Lumbar interbody fusion: recent advances in surgical techniques and bone healing strategies

Meng, Bin; Bunch, Joshua; Burton, Douglas C.; Wang, Jinxi

doi:10.1007/s00586-020-06596-0

Cited by 77 publications

(75 citation statements)

References 108 publications

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“…Interbody procedures with cage insertion are essential for lumbar fusion surgery, and techniques for interbody procedure have advanced over time [ 2 , 3 , 4 , 5 ]. Conventionally, cage insertion via the transforaminal route after a posterior approach (transforaminal lumbar interbody fusion, TLIF) has been the gold-standard procedure for interbody fusion; however, the procedure has several drawbacks, including neural injury, endplate violation, cage subsidence, cage migration, and other critical problems [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…Lateral-access cage insertion techniques via the retroperitoneal space have been invented to reduce the problems related to TLIF procedures, including lateral lumbar interbody fusion (LLIF) or oblique lateral interbody fusion (OLIF) [ 2 , 4 , 7 , 11 , 12 , 13 , 14 , 15 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. LLIF is conducted via the intermuscular approach dissecting the psoas muscle; thus, it can cause psoas muscle-related complications, including anterior thigh pain, leg weakness, nerve root injury, and others [ 2 , 4 , 11 , 13 , 14 , 25 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

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Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

Lee

Kim

Choo

et al. 2021

Life

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Preoperative pathology requiring fusion surgery has a great impact on postoperative outcomes. However, the previous clinical and meta-analysis studies did not control for the pathology. In this systematic review, the authors aimed to compare oblique lumbar interbody fusion (OLIF) with transforaminal interbody fusion (TLIF) as an interbody fusion technique in lumbar fusion surgery for patients with degenerative spondylolisthesis (DS). We systematically searched for relevant articles in the available databases. Among the 3022 articles, three studies were identified and met the inclusion criteria. In terms of radiological outcome, the amount of disc height restoration was greater in the OLIF group than in the TLIF group, but there was no significant difference between the two surgical techniques (p = 0.18). In the clinical outcomes, the pain improvement was not significantly different between the two surgical techniques. In terms of surgical outcomes, OLIF resulted in a shorter length of hospital stay and less blood loss than TLIF (p < 0.0001 and p = 0.02, respectively). The present meta-analysis indicated no significant difference in clinical, radiological outcomes, and surgical time between TLIF and OLIF for DS, but the lengths of hospital stay and blood loss were better in OLIF than TLIF. Though encouraging, these findings were based on low-quality evidence from a small number of retrospective studies that are prone to bias.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

Lee

Kim

Choo

et al. 2021

Life

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“…However, in low-grade spondylolisthesis, the impact of sagittal rotation and anterior displacement to spinopelvic factors is far less immanent than compared to higher grades of spondylolisthesis. Regarding surgical procedure, due to a greater (bilateral) removal of dorsal vertebral structures, PLIF might allow further modulation of sacral inclination and lumbar lordosis [27]. However, the influence of the procedure might not be significant.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up

Lenz

Oikonomidis

Hartwig

et al. 2020

Arch Orthop Trauma Surg

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Introduction Lumbar spinal fusion surgery is a widely accepted surgical treatment in degenerative causes of lumbar spondylolisthesis. The benefit of reduction of anterior displacement and restoration of sagittal parameters is still controversially debated. Purpose of the underlying publication was to analyze the influence of radiographic sagittal parameters of the spine in aspects of changes in postoperative clinical outcome. Materials and methods By prospective analysis, we included patients with low-grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) with mono- or bisegmental fusion surgery with a minimum follow-up data of 3 years. For clinical outcome measures, COMI, ODI and EQ-5D were used. Spinopelvic parameters (sacral inclination, pelvic tilt, sacral slope and pelvic incidence, lumbar lordosis and lumbar index as well as anterior displacement and sagittal rotation) were measured on plain radiographs. Results We could observe a significant benefit in clinical outcome after lumbar fusion surgery in low-grade spondylolisthesis in our mid-term follow-up data including 32 patients. By surgical reduction, we could see significant restoration of anterior displacement and sagittal rotation. Interestingly, a significant correlation between restoration of both sagittal rotation and sacral inclination and clinical outcome score was observed in the 3-year follow-up. Conclusion In low-grade spondylolisthesis, spinal fusion surgery is a well-established surgical procedure; however, the impact of sagittal parameters and reduction of anterior displacement remains controversial. Within our findings, restoration of sagittal parameters showed significant correlation to improvement in clinical outcome in our mid-term follow-up data.

