Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion as an Adjunct to Posterior Instrumented Correction of Degenerative Lumbar Scoliosis

Crandall, Dennis G.; Revella, Jan

doi:10.1097/brs.0b013e3181b612db

Cited by 98 publications

(66 citation statements)

References 32 publications

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“…Other evidence resulting from our study is the higher incidence of complications in patients who underwent interbody fusion (PLIF or TLIF) in addition to conventional posterior fusion. Posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) techniques have been introduced in the last years to achieve a better lumbar fusion and stabilisation, using specifically designed cages packed with bone graft [17][18][19]. However, none of these instrumentations has solved the problem of non-union in the complex pathology of degenerative scoliosis.…”

Section: Discussionmentioning

confidence: 99%

Do benefits overcome the risks related to surgery for adult scoliosis? A detailed analysis of a consecutive case series

et al. 2013

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Purpose The surgical approach to adult spine deformities is complex and presents a high incidence of complications. Methods We report here a prospective consecutive case series analysis of 20 patients submitted to posterior correction and instrumented fusion for adult degenerative scoliosis. Clinical outcomes were assessed by self-reported measures. Pre-operative and post-operative complications were analysed during a mean 30-month follow-up period. Results Eleven patients (55 %) presented pre-operative or post-operative complications. Fifteen different complications occurred, six in the early pre-operative period and nine during follow-up period: ten of these complications occurred in patients who underwent a previous surgery for spine disease. Conclusions The clinical improvement at the final follow-up resulted as statistically significant only for the group of patients exposed to posterior fusion without interbody fusion. The observations reported here have to be considered for a shared decision-making in the management of adult scoliosis.

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Section: Discussionmentioning

confidence: 99%

Do benefits overcome the risks related to surgery for adult scoliosis? A detailed analysis of a consecutive case series

et al. 2013

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“…Traditional approaches to deformity correction include A/P approaches and posterior-only approaches, both of which have been shown to be effective. 5,16 However, the anterior approach is associated with complications such as vascular injury, ileus, and retrograde ejaculation. 21 Posterior approaches (PLIF and TLIF) place the nerve roots and thecal sac at greater risk because these structures must necessarily be exposed, and then protected, during graft insertion.…”

Section: Discussionmentioning

confidence: 99%

Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

Tormenti¹,

Maserati²,

Bonfield³

et al. 2010

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251

180

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Object The authors recently used a combined approach of minimally invasive transpsoas extreme lateral interbody fusion (XLIF) and open posterior segmental pedicle screw instrumentation with transforaminal lumbar interbody fusion (TLIF) for the correction of coronal deformity. The complications and radiographic outcomes were compared with a posterior-only approach for scoliosis correction. Methods The authors retrospectively reviewed all deformity cases that were surgically corrected at the University of Pittsburgh Medical Center Presbyterian Hospital between June 2007 and August 2009. Eight patients underwent combined transpsoas and posterior approaches for adult degenerative thoracolumbar scoliosis. The comparison group consisted of 4 adult patients who underwent a posterior-only scoliosis correction. Data on intra- and postoperative complications were collected. The pre- and postoperative posterior-anterior and lateral scoliosis series radiographic films were reviewed, and comparisons were made for coronal deformity, apical vertebral translation (AVT), and lumbar lordosis. Clinical outcomes were evaluated by comparing pre- and postoperative visual analog scale scores. Results The median preoperative coronal Cobb angle in the combined approach was 38.5° (range 18–80°). Following surgery, the median Cobb angle was 10° (p < 0.0001). The mean preoperative AVT was 3.6 cm, improving to 1.8 cm postoperatively (p = 0.031). The mean preoperative lumbar lordosis in this group was 47.3°, and the mean postoperative lordosis was 40.4°. Compared with posterior-only deformity corrections, the mean values for curve correction were higher for the combined approach than for the posterior-only approach. Conversely, the mean AVT correction was higher in the posterior-only group. One patient in the posterior-only group required revision of the instrumentation. One patient who underwent the transpsoas XLIF approach suffered an intraoperative bowel injury necessitating laparotomy and segmental bowel resection; this patient later underwent an uneventful posterior-only correction of her scoliotic deformity. Two patients (25%) in the XLIF group sustained motor radiculopathies, and 6 of 8 patients (75%) experienced postoperative thigh paresthesias or dysesthesias. Motor radiculopathy resolved in 1 patient, but persisted 3 months postsurgery in the other. Sensory symptoms persisted in 5 of 6 patients at the most recent follow-up evaluation. The mean clinical follow-up time was 10.5 months for the XLIF group and 11.5 months for the posterior-only group. The mean visual analog scale score decreased from 8.8 to 3.5 in the XLIF group, and it decreased from 9.5 to 4 in the posterior-only group. Conclusions Radiographic outcomes such as the Cobb angle and AVT were significantly improved in patients who underwent a combined transpsoas and posterior approach. Lumbar lordosis was maintained in all patients undergoing the combined approach. The combination of XLIF and TLIF/posterior segmental instrumentation techniques may lead to less blood loss and to radiographic outcomes that are comparable to traditional posterior-only approaches. However, the surgical technique carries significant risks that require further evaluation and proper informed consent.

