A comparative study of perioperative complications between transforaminal versus posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis

Liu, Jiaming; Deng, Hui-Lin; Long, Xin-Hua; Chen, Xuanyin; Xu, Risheng; Liu, Zhi‐Li

doi:10.1007/s00586-015-4086-8

Cited by 64 publications

(75 citation statements)

References 20 publications

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“…Many studies assessing long-term follow-up data have shown that poor bone fusion results in degeneration of the vertebral body, functional disability, lumbar spine instability, and pain. [16,17] We observed a higher fusion rate in the rhBMP-2 group than in the non-rhBMP-2 group, which was consistent with prior studies reporting a higher fusion rate compared with autologous bone grafts. [18] Vaidya et al demonstrated that radiologic signs of fusion in patients receiving allografts and rhBMP-2 appeared earlier than those in patients not receiving rhBMP-2, with the signs appearing at 6 and 19 months, respectively.…”

Section: Fusion Ratesupporting

confidence: 90%

Evaluations of minimally invasive transforaminal lumbar interbody fusion performed with rhBMP-2

Hou

Xiang

et al. 2019

Preprint

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Background: The combination of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and recombinant human bone morphogenetic protein 2 (rhBMP-2) is widely used for its advantage of rapid recovery and improved bone fusion. However, no previous study has reported the synergistic effect of MIS-TLIF with rhBMP-2 in patients with degenerative lumbar disease (DLD). Objective: To investigate the radiographic and patient-reported outcomes (PROs) in patients with DLD who underwent MIS-TLIF with and without a low dose of rhBMP-2. Methods: We retrospectively reviewed 48 patients treated with MIS-TLIF from 2013 to 2016. The patients were classified into the rhBMP-2 group (n = 25) and non-rhBMP-2 group (n = 23). Fusion-related parameters were measured before and after the operation. Clinical data included the numeric rating scale (NRS) score, Japanese Orthopedic Association (JOA) scores, and the MOS 36-item short form health survey (SF-36) score, which were documented to evaluate the effect of surgery. Results: In the 48 patients who underwent MIS-TLIF, the operated disc was predominantly at the L4/5 and L5/S1 levels. ADH, MDH, and PDH increased significantly in both groups after surgery (P < 0.05). FH improved in the rhBMP-2 group, but not in the non-rhBMP-2 group. There was no obvious improvement in SA in both groups. Furthermore, the SL showed a significant difference in both groups and a significant improvement over the baseline. The LL showed significant improvement in the two groups at the early follow-up (P < 0.05), but the improvement did not persist. Cage subsidence had no significant effect on different subsidence grades. In addition, no differences in cage subsidence were observed in different types of modic change (MC), except for MC 0 in both groups. There was no difference in PROs even though all clinical outcomes improved significantly during the postoperative follow-up period in both groups. Conclusion: MIS-TLIF with the low doses of rhBMP-2 resulted in an improvement in radiographic and clinical results, but not a longer-lasting restoration for radiographic outcomes. Cage subsidence is not associated with the MC. Further, our clinical data demonstrated no difference between both groups.

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Section: Fusion Ratesupporting

confidence: 90%

Evaluations of minimally invasive transforaminal lumbar interbody fusion performed with rhBMP-2

Hou

Xiang

et al. 2019

Preprint

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“…In the current study, both the operative time and blood loss in PLIF was significantly higher compared to TLIF (p = 0.0004 and 0.0001, respectively). Liu et al [26] have similarly reported that both the intraoperative time and blood loss volume were higher in the PLIF group than those of the TLIF group. This might be attributed to the necessity if the bilateral exposure in PLIF compared to the unilateral exposure required in TLIF.…”

Section: Discussionmentioning

confidence: 92%

Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in the treatment of single-level lumbar spondylolisthesis

