scholarly journals Spinal arthrodesis via lumbar interbody fusion without direct decompression as a treatment for recurrent radicular pain due to epidural fibrosis: patient series

2021 ◽  
Vol 1 (20) ◽  
Author(s):  
Kevin Swong ◽  
Michael J. Strong ◽  
Jay K. Nathan ◽  
Timothy J. Yee ◽  
Brandon W. Smith ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Lumbar Discectomy ◽  
Spinal Instability ◽  
Complication Rates ◽  
Epidural Fibrosis ◽  
Lumbar Interbody Fusion ◽  
Lumbar Radiculopathy ◽  
Success Rates ◽  
Spinal Arthrodesis ◽  
Radicular Symptoms

BACKGROUND Lumbar radiculopathy is the most common indication for lumbar discectomy, but residual postoperative radicular symptoms are common. Postoperative lumbar radiculopathy secondary to scar formation is notoriously difficult to manage, with the mainstay of treatment focused on nonoperative techniques. Surgical intervention for epidural fibrosis has shown unacceptably high complication rates and poor success rates. OBSERVATIONS Three patients underwent spinal arthrodesis without direct decompression for recurrent radiculopathy due to epidural fibrosis. Each patient previously underwent lumbar discectomy but subsequently developed recurrent radiculopathy. Imaging revealed no recurrent disc herniation, although it demonstrated extensive epidural fibrosis and scar in the region of the nerve root at the previous surgical site. Dynamic radiographs showed no instability. Two patients underwent lateral lumbar interbody fusion, and one patient underwent anterior lumbosacral interbody fusion. Each patient experienced resolution of radicular symptoms by the 1-year follow-up. Average EQ visual analog scale scores improved from 65 preoperatively to 78 postoperatively. LESSONS Spinal arthrodesis via lumbar interbody fusion, without direct decompression, may relieve pain in patients with recurrent radiculopathy due to epidural fibrosis, even in the absence of gross spinal instability.

scholarly journals Exploratory meta-analysis on dose-related efficacy and morbidity of bone morphogenetic protein in spinal arthrodesis surgery

2016 ◽  
Vol 24 (3) ◽  
pp. 457-475 ◽  
Author(s):  
Christoph P. Hofstetter ◽  
Anna S. Hofer ◽  
Allan D. Levi
Keyword(s):  
Spinal Fusion ◽  
Bone Morphogenetic Protein ◽  
Interbody Fusion ◽  
Meta Analysis ◽  
Fusion Rate ◽  
Control Group ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Morphogenetic Protein ◽  
Spinal Arthrodesis

OBJECT Bone morphogenetic protein (BMP) is frequently used for spinal arthrodesis procedures in an “off-label” fashion. Whereas complications related to BMP usage are well recognized, the role of dosage is less clear. The objective of this meta-analysis was to assess dose-dependent effectiveness (i.e., bone fusion) and morbidity of BMP used in common spinal arthrodesis procedures. A quantitative exploratory meta-analysis was conducted on studies reporting fusion and complication rates following anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF) supplemented with BMP. METHODS A literature search was performed to identify studies on BMP in spinal fusion procedures reporting fusion and/or complication rates. From the included studies, a database for each spinal fusion procedure, including patient demographic information, dose of BMP per level, and data regarding fusion rate and complication rates, was created. The incidence of fusion and complication rates was calculated and analyzed as a function of BMP dose. The methodological quality of all included studies was assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were analyzed using a random-effects model. Event rates are shown as percentages, with a 95% CI. RESULTS Forty-eight articles met the inclusion criteria: ACDF (n = 7), PCF (n = 6), ALIF (n = 9), TLIF/PLIF (n = 17), and PLF (n = 9), resulting in a total of 5890 patients. In ACDF, the lowest BMP concentration analyzed (0.2–0.6 mg/level) resulted in a fusion rate similar to the highest dose (1.1–2.1 mg/level), while permitting complication rates comparable to ACDF performed without BMP. The addition of BMP to multilevel constructs significantly (p < 0.001) increased the fusion rate (98.4% [CI 95.4%–99.4%]) versus the control group fusion rate (85.8% [CI 77.4%–91.4%]). Studies on PCF were of poor quality and suggest that BMP doses of ≤ 2.1 mg/level resulted in similar fusion rates as higher doses. Use of BMP in ALIF increased fusion rates from 79.1% (CI 57.6%–91.3%) in the control cohort to 96.9% (CI 92.3%–98.8%) in the BMP-treated group (p < 0.01). The rate of complications showed a positive correlation with the BMP dose used. Use of BMP in TLIF had only a minimal impact on fusion rates (95.0% [CI 92.8%–96.5%] vs 93.0% [CI 78.1%–98.0%] in control patients). In PLF, use of ≥ 8.5 mg BMP per level led to a significant increase of fusion rate (95.2%; CI 90.1%–97.8%) compared with the control group (75.3%; CI 64.1%–84.0%, p < 0.001). BMP did not alter the rate of complications when used in PLF. CONCLUSIONS The BMP doses used for various spinal arthrodesis procedures differed greatly between studies. This study provides BMP dosing recommendations for the most common spine procedures.

