Accidental Durotomy in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Frequency, Risk Factors, and Management

Klingler, Jan-Helge; Volz, Florian; Krüger, Marie T.; Kogias, Evangelos; Roelz, Roland; Scholz, Christoph; Sircar, Ronen; Hubbe, Ulrich

doi:10.1155/2015/532628

Cited by 31 publications

(12 citation statements)

References 24 publications

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“…The surgical technique of performing minimally invasive stabilization procedures with screw-rod instrumentation (CD Horizon Sextant II or CD Horizon Longitude, Medtronic, Minneapolis, USA) has been described in detail elsewhere [ 14 ]. For minimally invasive thoracic instrumentation we routinely use intraoperative spinal navigation for accurate screw placement (Cart II system, Stryker, Freiburg, Germany; software: SpineMap 3D navigation) [ 15 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

Klingler

Scholz

Kogias

et al. 2015

The Scientific World Journal

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Purpose. To describe the minimally invasive technique for cement augmentation of cannulated and fenestrated screws using an injection cannula as well as to report its safety and efficacy. Methods. A total of 157 cannulated and fenestrated pedicle screws had been cement-augmented during minimally invasive posterior screw-rod spondylodesis in 35 patients from January to December 2012. Retrospective evaluation of cement extravasation and screw loosening was carried out in postoperative plain radiographs and thin-sliced triplanar computed tomography scans. Results. Twenty-seven, largely prevertebral cement extravasations were detected in 157 screws (17.2%). None of the cement extravasations was causing a clinical sequela like a new neurological deficit. One screw loosening was noted (0.6%) after a mean follow-up of 12.8 months. We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency. Conclusions. The presented minimally invasive cement augmentation technique using an injection cannula facilitates convenient and safe cement delivery through polyaxial cannulated and fenestrated screws during minimally invasive screw-rod spondylodesis. Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified. This trial is registered with German Clinical Trials DRKS00006726.

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Section: Methodsmentioning

confidence: 99%

Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

Klingler

Scholz

Kogias

et al. 2015

The Scientific World Journal

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“…Dural tears occurred in 3.9–6.1% of the patients undergoing MI-TLIF [Tables 3 – 5 ]. [ 20 23 40 ] Wong et al . (2015) found a 5.1% durotomy rate for 513 MI-TLIF.…”

Section: Introductionmentioning

confidence: 99%

“…(2015) noted that for 372 MIS TLIF (514 levels) there were 32 durotomies (6.2%) that highly correlated with more advanced age (e.g., over 65) and obesity. [ 20 ] Liu et al . (2016) found 4 (3.9%) instances of dural tears out of 101 TLIF (101 patients).…”

Section: Introductionmentioning

confidence: 99%

Lower complication and reoperation rates for laminectomy rather than MI TLIF/other fusions for degenerative lumbar disease/spondylolisthesis: A review

Epstein

2018

Surg Neurol Int

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Background:Utilizing the spine literature, we compared the complication and reoperation rates for laminectomy alone vs. instrumented fusions including minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) for the surgical management of multilevel degenerative lumbar disease with/without degenerative spondylolisthesis (DS).Methods:Epstein compared complication and reoperation rates over 2 years for 137 patients undergoing laminectomy alone undergoing 2-3 level (58 patients) and 4-6 level (79 patients) Procedures for lumbar stenosis with/without DS. Results showed no new postoperative neurological deficits, no infections, no surgery for adjacent segment disease (ASD), 4 patients (2.9%) who developed intraoperative cerebrospinal fluid (CSF) fistulas, no readmissions, and just 1 reopereation for a (postoperative day 7). These rates were compared to other literature for lumbar laminectomies vs. fusions (e.g. particularly MI TLIF) addressing pathology comparable to that listed above.Results:Some studies in the literature revealed an average 4.8% complication rate for laminectomy alone vs. 8.3% for decompressions/fusion; at 5 postoperative years, reoperation rates were 10.6% vs. 18.4%, respectively. Specifically, the MI TLIF literature complication rates ranged from 7.7% to 23.0% and included up to an 8.3% incidence of wound infections, 6.1% durotomies, 9.7% permanent neurological deficits, and 20.2% incidence of new sensory deficits. Reoperation rates (1.6–6%) for MI TLIF addressed instrumentation failure (2.3%), cage migration (1.26–2.4%), cage extrusions (0.8%), and misplaced screws (1.6%). The learning curve (e.g. number of cases required by a surgeon to become proficient) for MI TLIF was the first 33-44 cases. Furthermore, hospital costs for lumbar fusions were 2.6 fold greater than those for laminectomy alone, with overall neurosurgeon reimbursement quoted in one study as high as $142,075 per year.Conclusions:The spinal literature revealed lower complication and reoperation rates for lumbar laminectomy alone vs. higher rates for instrumented fusion, including MI TLIF, for degenerative lumbar disease with/without DS.

