Comparison of early clinical outcome of Endo-ULBD technique and PLIF technique on the treatment of multi-segmental lumbar central spinal stenosis / 西安交通大学学报(医学版)

【Objective】 Compare the early outcome and safety of endoscopy-unilateral laminectomy for bilateral decompression （Endo-ULBD） and posterior lumbar interbody fusion （PLIF） in the treatment of multi-segment lumbar central spinal stenosis. 【Methods】 We retrospectively analyzed 68 patients with multi-segment central lumbar spinal stenosis treated between October 2019 and October 2020 in the Department of Spine Surgery， Affiliated Hospital of Qingdao University. Of them 33 patients were treated with Endo-ULBD and 35 ones were treated with PLIF. We compared the operation time， times of intraoperative fluoroscopy， estimated intraoperative blood loss， incision length， postoperative time to get out of bed， postoperative hospital duration， complications， visual analogue scale （VAS）， Oswestry dysfunction index （ODI） score before and 1 day， 1 month， and 3 months after operation， Japanese Orthopedic Association Assessment Treatment Score （JOA）， and modified MacNab score 3 months after operation between the two groups of patients. 【Results】 Compared with PLIF group， Endo-ULBD group had significantly shorter operation time， smaller incision length， less intraoperative blood loss， shorter postoperative bed time and postoperative hospital stay， and fewer surgical complications （all P0.05）. However， after treatment Endo-ULBD group outperformed PLIF group in lower back pain VAS， ODI， JOA and the 3-month follow-up excellent and good rates （P<0.05）. 【Conclusion】 For patients with multi-segment central lumbar spinal stenosis， Endo-ULBD treatment can achieve better early clinical outcome than PLIF surgery， with less bleeding， shorter operation time， faster postoperative recovery， and fewer complications.

Biomechanical Properties of Porous Titanium Cages for Different Lumbar Interbody Fusion Surgeries / 医用生物力学

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.

Comparison of clinical efficacy between mini-invasive transforminal lumbar interbody fusion(mis-TLIF) assisted by Quadrant system and PLIF treatment for lumber spondylolisthesis / 临床外科杂志

Objective To comparison of clinical efficacy between mini-invasive transforminal lumbar interbody fusion(mis-TLIF) assisted by Quadrant system and open posterior lumbar interbody fusion (PLIF)treatment for lumber spondylolisthesis,to find a better treatment for lumbar spondylolisthesis.Methods A total of 65 cases who were under lumber spondylolisthesis were retrospectively selected from our hospital,26 cases in mini-invasive transforminal lumbar interbody fusion assisted by Quadrant system (mis-TLIF group).39 cases in open posterior lumbar interbody fusion(PLIF group).Record the incision length,intraoperative blood loss,opertive time,bed time,hospital time,pre-and post-operative visual analogue scale(VAS) and Oswestry disability index(ODI) score were recorded respectively.After surgery,the imaging(X-Ray) evalute the vertebral fusion status.Results There were no significant difference between mis-TLIF group and PLIF group in BMI [(22.77 ± 4.38) kg/m2 and (21.28 ± 5.24) kg/m2],preoperative VAS score [(6.46 ± 1.67) and (6.59 ± 1.56)],preoperative ODI score [(58.70 ± 7.19) ％ and (60.10 ± 9.56) ％] (all P ＞ 0.05).There were significant difference between two groups in incision length [(6.10 ± 0.95) cm and (11.12 ± 2.02) cm],intraoperative blood loss [(247.31 ± 36.72) ml and (340.51 ± 64.32) ml],opertive time[(179.96 ± 17.54) min and(151.85 ± 16.06) min],bed time[(3.62 ± 1.44) d and (4.98 ± 1.74) d],hospital time [(9.38 ± 2.60) d and (11.95 ± 3.61) d] (all P ＜ 0.05).Postoperatively VAS score was assesssd at 1 month [(3.15 ± 1.08]),3months [(1.58 ± 0.81)],6months [(1.08 ± 0.74)] and ODI score was(30.77 ± 6.45) ％,(25.54 ± 6.33) ％,(20.23 ± 7.05) ％,respectively in mis-TLIF group were lower than those of PLIF group (P ＜ 0.05).There were no significant difference between two groups in the fusion rate in 3 months,6 months after operation.Conclusion Mis-TLIF had a lot of advantages relative to PLIF in the treatment of lumber spondylolisthesis,be like less trauma,less bleeding,less hospital time,quick rehabilitation and good curative effect,provide a new minimally invasive method for lumber spondylolisthesis patient.