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

2020 ◽  
Vol 49 (3) ◽  
pp. E11 ◽  
Author(s):  
Yoshifumi Kudo ◽  
Ichiro Okano ◽  
Tomoaki Toyone ◽  
Akira Matsuoka ◽  
Hiroshi Maruyama ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Decompression Surgery ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Posterior Decompression ◽  
Lateral Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

scholarly journals Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion

2013 ◽  
Vol 35 (2) ◽  
pp. E7 ◽  
Author(s):  
Pedro S. Silva ◽  
Paulo Pereira ◽  
Pedro Monteiro ◽  
Pedro A. Silva ◽  
Rui Vaz
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Interbody Fusion ◽  
Operative Time ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Adjacent Level ◽  
Negative Exponential

Object Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has the potential advantage of minimizing soft-tissue damage and reducing recovery time compared to open procedures. A steep learning curve has been described for the technique. The aim of the present study was to define the learning curve that describes the progress of a single surgeon performing the MI-TLIF. Methods One hundred fifty consecutive patients with degenerative lumbar disease who underwent 1- or 2-level MI-TLIF were included in the study. Operative time, corrected operative time per level, and complications were analyzed. The learning curve was assessed using a negative exponential curve-fit regression analysis. Results One hundred ten patients underwent 1-level and 18 patients underwent 2-level MI-TLIF; the remaining 22 underwent a single-level procedure plus an ancillary procedure (decompression at adjacent level, vertebral augmentation through fenestrated pedicle screws, interspinous device at adjacent level). Negative exponential curves appropriately described the relationship between operative time and experience for 1-level surgery and after correction of operative time per level (R2 = 0.65 and 0.57). The median operative time was 140 minutes (interquartile range 120–173 minutes), and a 50% learning milestone was achieved at Case 12; a 90% learning milestone was achieved at Case 39. No patient required transfusion in the perioperative period. The overall complication rate was 12.67% and the most frequent complication was a dural tear (5.32%). Before the 50% and 90% learning milestones, the complication rates were 33% and 20.51%, respectively. Conclusions The MI-TLIF is a reliable and effective option for lumbar arthrodesis. According to the present study, 90% of the learning curve can be achieved at around the 40th case.

scholarly journals Characterizing the Risk and Outcome Profiles of Lumbar Fusion Procedures in Patients With Opioid Use Disorders: A Step Towards Improving Enhanced Recovery Protocols for a Unique Patient Population

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Michael L Martini ◽  
Dominic A Nistal ◽  
Brian C Deutsch ◽  
Jeffrey Gilligan ◽  
Robert J Rothrock ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Enhanced Recovery ◽  
Lumbar Fusion ◽  
National Level ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Opioid Use ◽  
Opioid Use Disorders ◽  
Procedure Type ◽  
Total Charges

