A Randomized Prospective Study of Posterolateral Lumbar Fusion

Yaszemski, Michael J.; Lauerman, William C.; Cain, James E.; Glover, James; Lawson, Kevin; Coe, Jeffrey D.; Topper, Steven M.

doi:10.1097/00007632-199903150-00010

Cited by 189 publications

(18 citation statements)

References 17 publications

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“…Nerve decompression, PLF, and simple decompression for symptomatic treatment are sufficient surgical methods; however, the addition of PLIF or TLIF to the surgical procedure provides a more durable fusion. 2,4,6,16 Additionally, cages placed at the intervertebral disc preserve disc space, height, lumbar lordosis, and coronal and sagittal balance. 3 In other studies, no difference was observed in flexion-extension, lateral bending, or axial rotation graphics obtained postoperatively at month 6 in patients who underwent a single-level PLIF or TLIF.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Comparison of Radiological and Clinical Outcomes of PLIF and TLIF Techniques in Patients Who Underwent Lumbar Spinal Posterior Stabilization

Asil¹,

Yaldız

2016

Medicine

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Section: Discussionmentioning

confidence: 99%

Retrospective Comparison of Radiological and Clinical Outcomes of PLIF and TLIF Techniques in Patients Who Underwent Lumbar Spinal Posterior Stabilization

Asil¹,

Yaldız

2016

Medicine

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“…It is estimated that more than 200000 spine fusion procedures are performed each year in the United States3). Posterior lumbar arthrodesis is the most common procedure performed, and failure to achieve a solid bony union (nonunion) occurs in 10-40% of patients with a single-level fusion and more frequently when multiple levels are attempted11,12,27).…”

Section: Discussionmentioning

confidence: 99%

Effect of Dietary Calcium on Spinal Bone Fusion in an Ovariectomized Rat Model

Cho

et al. 2012

J Korean Neurosurg Soc

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ObjectiveTo evaluate the effect of calcium supplementation on spinal bone fusion in ovariectomized (OVX) rats.MethodsSixteen female Sprague Dawley rats underwent bilateral ovariectomy at 12 weeks of age to induce osteoporosis and were randomly assigned to two groups : control group (n=8) and calcium-supplemented group (OVX-Ca, n=8). Autologous spinal bone fusion surgery was performed on both groups 8 weeks later. After fusion surgery, the OVX-Ca group was supplemented with calcium in drinking water for 8 weeks. Blood was obtained 4 and 8 weeks after fusion surgery. Eight weeks after fusion surgery, the rats were euthanized and the L4-5 spine removed. Bone fusion status and fusion volume were evaluated by manual palpation and three-dimensional computed tomography.ResultsThe mean fusion volume in the L4-5 spine was significantly greater in the OVX-Ca group (71.80±8.06 mm3) than in controls (35.34±8.24 mm3) (p<0.01). The level of osteocalcin, a bone formation marker, was higher in OVX-Ca rats than in controls 4 weeks (610.08±10.41 vs. 551.61±12.34 ng/mL) and 8 weeks (552.05±19.67 vs. 502.98±22.76 ng/mL) after fusion surgery (p<0.05). The level of C-terminal telopeptide fragment of type I collagen, a bone resorption marker, was significantly lower in OVX-Ca rats than in controls 4 weeks (77.07±12.57 vs. 101.75±7.20 ng/mL) and 8 weeks (69.58±2.45 vs. 77.15±4.10 ng/mL) after fusion surgery (p<0.05). A mechanical strength test showed that the L4-5 vertebrae in the OVX-Ca group withstood a 50% higher maximal load compared with the controls (p<0.01).ConclusionDietary calcium given to OVX rats after lumbar fusion surgery improved fusion volume and mechanical strength in an ovariectomized rat model.

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“…Instrumented fusion has been reported to have a higher fusion rate than noninstrumented fusion 21,22). Therefore, a meta-analysis or systematic review to compare the noninstrumented fusion rates according to the surgical approach may provide different results to the present findings.…”

Section: Discussionmentioning

confidence: 59%

Fusion Rates of Instrumented Lumbar Spinal Arthrodesis according to Surgical Approach: A Systematic Review of Randomized Trials

et al. 2011

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BackgroundLumbar spine fusion rates can vary according to the surgical technique. Although many studies on spinal fusion have been conducted and reported, the heterogeneity of the study designs and data handling make it difficult to identify which approach yields the highest fusion rate. This paper reviews studies that compared the lumbosacral fusion rates achieved with different surgical techniques.MethodsRelevant randomized trials comparing the fusion rates of different surgical approaches for instrumented lumbosacral spinal fusion surgery were identified through highly sensitive and targeted keyword search strategies. A methodological quality assessment was performed according to the checklist suggested by the Cochrane Collaboration Back Review Group. Qualitative analysis was performed.ResultsA literature search identified six randomized controlled trials (RCTs) comparing the fusion rates of different surgical approaches. One trial compared anterior lumbar interbody fusion (ALIF) plus adjunctive posterior transpedicular instrumentation with circumferential fusion and posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF). Three studies compared PLF with circumferential fusion. One study compared three fusion approaches: PLF, PLIF and circumferential fusion.ConclusionsOne low quality RCT reported no difference in fusion rate between ALIF with posterior transpedicular instrumentation and circumferential fusion, and PLIF and circumferential fusion. There is moderate evidence suggesting no difference in fusion rate between PLF and PLIF. The evidence on the fusion rate of circumferential fusion compared to PLF from qualitative analysis was conflicting. However, no general conclusion could be made due to the scarcity of data, heterogeneity of the trials included, and some methodological defects of the six studies reviewed.

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A Randomized Prospective Study of Posterolateral Lumbar Fusion

Abstract: These results do not provide data that indicate a benefit in outcome from added instrumentation in elective lumbar fusions.

Cited by 189 publications

References 17 publications

Retrospective Comparison of Radiological and Clinical Outcomes of PLIF and TLIF Techniques in Patients Who Underwent Lumbar Spinal Posterior Stabilization

Retrospective Comparison of Radiological and Clinical Outcomes of PLIF and TLIF Techniques in Patients Who Underwent Lumbar Spinal Posterior Stabilization

Effect of Dietary Calcium on Spinal Bone Fusion in an Ovariectomized Rat Model

Fusion Rates of Instrumented Lumbar Spinal Arthrodesis according to Surgical Approach: A Systematic Review of Randomized Trials

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