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Comparison Of CLIF And TLIF In Treatment Of Degenerative Lumbar Spondylolisthesis Combined With Lumbar Spinal Stenosis London Spine

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Published article

CLIF in the treatment of DLS combined with LSS can achieve the similar effectiveness with traditional TLIF, and has such advantages as minimal invasion and faster recovery.Lumbar Disc Replacement Expert. Best Spinal Surgeon UK


Objective: To observe the difference between crenel lateral interbody fusion (CLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis (DLS) combined with lumbar spinal stenosis (LSS).

Methods: The clinical data of DLS combined with LSS patients meeting the selection criteria admitted between May 2018 and May 2019 were retrospectively analyzed. According to different surgical methods, the patients were divided into CLIF group (33 cases) and TLIF group (32 cases). There were no significant differences ( P>0.05) between the two groups in gender, age, disease duration, lesion segments, lumbar bone mineral density, degree of lumbar spondylolisthesis, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), intervertebral space height, intervertebral foramen height, lumbar lordosis (LL), and segmental lordosis (SL). The operation time, intraoperative blood loss, and perioperative complications were recorded and compared between the two groups. Lumbar CT scan was performed at last follow-up to compare the intervertebral fusion rate between the two groups. Intervertebral space height, intervertebral foramen height, LL, and SL were measured before operation, at 2 weeks, 3 months after operation, and at last follow-up. VAS score and ODI were used to evaluate the pain and improvement of the quality of life of the patients.

Results: There were no neurological and vascular complications in the two groups. The operation time and intraoperative blood loss in CLIF group were significantly less than those in TLIF group ( P<0.05). Patients in both groups were followed up for a median time of 18 months. All the incisions healed by first intention except 1 incision in TLIF group because of poor blood glucose control. No complications such as bedsore, falling pneumonia, and deep venous thrombosis were found in both groups. At last follow-up, the intervertebral fusion rates in CLIF and TLIF group were 90.91% (30/33) and 93.75% (30/32), respectively, showing no significant difference ( χ 2=0.185, P=0.667). The VAS score, ODI, intervertebral space height, intervertebral foramen height, LL, and SL were significantly improved in both groups at each time point after operation ( P<0.05). Except that VAS score in CLIF group was significantly lower than that in TLIF group at 2 weeks after operation ( Z=-4.303, P=0.000), there were no significant differences in VAS score and ODI between the two groups at other time points ( P>0.05). The intervertebral space height, intervertebral foramen height, LL, and SL in CLIF group were significantly higher than those in TLIF group at each time point after operation, and the differences were significant ( P<0.05).

CLIF in the treatment of DLS combined with LSS can achieve the similar effectiveness with traditional TLIF, and has such advantages as minimal invasion and faster recovery.

目的: 比较改良侧方腰椎椎间融合术(crenel lateral interbody fusion,CLIF)与经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)合并腰椎管狭窄症(lumbar spinal stenosis,LSS)的疗效。.

方法: 回顾分析 2018 年 5 月—2019 年 5 月收治并符合选择标准的 DLS 合并 LSS 患者临床资料。根据手术方式分为 CLIF 组 33 例及 TLIF 组 32 例。两组患者性别、年龄、病程、病变节段、腰椎骨密度、腰椎滑脱程度及术前疼痛视觉模拟评分(VAS)、Oswestry 功能障碍指数(ODI)、椎间隙高度、椎间孔高度、腰椎前凸角(lumbar lordosis,LL)、融合节段前凸角(segmental lordosis,SL)等一般资料比较,差异均无统计学意义( P>0.05)。记录并比较两组患者手术时间、术中出血量、围术期并发症发生情况;末次随访时行腰椎 CT 检查,比较两组椎间融合率;术前及术后 2 周、3 个月、末次随访时测量椎间隙高度、椎间孔高度、LL、SL,采用 VAS 评分、ODI 评估患者疼痛及生活质量改善情况。.

结果: 两组患者术中未出现神经及血管损伤相关并发症。CLIF 组手术时间及术中出血量均显著少于 TLIF 组( P<0.05)。两组患者均获随访,随访时间中位数均为 18 个月。除 TLIF 组术后 1 例因血糖控制不佳手术切口愈合不良外,两组其余患者手术切口均Ⅰ期愈合。两组均未出现褥疮、坠积性肺炎及下肢深静脉血栓形成等并发症。末次随访时,CLIF 组和 TLIF 组椎间融合率分别为 90.91%(30/33)和 93.75%(30/32),差异无统计学意义( χ 2=0.185, P=0.667)。两组术后各时间点 VAS 评分、ODI、椎间隙高度、椎间孔高度、LL 及 SL 均较术前显著改善( P<0.05)。除术后 2 周 CLIF 组 VAS 评分低于 TLIF 组,差异有统计学意义( Z=−4.303, P=0.000)外,其余各时间点两组间 VAS 评分及 ODI 比较差异均无统计学意义( P>0.05);术后各时间点 CLIF 组椎间隙高度、椎间孔高度、LL 及 SL 均显著大于 TLIF 组,差异有统计学意义( P<0.05)。.

