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Extraforaminal lumbar interbody fusion for cage migration after screw removal: a case report.
Korean J Spine. 2013 Jun;10(2):104-6
Authors: Kim MH, Kim SW, Kim SH, Kim HS

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Radiographic Results of Minimally Invasive (MIS) Lumbar Interbody Fusion (LIF) Compared with Conventional Lumbar Interbody Fusion.

Korean J Spine. 2013 Jun;10(2):65-71

Authors: Lim JK, Kim SM

OBJECTIVE: To evaluate the radiographic results of minimally invasive (MIS) anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF).
METHODS: Twelve and nineteen patients who underwent MIS-ALIF, MIS-TLIF, respectively, from 2006 to 2008 were analyzed with a minimum 24-months’ follow-up. Additionally, 18 patients treated with single level open TLIF surgery in 2007 were evaluated as a comparative group. X-rays and CT images were evaluated preoperatively, postoperatively, and at the final follow-up. Fusion and subsidence rates were determined, and radiographic parameters, including lumbar lordosis angle (LLA), fused segment angle (FSA), sacral slope angle (SSA), disc height (DH), and foraminal height (FH), were analyzed. These parameters were also compared between the open and MIS-TLIF groups.
RESULTS: In the MIS interbody fusion group, statistically significant increases were observed in LLA, FSA, and DH and FH between preoperative and final values. The changes in LLA, FSA, and DH were significantly increased in the MIS-ALIF group compared with the MIS-TLIF group, but SSA and FH were not significantly different. No significant differences were seen between open and MIS-TLIF except for DH. The interbody subsidence and fusion rates of the MIS groups were 12.0±4% and 96%, respectively.
CONCLUSION: Radiographic results of MIS interbody fusion surgery are as favorable as those with conventional surgery regarding fusion, restoration of disc height, foraminal height, and lumbar lordosis. MIS-ALIF is more effective than MIS-TLIF for intervertebral disc height restoration and lumbar lordosis.

PMID: 24757461 [PubMed]

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Fusion techniques for adult isthmic spondylolisthesis: a systematic review.
Arch Orthop Trauma Surg. 2014 Apr 9;
Authors: Wang SJ, Han YC, Liu XM, Ma B, Zhao WD, Wu DS, Tan J

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Radiological and clinical outcomes following extreme lateral interbody fusion.

J Neurosurg Spine. 2014 Apr 4;

Authors: Alimi M, Hofstetter CP, Cong GT, Tsiouris AJ, James AR, Paulo D, Elowitz E, Härtl R

Object Extreme lateral interbody fusion (ELIF) is a popular technique for anterior fixation of the thoracolumbar spine. Clinical and radiological outcome studies are required to assess safety and efficacy. The aim of this study was to describe the functional and radiological impact of ELIF in a degenerative disc disease population with a longer follow-up and to assess the durability of this procedure. Methods Demographic and perioperative data for all patients who had undergone ELIF for degenerative lumbar disorders between 2007 and 2011 were collected. Trauma and tumor cases were excluded. For radiological outcome, the preoperative, immediate postoperative, and latest follow-up coronal Cobb angle, lumbar sagittal lordosis, bilateral foraminal heights, and disc heights were measured. Pelvic incidence (PI) and PI-lumbar lordosis (PI-LL) mismatch were assessed in scoliotic patients. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS), as well as the Macnab criteria. Results One hundred forty-five vertebral levels were surgically treated in 90 patients. Pedicle screw and rod constructs and lateral plates were used to stabilize fixation in 77% and 13% of cases, respectively. Ten percent of cases involved stand-alone cages. At an average radiological follow-up of 12.6 months, the coronal Cobb angle was 10.6° compared with 23.8° preoperatively (p < 0.0001). Lumbar sagittal lordosis increased by 5.3° postoperatively (p < 0.0001) and by 2.9° at the latest follow-up (p = 0.014). Foraminal height and disc height increased by 4 mm (p < 0.0001) and 3.3 mm (p < 0.0001), respectively, immediately after surgery and remained significantly improved at the last follow-up. Separate evaluation of scoliotic patients showed no statistically significant improvement in PI and PI-LL mismatch either immediately postoperatively or at the latest follow-up. Clinical evaluation at an average follow-up of 17.6 months revealed an improvement in the ODI and the VAS scores for back, buttock, and leg pain by 21.1% and 3.7, 3.6, and 3.7 points, respectively (p < 0.0001). According to the Macnab criteria, 84.8% of patients had an excellent, good, or fair functional outcome. New postoperative thigh numbness and weakness was detected in 4.4% and 2.2% of the patients, respectively, which resolved within the first 3 months after surgery in all but 1 case. Conclusions This study provides what is to the authors’ knowledge the most comprehensive set of radiological and clinical outcomes of ELIF in a fairly large population at a midterm follow-up. Extreme lateral interbody fusion showed good clinical outcomes with a low complication rate. The procedure allows for at least midterm clinically effective restoration of disc and foraminal heights. Improvement in coronal deformity and a small but significant increase in sagittal lordosis were observed. Nonetheless, no significant improvement in the PI-LL mismatch was achieved in scoliotic patients.

