The periumbilical incision for anterior lumbar interbody fusions.
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ABSTRACT:
SUBMITTER: Abdoli S
PROVIDER: S-EPMC7371723 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundLumbar interbody fusion is among the most common types of spinal surgery performed. Over time, the term has evolved to encompass a number of different approaches to the intervertebral space, as well as differing implant materials. Questions remain over which approaches and materials are best for achieving fusion and restoring disc height.Questions/purposesWe reviewed the literature on the advantages and disadvantages of various methods and devices used to achieve and augment fusion between the disc spaces in the lumbar spine.MethodsUsing search terms specific to lumbar interbody fusion, we searched PubMed and Google Scholar and identified 4993 articles. We excluded those that did not report clinical outcomes, involved cervical interbody devices, were animal studies, or were not in English. After exclusions, 68 articles were included for review.ResultsPosterior approaches have advantages, such as providing 360° support through a single incision, but can result in retraction injury and do not always restore lordosis or correct deformity. Anterior approaches allow for the largest implants and good correction of deformities but can result in vascular, urinary, psoas muscle, or lumbar plexus injury and may require a second posterior procedure to supplement fixation. Titanium cages produce improved osteointegration and fusion rates but also increase subsidence caused by the stiffness of titanium relative to bone. Polyetheretherketone (PEEK) has an elasticity closer to that of bone and shows less subsidence than titanium cages, but as an inert compound PEEK results in lower fusion rates and greater osteolysis. Combination PEEK-titanium coating has not yet achieved better results. Expandable cages were developed to increase disc height and restore lumbar lordosis, but the data on their effectiveness have been inconclusive. Three-dimensionally (3D)-printed cages have shown promise in biomechanical and animal studies at increasing fusion rates and reducing subsidence, but additive manufacturing options are still in their infancy and require more investigation.ConclusionsAll of the approaches to spinal fusion have plusses and minuses that must be considered when determining which to use, and newer-technology implants, such as PEEK with titanium coating, expandable, and 3D-printed cages, have tried to improve upon the limitations of existing grafts but require further study.
| S-EPMC7253570 | biostudies-literature
Project description: Not available
| S-EPMC6583231 | biostudies-literature
Project description:The datasets presented here quantify and compare the relative carbon footprints emitted by general versus spinal anesthesia in patients undergoing single-level transforaminal lumbar interbody fusions (TLIFs). Data were retrospectively collected from electronic medical records of 100 consecutive patients who underwent a single-level TLIF from a single neurosurgeon at a U.S. academic center. 50 patients were under general anesthesia, and another 50 patients were under spinal anesthesia. Clinic and operative notes were used to extract demographic and surgical information, whereas anesthesia records were used to extract anesthetic information. Using the anesthetic information, carbon dioxide equivalents (CO2e) were calculated for each type of anesthetic and summed together to compute the total carbon footprint for each patient. Our article entitled "Assessing the environmental carbon footprint of spinal versus general anesthesia in single-level transforaminal lumbar interbody fusions" is based on this data [1]. Raw datasets of the primary data collection as well as cleaned and analyzed datasets are presented. These datasets highlight the first known environmental impact calculation from medical records of a spine procedure, serving as a model for other interested investigators to explore and emulate. This data brief may help to pave the way towards future environmental research and practice changes within neurosurgical and orthopedic literature, an issue critical to the sustainability of our modern society.
| S-EPMC9079166 | biostudies-literature
Project description:Aim To compare anterior fusion in standalone anterior lumbar interbody fusion (ALIF) using cage and screw constructs and anterior cage-alone constructs with posterior pedicle screw supplementation but without posterior fusion. Methods Eighty-five patients underwent single- or two-level ALIF procedure for degenerative disk disease or lytic spondylolisthesis (SPL). Posterior instrumentation was performed without posterior fusion in all cases of lytic SPL and when the anterior cage used did not have anterior screw through cage fixation. Results Seventy (82%) patients had adequate radiological follow-up at a mean of 19 months. Forty patients had anterior surgery alone (24 single level and 16 two levels) and 30 had front-back surgery (15 single level and 15 two levels). Anterior locked pseudarthrosis was only seen in the anterior surgery-alone group when using the STALIF cage (Surgicraft, Worcestershire, UK) (37 patients). This occurred in five of the single-level surgeries (5/22) and nine of the two-level surgeries (9/15). Fusion was achieved in 100% of the front-back group and only 65% (26/40) of the anterior surgery-alone group. Conclusion Posterior pedicle screw supplementation without posterolateral fusion improves the fusion rate of ALIF when using anterior cage and screw constructs. We would recommend supplementary posterior fixation especially in cases where more than one level is being operated.