Abstract INTRODUCTION This national-level study sought to provide a necessary assessment of the risks and outcomes for different lumbar fusion procedures in patients with opioid use disorders (OUDs) to help guide the future development of targeted enhanced recovery after surgery (ERAS) protocols for this unique population. METHODS Data for patients with or without OUDs who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lateral transverse lumbar interbody fusion (LLIF) for lumbar disc degeneration (LDD) were collected from the 2013 to 2014 National Inpatient Sample. Multivariable logistic regression was implemented to analyze how OUD impacted in-hospital complications, length of hospitalization, discharge disposition, and total charges by procedure type. RESULTS A total of 139 995 patients with LDD were identified, with 1280 patients (0.91%) also having a concurrent OUD diagnosis. Overall complication rates were higher in OUD patients (48.44% vs 31.01%; P < .0001). OUD patients had higher odds of pulmonary (P = .0006), infectious (P < .0001), and hematological complications (P = .0009). Multivariate regression modeling of outcomes by procedure type showed that following ALIF, OUD increased odds of nonhome discharge (P = .0007), extended hospitalization (P = .0002), and greater total charges (P = .0054). This analysis also revealed that OUD increased odds of complication (P = .0149 and P = .0471), extended hospitalization (P = .0439 and P = .0001), and higher total charges (P < .0001) following PLIF and LLIF procedures, respectively. CONCLUSION Obtaining a better understanding of the risks and outcomes that OUD patients face perioperatively is a necessary step towards developing more effective ERAS protocols for this vulnerable population. This study, which sought to characterize outcome profiles for lumbar fusion procedures in OUD patients on a national level, found this population experienced increased odds of complication, extended hospitalization, nonhome discharge, and higher total charges. Results from this study warrant future prospective studies to better understand these associations and further the development of ERAS programs to improve patient care and reduce cost burden.

Lateral lumbar interbody fusion without intraoperative neuromonitoring: a single-center consecutive series of 157 surgeries

2019 ◽  
Vol 30 (4) ◽  
pp. 439-445 ◽  
Author(s):  
Sandro M. Krieg ◽  
Lukas Bobinski ◽  
Lucia Albers ◽  
Bernhard Meyer
Keyword(s):  
Interbody Fusion ◽  
Intraoperative Neuromonitoring ◽  
Sensory Deficit ◽  
Leg Pain ◽  
Csf Leak ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Motor Weakness ◽  
Lateral Lumbar Interbody Fusion ◽  
The Mean

OBJECTIVELateral lumbar interbody fusion (LLIF) is frequently used for anterior column stabilization. Many authors have reported that intraoperative neuromonitoring (IONM) of the lumbar plexus nerves is mandatory for this approach. However, even with IONM, the reported motor and sensory deficits are still considerably high. Thus, the authors’ approach was to focus on the indication, trajectory, and technique instead of relying on IONM findings per se. The objective of this study therefore was to analyze the outcome of our large cohort of patients who underwent LLIF without IONM.METHODSThe authors report on 157 patients included from 2010 to 2016 who underwent LLIF as an additional stabilizing procedure following dorsal instrumentation. LLIF-related complications as well as clinical outcomes were evaluated.RESULTSThe mean follow-up was 15.9 ± 12.0 months. For 90.0% of patients, cage implantation by LLIF was the first retroperitoneal surgery. There were no cases of surgery-related hematoma, vascular injury, CSF leak, or any other visceral injury. Between 1 and 4 cages were implanted per surgery, most commonly at L2–3 and L3–4. The mean length of surgery was 92.7 ± 35 minutes, and blood loss was 63.8 ± 57 ml. At discharge, 3.8% of patients presented with a new onset of motor weakness, a new sensory deficit, or the deterioration of leg pain due to LLIF surgery. Three months after surgery, 3.5% of the followed patients still reported surgery-related motor weakness, 3.6% leg pain, and 9.6% a persistent sensory deficit due to LLIF surgery.CONCLUSIONSThe results of this series demonstrate that the complication rates for LLIF without IONM are comparable, if not superior, to those in previously reported series using IONM. Hence, the authors conclude that IONM is not mandatory for LLIF procedures if the surgical approach is tailored to the respective level and if the visualization of nerves is performed.

scholarly journals Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Wei Wang ◽  
Xiangyao Sun ◽  
Tongtong Zhang ◽  
Siyuan Sun ◽  
Chao Kong ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Reoperation Rates ◽  
Topping Off