PMID: 24702513 [PubMed – as supplied by publisher]

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Minimally invasive lateral lumbar interbody fusion with direct psoas visualization.
J Orthop Surg Res. 2014 Mar 26;9(1):20
Authors: Yuan PS, Rowshan K, Verma RB, Miller LE, Block JE

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Two-year radiographic and clinical outcomes of a minimally invasive, lateral, transpsoas approach for anterior lumbar interbody fusion in the treatment of adult degenerative scoliosis.

Eur Spine J. 2014 Mar 12;

Authors: Khajavi K, Shen AY

PURPOSE: The purpose of this study was to examine radiographic and clinical outcomes in the treatment of adult degenerative scoliosis using a minimally invasive (MI) lateral approach for anterior lumbar interbody fusion (IBF).
METHODS: A prospective study of 24 consecutive degenerative scoliosis patients treated with MI, 90° lateral, transpsoas approach for anterior IBF was conducted. Twenty-one patients (88 %) were available for at least 12 months follow-up (mean 24 months).
RESULTS: Mean operating time, estimated blood loss, and length of stay was 218 min, 68 mL, and 2.2 days, respectively. Complications occurred in one (5 %) case, a postoperative foot drop. At the last follow-up, disability improved by 50 % from 48.4 to 24.4. Back pain improved by 59 % from 7.0 to 2.9. Leg pain improved by 41 % from 5.6 to 3.3. In patients with a baseline score greater than 2.0, leg pain decreased by 42 % from 6.6 to 3.8. SF-36 physical component score improved by 41 % from 28.0 to 39.6, while mental component score increased by 18 % from 42.2 to 49.8. All changes were statistically significant, p < 0.05. Cobb angle was corrected from 27.7° to 16.6° and lumbar lordosis increased 39 % from -31.8° to -44.0°. Disc height increased from 5.7 to 11.6 mm, segmental lordosis increased by 48 % from 11.6° to 17.2°, and foraminal height increased from 16.4 to 21.7 mm. At the last follow-up, 100 % of patients were satisfied with their outcome, and 86 % would undergo the same procedure again. No revisions occurred.
CONCLUSIONS: MI lateral IBF in the treatment of degenerative scoliosis results in lower complication rates and clinical and radiographic outcomes equivalent to reports in the literature of conventional approaches.

PMID: 24619605 [PubMed – as supplied by publisher]

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Prior Abdominal Surgery is Associated With an Increased Risk of Post-Operative Complications Following Anterior Lumbar Interbody Fusion.

Spine (Phila Pa 1976). 2014 Feb 27;

Authors: Osler P, Kim SD, Hess KA, Phan P, Simpson AK, Mansfield FL, Berger D, Craveiro VL, Wood KB

