Anterior Lumbar Interbody Fusion for Treatment of Failed Back Surgery Syndrome: An Outcome Analysis

Duggal, Neil; Mendiondo, Ignacio; Pares, Heraldo; Jhawar, Balraj S.; Das, Kaushik; Kenny, Kathy J.; Dickman, Curtis A.; Angevine, Peter D.; McCormick, Paul C.; Kurpad, Shekar N.; Mueller, Wade; Benzel, Edward C.; Wang, Michael Y.; Haid, Regis W.; Traynelis, Vincent C.

doi:10.1227/01.neu.0000108423.87889.9e

Cited by 58 publications

(47 citation statements)

References 39 publications

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“…Failed back surgery syndrome (FBSS) is characterized by the presence of intractable pain and varying degrees of functional incapacity after lumbar spine surgery. It occurs in 13-61% of patients who undergo back surgery [4,34]. The reasons for FBSS include inadequate surgical decompression, recurrent disc herniation, lumbar instability, extensive epidural scar, and inadequate fusion [7].…”

Section: Introductionmentioning

confidence: 99%

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Huang

Fan

2009

Eur Spine J

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Postlaminectomy epidural adhesion is implicated as a main cause of ''failed back surgery syndrome'' and associated with increased risk of complications during revision surgery. Various materials acting as mechanical barriers to reduce fibroblasts infiltration into epidural space have met with limited success. In present research, amniotic membrane (AM) was studied to investigate its effects on reducing epidural scar adhesion after laminectomy in a canine model. Laminectomy sites were created at L-1, L-3, L-5, and L-7 levels in 24 adult mongrel dogs. Freeze dried AM (FAM), cross-linked AM (CAM), and autologous free fat (AFF) were implanted, respectively, at a randomly assigned site in each dog with the remaining untreated site serving as internal control. The animals were sacrificed at 1, 6, and 12 weeks postoperatively. Then, gross pathologic observation including scar amount and adhesion tenacity, qualitative histology evaluation, and quantitative histology analysis were compared. Gross observation demonstrated that scar amount and adhesion tenacity of CAM group were significantly lower in comparison with those of FAM and non-treatment groups. A white, slightly vascularized CAM layer covered the dura mater without tenacious scar adhesion. The histology analysis also indicated reduced fibroblasts infiltration and consequent epidural fibrosis, which were similar to the results of AFF group. In conclusion, the CAM is effective in reducing epidural fibrosis and scar adhesion after laminectomy in canine model. It is a promising biomaterial for future clinical applications.

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Section: Introductionmentioning

confidence: 99%

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Huang

Fan

2009

Eur Spine J

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“…16 more likely to experience reduced postoperative pain and improved functional status than patients with degenerative disk disease after ALIF. 4,19) Therefore, the high proportion of our patients (22 of 24) with spondylolisthesis seems another reason for good clinical results of the present study.…”

Section: Discussionmentioning

confidence: 55%

“…3,4,9,11,[16][17][18] In the present study, two-level ALIF with percutaneous PSF yielded good clinical results; the mean values of VAS (for back pain and leg pain) and ODI scores decreased significantly after surgery and clinical success was achieved in 22 of the 24 patients. The good clinical results of the present study might be attributable to the advantages of ALIF over posterior fusion surgery, as decompression and fusion can be achieved without removing the posterior bony structures and retracting the neural structures.…”

Section: Discussionmentioning

confidence: 67%

“…8,11,14,26) Anterior lumbar interbody fusion (ALIF) could be a solution to these problems related to posterior fusion surgeries, because the anterior retroperitoneal exposure used to access the disk space avoids stripping of the lumbar paraspinal muscles, preserves the posterior midline complexes, and minimizes the risks of neural complications. 4,10,14,19,22) ALIF with percutaneous pedicle screw fixation (PSF) is supposed to be a good alternative for posterior lumbar fusion surgery, especially in patients requiring multi-level fusion surgery. However, no study has specifically focused on the surgical outcomes of two-level ALIF with percutaneous PSF.…”

Section: Introductionmentioning

confidence: 99%

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Two-Level Anterior Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation: A Minimum 3-Year Follow-up Study

Lee

Maeng

2010

Neurol. Med. Chir.(Tokyo)

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The clinical and radiological outcomes of two-level anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PSF) were evaluated in 24 consecutive patients who underwent twolevel ALIF with percutaneous PSF for segmental instability and were followed up for more than 3 years. Clinical outcomes were assessed using a visual analogue scale (VAS) score and the Oswestry Disability Index (ODI). Sagittal alignment, bone union, and adjacent segment degeneration (ASD) were assessed using radiography and magnetic resonance imaging. The mean age of the patients at the time of operation was 56.3 years (range 39-70 years). Minor complications occurred in 2 patients in the perioperative period. At a mean follow-up duration of 39.4 months (range 36-42 months), VAS scores for back pain and leg pain, and ODI score decreased significantly (from 6.5, 6.8, and 46.9% to 3.0, 1.9, and 16.3%, respectively). Clinical success was achieved in 22 of the 24 patients. The mean segmental lordosis, whole lumbar lordosis, and sacral tilt significantly increased after surgery (from 25.19 , 39.29 , and 32.69to 32.99 , 44.59 , and 36.69 , respectively). Solid fusion was achieved in 21 patients. ASD was found in 8 of the 24 patients. No patient underwent revision surgery due to nonunion or ASD. Two-level ALIF with percutaneous PSF yielded satisfactory clinical and radiological outcomes and could be a useful alternative to posterior fusion surgery.

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“…This abnormal process may present as disc degeneration (39%), instability (24.6%), disc herniation (28%), and stenosis of the canal (33%). 7,8 Less frequently, vertebral fracture, and scoliosis may be cited (17%). 8 While ADD is only imageological in most cases (with prevalence of up to 90%) 4,9,10 (Figure 1), the percentage of patients with clinical signs is significant, reaching 30% over 5 years.…”

Section: Introductionmentioning

confidence: 99%

Adjacent Level Degeneration and Post-Traumatic Deformity After Thoracolumbar Fractures

Sebben

Graells

Benato³

et al. 2017

Coluna/Columna

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Objectives: To evaluate thoracolumbar fractures and the complications such as adjacent disc degeneration (ADD) and post-traumatic deformity. Methods: We evaluated 32 patients divided into two equal groups, 16 in the case group (removal of the synthesis material) and 16 in the control group (not submitted to removal of the synthesis material) in order to verify if there was difference between the incidence of these complications. Results: There were no statistically significant differences between the groups regarding the progression of the ADD and the post-traumatic deformity, but both progressed during the 2-year follow-up. Conclusion: It was concluded that the removal of the synthesis material was not effective in preventing these complications after surgical fractures of the thoracolumbar spine.Keywords: Intervertebral disc degeneration; Fractures; Spine. RESUMO

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Anterior Lumbar Interbody Fusion for Treatment of Failed Back Surgery Syndrome: An Outcome Analysis

Abstract: On the basis of our results, we found ALIF to be a safe and effective procedure for the treatment of FBSS for selected patients.

Cited by 58 publications

References 39 publications

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Two-Level Anterior Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation: A Minimum 3-Year Follow-up Study

Adjacent Level Degeneration and Post-Traumatic Deformity After Thoracolumbar Fractures

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