| S-EPMC3864421 | biostudies-other
Project description:BackgroundThe most commonly used cages for intervertebral disc replacement in lumbar fusion procedures are made predominantly from polyetheretherketone (PEEK). There is sufficient data studying their subsidence and failure rates from a variety of approaches. A novel implant is now available for commercial use, 3D-printed porous titanium (3DppTi) alloy cages, which have recently become available for use in spinal procedures. They have been shown in ovine models to have superior efficacy and fusion rates compared to traditional cages. However, there is limited data on their use in clinical practice and long-term outcomes associated with them.MethodsA retrospective chart review was performed, of all patients in a single institution who underwent lumbar spine fusion surgery via an anterior or lateral approach with a 3D-printed titanium alloy cage, between January 2020 and February 2021. Clinic letters, imaging and operation reports were independently reviewed to assess for fusion, or evidence of subsidence on follow-up.ResultsFifty patients were identified as meeting inclusion criteria, with a total of 66 operative levels. Of these operative levels, 32 were via an anterior approach and 34 via a lateral approach. One patient demonstrated a Marchi grade 0 subsidence, with recurrence of radiculopathy 2 months after an anterior approach, requiring posterior decompression and stabilization. A second patient demonstrated a Marchi grade 1 subsidence after a lateral approach, but did not require further surgery as they were asymptomatic at 2 years of follow-up. This study demonstrated an overall subsidence rate of 3.03%. There was a median follow-up time of 11.3 months for all patients.Conclusions3D-printed titanium alloy cages demonstrate a lower subsidence rate compared to historically published rates for alternative intervertebral cages, in anterior and lateral lumbar spine fusion surgery.
| S-EPMC10982926 | biostudies-literature
Project description:Background:Comparison of single-level open and minimally invasive transforaminal lumbar interbody fusions (O-TLIF and MI-TLIF) of a single surgeon and presentation of his MI-TLIF learning curve in a retrospective observational cohort study. Methods:27 MI-TLIF and 31 O-TLIF patients, performed between 03/01/2013 and 03/31/2018, were compared regarding the operative time, blood loss, blood transfusion frequency, postoperative length of stay (LOS), and adverse events. An overall comparison of pre- and postoperative Oswestry Disability Index (ODI) results and Visual Analog Score (VAS) results of low back and leg pain was performed in the case of the two techniques. For a learning curve presentation, the MI-TLIF cases were compared and the optimal operative time was determined. Results:The gender ratio and age did not differ in the groups. Operative time showed no difference (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (p=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2?±?33.7 minutes) and O-TLIF groups (160?±?33.6 minutes). Intraoperative blood loss was less (. Conclusions:Similar operative time and postoperative quality of life improvement can be achieved by MI-TLIF procedure as with O-TLIF, and additionally LOS and blood loss can be reduced. When comparing parameters, MI-TLIF can be an alternative option for O-TLIF with a similar complication profile. The learning curve of MI-TLIF can be steep, although it depends on the circumstances.
| S-EPMC7003267 | biostudies-literature
Project description:Study Design Retrospective analysis of prospectively collected observational data. Objective To assess the safety and efficacy of anterior lumbar interbody fusion (ALIF) as a salvage option for lumbar pseudarthrosis following failed posterior lumbar fusion surgery. Methods From 2009 to 2013, patient outcome data was collected prospectively over 5 years from 327 patients undergoing ALIF performed by a single surgeon (R.J.M.) with 478 levels performed. Among these, there were 20 cases of failed prior posterior fusion that subsequently underwent ALIF. Visual analog score (VAS), Oswestry Disability Index (ODI), and Short Form 12-item health survey (SF-12) were measured pre- and postoperatively. The verification of fusion was determined by utilizing a fine-cut computed tomography scan at 12-month follow-up. Results There was a significant difference between the preoperative (7.25 ± 0.8) and postoperative (3.1 ± 2.1) VAS scores (p < 0.0001). The ODI scale also demonstrated a statistically significant reduction from preoperative (56.3 ± 16.5) and postoperative (30.4 ± 19.3) scores (p < 0.0001). The SF-12 scores were significantly improved after ALIF salvage surgery: Physical Health Composite Score (32.18 ± 5.5 versus 41.07 ± 9.67, p = 0.0003) and Mental Health Composite Score (36.62 ± 12.25 versus 50.89 ± 10.86, p = 0.0001). Overall, 19 patients (95%) achieved successful fusion. Conclusions Overall, our results suggest that the ALIF procedure results not only in radiographic improvements in bony fusion but in significant improvements in the patient's physical and mental experience of pain secondary to lumbar pseudarthrosis. Future multicenter registry studies and randomized controlled trials should be conducted to confirm the long-term benefit of ALIF as a salvage option for failed posterior lumbar fusion.
