A minimally invasive posterior lumbar interbody fusion for degenerative lumbar spine instabilities

Logroscino, Carlo Ambrogio; Proietti, Luca; Pola, Enrico; Scaramuzzo, Laura; Tamburrelli, Francesco Ciro

doi:10.1007/s00586-011-1762-1

Cited by 36 publications

(36 citation statements)

References 11 publications

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“…Many authors have reported excellent clinical outcomes as well as high fusion rates after PLIF [10,11], indicating that PLIF is an appropriate procedure for treating an abnormal mobile segment. Although transforaminal lumbar interbody fusion (TLIF) is also reported to produce high fusion rate and excellent clinical outcomes [18,19], the additional fusion needs enough rigidity because of more stress by the longer lever arm. PLIF has more advantage in achieving solid fusion by removing intervertebral material and cartilaginous endplates through bilateral wide annulotomy and harvesting more amount of local autograft.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion

et al. 2013

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Purpose Adjacent segment disease (ASD) is an increasing problematic complication following lumbar fusion surgeries. ASD requires appropriate treatment, although there are only few reports on surgery for ASD. This study aimed to clarify surgical outcomes of posterior lumbar interbody fusion (PLIF) for ASD. Methods Medical charts of 18 patients who underwent the second (repeat) PLIF for ASD were retrospectively investigated (average follow-up, 40 [27-66] months). Modified Japanese Orthopaedic Association (JOA) score and Whitecloud classification were used as outcome measures. Results Mean modified JOA score improved from 7.7 just before repeat PLIF to 11.4 at maximum recovery and declined to 10.2 at final follow-up. Mean recovery rate of modified JOA score was 52.9 % at maximum recovery and 31.6 % at final follow-up. According to Whitecloud classification, 17 patients (94 %) were excellent or good and only 1 was fair at maximum recovery, whereas 10 (56 %) were excellent or good, 6 were fair, and 2 were poor at final follow-up. Eight patients (44 %) deteriorated again because of recurrent ASD. Two poor patients underwent a third PLIF. Conclusion PLIF is effective for ASD after PLIF in the short term, although it tends to lead to a high incidence of recurrent ASD.

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Section: Discussionmentioning

confidence: 99%

Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion

et al. 2013

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“…However, the approach-related morbidity, that results from iatrogenic soft-tissue injury, which includes paraspinal muscle injury, has become a major problem [1,2]. Several procedures, including minimally invasive techniques, have been developed as potential solutions to this problem [3][4][5][6]. Lumbar spinous process-splitting laminectomy, in which the muscular attachment is left intact, has been reported to decrease the degree of postoperative paraspinal muscular atrophy [7].…”

Section: Introductionmentioning

confidence: 99%

Spinous process-splitting open pedicle screw fusion provides favorable results in patients with low back discomfort and pain compared to conventional open pedicle screw fixation over 1 year after surgery

et al. 2012

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Introduction The conventional open pedicle screw fusion (PSF) requires an extensive detachment of the paraspinal muscle from the posterior aspect of the lumbar spine, which can cause muscle injury and subsequently lead to ''approachrelated morbidity''. The spinous process-splitting (SPS) approach for decompression, unilateral laminotomy for bilateral decompression, and the Wiltse approach for pedicle screw insertion are considered to be less invasive to the paraspinal musculature. We investigated whether SPS open PSF combined with the abovementioned techniques attenuates the paraspinal muscle damage and yields favorable clinical results, including alleviation in the low back discomfort, in comparison to the conventional open PSF. Methods We studied 53 patients who underwent singlelevel PSF for the treatment of degenerative spondylolisthesis (27 patients underwent SPS open PSF and the other 26 underwent the conventional open PSF). The clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) score, the Roland-Morris disability questionnaire (RDQ), and the visual analog scale (VAS) for low back pain and low back discomfort (heavy feeling or stiffness). Postoperative multifidus (MF) atrophy was evaluated using MRI. Follow-up examinations were performed at 1 and 3 years after the surgery.Results Although there was no significant difference in the JOA and RDQ score between the two groups, the VAS score for low back pain and discomfort after the surgery were significantly lower in the SPS open PSF group than in the conventional open PSF group. The extent of MF atrophy after SPS open PSF was reduced more significantly than after the conventional open PSF during the follow-up. The MF atrophy ratio was found to correlate with low back discomfort at the 1-year follow-up examination. ConclusionIn conclusion, SPS open PSF was less damaging to the paraspinal muscle than the conventional open PSF and had a significant clinical effect, reducing low back discomfort over 1 year after the surgery.

