Comparative effectiveness and safety of posterior lumbar interbody fusion, Coflex, Wallis, and X-stop for lumbar degenerative diseases: A systematic review and network meta-analysis

Mo, Zhuomao; Li, Dong; Zhang, Renwen; Chang, Minmin; Yang, Binbin; Tang, Shujie

doi:10.1016/j.clineuro.2018.06.030

Cited by 30 publications

(36 citation statements)

References 19 publications

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“…Biomechanically, these techniques partly simulate the kinematics of the surgical level and provide segmental stability in extension [ 6 , 7 ]. Until now, many interspinous stabilizing devices have been used for the treatment of LSS, such as X-STOP (Medtronic, MN, USA), WALLIS (Abbott Spine, TX, USA), and Superion (VertiFlex, San Clemente, CA, USA) [ 8 – 10 ]. Since first introduced in 1994, Coflex (Paradigm Spine, NY, USA) device, an interlaminar stabilization device, has been gaining popularity in clinical use [ 11 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, the interlaminar devices and interspinous process devices are frequently categorized together [ 8 , 21 , 22 ]. Most previous studies have focused only on comparing interlaminar or interspinous device to other lumbar surgical techniques [ 9 , 10 , 12 , 15 , 23 ], and few studies have focused on assessing whether the position of such device placement has an influence on biomechanical or clinical outcomes. In order to assess whether there is a fundamental difference in the biomechanical performance of the interlaminar device and interspinous process device, we comprehensively compared the biomechanical characteristics of DA, DF, decompression with interlaminar stabilization (ILS), and decompression with interspinous stabilization (ISS) by using the finite element (FE) methods.…”

Section: Introductionmentioning

confidence: 99%

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Interlaminar stabilization offers greater biomechanical advantage compared to interspinous stabilization after lumbar decompression: a finite element analysis

Teng

2020

J Orthop Surg Res

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Background Interlaminar stabilization and interspinous stabilization are two newer minimally invasive methods for lumbar spine stabilization, used frequently in conjunction with lumbar decompression to treat lumbar stenosis. The two methods share certain similarities, therefore, frequently being categorized together. However, the two methods offer distinct biomechanical properties, which affect their respective effectiveness and surgical success. Objective To compare the biomechanical characteristics of interlaminar stabilization after lumbar decompression (ILS) and interspinous stabilization after lumbar decompression (ISS). For comparison, lumbar decompression alone (DA) and decompression with instrumented fusion (DF) were also included in the biomechanical analysis. Methods Four finite element models were constructed, i.e., DA, DF, ISS, and ILS. To minimize device influence and focus on the biomechanical properties of different methods, Coflex device as a model system was placed at different position for the comparison of ISS and ILS. The range of motion (ROM) and disc stress peak at the surgical and adjacent levels were compared among the four surgical constructs. The stress peak of the spinous process, whole device, and device wing was compared between ISS and ILS. Results Compared with DA, the ROM and disc stress at the surgical level in ILS or ISS were much lower in extension. The ROM and disc stress at the surgical level in ILS were 1.27° and 0.36 MPa, respectively, and in ISS 1.51°and 0.55 MPa, respectively in extension. This is compared with 4.71° and 1.44 MPa, respectively in DA. ILS (2.06–4.85° and 0.37–0.98 MPa, respectively) or ISS (2.07–4.78° and 0.37–0.98 MPa, respectively) also induced much lower ROM and disc stress at the adjacent levels compared with DF (2.50–7.20° and 0.37–1.20 MPa, respectively). ILS further reduced the ROM and disc stress at the surgical level by 8% and 25%, respectively, compared to ISS. The stress peak of the spinous process in ILS was significantly lower than that in ISS (13.93–101 MPa vs. 31.08–172.5 MPa). In rotation, ILS yielded a much lower stress peak in the instrumentation wing than ISS (128.7 MPa vs. 222.1 MPa). Conclusion ILS and ISS partly address the issues of segmental instability in DA and hypermobility and overload at the adjacent levels in DF. ILS achieves greater segmental stability and results in a lower disc stress, compared to ISS. In addition, ILS reduces the risk of spinous process fracture and device failure.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interlaminar stabilization offers greater biomechanical advantage compared to interspinous stabilization after lumbar decompression: a finite element analysis

Teng

2020

J Orthop Surg Res

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“…Compared with direct meta-analysis, it has many advantages, including comparisons of multiple interventions, calculation of indirect evidence, and rank of included treatments. 26 , 27 We hypothesize that network meta-analysis will show no difference in clinical outcomes among ACL graft options, and we performed this network meta-analysis to evaluate the effectiveness of various graft options for ACL reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy of Graft Options in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Network Meta-Analysis

