The expandable transforaminal lumbar interbody fusion—maximum 3 year follow up

Boktor, Joseph; Verghese, Navin

doi:10.1016/j.spinee.2016.12.018

Cited by 9 publications

(19 citation statements)

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“…Brantigan and Steffee criteria for interbody fusion were used for evaluation of the fusion rate (Table 2). 1,2,12 Fusion grades 4 and 5 were considered interbody fusion.…”

Section: Analysis Of Clinical and Radiological Resultsmentioning

confidence: 99%

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Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery

Heo¹,

Park²

2019

Neurosurgical Focus

105

123

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OBJECTIVEThe aims of enhanced recovery after surgery (ERAS) are to improve surgical outcomes, shorten hospital stays, and reduce complications. The objective of this study was to introduce ERAS with biportal endoscopic transforaminal lumbar interbody fusion (TLIF) and to investigate the clinical results.METHODSPatients were divided into two groups based on the fusion procedures. Patients who received microscopic TLIF without ERAS were classified as the non-ERAS group, whereas those who received percutaneous biportal endoscopic TLIF with ERAS were classified as the ERAS group. The mean Oswestry Disability Index (ODI) and visual analog scale (VAS) scores were compared between the two groups. In addition, demographic characteristics, diagnosis, mean operative time, estimated blood loss (EBL), fusion rate, readmissions, and complications were investigated and compared.RESULTSForty-six patients were grouped into the non-ERAS group (microscopic TLIF without ERAS) and 23 patients into the ERAS group (biportal endoscopic TLIF with ERAS). The VAS score for preoperative back pain on days 1 and 2 was significantly higher in the non-ERAS group than in the ERAS group (p < 0.05). The mean operative duration was significantly higher in the ERAS group than in the non-ERAS group, while the mean EBL was significantly lower in the ERAS group than in the non-ERAS group (p < 0.05). There was no significant difference in fusion rate between the two groups (p > 0.05). Readmission was required in 2 patients who were from the non-ERAS group. Postoperative complications occurred in 6 cases in the non-ERAS group and in 2 cases in the ERAS group.CONCLUSIONSPercutaneous biportal endoscopic TLIF with an ERAS pathway may have good aspects in reducing bleeding and postoperative pain. Endoscopic fusion surgery along with the ERAS concept may help to accelerate recovery after surgery.

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“…Brantigan and Steffee criteria for interbody fusion were used for evaluation of the fusion rate (Table 2). 1,2,12 Fusion grades 4 and 5 were considered interbody fusion.…”

Section: Analysis Of Clinical and Radiological Resultsmentioning

confidence: 99%

“…Unfortunately, the fusion rate of this study was relatively lower than the rate reported in previously published studies. 1 It was difficult to determine interbody fusion using only follow-up radiographic examination. Moreover, a 1-year follow-up period may be too short for evaluation of fusion rate.…”

Section: Discussionmentioning

confidence: 99%

Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery

Heo¹,

Park²

2019

Neurosurgical Focus

105

123

View full text Add to dashboard Cite

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“…For example, Kim et al 27 and Stein et al 28 each observed postoperative retropulsion of a stackable PEEK layer used for expansion in 1 type of device. In studies 8,9,21,29 of other expandable PLIF and TLIF devices, no device-related complications were observed intraoperatively or postoperatively. Similarly, the current study revealed no device-related AEs.…”

Section: Discussionmentioning

confidence: 95%

Bidirectional Expandable Technology for Transforaminal or Posterior Lumbar Interbody Fusion: A Retrospective Analysis of Safety and Performance

Coric

Roybal²,

Grubb³

et al. 2020

Int J Spine Surg

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Background: Expandable devices for transforaminal or posterior lumbar interbody fusion (TLIF and PLIF, respectively) may enable greater restoration of disc height, foraminal height, and stability within the interbody space than static spacers. Medial-lateral expansion may also increase stability and resistance to subsidence. This study evaluates the clinical and radiographic outcomes from early experience with a bidirectional expandable device.Methods: This was a retrospective analysis of a continuous series of patients across 3 sites who had previously undergone TLIF or PLIF surgery with a bidirectional expandable interbody fusion device (FlareHawk, Integrity Implants, Inc) at 1 or 2 contiguous levels between L2 and S1. Outcomes included the Oswestry Disability Index (ODI), a visual analog scale (VAS) for back pain or leg pain, radiographic fusion by 1 year of follow-up, subsidence, device migration, and adverse events (AE).Results: There were 58 eligible patients with radiographs for 1-year fusion assessments and 45 patients with ODI, VAS back pain, or VAS leg pain data at baseline and a mean follow-up of 4.5 months. The ODI, VAS back pain, and VAS leg pain scores improved significantly from baseline to final follow-up, with mean improvements of 14.6 6 19.1, 3.4 6 2.6, and 3.9 6 3.4 points (P , .001 for each), respectively. In addition, 58% of patients achieved clinically significant improvements in ODI, 76% in VAS back pain, and 71% in VAS leg pain. By 1 year, 96.6% of patients and 97.4% of levels were considered fused. There were zero cases of device subsidence and 1 case of device migration (1.7%). There were zero device-related AEs, 1 intraoperative dural tear, and 3 subsequent surgical interventions.Conclusions: The fusion rate, improvements in patient-reported outcomes, and the AEs observed are consistent with those of other devices. The bidirectional expansion mechanism may provide other important clinical value, but further studies will be required to elucidate the unique advantages.Level of Evidence: 4.

