=0.587). The coronal Cobb angle, AVT, LSC Cobb angle, and L 5TA in group A were significantly higher than those in group B before operation ( P0.05), and there were significant differences between the two groups in parameters including the variance of CBD, L 5TA, and AVR ( P<0.05). Univariate analysis showed that preoperative L 5TA was the influencing factor of postoperative coronal imbalance ( P<0.05). Multivariate logistic regression analysis showed that preoperative L 5TA≥15° was an independent risk factor of postoperative coronal imbalance, and variance of pre- and post-operative AVR was a protective factor. Conclusion: Preoperative L 5TA≥15° is an independent risk factor for coronal imbalance in patients with degenerative lumbar scoliosis after posterior long-level fixation and fusion.
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Objective: To investigate the effectiveness of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion (TLIF). Methods: A retrospective analysis was made of 161 patients with single segment L 4 or L 5 isthmic spondylolisthesis treated between January 2013 and December 2015. According to the implantation of Cage, they were divided into trial group (85 cases, modified direction-changeable lumbar Cage implanted in TLIF) and control group (76 cases, traditional nondirection-changeable Cage implanted in TLIF). There was no significant difference in the general data of gender, age, disease duration, slippage segment, and slippage grade between the two groups ( P>0.05). The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time were recorded and compared between the two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate the effectiveness of the patients before operation, and at 3, 6, and 12 months after operation, and the incidence of complications was recorded and analyzed. CT examinations were performed at 6 and 12 months after operation, and lumbar fusion was evaluated by Bridwell criteria. Results: The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time in trial group were significant less than those in control group ( P0.05). Conclusion: Both Cages can obtain the similar effectiveness. The modified direction-changeable lumbar Cage can significantly reduce the fluoroscopy times and radiation dose during TLIF, shorten the operation time, and effectively reduce the radiation exposure of patients and medical staff.