Analysis on surgical treatment efficacy of lumbar spondylolisthesis patients with modic change / 局解手术学杂志

Objective To investigate the treatment efficacy of lumbar spondylolisthesis patients with modic change. Methods The da-ta of 45 lumbar spondylolisthesis patients with modic change were analyzed retrospectively,which were admitted into hospital from January 2010 to December 2013 and received posterior lumbar interbody fusion ( PLIF) surgery. Those patients were tested by X-ray and Magnetic resonance imaging ( MRI) and confirmed the type of spondylolisthesis and Modic change. Based on the degree of spondylolysis and whether combined or not with Modic change,all the patients were divided into six groups:group A with Ⅱ grade spondylolisthesis;group B with Ⅲgrade spondylolisthesis;group C with Ⅱ grade spondylolisthesis with Modic typeⅠ;group D withⅡgrade spondylolisthesis with Modic typeⅡ;group E with Ⅲ grade spondylolisthesis with Modic type Ⅰ;group F with Ⅲ grade spondylolisthesis with Modic type Ⅱ. Those patients were evaluated preoperatively and postoperatively the scores according to the Visual Analogue Scale ( VAS) and Oswestry Disability Index ( ODI) systems,the obtained data were statistically analyzed and then were used to evaluated the treatment efficacy. Results The treatment efficacy of those patients were evaluated by follow-up work based on the scores of VAS and ODI systems,the results indicated that all those patients were improved in the scores of pain and ODI at different agrees. Within groups,the scores of low back and leg pain in VAS system and ODI preoperative were all significantly lower than that of postoperative (P0. 05). Conclusion Those spondylolisthesis patients with Modic change could obtained satisfactory clinical efficacy after posterior lumbar interbody fusion ( PLIF) surgery.

The Result of Minimal Invasive Anterior Lumbar Interbody Fusion with Posterior Lumbar Interbody Fusion on Degenerative Lumbar Flat Back Disease

STUDY DESIGN: Restrospective study. OBJECTIVES: We tried to find out the effects of minimal invasive anterior lumbar interbody fusion (ALIF) combined with posterior lumbar interbody fusion for degenerative lumbar flat back disease. SUMMARY OF LITERATURE REVIEW: ALIF combined with PLIF is effective in correcting lumbar lordosis. However, the complication rate with conventional ALIF is higher on the lower level. MATERIALS AND METHODS: 21 cases (9 men and 12 women, 46-83 years of age) of having undergone minimal invasive ALIF and PLIF due to degenerative flat back disease were reviewed. The follow-up period was an average of 23 months. We compared the pre-postoperative pain, the functional outcome, the correction of sagittal imbalance and lordotic angle. RESULTS: At final follow-up, 21 cases with the solid fusion experienced a great improvement in their lower back pain(VAS: 7.3 --> 2.6) and leg pain (VAS: 7.0 --> 2.7) and ODI(38.5 --> 18.1). And we experienced correction in sagital imbalance. On levels with anterior fusion, lordotic angle is corrected 6.3 degrees while on levels with posterior fusion, lordotic angle is corrected 9.7 degrees. Plumb line is corrected by 5.2cm, and no complication was found in the follow-up period. CONCLUSIONS: Combined surgery with minimal invasive anterior lumbar interbody fusion and posterior fusion is an effective procedure on patients who need long level surgery for correction of lumbar deformity and decompression.

