Posterior lumbar interbody fusion combined with instrumented postero-lateral fusion: 5-year results in 60 patients

Freeman, Brian J. C.; Licina, P.; Mehdian, S. H.

doi:10.1007/s005860050007

Cited by 74 publications

(47 citation statements)

References 27 publications

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“…Intraoperative complications in the TLIF group were all neurological and our rate (4.6%) was similar to previous publications describing complications after PLIF procedures [13,20,26]. Strikingly, there was a significantly higher rate of early revision surgery in the TLIF group.…”

Section: Discussionsupporting

confidence: 88%

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Faúndez¹,

Schwender

Safriel³

et al. 2009

Eur Spine J

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Abundant data are available for direct anterior/ posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre-and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups.

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Section: Discussionsupporting

confidence: 88%

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Faúndez¹,

Schwender

Safriel³

et al. 2009

Eur Spine J

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“…These results are similar to those in previously reported large series involving a standard TLIF or PLIF procedure. 1,6 In follow-up evaluations, 13 of our patients had some degree of fusion demonstrated on a CT scan obtained 6 months postoperatively. Other studies have generally shown very high fusion rates for interbody constructs.…”

Section: Neurosurg Focus / Volume 20 / March 2006mentioning

confidence: 83%

“…In this study, 86% of patients demonstrated good clinical outcomes at 2 years, and these investigators reported a fusion rate of 98.9%. Freeman, et al, 6 also reported an 83% success rate after a 5-year follow-up period in 60 patients treated with a PLIF procedure in which posterior pedicle screws were used. Similar results have been described with TLIF procedures.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation

Deutsch¹,

Musacchio²

2006

FOC

125

107

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Object Posterior lumbar interbody fusion (PLIF) has been shown to be effective in the treatment of axial low-back pain. Minimally invasive spine surgery for arthrodesis has several advantages, including quicker patient recovery, less postoperative pain, and less destruction of adjacent tissue. The purpose of this paper is to evaluate the clinical outcomes after PLIF procedures in which unilateral pedicle screw fixation was used. Methods Prospective data were collected in 34 patients undergoing a one-level minimally invasive transforaminal lumbar interbody fusion (TLIF) in 2003. Conservative therapy, including physical therapy and aggressive multimodality pain management, had failed in all patients. Selection was based on magnetic resonance imaging studies demonstrating degenerative disc disease. All patients underwent a unilateral TLIF procedure in conjunction with posterior unilateral pedicle screw fixation. Twenty patients in whom the follow-up duration was longer than 6 months were included in this study. The follow-up duration in all patients ranged from 6 to 12 months. Seventeen (85%) of 20 patients had a good result, which was defined as a greater than 20-point reduction in the Oswestry Disability Index (ODI) score. The other three patients had no improvement. The mean preoperative ODI score of 57 improved to 25 after surgery (p < 0.005). In the 17 patients who demonstrated improvement, the mean ODI score improved from 57 to 18. The patients' visual analog scale pain scores improved from 8.3 to 1.4 (p < 0.005) after surgery. In patients who received Workers' Compensation, three (75%) of four improved. Follow-up computerized tomography scans were obtained in all 20 patients at 6 months. At that time, 13 of the patients demonstrated some degree of fusion, and no symptomatic pseudarthrosis was noted. Conclusions Minimally invasive TLIF in conjunction with unilateral pedicle screw instrumentation is an effective treatment for axial low-back pain in appropriately selected patients.

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“…The standard fusion techniques used in this study are widely accepted spine surgical techniques [8,13,47,50]. Fritzell et al [14] compared different fusion techniques in a prospective randomized study, and they concluded that ALIF and PLIF procedures are inferior to non-instrumented or instrumented posterolateral fusion (PLF).…”

Section: Discussionmentioning

confidence: 99%

Segment-by-segment stabilization for degenerative disc disease: a hybrid technique

Schwarzenbach¹,

Rohrbach²,

Berlemann³

2010

Eur Spine J

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Patients with multisegmental degenerative disc disease (DDD) resistant to conservative therapy are typically treated with either fusion or non-fusion surgical techniques. The two techniques can be applied at adjacent levels using Dynesys Ò (Zimmer GmbH, Winterthur, Switzerland) implants in a segment-by-segment treatment of multiple level DDD. The objective of this study was to evaluate the clinical and radiological outcome of patients treated using this segment-by-segment application of Dynesys in some levels as a non-fusion device and in other segments in combination with a PLIF as a fusion device. A consecutive case series is reported. The sample included 16 females and 15 males with a mean age of 53.6 years (range 26.3-76.4 years). Mean follow-up time was 39 months (range 24-90 months). Preoperative Oswestry disability index (ODI), back-and leg-pain scores (VAS) were compared to postoperative status. Fusion success and system failure were assessed by an independent reviewer who analyzed AP and lateral X-rays. Back pain improved from 7.3 ± 1.7 to 3.4 ± 2.7 (p \ 0.000002), leg pain from 6.0 ± 2.9 to 2.3 ± 2.9 (p \ 0.00006), and ODI from 51.6 ± 13.2% to 28.7 ± 18.0% (p \ 0.00001). Screw loosening occurred in one of a total of 222 implanted screws (0.45%). The results indicate that segment-by-segment treatment with Dynesys Ò in combination with interbody fusion is technically feasible, safe, and effective for the surgical treatment of multilevel DDD.

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Posterior lumbar interbody fusion combined with instrumented postero-lateral fusion: 5-year results in 60 patients

Cited by 74 publications

References 27 publications

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation

Segment-by-segment stabilization for degenerative disc disease: a hybrid technique

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