Liu

Yang

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate the effectiveness of various graft options for anterior cruciate ligament reconstruction using network meta-analysis. Methods A medical literature search was conducted of PubMed, the Cochrane Library, Embase, SCOPUS, and Web of Science from their inception through March 1, 2019. The outcomes, including International Knee Documentation Committee (IKDC) form, Lachman test, Lysholm score, Pivot shift test, and Tegner score, were evaluated among graft options. Data extraction was carried out according to inclusion and exclusion criteria, and a network meta-analysis was performed using STATA 14.0. Results A total of 45 trials with 3992 patients were included. The forest plots revealed no significant differences in IKDC, Lysholm, or Tegner score among the grafts. In Lachman score, a significant difference was found in the comparisons of hamstring tendon allograft (HT-AL) versus patellar tendon autograft (PT-AU) and HT-AL versus hamstring tendon autograft (HT-AU). In pivot shift test, PT-AU was superior to all the other grafts, and quadriceps tendon autograft (QT-AU) was superior to HT-AL and artificial ligament (Art-L) in the number of cases with negative results. According to surface under the cumulative ranking area (SUCRA), PT-AU had the highest probability to be the best intervention in Lachman test and Tegner score; tibialis anterior tendon allograft (TA-AL) in IKDC and Lysholm score; and QT-AU in pivot shift test. Based on the cluster analysis of SUCRA, PT-AU was considered the most appropriate intervention by IKDC and Lachman test. Conclusion This study suggests that PT-AU may be the most appropriate graft for ACL reconstruction according to IKDC and Lachman test results. Level of Evidence Level I, network meta-analysis of randomized controlled trials.

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“…Posterior lumbar interbody fusion (PLIF) is the most common surgery for degenerative lumbar disease (DLD), such as lumbar disc herniation and lumbar spinal stenosis. However, PLIF achieves the clinical efficacy at the expense of mobility of the affected lumbar spine segments, increasing the load to adjacent segments and accelerating degenerative disc disease and facet joint degeneration, which further increases the risk of adjacent segment degeneration (ASD) [1–4]. The incidence of ASD, following open or MIS lumbar instrumented fusions, ranged up to 30% [5].…”

Section: Introductionmentioning

confidence: 99%

“…A non-fusion interspinous device, such as Coflex, is a known alternative technique to PLIF [10]. It preserves a certain degree of vertebral activity, which reduces the incidence of ASD [4, 10, 11]. Previously biomechanical and clinical literatures show that Coflex is a safe and effective treatment for DLD [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Topping-off surgery vs posterior lumbar interbody fusion for degenerative lumbar disease: a comparative study of clinical efficacy and adjacent segment degeneration

Hai

Meng

et al. 2019

J Orthop Surg Res

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Background Studies have shown that adjacent segment degeneration (ASD) is a common complication after posterior lumbar interbody fusion (PLIF), even a second surgery is required for some patients. It remains unclear whether the non-fusion surgery can relieve ASD. Therefore, this study aims to investigate the clinical outcomes of Topping-off surgery (fusion combined with Coflex) and PLIF for degenerative lumbar disease (DLD) and the efficacy on preventing ASD. Method A retrospective analysis was performed on the clinical data of 99 patients with DLD from January 2011 to December 2014, who were performed by Topping-off surgery (L4–5 PLIF + L3–4 Coflex, n = 45) or PLIF (L3–5 PLIF, n = 54). All patients included in the analysis had a minimum of 3 years of follow-up. Clinical data were used to assess the clinical efficacy, and radiographic parameters were measured for evaluation of the incidence of ASD. Results The mean ages of Topping-off group and PLIF group were 53.5 and 65.7 years old, respectively ( P < 0.05). The surgical time, intraoperative blood loss, Oswestry disability index (ODI), and visual analog scale (VAS) were significantly different between the two groups ( P < 0.05). Intervertebral mobility (L2-L3) of the Topping-off group was not changed significantly at 3 years after surgery than before ( P > 0.05), while that of PLIF group was increased considerably ( P < 0.05). As to intergroup comparison, intervertebral mobility (L2-L3) of Topping-off group was superior to those of the PLIF group ( P < 0.05). Surprisingly, there was no significant difference in the general adjacent segment mobility (GASM) at L2–4 of the Topping-off group and intervertebral mobility (L2–L3) of PLIF group at 3 years after surgery ( P > 0.05). Lumbar MRI at three post-operative years indicated that the modified Pfirrman grading of disc (L2–L3) in the Topping-off group was much better than that of the PLIF group ( P < 0.05). Conclusion This study showed that Topping-off surgery had the benefits of less invasiveness, less bleeding, and comparable clinical efficacy as PLIF for DLD. The segment with Coflex insertion undertook part of the mobility and stress in the proximal lumbar spine, which is conducive to alleviating ASD.

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Comparative effectiveness and safety of posterior lumbar interbody fusion, Coflex, Wallis, and X-stop for lumbar degenerative diseases: A systematic review and network meta-analysis

Cited by 30 publications

References 19 publications

Interlaminar stabilization offers greater biomechanical advantage compared to interspinous stabilization after lumbar decompression: a finite element analysis

Interlaminar stabilization offers greater biomechanical advantage compared to interspinous stabilization after lumbar decompression: a finite element analysis

Comparative Efficacy of Graft Options in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Network Meta-Analysis

Topping-off surgery vs posterior lumbar interbody fusion for degenerative lumbar disease: a comparative study of clinical efficacy and adjacent segment degeneration

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