Simultaneous Combined Anterior and Posterior Fusion, An Independent Analysis of A Treatment for the Disabled Low-Back Pain Patient

Kozák, J; O’Brien, John P.

doi:10.1097/00007632-199004000-00014

Cited by 169 publications

(57 citation statements)

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“…Average blood loss using the conventional approach in group-1 was 600 ml, which is similar to that reported in literature [20,25]. The 260 ml average blood loss in group 2 was significantly less compared to group 1.…”

Section: Discussionsupporting

confidence: 86%

“…By combining the anterior lumbar interbody fusion with posterior instrumentation, the pseudoarthrosis rate decreases substantially [3,7]. Many reports have documented high fusion rates (88-100%) and low pseudoarthrosis rates using anteroposterior fusion [13,20,23,24,35]. A fusion rate of 92% in group 1 (conventional approach) of this study is similar to that in other series with anteriorposterior fusion.…”

Section: Discussionsupporting

confidence: 82%

“…In this study, there was no incidence of sexual dysfunction. No sexual dysfunctions were reported by Penta et al and DeWald et al in minimal-invasive approaches [9,27]; nor by Hacker and Kozak et al by the conventional approaches [14,20]. In a prospective study, Sasso et al documented that a transperitoneal approach to the lumbar spine L4-S1 has a 10-times greater chance of causing retrograde ejaculation in men than a retroperitoneal approach for anterior lumbar interbody fusion [33].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

et al. 2004

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

et al. 2004

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“…Anterior lumbar interbody fusion was introduced by Carpener in 1932 [9], and since then has been modified and refined by numerous authors for various surgical indications [8,10,17,21,27,35,45]. Regardless of the approach used to achieve anterior lumbar interbody fusion (anterior midline, pararectal, anterolateral, retroperitoneal, transperitoneal, or others), a major challenge is management of the retroperitoneal blood vessels.…”

Section: Introductionmentioning

confidence: 99%

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Mehren

Mayer

Zandanell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

137

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Background During the last 20 years several less-invasive anterior approaches to the lumbar spine have become standard, including the extreme lateral transpsoas approach. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid neurologic complications. Interestingly, despite neuromonitoring, the reported risk of neurologic deficits with the extreme lateral transpsoas approach is greater than observed with other anterior approaches. An alternative lateral, oblique, psoassparing approach, recently named the oblique lumbar interbody fusion, uses the anatomic pathway between the abdominal vessels anteriorly and the lumbar plexus laterally to decrease the risk of neurologic and vascular injury; however, as yet, little on this new approach has been reported. Questions/purposesWe asked: what proportion of patients experienced (1) perioperative complications (overall complications), (2) vascular complications, and (3) neurologic complications after less-invasive anterior lumbar interbody fusion through the oblique lumbar interbody approach at one high-volume center? Methods We performed a chart review of intra-and perioperative complications of all patients who had undergone minimally invasive anterior lumbar interbody fusion through a lateral psoas-sparing approach from L1 to L5 during a 12-year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). During the study period, the oblique, psoas-sparing approach was the preferred approach of the participating surgeons in this study, and it was performed in 812 patients, all of whom are studied here, and all of whom have complete data for assessment of the short-term (inpatient-only) complications that we studied. In general, we performed this approach whenever possible, although it generally was avoided when a patient previously had undergone an open retro-or transperitoneal abdominal procedure, or previous implantation of hernia mesh in the abdomen. During the study period, posterior fusion techniques were used in an additional 573 patients instead of the oblique lumbar interbody fusion when we needed to decompress the spinal canal beyond what is possible through the anterior approach. In case of spinal stenosis calling for fusion in combination with a high disc space, severe endplate irregularity, or severe biomechanical instability, we combined posterior decompression with oblique lumbar interbody fusion in 367 patients. Complications were evaluated by an independent observer who was not involved in the decisionmaking process, the operative procedure, nor the Each author certifies that he or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 ed...

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“…Some authors advocate an anterior procedure for patients in w h o m posterolateral fusion surgery has failed; others advocate an anterior or combined anterior and posterior fusion as the index procedure [3,17,22]. The choice between an anterior or posterior primary fusion for degenerative disc disease is usually based upon opinion rather than on science.…”

Section: Introductionmentioning

confidence: 99%

Vertebral body MRI related to lumbar fusion results

et al. 1997

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The evaluation of continued pain after a technically successful posterolateral lumbar spine fusion is often challenging. Although the intervertebral disc is often a source of low back pain, abnormal endplates may also be a focus of pain, and possibly a source of continued pain after a posterolateral fusion. MRI allows noninvasive evaluation for disc degeneration, as well as for abnormal endplates and adjacent vertebral body marrow. Previous studies have found inflammatory marrow changes, adjacent to abnormal endplates, associated with disc degeneration in low back pain patients. In this study, preoperative MRI scans in 89 posterolateral lumbar fusion patients were reviewed, by an independent radiologist, to determine whether vertebral body marrow changes adjacent to the endplates were related to contined pain. Independent chart review and follow-up telephone interview of all patients at a 4-year follow-up (mean) formed the basis for the clinical results. Vertebral body MRI signals consistent with inflammatory or fatty changes were found in 38% of patients, and always occurred adjacent to a degenerated disc. Inflammatory MRI vertebral body changes were significantly related to continued low back pain at P = 0.03. We conclude that posterolateral lumbar fusion has a less predictable result for the subset of degenerative disc patients with abnormal endplates and associated marrow inflammation. More research is needed to determine the biological and biomechanical effects of a posterolateral fusion upon the endplate within the fused segments. If indeed further study supports the hypothesis that abnormal endplates associated with inflammation are a source of pain, then treating the endplates directly by anterior fusion may be a preferred treatment for this subset of degenerative patients.

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Simultaneous Combined Anterior and Posterior Fusion, An Independent Analysis of A Treatment for the Disabled Low-Back Pain Patient

Cited by 169 publications

References 0 publications

Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Vertebral body MRI related to lumbar fusion results

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