Management of Deep Wound Infection After Posterior Lumbar Interbody Fusion With Cages

STUDY DESIGN: Retrospective study OBJECTIVES: The purpose of this study was to analyze patients who developed deep wound infections after receiving PLIF for degenerative lumbar disease, and report the treatment outcomes. SUMMARY OF LITERATURE REVIEW: Few studies have examined deep wound infections after PLIF, and there is some controversy regarding whether screws or cages need to be removed to treat infections. MATERIALS AND METHODS: Nine cases(spinal stenosis 6, spondylolisthesis 3) developed a deep wound infection after PLIF from 2001 to 2007. The mean follow up was 48 months (24-72). The clinical results were evaluated using MacNab's criteria. RESULTS: The diagnosis of infection was made based on the clinical symptoms and signs, and inflammatory markers, such as ESR and CRP. The time to diagnosis was less than one week (2), three weeks (2), six weeks (1) and three months or more (4). Bacterial identification was performed on seven cases. MRSA was detected in one of them, and no bacteria were identified in the other six. In two of them, the infection subsided with antibiotic therapy only. In 7 cases, removal of the cage and anterior iliac strut graft was needed for infection control. In four cases, loosened screws were removed during debridement. In 2 cases, additional surgery for pseudarthrosis was required after curing the infection. CONCLUSIONS: In deep infections after PLIF, early diagnosis and bacterial identification are important for reducing the need for a later radical operation. It is recommended that blood markers of infection be measured with a short follow-up period. In a case of persistent infection against prolonged antibiotics, removal of the cage or screw is needed to treat the infection earlier.

Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis

The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.

O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espondilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida.

Comparison of Posterior Lumbar Interbody Fusion with Posterolateral Fusionin Degenerative Lumbar Spinal Disorders / 대한정형외과학회잡지

PURPOSE: This study compared the surgical treatment results between posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) with pedicle screw fixation in degenerative lumbar spinal disorders. MATERIALS AND METHODS: In 45 cases of PLF (group I) and 45 cases of PLIF (group II), lumbar lordosis, segmental lordosis, bone union and complications were considered to be an evaluation criterion. Kim's functional evaluation scale was used for the clinical results. RESULTS: The average lumbar lordosis in group I was 36.84+/-8.31 degrees preoperatively, 40.58+/-7.61 degrees postoperatively and 35.73+/-7.61 degrees at the last follow up. On the other hand, the respective changes in the average lumbar lordosis were 31.53+/-7.09 degrees, 39.11+/-7.21 degrees, and 35.47+/-7.76 degrees in group II. Definitive solid union was obtained in 41 cases in group I (91.1%) and 43 cases in group II (95.6%). The rate of complications was 24.4% (11 cases) in group I and 2.2% (6 cases) in group II, and a satisfactory functional outcome were obtained in 43 cases (95.6%) in group I and 41 cases (91.1%) in group II. CONCLUSION: Both PLF and PLIF on short segment fusion provided satisfactory bone union and clinical results. In segmental lordosis, there were no significant differences between the two groups. However, PLIF was more effective in preventing lumbar lordosis and complications than PLF. A longer term follow up will be needed to evaluate the adjacent segmental degeneration and maintenance of the sagittal balance.

Clinical application of spinous process forming in posterior lumbar interbody fusion / 中国矫形外科杂志

[Objective]To explore the feasibility and clinical effects of spinous proscess forming in posterior in the treatment of lower lumbar diseases. [Methods]Seventy-seven cases suffered from lower lumbar diseases were treated using spinous proscess forming as interbody fusion material.The cases included 35 of lumbar disc herniation,21 of spondylolysis,11 of degenerative spondylolisthesis and 10 of spinal canal stenosis.The clinical data and imaging results were investigated.[Results]Seventy-two patiens were followed up for 1 to 2 years while 5 were lost.During following-up,no loosened internal fixation,broken nail or stick,infravertebra prolapsed,or detachment recurrence was found.Preoperative the height of intervertebral space was 8.5?1.9 mm,10.9?1.8 mm at 2 weeks postoperatively and was 10.7?1.7 mm at last follow-up.The height of intervertebral space were significantly increased postoperatively with statistically significant difference(P

Posterior circumferential fusion for severe lumbar stenosis of the elderly / 中国矫形外科杂志