The treatment effects of topping-off technique were still controversial. This study compared all available data on postoperative clinical and radiographic outcomes of topping-off technique and posterior lumbar interbody fusion (PLIF). PubMed, EMBASE, and Cochrane were systematically reviewed. Variations included radiographical adjacent segment disease (RASD), clinical adjacent segment disease (CASD), global lumbar lordosis (GLL), visual analogue scale (VAS) of back (VAS-B) and leg (VAS-L), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, duration of surgery, estimated blood loss (EBL), reoperation rates, and complication rates. Sixteen studies, including 1372 cases, were selected for the analysis. Rates of proximal RASD (P=0.0004), distal RASD (P=0.03), postoperative VAS-B (P=0.0001), postoperative VAS-L (P=0.02), EBL (P=0.007), and duration of surgery (P=0.02) were significantly lower in topping-off group than those in PLIF group. Postoperative ODI after 3 years (P=0.04) in the topping-off group was significantly less than that in the PLIF group. There was no significant difference in the rates of CASD (P=0.06), postoperative GLL (P=0.14), postoperative ODI within 3 years (P=0.24), and postoperative JOA (P=0.70) and in reoperation rates (P=0.32) and complication rates (P=0.27) between topping-off group and PLIF. The results confirmed that topping-off technique could effectively prevent ASDs after lumbar internal fixation. However, this effect is effective in preventing RASD. Topping-off technique is more effective in improving the subjective feelings of patients rather than objective motor functions compared with PLIF. With the development of surgical techniques, both topping-off technique and PLIF are safe.

scholarly journals Novel bioabsorbable interbody fusion spacer–assisted fusion for correction of spinal deformity

2003 ◽  
Vol 14 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Rebekah C. Austin ◽  
Charles L. Branch ◽  
Joseph T. Alexander
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Low Back ◽  
The Novel ◽  
Lumbar Interbody Fusion ◽  
Fusion Technique ◽  
Scoliotic Deformity ◽  
Radicular Symptoms

Object The authors report the cases of 12 patients with medically refractory mechanical low-back pain and intermittent radicular symptoms in whom radiography demonstrated evidence of multilevel lumbosacral degenerative kyphotic and scoliotic deformity and spondylolisthesis. Methods These patients underwent multilevel posterior lumbar interbody fusion in which Macropore bioabsorbable spacers were placed. Each patient underwent at least 1 year of clinical and radiographic follow up. Conclusions This series illustrates the novel use of bioabsorbable interbody spacers and fusion technique for correction of spinal deformity due to advanced degenerative kyphoscoliosis and spondylolisthesis.

scholarly journals The Negligible Influence of Chronic Obesity on Hospitalization, Clinical Status, and Complications in Elective Posterior Lumbar Interbody Fusion

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Olaf Suess ◽  
Theodoros Kombos ◽  
Frank Bode
Keyword(s):  
Interbody Fusion ◽  
Clinical Status ◽  
Operating Time ◽  
Posterior Lumbar Interbody Fusion ◽  
The Body ◽  
Cerebrospinal Fluid Leakage ◽  
Wound Complications ◽  
Spinal Instability ◽  
Lumbar Interbody Fusion ◽  
Implant Complications

Background. Posterior lumbar interbody fusion (PLIF) is a common surgical treatment for degenerative spinal instability, but many surgeons consider obesity a contraindication for elective spinal fusion. The aim of this study was to analyze whether obesity has any influence on hospitalization parameters, change in clinical status, or complications.Methods. In this prospective study, regression analysis was used to analyze the influence of the body mass index (BMI) on operating time, postoperative care, hospitalization time, type of postdischarge care, change in paresis or sensory deficits, pain level, wound complications, cerebrospinal fluid leakage, and implant complications.Results. Operating time increased only 2.5 minutes for each increase of BMI by 1. The probability of having a wound complication increased statistically with rising BMI. Nonetheless, BMI accounted for very little of the variation in the data, meaning that other factors or random chances play a much larger role.Conclusions. Obesity has to be considered a risk factor for wound complications in patients undergoing elective PLIF for degenerative instability. However, BMI showed no significant influence on other kinds of peri- or postoperative complications, nor clinical outcomes. So obesity cannot be considered a contraindication for elective PLIF.

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