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“…6,8,13 The socioeconomic impact is staggering, and direct medical costs have tripled in the past decade. 14,16,18 Concurrently, the rates of lumbar fusions for degenerative lumbar disease have quadrupled, contributing to a significant increase in back-related health care utilization and costs.…”

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confidence: 99%

Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes?

Adogwa

Elsamadicy

Han

et al. 2016

SPI

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OBJECTIVE With the recent passage of the Patient Protection and Affordable Care Act, there has been a dramatic shift toward critical analyses of quality and longitudinal assessment of subjective and objective outcomes after lumbar spine surgery. Accordingly, the emergence and routine use of real-world institutional registries have been vital to the longitudinal assessment of quality. However, prospectively obtaining longitudinal outcomes for patients at 24 months after spine surgery remains a challenge. The aim of this study was to assess if 12-month measures of treatment effectiveness accurately predict long-term outcomes (24 months). METHODS A nationwide, multiinstitutional, prospective spine outcomes registry was used for this study. Enrollment criteria included available demographic, surgical, and clinical outcomes data. All patients had prospectively collected outcomes measures and a minimum 2-year follow-up. Patient-reported outcomes instruments (Oswestry Disability Index [ODI], SF-36, and visual analog scale [VAS]-back pain/leg pain) were completed before surgery and then at 3, 6, 12, and 24 months after surgery. The Health Transition Index of the SF-36 was used to determine the 1- and 2-year minimum clinically important difference (MCID), and logistic regression modeling was performed to determine if achieving MCID at 1 year adequately predicted improvement and achievement of MCID at 24 months. RESULTS The study group included 969 patients: 300 patients underwent anterior lumbar interbody fusion (ALIF), 606 patients underwent transforaminal lumbar interbody fusion (TLIF), and 63 patients underwent lateral interbody fusion (LLIF). There was a significant correlation between the 12- and 24-month ODI (r = 0.82; p < 0.0001), SF-36 Physical Component Summary score (r = 0.89; p < 0.0001), VAS-back pain (r = 0.90; p < 0.0001), and VAS-leg pain (r = 0.85; p < 0.0001). For the ALIF cohort, patients achieving MCID thresholds for ODI at 12 months were 13-fold (p < 0.0001) more likely to achieve MCID at 24 months. Similarly, for the TLIF and LLIF cohorts, patients achieving MCID thresholds for ODI at 12 months were 13-fold and 14-fold (p < 0.0001) more likely to achieve MCID at 24 months. Outcome measures obtained at 12 months postoperatively are highly predictive of 24-month outcomes, independent of the surgical procedure. CONCLUSIONS In a multiinstitutional prospective study, patient-centered measures of surgical effectiveness obtained at 12 months adequately predict long-term (24-month) outcomes after lumbar spine surgery. Patients achieving MCID at 1 year were more likely to report meaningful and durable improvement at 24 months, suggesting that the 12-month time point is sufficient to identify effective versus ineffective patient care.

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Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion as an Adjunct to Posterior Instrumented Correction of Degenerative Lumbar Scoliosis

Abstract: With current deformity correction techniques, both ALIF and TLIF are effective in DLS surgery. Anterior surgery is not routinely required to treat all cases of DLS.

Cited by 98 publications

References 32 publications

Do benefits overcome the risks related to surgery for adult scoliosis? A detailed analysis of a consecutive case series

Do benefits overcome the risks related to surgery for adult scoliosis? A detailed analysis of a consecutive case series

Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes?

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