scholarly journals Utilization of anterior lumbar interbody fusion for severe kyphotic deformity secondary to Pott’s disease: illustrative case

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Gabrielle Luiselli ◽  
Rrita Daci ◽  
Peter Cruz-Gordillo ◽  
Ashwin Panda ◽  
Omar Sorour ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Spinal Tuberculosis ◽  
Anterior Lumbar Interbody Fusion ◽  
Kyphotic Deformity ◽  
Symptom Improvement ◽  
Illustrative Case ◽  
Lumbar Interbody Fusion ◽  
Vertebral Column Resection

BACKGROUND Spinal tuberculosis may result in severe kyphotic deformity. Effective restoration of lordosis and correction of sagittal balance often requires invasive osteotomies associated with significant morbidity. The advantages of focusing on symptomatic management and staging in the initial treatment of these deformities have not been well reported to date. OBSERVATIONS The authors reported the case of a 64-year-old Vietnamese woman with a history of spinal tuberculosis who underwent anterior lumbar interbody fusion (ALIF) for symptomatic treatment of L5–S1 radiculopathy resulting from fixed kyphotic deformity. Postoperatively, the patient experienced near immediate symptom improvement, and radiographic evidence at 1-year follow-up showed continued lordotic correction of 30° as well as stable sagittal balance. LESSONS In this case, an L5–S1 ALIF was sufficient to treat the patient’s acute symptoms and provided satisfactory correction of a tuberculosis-associated fixed kyphotic deformity while effectively delaying more invasive measures, such as a vertebral column resection. Patients with adult spinal deformity may benefit from less invasive staging procedures before treating these deformities with larger surgeries.

scholarly journals Does L5-S1 Anterior Lumbar Interbody Fusion Improve Sagittal Alignment or Fusion Rates in Long Segment Fusion for Adult Spinal Deformity?

2020 ◽  
pp. 219256822092183
Author(s):  
Andrew J. Meyers ◽  
Joseph B. Wick ◽  
Pope Rodnoi ◽  
Ahsan Khan ◽  
Eric O. Klineberg
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Surgical Morbidity ◽  
Lumbosacral Fusion ◽  
Hardware Complications ◽  
Global Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: To assess whether the addition of L5-S1 anterior lumbar interbody fusion (ALIF) improves global sagittal alignment and fusion rates in patients undergoing multilevel spinal deformity surgery. Methods: Two-year radiographic outcomes, including lumbar lordosis, pelvic incidence, pelvic tilt, and T1 pelvic angle; hardware complications; and nonunion/pseudarthrosis rates were compared between patients who underwent lumbosacral fusion at 4 or more vertebral levels with and without L5-S1 ALIF between November 2003 and September 2016. Results: A total of 51 patients who underwent fusion involving a mean of 11.1 levels with minimum 2-year postoperative radiographic follow-up data were included. Patients who underwent L5-S1 ALIF did not have significant improvement in global sagittal alignment parameters and demonstrated a trend toward a higher rate of nonunion and hardware failure. Conclusions: L5-S1 ALIF did not confer significant benefit in terms of global sagittal alignment and fusion rates in patients undergoing multilevel lumbosacral fusion. Given these results and that L5-S1 ALIF is associated with increased surgical morbidity, surgeons should be judicious in including L5-S1 ALIF in large multilevel constructs.

Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

2007 ◽  
Vol 7 (4) ◽  
pp. 379-386 ◽  
Author(s):  
Patrick C. Hsieh ◽  
Tyler R. Koski ◽  
Brian A. O'Shaughnessy ◽  
Patrick Sugrue ◽  
Sean Salehi ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Interobserver Reliability ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Mean Values ◽  
Radiographic Measurements ◽  
Foraminal Height

Object A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance. To the authors' knowledge, there has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters. The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis. Methods The medical records and radiographs of 32 patients undergoing ALIF and 25 patients undergoing TLIF from between 2000 and 2004 were retrospectively reviewed. Clinical data and radiographic measurements, including preoperative and postoperative foraminal height, local disc angle, and lumbar lordosis, were obtained. Statistical analyses included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed. Results Our results indicate that ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The ALIF procedure increased foraminal height by 18.5%, whereas TLIF decreased it by 0.4%. In addition, ALIF increased the local disc angle by 8.3° and lumbar lordosis by 6.2°, whereas TLIF decreased the local disc angle by 0.1° and lumbar lordosis by 2.1°. Conclusions The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.

Multicenter assessment of outcomes and complications associated with transforaminal versus anterior lumbar interbody fusion for fractional curve correction

2021 ◽  
pp. 1-14
Author(s):  
Thomas J. Buell ◽  
Christopher I. Shaffrey ◽  
Shay Bess ◽  
Han Jo Kim ◽  
Eric O. Klineberg ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Interbody Fusion ◽  
Short Form ◽  
Adult Spinal Deformity ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Curve Correction ◽  
Sagittal Vertical Axis ◽  
Operative Duration

