Comparison of Farfan modified and Frobin methods to evaluate the intervertebral disc height

2023

J Orthop Surg Res

Background Oblique lumbar interbody fusion (OLIF) has been used to treat lumbar intervertebral instability, which has some advantages including less trauma, less blood loss, faster recovery and bigger cage. However, it usually needs posterior screws fixation for biomechanical stability, and possible direct decompression for relieving neurologic symptoms. In this study, OLIF and anterolateral screws rod fixation through mini-incision were combined with percutaneous transforaminal endoscopic surgery (PTES) for the treatment of multi-level lumbar degenerative diseases (LDDs) with intervertebral instability. The purpose of study is to evaluate the feasibility, efficacy and safety of this hybrid surgery. Methods From July 2017 to May 2018, 38 cases of multi-level LDDs of disc herniation, foramen stenosis, lateral recess stenosis or central canal stenosis with intervertebral instability and neurologic symptoms undergoing one-stage PTES combined with OLIF and anterolateral screws rod fixation through mini-incision were recruited in this retrospective study. The culprit segment was predicted according to the position of patient’s leg pain and PTES under local anesthesia was performed for the culprit segment in the prone position to enlarge the foramen, remove the flavum ligamentum and herniated disc for the lateral recess decompression and expose bilateral traversing nerve roots for the central spinal canal decompression through an unilateral incision. During the operation, communicate with the patients to confirm the efficacy using VAS. And then mini-incision OLIF using allograft, autograft bone harvested in PTES and anterolateral screws rod fixation were performed in the right lateral decubitus position under general anesthesia. Back and leg pain were preoperatively and postoperatively evaluated using VAS. And the clinical outcomes were evaluated with ODI at the 2-year follow-up. The fusion status was assessed according to Bridwell’s fusion grades. Results There were 27 cases of 2-level, 9 cases of 3-level and 2 cases of 4-level LDDs with single-level instability on the X-ray, CT and MRI. Five cases of L3/4 instability and 33 cases of L4/5 instability were included. PTES was performed for 1 segment of 31 cases (25 cases of instability segment, 6 cases of no instability segment) and 2 segments including instability segment of 7 cases. Then, all instability segments were treated using mini-incision OLIF and anterolateral screws rod fixation. The average operation duration was 48.9 ± 7.3 min per level for PTES and 69.2 ± 11.6 min for OLIF and anterolateral screws rod fixation. The mean frequency of intraoperative fluoroscopy was 6 (5–9) times per level for PTES and 7 (5–10) times for OLIF. There was a mean blood loss of 30 (15–60) ml, and the incision length was 8.1 ± 1.1 mm for PTES and 40.0 ± 3.2 mm for OLIF. The mean hospital stay was 4 (3–6) days. The average follow-up duration was 31.1 ± 4.0 months. For the clinical evaluation, the VAS pain index and the ODI showed excellent outcomes. Fusion grades based on the Bridwell grading system at 2-year follow-up were grade I in 29 segments (76.3%) and grade II in 9 segments (23.7%). One patient encountered nerve root sleeves rupture during PTES and did not confront cerebrospinal fluid leakage or other abnormal clinical symptoms. There were two cases of hip flexion pain and weakness, which was relieved during 1 week after surgery. No patients had any form of permanent iatrogenic nerve damage and a major complication. No failure of instruments was observed. Conclusions The hybrid surgery of PTES combined with OLIF and anterolateral screws rod fixation is a good choice of minimally invasive surgery for multi-level LDDs with intervertebral instability, which can get direct neurologic decompression, easy reduction, rigid fixation and solid fusion, and hardly destroy the paraspinal muscles and bone structures.

Section: Pre-and Postoperative Imagingmentioning

confidence: 99%

Hybrid surgery of percutaneous transforaminal endoscopic surgery (PTES) combined with OLIF and anterolateral screws rod fixation for treatment of multi-level lumbar degenerative diseases with intervertebral instability

2023

J Orthop Surg Res

“…Posteroanterior and lateral radiographs are obtained to assess the slip degree of vertebral body according to the Meyerding Classification System of Spondylolisthesis (16). Intervertebral space height (17), lumbar lordotic angle, and operative segmental lordotic angle are measured on lumbar spine…”

Section: Patientsmentioning

confidence: 99%

“…The intervertebral space height is the average of anterior and posterior spaces between two adjacent vertebrae on the lateral x-ray; the lumbar lordotic angle is the angle between the upper endplate of first lumbar vertebra and the upper endplate of sacrum; the operative segmental lordotic angle is the angle between the upper endplate of upper vertebra and the lower endplate of lower vertebra in the surgical segment. A loss of at least 2 mm of intervertebral space height is generally considered cage subsidence on x-ray (17). The fusion status is assessed according to Bridwell's fusion grades on CT (18).…”

Section: Patientsmentioning

confidence: 99%

Percutaneous transforaminal endoscopic surgery combined with mini-incision OLIF and anterolateral screws rod fixation vs. MIS-TLIF for surgical treatment of single-level lumbar spondylolisthesis

Wei

et al. 2023

Front. Surg.