结论: 采用 CLIF 手术治疗 DLS 合并 LSS 可取得与传统 TLIF 相同的治疗效果,还具有创伤小、术后恢复快等优点。.

Keywords: Degenerative lumbar spondylolisthesis; crenel lateral interbody fusion; lumbar spinal stenosis; transforaminal lumbar interbody fusion.

The London Spine Unit : top treatment clinic on Harley Street UKRead the original here:Comparison of CLIF and TLIF in treatment of degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis

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Miles McWilliams
Miles McWilliams
I have known Dr Akmal and his team for the past 8 years, I have seen him and his team ON and OFF for issues regarding my neck, C4/5, C5/6 , C6/7. I first had 3 lots of injections into this area back at the start of things. This helped me for 3 years. Dr Akmal did not want to operate at the time due to my age still been under 40 then. After 3 years I had to see Dr Akmal and his team again. We tried the injection route again but after a few attempts we then had to make the call to cut. I had C5/6 and C6/7 +/- C4/5 anterior cervical decompression and fusion / disc replacement carried out. This was a success and I was out of the hospital within 3 days and recovery took place for the next few months. This year I was operated on the back of my neck for a posterior cervical foraminotomy on the left side at the C5/6 and C6/7 levels. We tried the injections last year but this did not help. Due to Covid to this should have been carried out last year. Dr Akmal explained the risks include nerve injury, dural tear and pain post-operatively but the procedure is fairly routine and the risks are relatively low. Surgery has now taken place back in February. I was released the same day later that evening and been back for my check ups and things are looking up. I am currently training for a half triathlon that I will take part in second week of July. I am doing anything from 120 km to 170 km a week on the bike and running now upto 10 km a day on my running days. I have not been able to swim yet due to pools been closed but I have no issues with movement in me neck. I am very happy I chose Dr Akmal from the start. I did seen two others before him, they were happy to just cut and not look at what was best for me. I also strongly believe the newer technology Dr Akmal uses has really helped me any my life style I lead with sports. I know I would not have had the same results if I did not take the route with Dr Akmal. I really can’t say much more but I am very happy I met Dr Akmal when I did, he has been great and so has his team. Patient Miles McWilliams 😊
Saima Kash
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It was a fantastic experience for my mother in law right from the beginning when she had her first appt with Mr Akmal and was recommended to have a spinal surgery. He has been fantastic, extremely helpful and professional in helping her understand her own condition and pros and cons of the surgery and support her through out the whole process. I would highly recommend him for his excellent professional skills and experience in dealing with patients specially elderly patients.
Radu Ghebaru
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Quick and easy to book appointments (online and over the phone). Very helpful receptionist. I had a consultation with dr Akmal who is very professional , patient , kind and understanding. he explained me in details my problem. Trustful and confident in his job, I decided to follow his advice and treatment. I had yesterday a spinal injection . No sides effects so far. A bit in pain but it’s normal. I am aware that I will see the results in one week time only. Great team , exceptional staff (from the receptionist to the nurses and dr Akmal). I would recommend Harley Street Hospital - London Spine Unit to anyone who is having back pains.
Ashraf Elawad
Ashraf Elawad
I had difficult times with my disc prolapse in my lower back. The pain was getting worse despite pain killers and physiotherapy. I was a bit nervous considering surgical treatment as a definte solution. The consultation with Mr. Mo Akmal was informative and reassuring and helped me to make a decision going ahead for the surgical option. On the day of the procedure, the staff was welcoming and looked experienced and knew exaclty what they were doing. Mr. Mo Akmal spoke to me before and after the procedure. In less than 2hrs, after the porcedure, I was able to stand, walk, and sit down with no pain. I strongly recommend Mr. Mo Akmal for anybody who has a similar condition.
Joe massimo
Joe massimo
I had minimally invasive spinal surgery for a Bulging disc at L5/S1 impinging on my S1 nerve root. Before surgery I couldn’t walk without a limp and would be in too much pain to walk further than a mile. Being only 21 years old and a keen athlete and student Osteopath, with an interest in sports rehabilitation, I wanted to get back to complete health and fitness from this injury. There is definitely a fear with spinal surgery that a lot of people have in the sports and therapy world however I knew I needed the operation to gain my leg function back and with Mr Mo Akmal and the team at the London spine Unit, I felt in great hands and they were very professional from start to finish with the process. They made me feel very comfortable and safe. I’d highly recommend Mr Mo Akmal and the Team at the London Spine Unit, they are very friendly and take great care of you. I’m feeling much better and am glad I chose to get the surgery done here.
Very good treatment from Mr. Akmal and the staff with amazing results. After the first spinal injection I was sure the treatment won't work but as the team encouraged me to keep going to the second injection it then total disappeared. They were also very helpful with all the documents needed for the insurance cover. Much appreciated! I was struggling