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“…DDD with loss of lordosis and disc height is the most common condition for debilitating back pain frequently associated with referred and radicular leg pain [1]. The goal of MIS LLIF for the treatment of DDD, is to restore and maintain disc height and lordosis to correct sagittal alignment with minimal complications associated with ALIF, PLIF, and TLIF procedures [3][4][5][6][12][13][14][15][16][17][18][19][20][21][22][23][24]. Restoring sagittal alignment is critical to achieving excellent short-and long-term outcomes, as seen in historical literature [15].…”

Section: Discussionmentioning

confidence: 99%

“…A two-year follow-up study by Boktor et al included 54 patients and 62 expandable TLIF interbody spacers between December 2013 to December 2015. Boktor et al also reported low complication rates, short hospital stay, and significant restoration and maintenance of disc height, neuroforaminal height, and segmental lordosis [ 24 ]. Boktor et al found a significant decrease of 37.6% in their patient’s average ODI scores from baseline preoperative values (61.4 ± 17) to two years postoperative (38.3 ± 22.1) (p<0.001) [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Laterally Placed Expandable Interbody Spacers With and Without Adjustable Lordosis Improve Radiographic and Clinical Outcomes: A Two-Year Follow-Up Study

Li¹,

Huang²,

Towner³

et al. 2021

Cureus

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IntroductionInterbody spacers are necessary for achieving disc height restoration when surgical intervention is used for the treatment of severe degenerative disc disease. Minimally invasive lateral lumbar interbody fusion (MIS LLIF) is a popular surgical approach that historically uses large static interbody spacers through a lateral approach. However, static spacers have been associated with iatrogenic distraction and excessive impaction forces, which may increase the risk of subsidence and loss of lordosis, compromising stability. Expandable interbody spacers with or without adjustable lordosis may help address these concerns by maximizing segmental lordosis and aiding in sagittal balance correction. This study describes the clinical and radiographic outcomes of patients treated with expandable interbody spacers with or without adjustable lordosis, for MIS LLIF. Materials and methodsThis is retrospective, single-surgeon Institutional Review Board-exempt chart review was of 103 consecutive patients who had undergone MIS LLIF at one to two contiguous level(s) utilizing expandable interbody spacers with or without adjustable lordosis (66/103 patients had adjustable lordosis spacers). Collection of clinical and radiographic functional outcomes occurred at preoperative and postoperative time points through 24 months. ResultsOne-hundred and three consecutive patients were evaluated-average age, 58.2 ± 12.1 years; 42.1% (45/107) were female. There were 78.6% (81/103) one-level cases and 21.4% (22/103) two-level cases for a total of 125 levels; 44.8% (56/125) were performed at L4-5 and 34.4% (43/125) at L3-4. The average estimated blood loss was 24.6 ± 12.3cc. Mean operative time was 61.0 ± 19.1 min, and mean fluoroscopic time was 28.2 ± 14.6 sec. Visual Analog Scale (VAS) back and leg pain scores decreased significantly by an average of 7.1 ± 1.0 points at 24 months (p<0.001). Oswestry Disability Index (ODI) scores significantly decreased by a mean of 67.4 ± 8.9 points at 24 months (p<0.001). Lumbar lordosis significantly improved by a mean of 3.1 ± 8.8° at 24 months (p=0.001). Anterior, middle, and posterior disc height significantly increased at 24 months by averages of 4.7 ± 3.1, 4.0 ± 3.0, and 2.1 ± 2.2mm, respectively (p<0.001). Neuroforaminal height had significantly increased at 24 months by a mean of 3.0 ± 3.6mm (p<0.001). Segmental lordosis significantly improved by 3.7 ± 2.9° at 24 months (p<0.001). There were 51 patients with abnormal preoperative Pelvic Incidence-Lumbar Lordosis (PI-LL) measurements that significantly improved by 9.1 ± 4.9° (p<0.001) and 52 patients with normal preoperative PI-LL measurements that improved by 0.2 ± 4.6° (p=0.748) at 24 months. One-hundred percent fusion occurred at all levels, and no findings of radiolucency were observed. One case of subsidence (1/125, 0.8%) was reported at 24 months. No implanted-related complications were reported, with 0% pseudoarthrosis and no secondary surgery required at the operative levels. ConclusionIndirect decompression and sagittal correction...

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The expandable transforaminal lumbar interbody fusion—maximum 3 year follow up

Cited by 9 publications

References 0 publications

Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery

Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery

Bidirectional Expandable Technology for Transforaminal or Posterior Lumbar Interbody Fusion: A Retrospective Analysis of Safety and Performance

Laterally Placed Expandable Interbody Spacers With and Without Adjustable Lordosis Improve Radiographic and Clinical Outcomes: A Two-Year Follow-Up Study

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