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“…The main advantages of LLIF involve the placement of a large cage without violating the posterior elements compared with MIS transforaminal interbody fusion (TLIF). Compared to ALIF, there is decreased risk of major artery or visceral injury with intact anterior annulus and ligaments [ 4 , 7 – 10 ]. It has also been suggested that LLIF can enhance the stability of the anterior column, create substantial indirect decompression with a restored disc and foraminal height, and significantly improve the coronal and sagittal alignment in selected de novo scoliosis cases [ 6 , 11 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of multilevel lateral interbody fusion with and without supplementary instrumentation: a three-dimensional finite element study

Park

et al. 2017

BMC Musculoskelet Disord

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BackgroundLateral lumbar interbody fusion (LLIF) is a popular, minimally invasive technique that is used to address challenging multilevel degenerative spinal diseases. It remains controversial whether supplemental instrumentation should be added for multilevel LLIF. In this study, we compared the kinematic stability afforded by stand-alone lateral cages with those supplemented by bilateral pedicle screws and rods (PSR), unilateral PSR, or lateral plate (LP) fixation using a finite-element (FE) model of a multi-level LLIF construct with simulated osteoporosis. Additionally, to evaluate the prospect of cage subsidence, the stress change characteristics were surveyed at cage-endplate interfaces.MethodsA nonlinear 3-dimensional FE model of the lumbar spine (L2 to sacrum) was used. After validation, four patterns of instrumented 3-level LLIF (L2-L5) were constructed for this analysis: (a) 3 stand-alone lateral cages (SLC), (b) 3 lateral cages with lateral plate and two screws (parallel to endplate) fixated separately (LPC), (c) 3 lateral cages with bilateral pedicle screw and rod fixation (LC + BPSR), and (d) 3 lateral cages with unilateral pedicle and rod fixation (LC + UPSR). The segmental and overall range of motion (ROM) of each implanted condition were investigated and compared with the intact model. The peak von Mises stresses upon each (superior) endplate and the stress distribution were used for analysis.ResultsBPSR provided the maximum reduction of ROM among the configurations at every plane of motion (66.7–90.9% of intact spine). UPSR also provided significant segmental ROM reduction (45.0–88.3%). SLC provided a minimal restriction of ROM (10.0–75.1%), and LPC was found to be less stable than both posterior fixation (23.9–86.2%) constructs. The construct with stand-alone lateral cages generated greater endplate stresses than did any of the other multilevel LLIF models. For the L3, L4 and L5 endplates, peak endplate stresses caused by the SLC construct exceeded the BPSR group by 52.7, 63.8, and 54.2% in flexion, 22.3, 40.1, and 31.4% in extension, 170.2, 175.1, and 134.0% in lateral bending, and 90.7, 45.5, and 30.0% in axial rotation, respectively. The stresses tended to be more concentrated at the periphery of the endplates.ConclusionsSLC and LPC provided inadequate ROM restriction for the multilevel LLIF constructs, whereas lateral cages with BPSR or UPSR fixation provided favorable biomechanical stability. Moreover, SLC generated significantly higher endplate stress compared with supplemental instrumentation, which may have increased the risk of cage subsidence. Further biomechanical and clinical studies are required to validate our FEA findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1387-6) contains supplementary material, which is available to authorized users.

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Accidental Durotomy in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Frequency, Risk Factors, and Management

Cited by 31 publications

References 24 publications

Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

Lower complication and reoperation rates for laminectomy rather than MI TLIF/other fusions for degenerative lumbar disease/spondylolisthesis: A review

Biomechanical comparison of multilevel lateral interbody fusion with and without supplementary instrumentation: a three-dimensional finite element study

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