[Objective]To evaluate the application and effectiveness of circumferential fusion for the treatment of severe lumbar stenosis of the elderly.[Method]Eighty-three elderly patients with severe lumbar stenosis were treated with circumferential fusion through one-stage posterior approach(PLIF+PLF)from November 2001 to May 2004 at author's department.Postoperative complications were observed.All patients were followed-up for 24~42 months.JOA scoring system was used to evaluate the operative outcome.Plain radiographs and CT were used to judge fusion status.[Result]All patients were able to ambulate 12~14 days after operation.Symptomatic deep venous thrombosis(DVT)happened in three patients.Ten patients had worsening pain in the back and lower extremities temporarily.At final follow-up,low back pain was relieved significantly.JOA scores improved from(13.6?3.8)points before surgery to(22.3?4.6)points.Bone fusion was achieved in all operated intervertebral spaces.[Conclusion]Posterior circumferential fusion is one of safe,effective and reasonable treatment choises for elderly patients with severe lumbar stenosis.

Posterior Lumbar Interbody Fusion via a Unilateral Approach

This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK(TM) (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.

Posterior Lumbar Interbody Fusion via a Unilateral Approach

This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK(TM) (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.

What are the Differences in Outcome among Various Fusion Methods of the Lumbar Spine?

OBJECTIVE: For Posterior lumbar interbody fusion(PLIF) various cages or iliac bone dowels are used with or without pedicle screw fixation(PSF). To evaluate and compare the clinical and radiological results of different fusion methods, we intend to verify the effect of added PSF on PLIF, the effect of bone cages and several factors which are thought to be related with the postoperative prognosis. METHODS: One hundred and ninety seven patients with lumbar spinal stenosis and instability or spondylolisthesis underwent various fusion operations from May 1993 to May 2003. The patients were divided into five groups, group A (PLIF with autologous bone dowels, N=24), group B (PLIF with bone cages, N=13), group C (PLIF with bone dowels and PSF, N=37), group D (PLIF with bone cages and PSF, N=30) and group E (PSF with intertransverse bone graft, N=93) for comparison and analyzed for the outcome and fusion rate. RESULTS: Outcome was not significantly different among the five groups. In intervertebral height (IVH) changes between pre- and post-operation, Group B (2.42+/-2.20mm) was better than Group A (-1.33+/-2.05mm). But in the Group C, D and E, the IVH changes were not different statistically. Fusion rate of group C, D was higher than that of Group A and B. But the intervertebral height(IVH) increased significantly in group B(2.42+/-2.20mm). Fusion rate of group C and D were higher than that of group A and D. CONCLUSION: Intervertebral cages are superior to autologous iliac bone dowels for maintaining intervertebral height in PLIF. The additional pedicle screw fixation seems to stabilize the graft and improve fusion rates.

Surgical Treatments for Lumbar Disc Disease in Adolescent Patients; Chemonucleolysis / Microsurgical Discectomy/ PLIF with Cages

The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1 - 4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no non- union cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications.

Wedge Shape Cage in Posterior Lumbar Interbody Fusion: Focusing on Changes of Lordotic Curve

OBJECTIVE: Lumbar lordotic curve on L4 to S1 level is important in maintaining spinal sagittal alignment. Although there has been no definite report in lordotic value, loss of lumbar lordotic curve may lead to pathologic change especially in degenerative lumbar disease. This study examines the changes of lumbar lordotic curve after posterior lumbar interbody fusion with wedge shape cage. METHODS: We studied 45patients who had undergone posterior lumbar interbody fusion with wedge shape cage and screw fixation due to degenerative lumbar disease. Preoperative and postoperative lateral radiographs were taken and one independent observer measured the change of lordotic curve and height of intervertebral space where cages were placed. Segmental lordotic curve angle was measured by Cobb method. Height of intervertebral space was measured by averaging the sum of anterior, posterior, and midpoint interbody distance. Clinical outcome was assessed on Prolo scale at 1month of postoperative period. RESULTS: Nineteen paired wedge shape cages were placed on L4-5 level and 6 paired same cages were inserted on L5-S1 level. Among them, 18patients showed increased segmental lordotic curve angle. Mean increased segmental lordotic curve angle after placing the wedge shape cages was 1.96? Mean increased disc height was 3.21mm. No cases showed retropulsion of cage. The clinical success rate on Prolo's scale was 92.0%. CONCLUSION: Posterior lumbar interbody fusion with wedge shape cage provides increased lordotic curve, increased height of intervertebral space, and satisfactory clinical outcome in a short-term period.

