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BACKGROUND:Previous literature reported that the fusion cage moved more than 2 mm from its original position,which means that the fusion cage moved backward.At present,clinical observation has found that the factors leading to the displacement of the fusion cage are complex,and the relationship between these factors and the cage retropulsion is not clear. OBJECTIVE:To explore the risk factors related to cage retropulsion after lumbar interbody fusion. METHODS:Retrospective analysis was conducted in 200 patients who underwent transforaminal lumbar interbody fusion surgery with a polyetheretherketone interbody fusion from February 2020 to February 2022.According to the distance from the posterior edge of the vertebral fusion cage to the posterior edge of the vertebral body after the operation(the second day after the removal of the drainage tube)and 1,3,6 and 12 months after the operation,patients were divided into cage retropulsion group(≥2 mm)and cage non-retropulsion group(<2 mm).The factors that may affect cage retropulsion,such as age,gender,body mass index,bone mineral density,operation time,bleeding,endplate injury,preoperative and postoperative interbody height,cage implantation depth,cage size,and segmental anterior convexity angle,were analyzed by univariate and logistic regression analysis. RESULTS AND CONCLUSION:(1)Posterior displacement of the fusion cage occurred in 15 cases(15/200).The differences in basic information such as age and body mass index between the two groups were not statistically significant.(2)The results of the univariate analysis were that gap height difference,time to wear a brace,segmental anterior convexity angle difference,bone mineral density,and age were related to posterior migration of the cage.(3)The results of logistic regression analysis were that cage size,endplate injury condition,and depth of cage implantation were risk factors for cage retropulsion.(4)These findings suggest that cage retropulsion after lumbar interbody fusion is caused by multiple factors,including segmental anterior convexity angle difference,bone mineral density,cage size,endplate damage,time to wear a brace,and depth of cage implantation.
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BACKGROUND:Minimally invasive surgery is developing rapidly.Robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are important posterior minimally invasive surgical approaches to treat lumbar degenerative diseases.However,it is worth discussing which operation method is more advantageous. OBJECTIVE:To compare the clinical efficacy and imaging examination between different operation groups,and discuss the clinical application value of robot-assisted minimally invasive lumbar posterior fusion technology to treat lumbar degenerative diseases. METHODS:Clinical data of 83 patients with lumbar degenerative diseases from January 2018 to June 2022 at the Department of Orthopedics,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital were retrospectively analyzed.Of them,27 patients received robot-assisted minimally invasive transforaminal lumbar interbody fusion treatment(group A);30 patients received robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion treatment(group B),and 26 traditional minimally invasive transforaminal lumbar interbody fusion patients were selected as the control group(group C).There were no significant differences in gender,age,body mass index,surgical segment,preoperative visual analog scale score and Oswestry Disability Index among the three groups(P＞0.05).The operation time,intraoperative blood loss,complications,fluoroscopic dose,fluoroscopic time,and fluoroscopic frequency were compared among the three groups.Gertzbein-Robbins'classification was used to evaluate the accuracy of percutaneous pedicle screw.Visual analog scale and Oswestry Disability Index scores were evaluated after surgery.The excellent and good rate of the three surgical options was evaluated using Macnab's criteria. RESULTS AND CONCLUSION:(1)The operation time of group A was significantly shorter than that of groups B and C(P＜0.05),but there was no significant difference between group B and group C(P＞0.05).The intraoperative blood loss in group B was significantly less than that in group A,and that in group A was significantly less than that in group C(P＜0.05).(2)The fluoroscopic dose,fluoroscopic time,and fluoroscopic frequency of group C were significantly higher than those of groups A and B(P＜0.05).(3)Visual analog scale score and Oswestry Disability Index in the three groups significantly improved after operation when compared with that before operation(P＜0.05),but there was no significant difference among the three groups 1 day and 6 months after surgery(P＞0.05).(4)Postoperative imaging showed that the accuracy of percutaneous pedicle screw placement in groups A and B was better than that in group C(P＜0.05).(5)There was no significant difference in the excellent and good rate of MacNab criteria among the three groups(P＞0.05).(6)There was no significant difference in complications among the three groups(P＞0.05).(7)The results indicated that robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are effective surgery methods for lumbar degenerative diseases.Compared with traditional minimally invasive transforaminal lumbar interbody fusion,robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery has higher efficiency,less intraoperative radiation and higher internal fixation accuracy,which has a good clinical application value.