| S-EPMC4733375 | biostudies-other
Project description:The cause of radiculopathy is the compression of the nerve root which can be secondary to sliding of the vertebra and reduced disc height. In some patients, decompression alone does not resolve this problem. We describe the uniportal endoscopic transforaminal lumbar interbody fusion technique. Full-endocopic foraminotomy and discectomy are followed by cage implementation and percutaneous instrumentation. The goal of this surgical method is decompression of nerve roots, segment stabilization, disc height, and sagittal alignment restoration. Uniportal endoscopic facet sparing transforaminal transkambin lumbar interbody fusion is a good surgical option to treat degenerative disc disease, mechanical instability, and spondylolisthesis. This method shows favourable clinical outcomes in selected patients.
| S-EPMC7410390 | biostudies-literature
Project description:BackgroundControversy exists regarding the ability of posterior (transforaminal) lumbar interbody fusion (PLIF/TLIF) to achieve lordosis. We hypothesized that an interbody device (IBD) designed for positioning in the anterior disc space produces greater lordosis than IBDs designed for straight-in positioning. The purpose of this study is to determine if using either an anterior-position or straight-in position IBD design were associated with successful achievement of postoperative lordosis.MethodsA consecutive series of patients undergoing a undergoing a single-level, posterior open midline (transforaminal) lumbar interbody fusion procedure for degenerative spine conditions during a time period when the two types of interbody devices were being used at surgeon discretion were identified from a multi-surgeon academic training center. Patient demographics and radiographic measures including surgical level lordosis (SLL), anterior disc height, middle disc height, posterior disc height, IBD height, and IBD insertion depth were measured on preop, immediate postop, and one-year postop standing radiographs using PACS. Group comparison and regression analysis were performed using SPSS.ResultsSixty-one patients were included (n=37 anterior, n=34 straight-in). Mean age was 59.8±8.7 years, 32 (52%) were female. There was no difference between IBD type (anterior vs. straight-in) for mean Pre-op SLL (19±7° vs. 20±6°, p=0.7), Post-op SLL (21±5° vs 21±6°, p=0.5), or Change in SLL (2±4° vs. 1±5°, p=0.2). Regression analysis showed that Pre-op SLL was the only variable associated with Change in SLL (Beta = negative 0.48, p=0.000). While the mean Change in SLL could be considered clinically insignificant, there was wide variability: from a loss of 9° to a gain of 13°. Gain of lordosis >5° only occurred when Pre-op SLL was <21°, and loss of lordosis >5° only occurred when Pre-op SLL was >21°.ConclusionsWhile group averages showed an insignificant change in segmental lordosis following a posterior (transforaminal) interbody fusion regardless of interbody device type, pre-operative lordosis was correlated with a clinically significant change in segmental lordosis. Preoperative hypolordotic discs were more likely to gain significant lordosis, while preoperative hyperlordotic discs were more likely to lose significant lordosis. Surgeon awareness of this tendency can help guide surgical planning and technique.
| S-EPMC9386101 | biostudies-literature
Project description:BackgroundDermabond Prineo is popular for wound closure due to its anti-microbial attribute, ease of application, and patient comfort. Reports of allergic contact dermatitis have increased, likely due to increased usage, mostly in breast augmentations and joint replacements. To the authors' knowledge, this is the first report of allergic contact dermatitis following spine surgery.Case descriptionThis case involved a 47-year-old male with a history of two posterior L5-S1 lumbar microdiscectomies. Dermabond Prineo was used in the revision microdiscectomy with no skin complications noted. Six weeks after revision microdiscectomy, the patient underwent discectomy and anterior lumbar interbody fusion of L5-S1, again closed with Dermabond Prineo. One week later, the patient presented with allergic contact dermatitis around his incision, which was treated with topical hydrocortisone and diphenhydramine. Around the same time, he was diagnosed with post-operative pneumonia.ConclusionsPrevious studies have suggested that repeated usage and duplicate coverage with 2-octyl cyanoacrylate (Dermabond Prineo) correlate with an increased risk of allergic reaction. Type IV hypersensitivity reactions require an initial sensitization to the allergen and subsequent re-exposure for reaction. In this case, the revision microdiscectomy closed with Dermabond Prineo functioned as the sensitization and repeated usage in a subsequent discectomy caused an allergic reaction. Providers should be aware of the increased risk of allergic reaction when using Dermabond Prineo for repeat surgeries.
| S-EPMC10331490 | biostudies-literature