ObjectiveOblique lumbar interbody fusion (OLIF) has been used to treat lumbar spine spondylolisthesis. However, it usually needs posterior pedicle screws fixation for biomechanical stability and possible posterior direct decompression for relieving neurologic symptoms. We use percutaneous transforaminal endoscopic surgery (PTES) combined with mini-incision OLIF and anterolateral screws rod fixation for surgical treatment of lumbar spondylolisthesis. The purpose of study is to evaluate the feasibility, efficacy, and safety of this method compared with minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).MethodsFrom July 2016 to May 2018, 65 patients of lumbar spondylolisthesis (L2–4) with neurologic symptoms were treated using PTES combined with mini-incision OLIF and anterolateral screws rod fixation (31 cases, group A) or MIS-TLIF (34 cases, group B) in this study. Operative duration, blood loss, incision length, fluoroscopy frequency, and hospital stay are compared. Preoperative and postoperative visual analog scale (VAS) pain scores of back and legs, Oswestry disability index (ODI), intervertebral space height, lumbar lordotic angle, operative segmental lordotic angle, and complications are recorded. The fusion status is assessed according to Bridwell's fusion grades.ResultsThe VAS score of back and leg pain and ODI significantly dropped after surgery in both groups (p < 0.001). There was no statistical difference of back and leg VAS score and ODI between two groups except that back VAS scores in group A were significantly lower than that of group B immediately after surgery (p = 0.000). Group A had significantly more intervertebral space height and operative segmental lordotic angle than group B postoperatively (p = 0.022, p = 0.002). Twenty-three segments (74.2%) were grade I and 8 segments (25.8%) were grade II in group A; 20 segments (58.8%) were grade I and 14 segments (41.2%) were grade II in group B at a 2-year follow-up (p = 0.194). No difference was observed in the complication rate between the two groups (6.5% vs. 5.9%, p = 0.924).ConclusionThe long-term clinical efficacy and complication rates of both groups are comparable. PTES combined with mini-incision OLIF and anterolateral screws rod fixation is a good choice of minimally invasive surgery for lumbar spondylolisthesis, which hardly destroys the paraspinal muscles and bone structures.

“…The lumbar lordotic angle is the angle between the upper endplate of rst lumbar vertebra and the upper endplate of sacrum; the operative segmental lordotic angle of L5/S1 is the angle between the upper endplate of L5 and S1 in the surgical segment. A loss of at least 2mm of intervertebral space height is generally considered cage subsidence on X-ray 14 . The fusion status was assessed according to the Bridwell's fusion grades on CT 15 .…”

Section: Pre-and Postoperative Imagingmentioning

confidence: 99%

Percutaneous Transforaminal Endoscopic Surgery (PTES) and OLIF with Self-lock Cage through mini-incision for Surgical Treatment of L5 Spondylolisthesis

Zhang

et al. 2022

Preprint

Purpose: We designed Percutaneous Transforaminal Endoscopic Surgery (PTES) technique and OLIF with self-lock cage through mini-incision for the treatment of L5 spondylolisthesis. The purpose of study is to evaluate the feasibility, efficacy and safety of this method.Methods: Thirteen cases of L5 spondylolisthesis with nerve root symptoms were included in this study. PTES under local anesthesia, and then OLIF with self-lock cage and allograft under general anesthesia was performed. Back and leg pain were preoperatively and postoperatively evaluated using VAS, and the clinical outcomes were evaluated with ODI before surgery and at 2-year follow-up. Anterior and posterior intervertebral space height, lumbar lordotic angle, and operative segmental lordotic angle were measured on lumbar spine X-rays preoperatively and postoperatively. The fusion status was assessed according to the Bridwell’s fusion grades.Results: The VAS significantly dropped after surgery and the ODI decreased from 64.7±7.8% to 12.9±4.3% 2 years after surgery (p<0.001). Anterior and posterior intervertebral space height, and operative segmental lordotic angle significantly improved after surgery (p<0.05). Fusion grades based on the Bridwell grading system at 2-year follow-up were grade I in 9 segments (69.2%), grade II in 4 segments (30.8%). No patients had any form of permanent iatrogenic nerve damage and a major complication. No failure of instruments was observed.Conclusion: PTES and OLIF with self-lock cage is a good choice of minimally invasive surgery for L5 spondylolisthesis, which can get direct neurologic decompression and satisfying fusion, and hardly destroy the rectus abdominis and its sheath, paraspinal muscles and bone structures.