Augmenting posterolateral fusion with transforaminal lumbar interbody fusion cage improves clinical outcome, but not fusion rate, of posterior decompression

Atıcı, Teoman; Yerebakan, Selcan; Ermutlu, Cenk; Özyalçın, Ali

doi:10.1177/0300060520910025

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…Atici et al [17] comparing fusion rates and clinical outcomes of instrumented PLF alone with cage-augmented TLIF, and they found that adding TLIF cages to PLF yielded better ODI and VAS scores, but showed no difference in fusion rates. Another study by Marques et al assessed the risk factors of pseudoarthrosis in adult spine deformity surgery.…”

Section: Discussionmentioning

confidence: 99%

Discoplasty as a salvage technique for pseudoarthrosis following multilevel TLIFS: A case report

Mahadhipta

Ajiantoro

Tendean

et al. 2022

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

Discoplasty as a salvage technique for pseudoarthrosis following multilevel TLIFS: A case report

Mahadhipta

Ajiantoro

Tendean

et al. 2022

International Journal of Surgery Case Reports

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“…Множество исследований показало, что декомпрессивно-стабилизирующие вмешательства имеют положительный клинический результат -до 80 % пациентов удовлетворены лечением [2]. Одной из главных целей декомпрессивно-стабилизирующего вмешательства является формирование прочного артифициального костнометаллического блока [3,4]. Однако в ряде случаев в послеоперационном периоде возникают такие нежелательные явления, как несостоятельность блока и проседание межтелового имплантата, которые сами по себе являются неудовлетворительными показателями рентгенологического исхода декомпрессивно-стабилизирующего лечения.…”

Section: Materials and Methods The Data Of Patients Who Underwent A S...unclassified

Vertebral bone density in Hounsfield units as a predictor of interbody non-union and implant subsidence in lumbar circumferential fusion

et al. 2022

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Objective. To determine the values of Hounsfield units (HU) of the lumbar vertebrae predicting unsatisfactory radiological results of circumferential interbody fusion at the lumbar level.Material and Methods. The data of patients who underwent a single-level decompression and stabilization intervention at the L4–L5 or L5–S1 level for degenerative diseases of the spine were analyzed. The CT images of the lumbar spine were assessed before surgery with the measurement of HU values of the vertebral bodies at the intervention level, as well as CT images one year after surgery to evaluate the degree of interbody block formation and subsidence of the cage. Three groups of patients were distinguished: patients with a formed interbody bone block and without cage subsidence (control group), patients with failed fusion and patients with cage subsidence.Results. The study presents CT data of 257 patients. The incidence of non-union was 32.3 % (83/257), and of cage subsidence – 43.6 % (112/257). The proportion of patients with reduced bone mineral density (BMD) was 26.1 % (67/257). Patients with non-union and subsidence had higher ODI scores (p = 0.045 and p = 0.050, respectively) compared to controls. The presence of fusion failure and subsidence is associated with reduced BMD (p < 0.05), HU values of vertebrae (p < 0.05), and higher ODI score (p < 0.05). According to the ROC analysis, threshold HU values were determined equal to 127 HU, 136 HU and 142 HU for the L4, L5, S1 vertebral bodies, respectively. Upon reaching these values, the risk of a combination of fusion failure and subsidence increases significantly (p = 0.022).Conclusions. Patients with non-union and cage subsidence have less satisfactory clinical outcomes. The HU values of the vertebral bodies equal to 127 HU, 136 HU and 142 HU for the L4, L5, and S1, respectively, are advisable to use in practice to predict non-union and subsidence after a single-level decompression and stabilization intervention at the lower lumbar levels.

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“…2,[15][16][17] However, while studies comparing TLIF and PLF exist, the literature may benefit from studies with larger sample sizes, narrower inclusion criteria, and longer follow-up intervals. 17,18 In a cohort of patients undergoing elective, single-level, open, posterior lumbar decompression and fusion, we sought to compare reoperation rates between TLIF and PLF, with secondary outcomes comparing 90-day complication and readmission rates.…”

Section: Introductionmentioning

confidence: 99%

Which Approach Leads to More Reoperations in Single-Level, Open, Posterior Lumbar Fusion: Transforaminal Lumbar Interbody Fusion or Posterolateral Fusion Alone?

et al. 2023

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Background: Transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) without an interbody device are two common approaches for single-level, open posterior fusion. Presently, it is unknown whether one of these operations leads to better outcomes. We sought to compare reoperation, complication, and readmission rates between TLIF and PLF for patients undergoing elective single-level, open, posterior lumbar fusion.Methods: A single-center, retrospective cohort study utilizing prospectively collected data was performed. Inclusion criteria were patients undergoing elective single-level, open, posterior lumbar decompression and fusion between October 2010 and April 2021 with at least 1-year follow-up. The two comparison groups were TLIF vs PLF alone without interbody. The primary outcome was need for reoperation at most recent follow-up. Secondary outcomes included 90-day complication and readmission rates. Univariate and multivariable logistic regression analyses were performed.Results: A total of 850 patients were included, 591 (69.5%) of whom underwent TLIF and 259 (30.5%) of whom underwent PLF. Median follow-up was 6.1 years (interquartile range 3.7-8.9). No significant difference was found in overall reoperation rates (12.4% vs 13.9%, P = 0.534). When stratified by <5-year follow-up (n = 231 TLIF, n = 85 PLF; 37.2%) and ≥5year follow-up (n = 360 TLIF, n = 174 PLF; 62.8%), no significant differences were seen in either cohort (<5 years: n = 24 TLIF vs n = 9 PLF, P = 0.959; 5+ years: n = 49 TLIF vs n = 27 PLF, P = 0.555). On multivariable logistic regression analysis, the presence of interbody fusion was not associated with reoperation (OR 2.26, 95% CI 0.66-7.74, P = 0.194).Clinical Relevance: For patients undergoing elective single-level, open, posterior lumbar fusion without isthmic spondylolisthesis, no differences were seen in reoperation rates at long-term follow-up. Similar 90-day complication and readmission rates were seen. These results suggest that in degenerative lumbar spine disease without isthmic spondylolisthesis, TLIF and PLF achieved similar outcomes.

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Augmenting posterolateral fusion with transforaminal lumbar interbody fusion cage improves clinical outcome, but not fusion rate, of posterior decompression

Cited by 6 publications

References 22 publications

Discoplasty as a salvage technique for pseudoarthrosis following multilevel TLIFS: A case report

Discoplasty as a salvage technique for pseudoarthrosis following multilevel TLIFS: A case report

Vertebral bone density in Hounsfield units as a predictor of interbody non-union and implant subsidence in lumbar circumferential fusion

Which Approach Leads to More Reoperations in Single-Level, Open, Posterior Lumbar Fusion: Transforaminal Lumbar Interbody Fusion or Posterolateral Fusion Alone?

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