Posterior Lumbar Interbody Fusion with Chip Bone and Pedicle Screw Fixation: Comparative Study between Local Chip Bone Graft and Autoiliac Chip Bone Graft / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of posterior lumbar interbody fusion utilizing pedicle screw fixation and chip bone graft, and to compare the radiologic and clinical results in two group which use local chip bone and autoiliac chip bone respectively. MATERIALS AND METHODS: We analyzed 58 cases of single segment chip bone posterior lumbar interbody fusion which were followed up for more than 1 year. Group I was operated with local chip bone and group II with autoiliac chip bone. Radiologic union was assessed, based on Brantigan & Steffee method and functional outcome by Kirkaldy-Willis criteria. Student t-test and Fisher's exact test were used for statistical analysis. RESULTS: Clinical satisfaction of group I and II were 81.3% and 88.1% respectively (p>0.05). Though 12% of group II complained about pain on the donor site, no one among them were assessed as unsatisfactory. Radiological union was confirmed in 75% in group I and 90% in group II (p>0.05). Twenty five percent of group I and nineteen percent of group II showed collapsed union without significant differences. There were no significant differences between group I and II in loss of disc height, segmental lordosis, operation time and blood loss. CONCLUSION: Both local and autoiliac chip bone posterior lumbar interbody fusion are useful methods in the aspect of radiologic union and functional outcome and there are no significant differences between two groups. However, considerable collapsed unions were observed in both groups. It is necessary to investigate long term influence of collapsed union on the adjacent segment and functional outcome.

Factors Influencing to Clinical Outcomes of the Surgically Treated Degenerative Lumbar Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: To examine the factors considered in the selection of therapeutic methods, and the methods for accessing postoperative clinical outcomes, in degenerative lumbar spondylolisthesis. OBJECTIVES: In this retrospective study, patients who had taken only posterolateral fusion, and with a posterior lumbar interbody fusion, were evaluated. The analyses of the pre- and post-operative factors associated with the clinical outcomes of the surgery for degenerative lumbar spondylolisthesis were also performed. MATERIALS AND METHOD: Of the patients who had received the surgery for degenerative lumbar spondylolisthesis, between January 1995 and December 2000, there were 59 for whom follow-up observations were possible, and these were selected for the present study. The patients were comprised of 19 males and 40 females, with ages ranging from 42 to 74 years (58.4+/-8.4 years old). Of the 59 patients, 39, and 20, received a posterolateral fusion, or both a posterolateral fusion and a posterior lumbar interbody fusion, respectively. In the present study, the pre-operative factors considered were the surgical method, sex, age, L1 axis S1 distance (LASD), lordosis angle and the degree and duration of spondylolisthesis, with the degree of fusion, the lordosis angle of the fused body, the lordosis angle at the final follow-up and the lordosis angle of the fused body at the final follow-up, used as the post-operative factors. Each factor was statistically tested to see if it had a significant correlation with clinical outcomes (Recovery rate by Hirabayashi's method). A value of P < 0.05 was considered as being statistically significant. RESULT: The posterolateral fusion group showed a significantly lower recovery rate with an LSAD over 35 mm, a degree of spondylolisthesis over 10 mm and a pre-operative lordosis angle under 20 degrees, indicating that an additional posterior lumbar interbody fusion would provide a good clinical outcome. At the final follow-up, both groups showed significantly lower recovery rates with a lumbar lordosis angle under 20 degrees, and the posterolateral fusion group showed significantly lower recovery rates when the post-operative lordosis angle of the fused segment was under 18 degrees, and with a lordosis angle of the fused segment was under 18 degrees at the final follow-up. These post-operative factors showed significant correlations with the clinical outcomes. CONCLUSIONS: It is considered that an additional posterior lumbar interbody fusion is indicated in patients with a LSAD over 35 mm, an anterior slippage over 10 mm and a lumbar lordosis angle over 20 degrees. It is also considered that the lordosis angles of the fused segment, and the post-operative lumbar lordosis, are important factors that require peri-operative correction and maintenance.