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BACKGROUND:At present,lumbar interbody fusion is widely used in the treatment of a variety of lumbar diseases.However,how to reduce postoperative complications such as pseudarthrosis formation,screw loosening and fracture,and cage failure remains a serious challenge. OBJECTIVE:To analyze the effect of total lumbar range of motion on the stress or strain of bone grafts,cage,and screw-rod system,so as to better guide patients to carry out lumbar activities to reduce the risks of pseudarthrosis formation and instrumentation failure. METHODS:An intact human L1-S1 finite element model was constructed using Mimics,3-Matic,HyperMesh,and Abaqus software and the transforaminal lumbar interbody fusion was simulated.The average strain of the interbody bone grafts and the peak stresses of the cage and screw-rod system were compared before and after applying the bending moment,and the changing trend with the total range of motion was analyzed.The stress nephogram was drawn to observe the stress distribution. RESULTS AND CONCLUSION:(1)Compared with applying the vertical compression load alone,the average strain of the interbody bone grafts,peak stresses of the cage and screw-rod system after applying bending moment increased by 2.6%-55.3%,65.6%-166.8%,and 36.0%-353.4%,respectively.(2)With the increase of total range of motion,the average strain of the interbody bone grafts increased nonlinearly and produced the maximum value under left and right axial rotation,while the peak stresses of the cage and screw-rod system increased linearly and produced the maximum value under left and right lateral bending.(3)The stress distribution of the interbody bone grafts and cage was related to the loading condition.The stress of the screw-rod system was mainly concentrated in the interfaces of the screw-bone and screw-rod.(4)Therefore,increasing axial rotation activity after operation may reduce the risk of pseudarthrosis formation,while reducing lateral bending activity may reduce the failure of the cage and screw-rod system.
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OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.
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Male , Female , Humans , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Spinal Stenosis/surgery , Blood Loss, Surgical , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Treatment Outcome , Pain, Postoperative , Muscles , Minimally Invasive Surgical Procedures/methodsABSTRACT
OBJECTIVE@#To investigate possible causes and preventive measures for asymptomatic pain in the limbs after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF).@*METHODS@#Clinical data from 50 patients with lumbar degenerative disease who underwent MIS-TLIF between January 2019 and September 2020 were retrospectively analyzed. The group included 29 males and 21 females aged from 33 to 72 years old, with an average age of (65.3±7.13) years. Twenty-two patients underwent unilateral decompression, and 28 underwent bilateral decompression. The side(ipsilateral or contralateral) and site(low back, hip, or leg) of the pain were recorded before surgery, 3 days after surgery, and 3 months after surgery. The pain degree was evaluated using the visual analogue scale(VAS) at each time point. The patients were further grouped based on whether contralateral pain occurred postoperatively (8 cases in the contralateral pain group and 42 in the no contralateral pain group), and the causes and preventive measures of pain were analyzed.@*RESULTS@#All surgeries were successful, and the patients were followed up for at least 3 months. Preoperative pain on the symptomatic side improved significantly, with the VAS score decreasing from (7.00±1.79) points preoperatively to (3.38±1.32) points at 3 days postoperatively and (3.98±1.17) points at 3 months postoperatively. Postoperative asymptomatic side pain (contralateral pain) occurred in 8 patients within 3 days after surgery, accounting for 16% (8/50) of the group. The sites of contralateral pain included the lumbar area (1 case), hip(6 cases), and leg (1 case). The contralateral pain was significantly relieved 3 months after surgery.@*CONCLUSION@#More cases of contralateral limb pain occur after unilateral decompression MIS-TLIF, and the reason may include contralateral foramen stenosis, compression of medial branches, and other factors. To reduce this complication, the following procedures are recommended: restoring intervertebral height, inserting a transverse cage, and withdrawing screws minimally.