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“…The challenges of learning, planning and performing procedures in spine surgery have been enriched by the recent development of new technological tools and instrumentations, able to assist surgeons and reducing surgical invasiveness (Minimally-Invasive Surgery, MIS) but maintaining a valuable profile of safety (1)(2)(3)(4)(5). One of the most promising applications of advancements in visual/haptic display technologies and computational power is represented by augmented reality (AR) (6), an emerging technological field.…”

Section: Introductionmentioning

confidence: 99%

“…Findings: A total number of 12 lumbar arthrodesis have been performed while using the described AR technology, with application spanning from telementoring (3), teaching (2), surgical planning superimposition and interaction with the hologram using a custom application for Microsoft hololens (1). Surgeons wearing the AR goggles reported a positive feedback as for the ergonomy, wearability and comfort during the procedure; being able to visualize a 3D reconstruction during surgery was perceived as a straightforward benefit, allowing to speed-up procedures, thus limiting post-operational complications.…”

mentioning

confidence: 99%

Augmented Reality in Medical Practice: From Spine Surgery to Remote Assistance

et al. 2021

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Background: While performing surgeries in the OR, surgeons and assistants often need to access several information regarding surgical planning and/or procedures related to the surgery itself, or the accessory equipment to perform certain operations. The accessibility of this information often relies on the physical presence of technical and medical specialists in the OR, which is increasingly difficult due to the number of limitations imposed by the COVID emergency to avoid overcrowded environments or external personnel. Here, we analyze several scenarios where we equipped OR personnel with augmented reality (AR) glasses, allowing a remote specialist to guide OR operations through voice and ad-hoc visuals, superimposed to the field of view of the operator wearing them.Methods: This study is a preliminary case series of prospective collected data about the use of AR-assistance in spine surgery from January to July 2020. The technology has been used on a cohort of 12 patients affected by degenerative lumbar spine disease with lumbar sciatica co-morbidities. Surgeons and OR specialists were equipped with AR devices, customized with P2P videoconference commercial apps, or customized holographic apps. The devices were tested during surgeries for lumbar arthrodesis in a multicenter experience involving author's Institutions.Findings: A total number of 12 lumbar arthrodesis have been performed while using the described AR technology, with application spanning from telementoring (3), teaching (2), surgical planning superimposition and interaction with the hologram using a custom application for Microsoft hololens (1). Surgeons wearing the AR goggles reported a positive feedback as for the ergonomy, wearability and comfort during the procedure; being able to visualize a 3D reconstruction during surgery was perceived as a straightforward benefit, allowing to speed-up procedures, thus limiting post-operational complications. The possibility of remotely interacting with a specialist on the glasses was a potent added value during COVID emergency, due to limited access of non-resident personnel in the OR.Interpretation: By allowing surgeons to overlay digital medical content on actual surroundings, augmented reality surgery can be exploited easily in multiple scenarios by adapting commercially available or custom-made apps to several use cases. The possibility to observe directly the operatory theater through the eyes of the surgeon might be a game-changer, giving the chance to unexperienced surgeons to be virtually at the site of the operation, or allowing a remote experienced operator to guide wisely the unexperienced surgeon during a procedure.

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Lumbar interbody fusion: recent advances in surgical techniques and bone healing strategies

Cited by 77 publications

References 108 publications

Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up

Augmented Reality in Medical Practice: From Spine Surgery to Remote Assistance

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