A comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion: a literature review and meta-analysis

Zhang, Qunhu; Yuan, Zhen; Zhou, Min; Liu, Huan; Xu, Yong; Ren, Yongxin

doi:10.1186/1471-2474-15-367

Cited by 72 publications

(64 citation statements)

References 45 publications

(45 reference statements)

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“…Modern posterior lumbar interbody fusion (PLIF) is a recognised technique for achieving lumbar fusion [20][21][22]. It involves the insertion of paired lordotic cages into the intervertebral disc space combined with posterior pedicle screw and rod instrumentation.…”

Section: Introductionmentioning

confidence: 99%

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

2017

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Purpose To examine monosegmental lordosis after posterior lumbar interbody fusion (PLIF) surgery and relate lordosis to cage size, shape, and placement. Methods Eighty-three consecutive patients underwent single-level PLIF with paired identical lordotic cages involving a wide decompression and bilateral facetectomies. Cage parameters relating to size (height, lordosis, and length) and placement (expressed as a ratio relative to the length of the inferior vertebral endplate) were recorded. Centre point ratio (CPR) was the distance to the centre of both cages and indicated mean position of both cages. Posterior gap ratio (PGR) was the distance to the most posterior cage and indicated position and cage length indirectly. Relationships between lordosis and cage parameters were explored. Results Mean lordosis increased by 5.98°(SD 6.86°). The cages used varied in length from 20 to 27 mm, in lordosis from 10°to 18°, and in anterior cage height from 10 to 17 mm. The mean cage placement as determined by CPR was 0.54 and by PGR was 0.16. The significant correlations were: both CPR and PGR with lordosis gain at surgery (r = 0.597 and 0.537, respectively, p \ 0.001 both), cage lordosis with the final lordosis (r = 0.234, p \ 0.05), and anterior cage height was negatively correlated with a change in lordosis (r = -0.297, p \ 0.01).Conclusion Cage size, shape, and position, in addition to surgical technique, determine lordosis during PLIF surgery. Anterior placement with sufficient ''clear space'' behind the cages is recommended. In addition, cages should be of moderate height and length, so that they act as an effective pivot for lordosis.

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Section: Introductionmentioning

confidence: 99%

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

2017

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“…A metaanalysis performed by Zhang and colleagues reported that variations in open approaches to the posterior lumbar interbody space can influence the rate of unintended durotomy. 46 Specifically, transforaminal lumbar interbody fusion (TLIF) procedures had a significantly lower durotomy rate as compared with posterior lumbar interbody fusion (PLIF), which is a more medial approach. 46 However, one drawback to making interpretations based on literature reviews is that lumbar surgical approaches and complication rates are evaluated based on a heterogenic population and multiple studies; there is a lack of randomized clinical trials and thus a high reliance on retrospective studies.…”

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confidence: 99%

“…46 Specifically, transforaminal lumbar interbody fusion (TLIF) procedures had a significantly lower durotomy rate as compared with posterior lumbar interbody fusion (PLIF), which is a more medial approach. 46 However, one drawback to making interpretations based on literature reviews is that lumbar surgical approaches and complication rates are evaluated based on a heterogenic population and multiple studies; there is a lack of randomized clinical trials and thus a high reliance on retrospective studies. 46 Minimally invasive spine surgery (MISS) refers to a modification of the traditional approach that minimizes muscle manipulation, soft tissue dissection, pain, and blood loss.…”

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confidence: 99%

Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

Ghobrial

Theofanis

Darden

et al. 2015

FOC

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OBJECT Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach. METHODS A MEDLINE search using the term “lumbar durotomy” (under the 2015 medical subject heading [MeSH] “cerebrospinal fluid leak”) was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology. RESULTS The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally, the authors included 5 studies (with a total of 1364 patients) that directly compared durotomy rates during open-approach versus minimally invasive procedures. Studies of open-approach surgery for lumbar degenerative disease reported a total of 1031 durotomies across all procedures, for an overall durotomy rate of 8.11% (range 2%–20%). Prospectively designed studies reported a higher rate of durotomy than retrospective studies (9.57% vs 4.32%, p = 0.05). Selected MISS studies reported a total of 93 durotomies for a combined durotomy rate of 6.78%. In studies of matched cohorts comparing open-approach surgery with MISS, the durotomy rates were 7.20% (34 durotomies) and 7.02% (68), respectively, which were not significantly different. CONCLUSIONS Spinal surgery for lumbar degenerative disease carries a significant rate of unintended durotomy, regardless of the surgical approach selected by the surgeon. Interpretation of unintended durotomy rates for lumbar surgery is limited by a lack of prospective and cohort-matched controlled studies.

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“…The benefits of the TLIF over the PLIF is the ability to perform the interbody fusion with less retraction and manipulation of the neural elements and ability to place larger cage. The TLIF approach maintains important midline ligaments [73,[76][77][78].…”

Section: Tlifmentioning

confidence: 99%

Role of Minimally Invasive Spine Surgery in Adults with Degenerative Lumbar Scoliosis: A Narrative Review

Tannoury

Haddadi

Kempegowda

et al. 2017

IrJNS

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Background and Aim: Degenerative lumbar scoliosis is a spinal deformity resulting from advanced disc degeneration and facet arthropathy. Given the inconclusive available literature and lack of high-quality data supporting the role of minimally invasive surgical management of degenerative lumbar scoliosis, this review intends to highlight and compare the various viable minimally invasive surgical methods for adult degenerative deformity correction. Methods and Materials/Patients:Online databases search including Medline, PubMed and Ovid was preformed using the keywords: adult, degenerative, lumbar scoliosis, etiology, clinical issues, diagnostic imaging, spinopelvic alignment, non-operative and surgical treatment options, minimally invasive, interbody fusion, and percutaneous pedicle screw fixation. Eighty-three studies, published after 2000, on degenerative lumbar scoliosis epidemiology, classification and management were identified and reviewed.Results: Minimally invasive surgical techniques available for interbody fusion include posterior lumbar interbody fusion, transformational lumbar interbody fusion, oblique lumbar interbody fusion, anterior lumbar interbody fusion, and extreme lateral interbody fusion. Each surgical option warrants technical considerations, indication, complications awareness, and functional and radiological outcomes assessment. Sound patients' selection is key for improved outcomes, and therefore the following factors should be well examined prior to surgical intervention: the patient's medical condition and underlying morbidities, the extent of the involved disc spaces, imaging characteristics, and surgeon skills. Conclusion:The superiority of one surgical technique over the others, was not proven due to lack of strong and supportive data. However, a comprehensive review of indications, benefits, and disadvantages of the minimally invasive surgical procedures is presented. There is an interest in minimally invasive surgery of the spine owing to lower complication rates and morbidity, with limited soft tissue disturbance, decreased blood loss, improved cosmesis, shorter hospital stay, earlier return to work, and therefore decreased general health care costs.

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A comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion: a literature review and meta-analysis

Cited by 72 publications

References 45 publications

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

Role of Minimally Invasive Spine Surgery in Adults with Degenerative Lumbar Scoliosis: A Narrative Review

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