Subject(s)
Male , Female , Humans , Middle Aged , Aged , Adult , Retrospective Studies , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Minimally Invasive Surgical Procedures/methods , Pain, Postoperative , Treatment OutcomeABSTRACT
Objective To investigate the clinical efficacy of endoscopic assisted minimally invasive trans foraminal lumbar interbody fusion(MIS-TLIF)and traditional open TLIF in the treatment of senile degenerative spondylolisthesis.Methods From January 2020 to March 2021,100 elderly patients with degenerative spondylolisthesis were selected and divided into MIS-TLIF group and TLIF group according to the surgical method,with 50 cases in each group.The preoperative and postoperative VAS,Japanese Orthopedic Association score(JO A)and Oswestry disability index(ODI),and the rate of interbody fusion and the incidence of complications were compared and analyzed between the two groups.Results In MIS-TLIF group,the operative time,intraoperative blood loss,incision length,postoperative drainage volume and hospital stay were(167.5±54.2)minutes,(173.8±47.1)ml,(3.5±0.7)cm,(69.6±16.3)ml,and(8.3±2.7)days,respectively.In the TLIF group,it was(136.3±38.9)minutes,(281.0±50.3)ml,(10.0±2.1)cm,(148.4±28.2)ml,and(11.2±3.1)days,respectively.The difference between the two groups was statistically significant(P＜0.05).The VAS,JO A and ODI scores of MIS-TLIF group were(2.17±0.62)points,(21.72±3.14)points and(13.22 ±2.43)points,respectively.The results in TLIF group were(3.24±1.06)points,(17.06±2.85)points and(16.83±2.87)points,respectively,and there was statistical significance between the two groups(P＜0.05).There was no significant difference in the rate of interbody fusion between the two groups at 12 months after operation(P＞0.05).The incidence of postoperative complications in MIS-TLIF group(8.00％)was significantly lower than that in TLIF group(24.00％,P＜0.05).Conclusion MIS-TLIF assisted by endoscope has the advantages of less trauma,faster recovery and less postoperative complications,and the short-term curative effect is more satisfactory than TLIF.
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OBJECTIVE@#To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation.@*METHODS@#A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score).@*RESULTS@#Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences ( P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). And there was no significant difference between the two groups at each time point after operation ( P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months ( P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group ( P<0.05).@*CONCLUSION@#For the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.
Subject(s)
Humans , Spinal Stenosis/surgery , Low Back Pain/surgery , Blood Loss, Surgical , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Retrospective Studies , Spinal FusionABSTRACT
OBJECTIVE@#To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.@*METHODS@#Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI.@*RESULTS@#The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697).@*CONCLUSION@#UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.
Subject(s)
Humans , Imaging, Three-Dimensional , Lumbar Vertebrae/surgery , Minimally Invasive Surgical Procedures , Pedicle Screws , Retrospective Studies , Spinal Fusion , Surgery, Computer-Assisted , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Objectives:To compare the clinical efficacies of percutaneous endoscopic posterior lumbar inter-body fusion(PE-PLIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treat-ment of grade Ⅰ and Ⅱ lumbar spondylolisthesis.Methods:The clinical data of 70 patients with single lev-el lumbar spondylolisthesis treated with PE-PLIF or MIS-TLIF in the Department of Minimally Invasive Spinal Surgery of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2020 and Jan-uary 2022 were analyzed retrospectively,including 33 males and 37 females,aged 59.6±11.0 years old.Ac-cording to different surgical methods,the patients were divided into PE-PLIF group of 36 cases and MIS-TLIF group of 34 cases.The operative time,intraoperativc blood loss,postoperative 3d serum indexes such as creatine kinase(CK),C-reactive protein(CRP)and interleukin-6(IL-6)were collected and compared between groups,as well as low back and leg pain visual analogue scale(VAS)and Oswestry disability index(ODI)be-fore operation,at 1 week,and 3 and 6 months,and 1 year after operation.3D reconstruction CT was used to evaluate interbody fusion according to the Bridwell's fusion grading system at 2 years after operation,and postoperative complications were also documented.Results:PE-PLIF group was significantly less than MIS-TLIF group in intraoperative blood loss(91.6±45.8mL vs 195.5±126.3mL,P=0.000),longer in operative time(227.5±58.0min vs 194.1±55.2min,P=0.016),and lower postoperative 3d CK,CRP,IL-6(P＜0.05).The VAS score and ODI in both groups were significantly improved compared with those before operation,while the VAS score in PE-PLIF group improved more obvious than that in MIS-TLIF group at one week after operation(P=0.02),and no statistically significant difference was there in the VAS scores between groups at other time points(P＞0.05).PE-PLIF group wasn't significantly different from MIS-TLIF group in the fusion conditions at 2 years after operation(86％vs 94％,P=0.430);There were no serious complications requiring revision surgery in both groups.Conclusions:PE-PLIF is less traumatic and relieves low back pain better at early postoperation than MIS-TLIF in the treatment of grade Ⅰ and grade Ⅱ lumbar spondylolisthesis,while PE-PLIF isn't significantly differ from MIS-TLIF in mid-to-long term clinical efficacy.