2019

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Background: Various surgical procedures have been recommended for the treatment of lumbar spondylolisthesis, but controversy still exists regarding the optimal surgical technique. In this study, we compared the clinical and radiologic outcomes of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation in the treatment of single-level lumbar spondylolisthesis. Methods: Ninety-four patients underwent lumbar interbody fusion with pedicle screw fixation for the treatment of adult lumbar spondylolisthesis. Forty-six had PLIF with two cages and pedicle fixation (group 1), and 48 had TLIF with one cage and pedicle fixation (group 2). The follow-up was performed clinically using the visual analog scale (VAS) and Oswestry Disability Index (ODI) Questionnaires. Outcome scores were assessed 3, 6, and 12 months after surgery. Radiographs were obtained postoperatively and at regular intervals for 6 months. Perioperative outcomes such as surgery time, blood loss, length of hospital stay, and incidence of surgical complications were also recorded. Results: Estimated blood loss and operative time in the TLIF group were significantly lower than those in the PLIF group. VAS for back pain and ODI were significantly better in the TLIF group than the PLIF group. However, at the time of the last follow-up, both groups had similar slip reduction and spinal fusion rates. More complication rate was encountered in the PLIF group compared to the TLIF group. Conclusions: Our study showed that TLIF is superior to PLIF with respect to functional outcome and complication rate in grade I/II single-level lumbar spondylolisthesis.

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“…Although the infection rate for the midline patients may appear high, it is consistent with the previously published infection rate at our center and other recent publications that evaluated degenerative lumbar spondylolisthesis. 5,21 Many potential barriers exist in the adoption of this surgical approach. Often, surgeons who are trained using a midline approach assume that decompression of central stenosis cannot be as adequately or safely performed from lateral to medial.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

Street

Glennie

Dea

et al. 2016

SPI

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OBJECTIVE The objective of this study was to determine if there is a significant difference in surgical site infection (SSI) when comparing the Wiltse and midline approaches for posterior instrumented interbody fusions of the lumbar spine and, secondarily, to evaluate if the reoperation rates and specific causes for reoperation were similar for both approaches. METHODS A total of 358 patients who underwent 1- or 2-level posterior instrumented interbody fusions for degenerative lumbar spinal pathology through either a midline or Wiltse approach were prospectively followed between March 2005 and January 2011 at a single tertiary care facility. A retrospective analysis was performed primarily to evaluate the incidence of SSI and the incidence and causes for reoperation. Secondary outcome measures included intraoperative complications, blood loss, and length of stay. A matched analysis was performed using the Fisher's exact test and a logistic regression model. The matched analysis controlled for age, sex, comorbidities, number of index levels addressed surgically, number of levels fused, and the use of bone grafting. RESULTS All patients returned for follow-up at 1 year, and adverse events were followed for 2 years. The rate of SSI was greater in the midline group (8 of 103 patients; 7.8%) versus the Wiltse group (1 of 103 patients; 1.0%) (p = 0.018). Fewer additional surgical procedures were performed in the Wiltse group (p = 0.025; OR 0.47; 95% CI 0.23–0.95). Proximal adjacent segment failure requiring reoperation occurred more frequently in the midline group (15 of 103 patients; 14.6%) versus the Wiltse group (6 of 103 patients; 5.8%) (p = 0.048). Blood loss was significantly lower in the Wiltse group (436 ml) versus the midline group (703 ml); however, there was no significant difference between the 2 groups in intraoperative complications or length of stay. CONCLUSIONS The patients who underwent the Wiltse approach had a decreased risk of wound breakdown and infection, less blood loss, and fewer reoperations than the midline patients. The risk of adjacent segment failure in short posterior constructs is lower with a Wiltse approach.

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A comparative study of perioperative complications between transforaminal versus posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis

Cited by 64 publications

References 20 publications

Evaluations of minimally invasive transforaminal lumbar interbody fusion performed with rhBMP-2

Evaluations of minimally invasive transforaminal lumbar interbody fusion performed with rhBMP-2

Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in the treatment of single-level lumbar spondylolisthesis

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

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