Long-term Result of Circumferential Stabilization for Spondylolytic Spondylolisthesis by One Stage Posterior Approach

OBJECTIVE: The purpose of this study is to evaluate the efficacy of circumferential fusion with PLIF(posterior lumbar interbody fusion) using fusion cages and pedicle screw fixation by one stage posterior approach in the patients with spondylolytic spondylolisthesis. METHODS: Total 254 patients with spondylolytic spondylolisthesis underwent circumferential fusion during last 10 years. Among them, 117 patients could be followed for more than two years (mean follow up period: 27.4+/-5.5 months). The clinical and radiographic data were reviewed retrospectively. RESULTS: The clinical success rate according to Prolo's scale was achieved in 86.3% of patients and the solid bony fusion was occurred in 92.3%. The anterior slipping was reduced from 9.54+/-3.89mm to 3.26+/-2.46mm(p<0.001, paired t-test). Angular instability in lateral dynamic X-ray was improved in all case immediately after surgery. There were 3 cases of instrument-related complication (2.6%) such as loosening, disconnection, and cage retropulsion. CONCLUSION: The circumferential stabilization with PLIF using fusion cages and pedicle screw fixation by one stage posterior approach has been found to be an effective and safe procedure, demonstrating a high fusion rate and clinical success with a rare complications.

Comparison of PLIF with Circumferential Fusion / 대한정형외과학회잡지

PURPOSE: To investigate the necessity of additional posterolateral fusion in posterior lumbar interbody fusion (PLIF) by comparing the clinical and radiological results of PLIF with circumferential fusion. MATERIALS AND METHODS: In 22 cases of circumferential fusion and 21 cases of PLIF, clinical outcomes were analyzed by Kirkaldy-Willis method. Intensity of pain, usage of analgesics and patient's satisfaction were also investigated. The fusion rates and changes of the heights and angles of discs in fused and adjacent segments were analyzed radiologically. RESULTS: No significant radiologic differences were found between two groups in terms of fusion rate, changes of disc height and angles in fused and adjacent segments. In each group, good or excellent results were obtained in 71% and 73%, respectively. A longer operation time was needed and the amount of blood loss was larger in the circumferential fusion groups. CONCLUSION: The addition of posterolateral fusion seems to have no more advantages than PLIF only.

The Posterior Decompression and Posterior Lumbar Interbody Fusion Using a Mini-open Technique: New Suggestion of Minimally Invasive Technique A Preliminary Report / 대한정형외과학회잡지

PURPOSE: To introduce mini-open posterior decompression with posterior lumbar interbody fusion (PLIF) and to assess its clinical outcomes. MATERIALS AND METHODS: Eight patients who underwent L4-5 posterior decompression with PLIF using a mini-open technique were followed up for an average 8 months. Three patients had degenerative lumbar spinal stenosis and five patients had spinal stenosis with degenerative spondylolisthesis. We performed posterior decompression with PLIF through a mini-incision (2.5 cm paramedian incision at the both sides) including percutaneous pedicle screw fixation. The operative time, amount of blood loss and complications were analyzed. Clinical outcomes were assessed by using McNab criteria and VAS (visual analogue scale) for postoperative back pain. RESULTS: The mean operative time was 172.5 min (range, 130-235 min). The mean amount of intraoperative blood loss was 178.1 mL (range, 95-310 mL). All procedures were completed without transfusion. VAS for back pain rapidly reduced from 10 on the immediate postoperative day to 3 on the third day and 2 on the seventh day. At the last follow up, five patients had no back pain and the three remaining patients had a VAS 0.75. The clinical outcomes were excellent in 5 patients and good in 3 patients. CONCLUSION: Mini-open posterior decompression and the PLIF technique offer a useful minimally-invasive modality for the treatment of single level spinal stenosis.