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Objectives The relevance of spinopelvic parameters in the patients' clinical and functional outcomes has been widely studied in long spinal fusion. Yet, the importance of the spinopelvic parameters in short-segment fusion surgeries needs further investigation. We analyzed the spinopelvic parameters and surgical outcomes of patients undergoing short-segment lumbar interbody fusion. Materials and Methods An observational, prospective study was conducted between January and June 2021. We selected 25 patients with lumbar stenosis, with or without concomitant spondylolisthesis, undergoing transforaminal lumbar interbody fusion. Variables related to the patient, diagnosis, and surgery were collected. The clinical and functional outcomes were assessed using the Visual Analogue Scale for low-back and leg pain and the Oswestry Disability Index (ODI). The surgical outcomes and spinopelvic parameters were analyzed pre- and postoperatively. Results There was a significant clinical and functional improvement after surgery (p < 0.001), with a mean ODI decrease of 63.6%. The variables of obesity, concomitant spondylolisthesis, absence of osteotomy, and two-level fusion were all associated with lower levels of improvement after surgery (p < 0.05). Pelvic incidence minus lumbar lordosis (PI-LL) was the only parameter that significantly changed regarding the pre and postoperative periods (p < 0.05). Before surgery, PI-LL < 10° correlates with less low-back pain after surgery (r » 0.435; p < 0.05). Postoperatively, no correlation was found between surgical outcomes and all the spinopelvic parameters analyzed. Conclusions The clinical and functional outcomes significantly improved with the surgical intervention but did not correlate with the change in spinopelvic parameters. Patients with preoperative PI-LL < 10° seem to benefit the most from surgery, showing greater improvement in back pain.
Objetivos A influência dos parâmetros espinopélvicos nos resultados clínicos e funcionais dos pacientes tem sido amplamente estudada nas cirurgias de fusão espinhal que envolvem longos segmentos. Contudo, a literatura é escassa acerca da fusão de segmentos curtos. Analisamos assim os parâmetros espinopélvicos e os resultados cirúrgicos de pacientes submetidos a fusão intersomática lombar de segmentos curtos. Materiais e Métodos Realizou-se um estudo prospectivo observacional entre janeiro e junho de 2021. Selecionaram-se 25 pacientes com estenose lombar, com ou sem espondilolistese, submetidos a fusão intersomática lombar transforaminal. Colheram-se dados relacionados com o paciente, o diagnóstico e a cirurgia. Os resultados clínicos e funcionais foram avaliados por meio da Escala Visual Analógica para dor lombar e dos membros inferiores e pela Escala de Incapacidade de Oswestry (Oswestry Disability Index, ODI, em inglês). Os resultados cirúrgicos e os parâmetros espinopélvicos foram analisadas no pré e no pós-operatório. Resultados Verificou-se uma melhoria clínica e funcional significativa após a cirurgia (p < 0,001), com redução média do ODI de 63,6%. As variáveis obesidade, espondilolistese concomitante, ausência de osteotomia e fusão de dois níveis associaram-se a menor melhoria no pós-operatório (p < 0,05). O único parâmetro que mudou significativamente antes e após a cirurgia (p < 0,05) foi a incidência pélvica menos a lordose lombar (IP-LL). No pré-operatório, uma IP-LL < 10° correlacionou-se com menos dor lombar após a cirurgia (r » 0,435; p < 0,05). No pós-operatório, não houve correlação entre os resultados clínicos e funcionais e os parâmetros espinopélvicos. Conclusão Os resultados clínicos e funcionais melhoraram significativamente após a cirurgia, mas não se correlacionam com a mudança dos parâmetros espinopélvicos. Pacientes com IP-LL< 10° no pré-operatório apresentam maior melhoria da dor lombar no pós-operatório.