Study Design: Retrospective chart reviewObjective: The purpose of this study was to determine whether a history of prior abdominal/pelvic surgery confers an increased risk of retroperitoneal anterior approach-related complications when undergoing anterior lumbar interbody fusion.Summary of Background Data: As anterior lumbar interbody fusion gains popularity, both anterior retroperitoneal approach have become increasingly utilized.Methods: The records of 263 patients, who underwent infra-umbilical retroperitoneal approach to the anterior aspect of the lower lumbar spine for a degenerative spine condition between 2007 and 2011were retrospectively reviewed. Patient’s demographics, risk factors, preoperative diagnosis, surgical history, level of the anterior fusion, and perioperative complications were collected. Anterior retroperitoneal approach to the spine was carried out by a single general surgeon.Results: 97 patients (37%) developed at least one complication. 49% of patients with a history of prior abdominal surgery developed a post-operative complication compared to 28% of patients without such history (RR = 1.747, P value ≤ 0.001). After controlling for other factors such as age, sex, BMI, diagnostic groups, pre-operative co-morbidities (hypertension, diabetes, smoking status) these differences remained statistically significant. When each type of complication was considered separately, there was a statistically significant difference in the incidence of general complications (RR = 2.384, P value = 0.007), instrumentation-related complications (RR = 2.954, P value = 0.010), and complications related to the anterior approach (RR = 1.797, P value = 0.021).Conclusions: Anterior lumbar interbody fusion via a midline incision and a retroperitoneal approach was associated with 37% overall rate of complication. Patients with history of prior abdominal or pelvic surgery are a higher risk for developing general, instrumentation and anterior approach related complications.

PMID: 24583724 [PubMed – as supplied by publisher]

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Injection of Bupivacaine into Disc Space to Detect Painful Nonunion after Anterior Lumbar Interbody Fusion (ALIF) Surgery in Patients with Discogenic Low Back Pain.
Yonsei Med J. 2014 Mar 1;55(2):487-92

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Posterior short segment pedicle screw fixation and TLIF for the treatment of unstable thoracolumbar/lumbar fracture.
BMC Musculoskelet Disord. 2014 Feb 11;15(1):40
Authors: Wang L, Li J, Wang H, Yang Q, Lv D,…

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[Preliminary clinical results of endoscopic assisted anterior lumbar interbody fusion.]

Zhonghua Wai Ke Za Zhi. 2013 Nov;51(11):1005-1009

Authors: Li QC, Liu ZZ, Yan HB, Jin DD

OBJECTIVE: To summarize the experiences of endoscopic assisted anterior lumbar interbody fusion (ALIF) with self-locking cage via retroperitoneal approach through small incision lateral to abdominal rectus.
METHODS: There were 47 cases of endoscopic assisted ALIF from April 2010 to April 2012 were reviewed retrospectively, including 28 male and 19 female patients whose age ranged from 39 to 65 years, averaged of (48 ± 11) years. Of 47 cases, 17 cases were founded instability in lumbar spine, 16 cases of discogenetic low back pain, 7 cases of degenerative spondylolithesis, and 7 cases of recurrent disc herniation. The level involved included 7 cases at L3-4 level, 33 cases at L4-5 level, 7 cases at L5-S1. X-ray and/or 3D CT scan were done in each patient at post-operative day 4, 1 month, 3 months, and 6 months. The height and angle of disc space, angle of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were recorded and measured, as well as length of incision, operation time, blood loss, complications and ratio of bone graft fusion. The clinical outcomes were evaluated by Oswestry disability index (ODI) and visual analogue scale (VAS).
RESULTS: Average length of incision was (6.2 ± 0.8)cm (5.3-7.8 cm) , average blood loss was (81 ± 20)ml (50-150 ml) , mean operation time was (96 ± 10)minutes (65-122 minutes) . There were significant improvement of ODI(48% ± 10% vs. 14% ± 5%), the VAS of back pain(6.3 ± 1.1 vs.0.7 ± 0.7) and VAS of leg pain(3.4 ± 2.1 vs.0.6 ± 0.6) during preoperative and postoperation last follow-up (t = 20.78, 25.92 and 8.74, P = 0.000). The disc height of operative segments were all recovered significantly (F = 18.971, P = 0.000) postoperatively, from preoperative (10.3 ± 2.4)mm to postoperative (12.6 ± 2.1)mm. For complications, 5 cases had peritoneum tear, 19 cases had bone donor site pain, 14 cases had abdominal distension and 5 cases had lower limb paraesthesia, which were all treated with supportive managements. Bony intervertebral fusion was obtained in all cases in 6 months postoperatively.
CONCLUSIONS: The advantages of endoscopic assisted ALIF with self-locking cage via retroperitoneal approach are less damage, rapid recovery, and less blood loss. Comparing with traditional ALIF procedure, the view of operative field is also improved.

PMID: 24444686 [PubMed – as supplied by publisher]

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