OBJECTIVE Few studies have compared fractional curve correction after long fusion between transforaminal lumbar interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) for adult symptomatic thoracolumbar/lumbar scoliosis (ASLS). The objective of this study was to compare fractional correction, health-related quality of life (HRQL), and complications associated with L4–S1 TLIF versus those of ALIF as an operative treatment of ASLS. METHODS The authors retrospectively analyzed a prospective multicenter adult spinal deformity database. Inclusion required a fractional curve ≥ 10°, a thoracolumbar/lumbar curve ≥ 30°, index TLIF or ALIF performed at L4–5 and/or L5–S1, and a minimum 2-year follow-up. TLIF and ALIF patients were propensity matched according to the number and type of interbody fusion at L4–S1. RESULTS Of 135 potentially eligible consecutive patients, 106 (78.5%) achieved the minimum 2-year follow-up (mean ± SD age 60.6 ± 9.3 years, 85% women, 44.3% underwent TLIF, and 55.7% underwent ALIF). Index operations had mean ± SD 12.2 ± 3.6 posterior levels, 86.6% of patients underwent iliac fixation, 67.0% underwent TLIF/ALIF at L4–5, and 84.0% underwent TLIF/ALIF at L5–S1. Compared with TLIF patients, ALIF patients had greater cage height (10.9 ± 2.1 mm for TLIF patients vs 14.5 ± 3.0 mm for ALIF patients, p = 0.001) and lordosis (6.3° ± 1.6° for TLIF patients vs 17.0° ± 9.9° for ALIF patients, p = 0.001) and longer operative duration (6.7 ± 1.5 hours for TLIF patients vs 8.9 ± 2.5 hours for ALIF patients, p < 0.001). In all patients, final alignment improved significantly in terms of the fractional curve (20.2° ± 7.0° to 6.9° ± 5.2°), maximum coronal Cobb angle (55.0° ± 14.8° to 23.9° ± 14.3°), C7 sagittal vertical axis (5.1 ± 6.2 cm to 2.3 ± 5.4 cm), pelvic tilt (24.6° ± 8.1° to 22.7° ± 9.5°), and lumbar lordosis (32.3° ± 18.8° to 51.4° ± 14.1°) (all p < 0.05). Matched analysis demonstrated comparable fractional correction (−13.6° ± 6.7° for TLIF patients vs −13.6° ± 8.1° for ALIF patients, p = 0.982). In all patients, final HRQL improved significantly in terms of Oswestry Disability Index (ODI) score (42.4 ± 16.3 to 24.2 ± 19.9), physical component summary (PCS) score of the 36-item Short-Form Health Survey (32.6 ± 9.3 to 41.3 ± 11.7), and Scoliosis Research Society–22r score (2.9 ± 0.6 to 3.7 ± 0.7) (all p < 0.05). Matched analysis demonstrated worse ODI (30.9 ± 21.1 for TLIF patients vs 17.9 ± 17.1 for ALIF patients, p = 0.017) and PCS (38.3 ± 12.0 for TLIF patients vs 45.3 ± 10.1 for ALIF patients, p = 0.020) scores for TLIF patients at the last follow-up (despite no differences in these parameters at baseline). The rates of total complications were similar (76.6% for TLIF patients vs 71.2% for ALIF patients, p = 0.530), but significantly more TLIF patients had rod fracture (28.6% of TLIF patients vs 7.1% of ALIF patients, p = 0.036). Multiple regression analysis demonstrated that a 1-mm increase in L4–5 TLIF cage height led to a 2.2° reduction in L4 coronal tilt (p = 0.011), and a 1° increase in L5–S1 ALIF cage lordosis led to a 0.4° increase in L5–S1 segmental lordosis (p = 0.045). CONCLUSIONS Operative treatment of ASLS with L4–S1 TLIF versus ALIF demonstrated comparable mean fractional curve correction (66.7% vs 64.8%), despite use of significantly larger, more lordotic ALIF cages. TLIF cage height had a significant impact on leveling L4 coronal tilt, whereas ALIF cage lordosis had a significant impact on restoration of lumbosacral lordosis. The advantages of TLIF may include reduced operative duration and hospitalization; however, associated HRQL was inferior and more rod fractures were detected in the TLIF patients included in this study.

scholarly journals Restoration of sagittal alignment in high-grade isthmic spondylolisthesis using the reverse Bohlman technique with anterior lumbar interbody fusion using a hyperlordotic cage at L4–5: illustrative case

2021 ◽  
Vol 1 (26) ◽  
Author(s):  
Terrence Ishmael ◽  
Vincent Arlet ◽  
Harvey Smith
Keyword(s):  
Interbody Fusion ◽  
Spinal Instrumentation ◽  
Anterior Lumbar Interbody Fusion ◽  
Illustrative Case ◽  
High Grade ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis ◽  
Interbody Cage ◽  
Circumferential Fusion ◽  
Sagittal Malalignment

BACKGROUND Circumferential fusion with or without reduction is the preferred treatment for high-grade isthmic spondylolisthesis. Reduction presents significant risk of neurological injury. The authors present one case in which the “reverse Bohlman” technique was used with the addition of a hyperlordotic interbody cage at L4–5 as a means to correct sagittal malalignment while avoiding the reduction of L5 on S1. OBSERVATIONS The patient was a 22-year-old woman with a long-term history of lower back pain and bilateral L5 radiculopathy secondary to high-grade isthmic lumbar spondylolisthesis. She underwent anterior lumbar interbody fusion using the reverse Bohlman technique plus a hyperlordotic interbody cage at L4–5, followed by decompression and posterior spinal instrumentation and fusion from L4 to the pelvis. At 2-year follow-up, she was found to have complete resolution of symptoms with clinical and radiographic evidence of fusion. Her spinopelvic parameters had significantly improved. LESSONS The reverse Bohlman technique with the addition of a hyperlordotic interbody cage at L4–5 is a potential alternative treatment method to correct sagittal malalignment while avoiding possible injury to the L5 nerve roots that can be seen in the reduction of high-grade isthmic spondylolisthesis.

Sign in / Sign up

Export Citation Format

Share Document