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【Objective】 To compare the clinical effects and screw placement accuracy for treating lumbar disc herniation between robot-assisted minimal invasive transforaminal lumbar interbody fusion (RA-MIS-TLIF) and minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF). 【Methods】 We retrospectively recruited 69 patients with single segment lumbar disc herniation treated between January 2018 and August 2019 at Honghui Hospital of Xi’an Jiaotong University. There were cases of 33 RA-MIS-TLIF (RA group) and 36 MIS-TLIF (MIS-TLIF group). Subsequently, the patients’ baseline characteristics were collected, including age, gender, body mass index, complication with diabetes, duration of symptoms, operated segment, and follow-up time. We also collected perioperative parameters such as operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, screw placement accuracy, wound drainage, hospitalization duration, postoperative complicatins, and fusion rate. Lower back pain, lower extremity pain visual analogue score (VAS), and lumbar Japanese Orthopaedic Association Scores (JOA) were obtained preoperatively, postoperative 3 days/6 months/12 months, and the last follow-up. 【Results】 All the procedures were successfully completed and the follow-up time was 14.82±1.83 (RA group) and 15.11±1.62 (MIS-TLIF group) months, without significant difference (P>0.05). Compared with MIS-TLIF group, RA group had less intraoperative blood loss [(116.67±18.48) min vs. (128.06±22.53) min], fluoroscopy frequency [(12.42±2.28) vs. (15.67±2.46)], screw placement accuracy (93.18% vs. 84.03%), postoperative drainage [(73.03±23.52) mL vs. (88.33±28.54) mL], and shorter hospitalization stay [(6.45±1.52)d vs. (7.69±1.85) d] (all P0.05). The VAS of lower back pain and lower extremity pain, and lumbar JOA were significantly improved after the operation (P0.05). Meanwhile, fusion rate and incidence of complications did not significantly differ between the two groups (P>0.05). 【Conclusion】 Both robot-assisted MIS-TLIF and MIS-TLIF can achieve excellent clinical effects in treating single-segment lumbar disc herniation. However, the former can improve the accuracy of screw placement and reduce intraoperative blood loss, fluoroscopy frequency, postoperative drainage and hospitalization time, which indicates a promising application.
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@#OBJECTIVE: The main objective of this study was to evaluate clinical and radiographic outcomes of computer minimally invasive transforaminal lumbar interbody fusion (CNMIS TLIF). METHODS: Blood loss, operating time, complications, and hospital stay were identified through chart review. Numeric rating scale (NRS) scores for pain were taken during recent follow-ups, and these were compared to the pre-operative scores. Three different examiners assessed the pre-operative lumbosacral spine radiographs. At a 2-years follow-up, the patients were evaluated with NRS and the radiographs reassessed by three other examiners. RESULTS: Seventy-four patients with a mean age of 54 years underwent CNMIS TLIF. Average blood loss was 300 mL, operative time was 4.5 hours, and the average length of hospital stay was 8.5 days. A total of four complications were noted in our study. There was an improvement of mean local lordosis and regional lordosis. The paired-sample t-test showed that the anterior, middle, and posterior disc heights at the cage level were significantly increased compared to the pre-operative values. CONCLUSION: CNMIS TLIF is a safe and efficient method to achieve spinal fusion. There was a significant improvement in clinical outcomes in terms of pain relief. Radiologic parameters such as local lordosis, regional lordosis, and anterior, middle, and posterior disc heights showed significant improvements at 2-years follow-up.
