Influence of contoured versus straight rod on clinical outcomes and sagittal parameters in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) at L4/5 level-more than 5 years follow-up

Zhao, Yiwei; Jia, Jinping; Liu, Wubo; Chen, Xi; Mai, Ruopeng; Tian, Yonghao; Zhao, Juan; Liu, Xinyu

doi:10.1016/j.jos.2019.03.008

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…Some studies specifically compared technical alternatives such as changing the fixation method or choosing a different cage type. 5,10,33,48 In this systematic review, the subsidence occurrence of the bilateral and unilateral screws was not distinguished. 13,23,53,55,56 The 6 studies listed in Table 4 investigated the relationship between subsidence and patient-reported outcomes.…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 80%

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Subsidence of Spinal Fusion Cages: A Systematic Review

Parisien

Wai²,

Frei³

2022

Int J Spine Surg

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Background: Although many research studies investigating subsidence of intervertebral fusion cages have been published, to our knowledge, no study has comprehensively compared cage subsidence among all lumbar intervertebral fusion (LIF) techniques. This study aimed to review the literature reporting evidence of cage subsidence linked to LIF. The amount of subsidence was compared and associated with the procedures and corresponding implants used, and the effect of cage subsidence on clinical outcomes was investigated.Methods: For this systematic review, the MEDLINE and PubMed databases were used to identify relevant studies. Search terms included lumbar, lumbar vertebrae, lumbar spine, cage, spinal fusion, prosthesis, prosthesis implantation, implantation, implants, interbody, spacer, and subsidence. Studies included in this review were those having more than 10 patients and reporting the amount of subsidence observed using computed tomography or x-ray imaging after surgery and at follow-up visits after a minimum of 6 weeks postsurgery. Data and scale definitions related to subsidence were extracted from articles for comparison of subsidence prevalence between the 5 LIF surgical procedures.Results: Forty articles were identified for inclusion. The review included data from 390 anterior lumbar intervertebral fusions (ALIFs), 2130 lateral lumbar intervertebral fusions (LLIFs), 560 posterior lumbar intervertebral fusions (PLIFs), 245 oblique lumbar intervertebral fusions (OLIFs), and 1634 transverse lumbar intervertebral fusions (TLIFs) for a total of 4959 patients who underwent LIF surgery. The minimum and maximum percentages of the number of patients having subsidence for each procedure in the included studies were as follows: ALIF stand-alone, 6% and 23.1%; LLIF stand-alone, 8.7% and 39.6%; LLIF with posterior fixation, 3.3% and 20.7%; OLIF with posterior fixation, 4.4% and 36.9%; PLIF with posterior fixation, 7.4% and 31.8%; and TLIF, 0.0% and 51.2%.Conclusions: The number of patients experiencing subsidence varied between studies within each fusion procedure. Our findings indicate that all 5 surgical methods are at risk of subsidence. Overall, ALIF without posterior fixation resulted in the lowest reported subsidence occurrence among the 5 surgical approaches. There is conflicting evidence on the association between subsidence and negative clinical outcomes.Clinical Relevance: This review defines and compares subsidence incidence between all LIF procedures and investigates the risk of symptomatic clinical outcomes.

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Section: Risk Of Bias Within Studiesmentioning

confidence: 80%

“…TLIF cages have significantly smaller footprint coverage than ALIF and LLIF cages. 3,5 Depending on the cage used and the surgeon's approach, the TLIF cage can either be placed on the interior or medial part of the endplate. TLIF does not provide enough segmental stability without the use of posterior fixation.…”

Section: Olifmentioning

confidence: 99%

Subsidence of Spinal Fusion Cages: A Systematic Review

Parisien

Wai²,

Frei³

2022

Int J Spine Surg

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“…Their study emphasized that the accuracy of rod bending angle was important for spinal sagittal balance and prevention of adjacent disc degeneration. Zhao et al performed a retrospective analysis to evaluate the effect of contoured versus straight rods on the radiographic and clinical outcomes in patients undergoing the minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) at L4/5 level, and found contoured or straight rods had no statistical difference in global spinopelvic parameters and clinical outcomes in 5 years follow-up [12]. One possible explanation for this opposite nding relative to our results is that stripping off spinal muscles attached to the lamina in PLIF surgery could reduce the stability of posterior spine components and the muscular decollement might result in the risk of postoperative back pain.…”