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“…Because of a reduced destruction of the soft tissues, proponents of these MIS techniques claim to achieve superior clinical results with reduced postoperative pain, narcotic use, and hospital length of stay [4,5,10,12,16,23]. On the other hand, performing percutaneous instrumentation, fusion and decompression in complex cases with severe arthritic and stenotic changes could increase the complication rate and lower the accuracy of pedicle screw insertion [6].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, it has been suggested that the procedure should be tailored to each patient depending on imaging findings and symptoms-for example, ventral approaches in cases of high-grade spondylolisthesis or unilateral approaches in cases of unilateral symptoms [2,29]. The authors of previous studies of MIS and especially MIS-TLIF have commonly neglected the heterogeneity of the patient population by including such complex cases in the patient population without differentiating the efficacy of the surgery on these patients [5,12,18,20,23,26]. Other authors either a priori excluded such complex cases from performing MIS techniques or recommended that MIS should be performed at the discretion of the surgeon [17].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported the favorable outcomes of MIS-TLIF accompanied by spinal instrumentation with percutaneous pedicle screw insertion and decompression in degenerative spondylolisthesis [1,3,5,12,20,21,23,25]. In the presence of severe spinal canal stenosis and distorted facet anatomy due to severe FJO, MIS techniques however could limit direct visualization of neural elements and pedicle screws relative to key anatomical structures and could increase the rate of complications and pedicle screw misplacement.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis

Archavlis

Nievas²

2013

Eur Spine J

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Purpose The object of this study was to compare minimally invasive surgery (MIS) with open surgery in a severely affected subgroup of degenerative spondylolisthetic patients with severe stenosis (SDS) and high-grade facet osteoarthritis (FJO). Methods From January 2009 to February 2010, 49 patients with severe SDS and high-grade FJO were treated using either MIS or open TLIF. Intraoperative and diagnostic data, including perioperative complications and length of hospital stay (LOS), were collected, using retrospective chart review. Surgical short-and long-term outcomes were assessed according to the Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain. Results Comparing MIS and open surgery, the MIS group had lesser blood loss, significantly lesser need for transfusion (p = 0.02), more rapid improvement of postoperative back pain in the first 6 weeks of follow-up and a shorter LOS. On the other hand, we experienced in the MIS group a longer operative time. The distribution on the postoperative ODI (p = 0.841), VAS leg (p = 0.943) and back pain (p = 0.735) scores after a mean follow-up of 2 years were similar. The overall proportion of complications showed no significant difference between the groups (29 % in the MIS group vs. 28 % in the open group, p = 0.999). Conclusion Minimally invasive surgery for severe SDS leads to adequate and safe decompression of lumbar stenosis and results in a faster recovery of symptoms and disability in the early postoperative period.

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A minimally invasive posterior lumbar interbody fusion for degenerative lumbar spine instabilities

Abstract: Percutaneous techniques may be helpful to reduce approach-related morbidity of conventional open surgery. The aim of the study was to evaluate the feasibility and safety of mini-open posterior lumbar interbody fusion for instabilities and degenerative disc diseases. From

Cited by 36 publications

References 11 publications

Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion

Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion

Spinous process-splitting open pedicle screw fusion provides favorable results in patients with low back discomfort and pain compared to conventional open pedicle screw fixation over 1 year after surgery

Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis

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