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Spinal Fusion , Minimally Invasive Surgical Procedures , ComputersABSTRACT
【Objective】 To compare the short-term clinical effects of oblique lateral interbody fusion （OLIF） and transforaminal lumbar interbody fusion （TLIF） for treating single-segment lumbar spondylolisthesis. 【Methods】 We retrospectively analyzed the data of 68 patients with single-segment degenerative lumbar spondylolisthesis from January 2019 to February 2020. According to different surgical methods， the patients were divided into OLIF+ anterior screw fixation group （33 cases） and TLIF + posterior pedicle screw fixation group （35 cases）. The operation time， intraoperative blood loss， postoperative drainage， postoperative hospital stay and complication rate were compared between the two groups of patients. The disc height （DH）， lumbar lordosis （LL）， fused segmental lordosis （FSL）， foraminal height （FH）， and spondylolisthesis angle （SA） were measured before and after surgery and during follow-up. The visual analogue scale （VAS） of waist pain and the Oswestry disability index （ODI） were used to evaluate the short-term clinical efficacy. 【Results】 The operation time， intraoperative blood loss， postoperative drainage， and postoperative hospital stay were less in OLIF group than in TLIF group （all P0.05）. The two groups had statistically significant differences in DH and FH after surgery （P0.05）. There were six （18.2%） and five （14.3%） cases of complications in OLIF group and TLIF group， respectively， with no significant difference （P>0.05）. 【Conclusion】 OLIF and TLIF are equally safe and effective in treating single-segment lumbar spondylolisthesis. However， OLIF combined with anterior screw fixation has the advantages of less surgical trauma， less blood loss， shorter operation time， reduced postoperative hospital stay and shorter recovery time. Therefore， it is a more minimally invasive surgical option.
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Objective To analyze the biomechanical characteristics of lumbar fusion by 3 internal fixation methods using three-dimensional (3D) finite element (FE) method. Methods The FE fixation models of physiological L4-5, unfixed fusion L4-5, translaminar facet screw (TLFS), lumbar pedical screw+translaminar facet screw (LPS+TLFS), bilateral pedical screw (BPS) with complete osteotomy or partial osteotomy of facet joint were established, respectively. The biomechanical characteristics of L4 centrum and implants under six motion states (spinal flexion, extension, lateral bending and axial rotation) in L4-5 fusion model and three fixation models were compared by FE analysis. Results The average maximal displacements of L4 centrum in L4-5 unfixed fusion model, TLFS model, TLFS+LPS model, BPS model were 1.410 8, 0.629 8, 0.336 9, 0.252 8 mm (complete osteotomy of facet joint) and 1.296 7, 0.844 9, 0.340 9, 0.273 8 mm (partial osteotomy of facet joint); the average maximal displacements of cage were 0.479 9, 0.319 5, 0.167 6, 0.126 4 mm (complete osteotomy of facet joint) and 0.378 7, 0.348 4, 0.183 5, 0.137 2 mm (partial osteotomy of facet joint)；the average maximum stresses of screws and rods during 6 motions in TLFS model, TLFS+LPS model, BPS model were 178.34, 79.55, 56.33 MPa (complete osteotomy of facet joint) and 142.29, 103.02, 59.69 MPa (partial osteotomy of facet joint). Conclusions In percutaneous transforaminal lumbar interbody fusion, the fixation effect of BPS model was similar to that of LPS+TLFS model. BPS model could achieve the best spinal stability, and LPS+TLFS model was also a good fixation method. The stability of TLFS model alone was relatively poor, but it was still better than that of cage bone graft without internal fixation. In the absence of internal fixation, preservation of the articular process significantly increased stability of the spine.
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BACKGROUND: Decompression-fixation-fusion is the key to spinal surgery since early effective fixation to achieve intervertebral fusion can restore spinal stability in lumbar degenerative disease. OBJECTIVE: To compare biomechanical stability of fusion segment and adjacent segments of bilateral pedicle screw fixation, unilateral pedicle screw fixation and unilateral pedicle screw combined with contralateral translaminar facet screw fixation under transforaminal lumbar interbody fusion. METHODS: Eighteen fresh calf L3-5 specimens were selected. Different forms of fixation were conducted under transforaminal lumbar interbody fusion. The specimens were divided into group A (complete specimens) and group B (bilateral pedicle screws), group C (unilateral pedicle screws), and group D (unilateral pedicle screw combined with contralateral translaminar facet screw). The range of motion of adjacent segment L3-4 and fusion segment L4-5 in six directions of backward extension, forward bending, left bending, right bending, left rotation and right rotation and the stiffness of fusion segment L4-5 were tested. RESULTS AND CONCLUSION: (1) For the range of motion of fusion segment L4-5, the stability was highest in the group B in six directions, followed by group D, which showed similar results in rotation in the group B (P > 0.05). The stability of right curvature and left rotation in group C was insufficient, and there was no significant difference in range of motion between group A and group C (P > 0.05). The range of motion in group A was largest and the stability was worst in the six motion directions. (2) For the stiffness value of fusion segment L4-5, the stiffness value of group B was largest in six directions, which was significantly different from other groups (P 0.05). There was no significant difference between group C and group A in the range of motion of six directions (P > 0.05). (4) The results showed that the motion ramge of unilateral pedicle screw fixation in the right and left rotation directions was large in the early stage, which was close to that of the complete specimen group. There is a shortage of stability, so we need to use it carefully and grasp the indications strictly. Unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation improves the disadvantages of asymmetric fixation of unilateral pedicle screw, increases the stability of rotation and lateral bending, and avoids the influence of bilateral pedicle screw fixation on adjacent segments, thus becoming an effective clinical surgical treatment.
