Comparison of paraspinal muscle injury in one‐level lumbar posterior inter‐body fusion: modified minimally invasive and traditional open approaches

Fan, Shunwu; Hu, Zhijun; Fang, Xiangqian; Zhao, Fengdong; Huang, Yue; Yu, Hejun

doi:10.1111/j.1757-7861.2010.00086.x

Cited by 81 publications

(78 citation statements)

References 22 publications

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“…Although this was not significant in the present study, the small sample size may mask the true difference. Postoperative MRI also found increased T 2 signal intensity ratio of the multifidus to psoas (control) muscle, similar to a prior study that also found greater changes in the open fusion group as compared to minimally invasive posterior interbody fusion [30]. The present study found only an insignificant trend for greater MRI muscle change with the more invasive pedicle screw approach.…”

Section: Discussionsupporting

confidence: 88%

Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study

Buttermann

Thorson

Mullin³

2013

Eur Spine J

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Purpose To compare single-level circumferential spinal fusion using pedicle (n = 27) versus low-profile minimally invasive facet screw (n = 35) posterior instrumentation. Method A prospective two-arm cohort study with 5-year outcomes as follow-up was conducted. Assessment included back and leg pain, pain drawing, Oswestry disability index (ODI), pain medication usage, self-assessment of procedure success, and [1-year postoperative lumbar magnetic resonance imaging. Results Significantly less operative time, estimated blood loss and costs were incurred for the facet group. Clinical improvement was significant for both groups (p \ 0.01 for all outcomes scales). Outcomes were significantly better for back pain and ODI for the facet relative to the pedicle group at follow-up periods [1 year (p \ 0.05). Postoperative magnetic resonance imaging found that 20 % had progressive adjacent disc degeneration, and posterior muscle changes tended to be greater for the pedicle screw group. Conclusion One-level circumferential spinal fusion using facet screws proved superior to pedicle screw instrumentation.

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Section: Discussionsupporting

confidence: 88%

Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study

Buttermann

Thorson

Mullin³

2013

Eur Spine J

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“…There are many other studies that demonstrate much greater injury to the surrounding tissues with a midline approach. 6,15 This is possibly the start of the cascade that leads to a greater incidence of adjacent segment pathology with the midline approach, which our data support. Also, a more lateral pedicle screw entry point has a much lower incidence of violating the adjacent facet and capsule of the caudal level.…”

Section: Discussionsupporting

confidence: 78%

“…1,20,[23][24][25] As a result, surgeons are examining options to reduce surgical site infection, and in doing so have revisited the utility of the Wiltse paraspinal approach as a potential alternative to minimizing wound complications in this high-risk group of patients. 2,3,6,8,11,16 aBBreViatiOnS BMP = bone morphogenetic protein; SSII = spine surgical invasiveness index. 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.…”

mentioning

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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“…PLIF allows reliable neurological decompression, satisfactory interbody fusion and disc height restoration [74]. Potential disadvantages [74,75], however, may be substantial paraspinal damage linked to long-term muscle retraction, battered root syndrome, and limited ability to achieve adequate lordosis consistently [73][74][75].…”

Section: Plifmentioning

confidence: 99%

“…Initially, the PLIF method is a conventional lumbar approach in which most spinal surgeons are well-skilled and experienced. A posterior access allows outstanding visualization of the nerve roots deprived of affecting blood supply to the graft [72,73]. PLIF allows reliable neurological decompression, satisfactory interbody fusion and disc height restoration [74].…”

Section: Plifmentioning

confidence: 99%

Role of Minimally Invasive Spine Surgery in Adults with Degenerative Lumbar Scoliosis: A Narrative Review

Tannoury

Haddadi

Kempegowda

et al. 2017

IrJNS

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Background and Aim: Degenerative lumbar scoliosis is a spinal deformity resulting from advanced disc degeneration and facet arthropathy. Given the inconclusive available literature and lack of high-quality data supporting the role of minimally invasive surgical management of degenerative lumbar scoliosis, this review intends to highlight and compare the various viable minimally invasive surgical methods for adult degenerative deformity correction. Methods and Materials/Patients:Online databases search including Medline, PubMed and Ovid was preformed using the keywords: adult, degenerative, lumbar scoliosis, etiology, clinical issues, diagnostic imaging, spinopelvic alignment, non-operative and surgical treatment options, minimally invasive, interbody fusion, and percutaneous pedicle screw fixation. Eighty-three studies, published after 2000, on degenerative lumbar scoliosis epidemiology, classification and management were identified and reviewed.Results: Minimally invasive surgical techniques available for interbody fusion include posterior lumbar interbody fusion, transformational lumbar interbody fusion, oblique lumbar interbody fusion, anterior lumbar interbody fusion, and extreme lateral interbody fusion. Each surgical option warrants technical considerations, indication, complications awareness, and functional and radiological outcomes assessment. Sound patients' selection is key for improved outcomes, and therefore the following factors should be well examined prior to surgical intervention: the patient's medical condition and underlying morbidities, the extent of the involved disc spaces, imaging characteristics, and surgeon skills. Conclusion:The superiority of one surgical technique over the others, was not proven due to lack of strong and supportive data. However, a comprehensive review of indications, benefits, and disadvantages of the minimally invasive surgical procedures is presented. There is an interest in minimally invasive surgery of the spine owing to lower complication rates and morbidity, with limited soft tissue disturbance, decreased blood loss, improved cosmesis, shorter hospital stay, earlier return to work, and therefore decreased general health care costs.

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Comparison of paraspinal muscle injury in one‐level lumbar posterior inter‐body fusion: modified minimally invasive and traditional open approaches

Abstract: Compared with TOPA, MMIA can significantly lessen paraspinal muscle injury, and reduce the incidence of low back pain.

Cited by 81 publications

References 22 publications

Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study

Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study

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

Role of Minimally Invasive Spine Surgery in Adults with Degenerative Lumbar Scoliosis: A Narrative Review

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