Microscopic anterior foraminal decompression combined with anterior lumbar interbody fusion

Shin, Sang-Ha; Choi, Won-Gyu; Hwang, Byeong-Wook; Tsang, Yi-Sheng; Chung, Ewy-Ryong; Lee, Hyeong-Chang; Lee, Sang-Jin; Lee, Sang-Ho

doi:10.1016/j.spinee.2013.07.458

Cited by 30 publications

(27 citation statements)

References 22 publications

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“…They described normal values as FA from 1.25 to 2.25 cm 2 , FH from 11 to 19 mm and FW from 5 to 12 mm [20]. The foraminal area on preoperative CT observed in our study was lower than normal values, but similar to the other studies analysing symptomatic degenerative disc disease population [6,13,20,24]. Foraminal area improvement by 49% is similar to that presented by Cho et al [6] Fig.…”

Section: Discussionsupporting

confidence: 90%

“…Sang-Ha Shin et al in their clinical study recommended direct removal of the lesion using a microsurgical technique for anterior foraminal decompression (AFD). For this technique, approximate identification of intervertebral foramen after removal of posterior annulus fibrosus or even posterior longitudinal ligament (PLL) is mandatory; therefore, one can consider AFD as difficult and risky manoeuvre [24]. An obstacle in performing this procedure is pathology at the L5/S1 level with a steep inclination of disc space, obesity and severe facet arthropathy [7].…”

Section: Discussionmentioning

confidence: 99%

“…It can also increase a disc space height and a foraminal area ensuring indirect nerve root decompression. Besides, lordotic cages can restore an angle of lumbar lordosis and improve sagittal balance [12,20,24].…”

Section: Introductionmentioning

confidence: 99%

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Anterior lumbar interbody fusion (ALIF): biometrical results and own experiences

Kapustka

Kiwic²,

Chodakowski³

et al. 2019

Neurosurg Rev

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Lumbar fusion is a mainstay in the treatment of low back pain resulting from degenerative disc disease. Anterior lumbar interbody fusion (ALIF) has become a reasonable treatment technique to achieve indirect foraminal decompression with high fusion rates. The aim of the study was to analyse the biometrical parameters of the lumbar spine and the clinical outcome. The medical records of 51 patients treated with ALIF between 2012 and 2016 were retrospectively reviewed. Anterior and posterior disc height (DH), lumbar lordosis (LL), local disc angle (LDA) and foraminal dimensions were obtained on pre-and postoperative plain radiographs and computed tomography scans using ImageJ and Surgimap software according to the pedicle-pedicle technique. To evaluate the interbody fusion status on the last follow-up CT scans, we used Bridwell criteria. Preoperative and 12 months postoperative Oswestry Disability Index (ODI) scores were determined for all patients. The average length of hospitalisation was 4 days. Most of the patients had degenerative disc disease with foraminal stenosis. Five patients had early complications like paresthesia of lower limbs, sympathetic dysfunction or wound infections, but there were no major complications. Statistically significant (P < .01) improvement was observed in foraminal dimensions (area = 49%, height = 33% and width = 19%), anterior DH (49%), posterior DH (69%), LDA (47%) and LL (17.5%). Posterior DH correlated significantly with foramen height improvement. Radiographic evidence of fusion according to the modified Bridwell criteria (grade I and grade II) was observed in 96% (49/51) of the patients in the last CT of the lumbar spine. We also observed significant improvement in functional recovery in 94% of patients. The mini-open ALIF approach is a reasonable alternative to the more extensive posterior approaches. ALIF significantly restores the height of the intervertebral disc, indirectly increases foraminal dimensions, increases lordosis angle with significant short and long-term pain relief and functional recovery.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anterior lumbar interbody fusion (ALIF): biometrical results and own experiences

Kapustka

Kiwic²,

Chodakowski³

et al. 2019

Neurosurg Rev

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“…However, surgical decompression generally includes bilateral laminectomy and posterior interbody fusion (PIF) using screws and rods in general anaesthesia. Complications related to scars and/or osteoporosis have been described with a conventional surgical approach [16][17][18] . For this reason, re-treatment with local anaesthesia should be preferred, particularly in elderly patients.…”

Section: Figurementioning

confidence: 99%

Posterior Arch Augmentation (Spinoplasty) before and after Single and Double Interspinous Spacer Introduction at the Same Level: Preventing and Treating the Failure?