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BACKGROUND: In the elderly patients with degenerative lumbar spinal stenosis, bilateral nerve root canal stenosis commonly shows only one side of symptoms. There is still controversy about whether or not decompression is needed on the side without symptoms or with less symptoms and how to operate. OBJECTIVE: To explore the safety and efficacy of robot-assisted unilateral-decompression using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique by investigating a series of cases with the radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms and by comparing clinical decompression effect and imaging changes before and after operation. METHODS: Cases with radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms subjected to unilateral decompression on the affected side, interbody fusion and bilateral fixation after robot-assisted MIS-TLIF in the same treatment group were retrospectively analyzed. Operation time, intraoperative blood loss and complications were recorded. The vertebral canal cross-sectional area, intervertebral foramen height, intervertebral space height, and lumbar lordosis angle were examined before and after surgery. Visual analogue scale scores for low back pain and leg pain were assessed before and after surgery. Oswestry disability index was used to assess lumbar function before and after surgery. Macnab criteria were used to evaluate the efficacy at the final follow-up after surgery. RESULTS AND CONCLUSION: (1) Operation time was 110-235 minutes, averagely 169.4 minutes. Intraoperative blood loss was 70-180 mL, averagely 112.4 mL. (2) After 3-8 months of follow-up, the visual analogue scale scores of low back pain and lower extremity pain 1 month after surgery and in final follow-up were significantly lower than those before operation (both P 0.05). (6) It is concluded that robot-assisted unilateral-decompression MIS-TLIF obtained satisfactory effect in bilateral lumbar canal stenosis patients presenting with unilateral symptoms.
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BACKGROUND: More and more studies have shown that lumbar-pelvic parameters are closely related to the clinical effect and adjacent segment degeneration after lumbar fusion, but the effect of minimally invasive transforaminal interbody fusion on lumbar-pelvic parameters is not clear. OBJECTIVE: To evaluate the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on the lumbar-pelvic imaging parameters in patients with single-segment lumbar spinal stenosis. METHODS: The clinical data of 85 patients with single-segment lumbar spinal stenosis treated by MIS-TLIF and open-TLIF in the First Affiliated Hospital of Dali University from January 2015 to January 2017 were retrospectively analyzed, including 39 cases of MIS-TLIF operation (MIS-TLIF group) and 46 cases of open-TLIF operation (open-TLIF group). On the standing lateral lumbar X-ray containing bilateral femoral heads: lumbar lordosis, segmental lordosis, height of the intervertebral disc, the L1 axis and S1 distance, pelvic incidence, pelvic tilt, and sacral slope were measured, and the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were calculated. RESULTS AND CONCLUSION: (1) During the last follow-up, lumbar lordosis, height of the intervertebral disc, and sacral slope were increased in both groups compared with preoperative parameters, but pelvic tilt was decreased compared with preoperatively, and the difference was significant (P 0.05). (2) During the last follow-up, lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope, and the L1 axis and S1 distance were not significantly different compared with preoperative parameters (P > 0.05). (3) The difference between pelvic incidence−lumbar lordosis was significantly decreased at the last follow-up compared with preoperative parameters in the two groups (P 0.05). (4) Above results indicated that for single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open-TLIF in recovery of lumbar lordosis, intervertebral height, and improving lumbar-pelvic balance.