Section: Resultsmentioning

confidence: 99%

“…Polyaxial screws are user-friendly to rod installation during posterior spinal surgery, which allows mutual adaptation of screw heads and rods in certain deviations. Some surgeons might even prefer unbent rods in single-segment PLIF surgery with a small LL [12]. However, although polyaxial screws partially compensated for LL and provided convenience during operation, the mismatch between screw heads and rod occurs, which might further impact the amount of lordosis and even clinical outcomes [5].…”

Section: Resultsmentioning

confidence: 99%

The association of rod curvature with postoperative outcomes in patients undergoing posterior lumbar interbody fusion for spinal stenosis

Han

et al. 2022

Preprint

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Background Restoration of sagittal balance is a key issue in posterior lumbar interbody fusion (PLIF) surgery and adverse postoperative outcomes are associated with inadequate restoration of sagittal alignment. However, there is still a lack of solid evidence about the impact of the rod curvature on sagittal spinopelvic radiographic parameters and clinical outcomes. Method A retrospective clinical study was conducted to compare patient characteristics between lumbar spinal stenosis patients who underwent PLIF with satisfactory postoperative results and those who had poor recovery resulted from adjacent segment degeneration after PLIF and needed revision surgery (i.e. Normal and Abnormal Groups). Patient demographics (age, gender, height, weight and BMI), surgical characteristics (number of fused levels, surgical time, blood loss and hospital stay) and radiographic parameters (lumbar lordosis [LL], sacral slope [SS], pelvic incidence [PI], pelvic tilt [PT], PI-LL, Cobb angle of fused segments [Cobb], rod curvature [RC], Posterior tangent angle of fused segments [PTA] and RC-PTA) were analyzed. Results Patients in the abnormal group had older median age and suffered more blood loss than those in the normal group. RC and RC-PTA were significantly lower in the abnormal group compared to the normal group. Multivariate regression analysis revealed that lower age and lower PTA were related to higher odds of better surgical outcomes. The receiver operating characteristic curve analysis showed that the RC classifier was a good predictor of postoperative outcomes. Conclusions The study revealed significant differences in age, blood loss, RC and RC-PTA between normal and abnormal groups, and RC was demonstrated to be a pretty good indicator for predicting postoperative outcomes.

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“…This may involve extensive muscle retraction and dissection with the removal of the facet joint in order to place a straight or curved cage. TLIF cages have significantly smaller footprint coverage than ALIF and LLIF cages [72], [75], [76].…”

Section: Tlifmentioning

confidence: 98%

Characterization and Design Optimization of Periodic Cellular Solids for Optimal Bone Ingrowth in Osseointegration Implants.

Parisien¹

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Post-operative complications of spinal lumbar fusion include cage subsidence and nonunion. The lack or delayed osseointegration of the fusion cage may be one of the problems resulting in poor outcomes. The use of micro-architectured truss-like lattice materials to improve implant osseointegration is getting more attention beyond spinal fusion. Therefore, the main goal of this research is to define the optimal lattice microscopic parameters to maximize bone ingrowth, for fusion spinal cages. A tool based on previous mechano-regulatory models is implemented numerically, to determine the fraction of void space within a structure that receives optimal stimulation for bone ingrowth. The model was used to replicate previous in silico and in vivo results and showed very good agreement when comparing the different lattice topologies, unit cell orientation, microscopic strut cross-section shape as well as strut size. Characterization of the performance of lattice materials, relevant for osseointegration, is conducted for fourteen unit cell topologies, with ten relative densities, under four axial loadings. Results suggested that Diamond, X-Shape, Tesseract and Rhombic Dodecahedron with horizontal orientation provide the best biomechanical environment for cells to grow and form bone tissue. Pressure (MPa) Circle Replication Circle Replication Circle Rodriguez et al. Circle Rodriguez et al.

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Influence of contoured versus straight rod on clinical outcomes and sagittal parameters in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) at L4/5 level-more than 5 years follow-up

Cited by 7 publications

References 28 publications

Subsidence of Spinal Fusion Cages: A Systematic Review

Subsidence of Spinal Fusion Cages: A Systematic Review

The association of rod curvature with postoperative outcomes in patients undergoing posterior lumbar interbody fusion for spinal stenosis

Characterization and Design Optimization of Periodic Cellular Solids for Optimal Bone Ingrowth in Osseointegration Implants.

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