Manfrè

2014

Interv Neuroradiol

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Lumbar spinal canal stenosis (LSCS) is one of the most common degenerative diseases in elderly patients. Failure of he treatment can occur, generally related to bone remodelling/fracture of spinous processes. PMMA augmentation of the posterior arch (spinoplasty, SP) has recently been proposed in case of neoplastic involvement. This study evaluated the efficacy of SP as a prophylactic treatment before introducing an interspinous spacer (IS). Moreover, we consider the possibility to treat patients who previously underwent IS implants with subsequent failure of the device, by introducing a second spacer at the same level, performing accessory SP. From January 2009 to September 2011, 174 patients with LSCS underwent CT-guided percutaneous IS implant in our department. From January 2011, all patients with osteoporosis underwent prophylactic SP before introducing the spacer. Moreover, in patients with re-stenosis related to bone remodelling and/or fracture, after strengthening the spinous processes with PMMA introduction, a second similar device was introduced to re-open the stenotic spinal canal. In patients with prophylactic treatment before spacer introduction, no restenosis occurred at three to 12 month follow-up. Patients who underwent second spacer implant at the same level after posterior arch augmentation again obtained a resolution of symptoms, and no further bone remodelling had occurred at follow-up controls. In conclusion, prophylactic SP prevents single spacer failure for bone remodelling/fracture, and allows failure repair by introducing a second spacer at the same level.

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“…Mayer, however, recommended the anterior approach in his book about minimally invasive spine surgery as an option to address foraminal pathologies [7]. In a larger series of 40 cases, sufficient selective surgical foraminal decompression and removal of osteophytic or discogenic pathologies at L4/5 or L5/S1 through an anterior approach was performed in combination with anterior cage implantation and posterior percutaneous pedicle screw fixation [9].…”

mentioning

confidence: 99%

Expert’s comment concerning Grand Rounds case entitled “Management of an unusual sciatica” by A. Bourghli, A. Chaballout, I. Obeid, L. Boissiere, J.-M. Vital and G. Khoury (Eur Spine J; doi:10.1007/s00586-016-4446-z)

Korge

2016

Eur Spine J

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The authors have described a rare pathology of a far anterior extraforaminal entrapment of the L5 nerve root at the L5/S1 level with corresponding symptoms due to a remarkable lateral compressing L5/S1 osteophyte [1]. Preoperative imaging including MRI and CT scan documented a close relation between the nerve root L5 itself, the osteophyte and the left common iliac vein. Due to the anatomical situation, they decided to solve the problem by resecting the osteophyte with accompanying nerve root release by using an anterior left-sided retroperitoneal approach under direct visual control of the nerve root and the corresponding vascular structures. Effectiveness of surgery was documented by the resected osteophyte, postoperative imaging and the postoperative clinical outcome with complete pain relief already in the short-term follow-up period.The preoperative history with a 3-years period without precise diagnosis (in which the authors apparently were not involved) is surprisingly long, especially when facing the three facts that there was obviously a clear L5 sciatica as well as an existing MRI and a pathology which was based on degenerative changes in form of an osteophyte and not on an acute anterior disc herniation. The frustrating course of non-successful conservative treatment over such a long time with a simple pain source represents a well-known dilemma and should always remember doctors to reevaluate their treatment concept after a period of longest 3 months (which is the time of onset of a pain chronification).Extraforaminal pathologies are rare and mostly located in the segment L4/5 with less frequency at L3/4 and even less at L5/S1. The approach to L5/S1 is technically demanding and requires in many cases a selective decision. Both posterior and anterior approaches to this anatomical region are known. More than 20 years ago, a sophisticated overview was published including posterior and anterior approach strategies [3].In earlier years, macroscopic posterior approaches were most popular. Since the introduction of the microscope into spine surgery, minimally invasive microscope-assisted posterior approaches using a transforaminal route became the access strategy of choice for extraforaminal pathologies. These approaches are technically demanding and mostly require the necessity to enlarge the transforaminal access corridor (especially at L5/S1). While mostly discogenic pathologies are treated, case reports exist as

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Microscopic anterior foraminal decompression combined with anterior lumbar interbody fusion

Cited by 30 publications

References 22 publications

Anterior lumbar interbody fusion (ALIF): biometrical results and own experiences

Anterior lumbar interbody fusion (ALIF): biometrical results and own experiences

Posterior Arch Augmentation (Spinoplasty) before and after Single and Double Interspinous Spacer Introduction at the Same Level: Preventing and Treating the Failure?

Expert’s comment concerning Grand Rounds case entitled “Management of an unusual sciatica” by A. Bourghli, A. Chaballout, I. Obeid, L. Boissiere, J.-M. Vital and G. Khoury (Eur Spine J; doi:10.1007/s00586-016-4446-z)

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