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Objective: To compare the effectiveness of modified transforaminal lumbar interbody fusion (modified-TLIF) and posterior lumbar interbody fusion (PLIF) for mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. Methods: The clinical data of 106 patients with mild to moderate lumbar spondylolisthesis (Meyerding classification≤Ⅱ degree) who met the selection criteria between January 2015 and January 2017 were retrospectively analysed. All patients were divided into modified-TLIF group (54 cases) and PLIF group (52 cases) according to the different surgical methods. There was no significant difference in preoperative clinical data of gender, age, disease duration, sliding vertebra, Meyerding grade, and slippage type between the two groups ( P>0.05). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, hospital stay, and complications of the two groups were recorded and compared. The improvement of pain and function were evaluated by the visual analogue scale (VAS) score and Japanese Orthopedic Association (JOA) score at preoperation, 1 week, and 1, 6, 12 months after operation, and last follow-up, respectively. The effect of slip correction was evaluated by slip angle and intervertebral altitude at preoperation and last follow-up, and the effectiveness of fusion was evaluated according to Suk criteria. Results: All patients were followed up, the modified-TLIF group was followed up 25-36 months (mean, 32.7 months), the PLIF group was followed up 24-38 months (mean, 33.3 months). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, and hospital stay of the modified-TLIF group were significantly less than those of the PLIF group ( P0.05). At last follow-up, the fusion rate of the modified-TLIF group and the PLIF group was 96.3% (52/54) and 98.1% (51/52), respectively, and no significant difference was found between the two groups ( χ2=0.000, P=1.000). About complications, there was no significant difference between the two groups in nerve injury on the opposite side within a week, incision infection, and pulmonary infection ( P>0.05). No case of nerve injury on the operation side within a week or dural laceration occurred in the modified-TLIF group, while 8 cases (15.4%, P=0.002) and 4 cases (7.7%, P=0.054) occurred in the PLIF group respectively. Conclusion: Modified-TLIF and PLIF are effective in the treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. However, modified-TLIF has relatively less trauma, lower blood loss, lower drainage volume, lower incidence of dural laceration and nerve injury, which promotes enhanced recovery after surgery.
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Objective: To analyze the restoration of intervertebral height and lordosis of fusion segment after open-transforaminal lumbar interbody fusion (Open-TLIF) and minimally invasive-TLIF (MIS-TLIF). Methods: Between January 2013 and February 2016, patients who treated with TLIF due to lumbar degenerative diseases and met the selection criteria were selected as the study objects. Among them, 41 patients were treated with open-TLIF (Open-TLIF group), 34 patients were treated with MIS-TLIF (MIS-TLIF group). There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, disease type, disease duration, pathological segment, and other general data. The intraoperative bleeding volume, hospital stay, visual analogue scale (VAS) score of waist and leg, and Oswestry disability index (ODI) were recorded before and after operation. The anterior disc height (ADH), posterior disc height (ADH), and segmental lordosis (SL) of fusion segment were measured by X-ray film before and at 6 months after operation. The differences of ADH, PDH, and SL between pre- and post-operation were calculated. Results: The intraoperative bleeding volume and hospital stay in Open-TLIF group were significantly higher than those in MIS-TLIF group ( t=14.619, P=0.000; t=10.021, P=0.000). All incisions healed by first intention without early complications. All patients were followed up 6-24 months (mean, 12.6 months) in Open-TLIF group and 6-24 months (mean, 11.5 months) in MIS-TLIF group. The preoperative VAS scores of waist and leg and ODI of the two groups significantly improved ( P0.05). Imaging examination showed the good intervertebral fusion. There was no significant difference in ADH, PDH, and SL between the two groups before operation and at 6 months after operation ( P>0.05). The differences of ADH, PDH, and SL between the two groups were not significant ( P>0.05). The ADH, PDH, and SL after operation significantly increased in the two groups ( P<0.05). Conclusion: Open-TLIF and MIS-TLIF show similar effectiveness and radiological change in the treatment of single lumbar degenerative diseases and the improved intervertebral height and lordosis, but MIS-TLIF can significantly reduce hospital stay and intraoperative blood loss.
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Objective@#We aimed to compare the clinical and radiological outcomes of midline lumbar fusion (MIDLF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.@*Methods@#Consecutively treated patients with lumbar pathology who underwent MIDLF ( @*Results@#The mean operative time and hematocrit (HCT, Day 1) were significantly shorter and lower in MIDLF cases (174 min @*Conclusion@#MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates, and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.