In February 2021 I felt excoriating pain in my lower back. I was unable to stand up straight with my right leg having spasms occurring every hour. The sciatic pain accelerated within days I was bed bound to the point I needed help with basic daily activities such as making a cup of tea. I read the reviews about Dr Akmal, which I found beneficial and decided to book a consultation to see him. I was booked for a Consultation with Dr Akaml as well as an MRI scan & blood tests. I was pleasantly surprised to find out that I would get the results on the same day with the treatment options. Dr Akmal was very friendly he discussed the MRI scan with me that showed disc L4-L5 impinging the nerve, he suggested two options. One was the laser treatment to shrink the disc or the second the option was a discectomy. This would be a day procedure with no overnight stay. At no point did I feel pressured to decide on the procedures. Dr Akmal is incredibly knowledgeable this was evident through his years of experience with spinal procedures, I was 100% that the best option would be the discectomy and the best Surgeon was Dr Akmal. I was so impressed with the service and care that was offered at the clinic it was no less than first class to be honest, with no waiting time at all. On the day of the procedure I was in a private room, a lovely healthcare assistant was there to help me get into the hospital gown. Every staff member was ever so kind, they all made me feel at ease. Once I woke up I felt no sciatic pain at all which was an amazing feeling, an emotional moment to finally be rid of that burning sensation. Of course, there was some slight discomfort where the procedure had taken place. After surgery, I was able to stand on my two feet as well as being able to walk without any discomfort. Finally making my own cooked breakfast was a heavenly feeling! I can say with complete confidence that I trust Dr Akmal he is no doubt, on top of his field, a great human being who I’m so grateful to have met. If you want your life back I would highly recommend you book yourself in for a consultation with Dr Akmal, he is worth every single penny! Thank you Dr Akmal!
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Sam Sahota
Sam Sahota
My personal experience of The London Spine Unit in Harley Street London and the whole team of surgeon Mo Akmal written two weeks after my Surgery . It’s been an absolutely amazing experience. I am a 58 year old male . Many years ago I was breaking some concrete with a very large sledgehammer that’s where all my problems started. During these many years I have undergone Facet joint injections, many appointments with Osteopaths,Chiropractors,Acupuncture,Massages etc etc the list is endless.They would be helpful for a few days and then the pain in my back and weakness in my legs would return. 2019 had Mri of lumbar area showed disc bulge trapping nerves in l4/5 areas I underwent an open surgery on Nhs to cut away part of the disc that was causing the problem.I was in hospital for 5 days and recovery took many months, Then the pain returned!!I then decided to live with the unbearable pain as I couldn’t go through all that again, I was recommended to Mo Akmal, he arranged a much clearer Mri within two hours he took a look and identified the problem the following week after my pre op assessment my keyhole surgery was done within 2 hours , immediately I was pain free I noticed immediately the pain free sensation I was very happy with the outcome , it was so simple , I could walk painfree. I came in a taxi in the morning and took a taxi back home in the evening . Mo akmal Is a very professional surgeon it was like talking to a friend no rush at all , didn’t even seem like a surgery, Member of his team calls me three times a week to see how I’m getting on. Now I don’t even think about my back as I have zero pain , I sleep well, I feel much better from within, I have no hesitation in recommending Mo Akmal . I am a person that does so much research into things like this as I know the risks aswell as the benefits,I jumped at the opportunity that was given to me for this keyhole surgery. I did not tell anyone of my friends as they really did not know the pain I was in and if I had told them I know they would of discouraged me of going ahead. 2 weeks later I feel totally pain free. If in any doubt I do not mind Mo giving my email to anyone as long as I can help them out of pain .i was always told use hot and cold packs on your back , it didn’t help much mine was a much more deep rooted problem that need proper intervention I have learnt over the years that very seldom will a therapist ever tell you to get an MRI to see exactly what is going on inside your body it’s left to your own judgement, no amount of alternative therapy would of actually helped my problem if I wanted to get to the root of the problem..It’s your choice to go ahead with treatment or not BUT atleast you will know and have a better understanding of exactly what is causing your problem. I would say Don’t suffer in silence do something about it like I did .
Mrs Michelle Hunter
Mrs Michelle Hunter
I would highly recommend Mr Mo Akmal and his team at the London Spine Unit. I have had issues with my lumbar spine for over 20 years and have struggled to find someone who could help. My situation was complicated by a separate neurological diagnosis 7 years ago. Mr Akmal listened to my medical history and offered informed and honest advice, taking a holistic view based on his extensive experience and listening to my opinion with an open mind. I have had 2 minimally invasive procedures at the London Spine Unit during the Covid pandemic. I felt very safe and well looked after on both occasions. The results were great, they allowed me to finally exercise without pain & weakness and to play with my 2yr old! (Which was very important with nursery closures in Scotland!). I still have a way to go but I feel like I have finally found someone who genuinely cares and understands, and I am no longer alone with my health journey. Thank-you Mr Akmal and your amazing team!!

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Abstract in English, Chinese Objective: To observe the difference between crenel lateral interbody fusion (CLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis (DLS) combined with lumbar spinal stenosis (LSS). Methods: The clinical data of DLS combined with LSS patients meeting the selection criteria admitted between May 2018 and May…

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